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Clinical Pathology II > MSK Conditions > Flashcards

MSK Conditions Flashcards

1
Q

Multiple Myeloma: MC Symptom

A

-Persistent skeletal pain (70% of cases) that is usually <6 months in duration
-Pain is usually back and rib pain

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2
Q

What type of fractures are common in multiple myeloma?

A

Pathological fractures; sudden onset of pain (vertebral collapse)

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3
Q

Multiple Myeloma: Areas of Swelling (7)

A

Ribs, skull, sternum, vertebrae, clavicle, shoulders, pelvis

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4
Q

Mutiple Myeloma: Other Signs/Symptoms

A

• Renal failure/insufficiency
• Recurrent bacterial infections
• Anemia
• Bleeding (purpura or epistaxis) – only in thrombocytopenia
• Weight loss, weakness, lethargy

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5
Q

Multiple Myeloma: Lab Findings (Protein)

A

-Serum total protein (high): High globulin, NL/low albumin*
-Serum protein electrophoresis: Reversed A:G Ratio*
-Bence Jones Proteinuria*

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6
Q

Multiple Myeloma: Lab Findings (CBC/Blood findings)

A

-N/N anemia
-PBS: Rouleau
-Increased ESR
-Normal: WBC, Platelets
-Lymphocytosis

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7
Q

Multiple Myeloma: Lab Findings (Enzymes)

A

-Normal ALP*: Marrow issue (osteoclastic), not bone

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8
Q

Multiple Myeloma: Other Lab Abnormalities

A

-Abnormal KFTs**: BUN, Creatinine, Uric Acid
-Serum Calcium: Elevated in some patients

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9
Q

Mulitple Myeloma: Follow-Up

A

• Suspicion – order protein electrophoresis
• Definitive diagnosis – bone marrow biopsy

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10
Q

Multiple Myeloma: X-Ray Findings

A

• Pelvis, spine, ribs and skull are most commonly affected
• Punched-out lytic lesions
• Bone scans are not usually helpful

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11
Q

Osteolytic Metastasis: Lab Findings

A

-Increased: Urine Calcium, Serum ACP (if prostate cancer)

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12
Q

Osteolytic Metastasis: X-Ray Findings

A

• Pathological fractures
• No periosteal reaction or sclerosis
• Kidney, lung, breast and thyroid are most common
• Kidney/thyroid - cause blow out lesions

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13
Q

Osteoblastic Metastasis: Lab Findings

A

-Increases: Serum ALP, Serum ACP (if prostate cancer)
-Decreased: Urine Calcium
-Normal: Serum Calcium

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14
Q

Osteoblastic Metastasis: X-Ray Findings

A

• Sclerosis
• Normal architecture is lost
• Usually breast or prostate

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15
Q

What is usually affected in multiple myeloma

A

Pelvis, spine, ribs and skull

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16
Q

Osteolytic Metastasis: Most commonly affected

A

• Kidney, lung, breast and thyroid are most common

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17
Q

Osteoblastic Metastasis: Most commonly affected

A

Breast or prostate

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18
Q

Primary Bone Tumors: Lab Abnormalities (“HEAL”)

A

• Hypercalcemia
• Anemia
• ESR/CRP elevations
• LDH elevation

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19
Q

Osteosarcoma: Signs/Symptoms

A

*Most significantly night pain
-Pain and swelling are the most consistent symptoms: Onset if gradual, progressive
-Pain is aching and persistent

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20
Q

Osteosarcoma: Lab Findings

A

Serum ALP increases

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21
Q

Osteoarthritis: Signs/Symptoms

A

-Pain worsened by exercise: Usually resolves in <30 mins
-Decreased ROM, Crepitis, joint deformity

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22
Q

Osteoarthritis: Lab Findings

A

Usually Normal Findings: ESR could become increased

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23
Q

Osteoarthritis: X-Ray

A

• Irregular or asymmetric narrowing of the joint space

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24
Q

Rheumatoid Arthritis: Signs/Symptoms

A

-Tenderness in nearly all inflammed joints (most sensitive)
-Joint pain on passive ROM
-Stiffness lasting >30 mins (morning/prolonged activity)
-Diffuse swelling of hands and wrists

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25
Rheumatoid Arthritis typically affects:
Small hand joints, feet, wrists, elbows, ankles is typical
26
Rheumatoid Arthritis: Systemic Symptoms (“SO FLAMED”)
• fatigue • malaise • depression • anorexia • lymphadenopathy • splenomegaly • ocular disease • entrapment neuropathies
27
________ are seen in 30-40% of RA patients
Subcutaneous nodules
28
What disease is typically found during lab findings w/ RA?
Anemia of chronic disease (80%)
29
Rheumatoid Arthritis: Lab Findings
• ESR is elevated in 90% of cases; CRP commonly elevated • Rheumatoid factor positive: Not specific for rheumatoid arthritis (some conditions cause false +) • Anti-Cyclic Citrullinated Peptide (Anti-CCP) Antibodies • ANA
30
Rheumatoid Arthritis: Early X-Ray Findings
• Early: Soft tissue swelling; Increased/decreased joint space; Subarticular osteoporosis; Marginal erosions/cysts
31
How to differentiate between Osteoarthritis and RA?
-Time: Osteoarthritis (>30 mins)/RA (>30mins) -Pain: Osteoarthritis (worsened w/ exercise)/RA (Worse in the morning and w/ passive ROM) -Lab Findings: Osteoarthritis (NL)/RA (Elevated ESR, RF, Anti-CCP, ANA & ACD is common-80%)
32
Where does Psoriatic Arthritis Most Commonly Occur?
-Psoriasis of the nails (90%) or skin (5%) • SI Joint & Spine • The DIPs of the fingers and toes are especially affected.
33
Psoriatic Arthritis: Signs/Symptoms
• Joint swelling, tenderness, warmth, restricted movement • Fever, malaise • Morning stiffness, pain • Sausage digit • No subcutaneous nodules
34
Psoriatic Arthritis: Lab Findings
• Increased serum uric acid in 30% of cases • HLA-B27 antigen present in patients with spondylitis-type psoriatic arthropathy • ESR elevated in acute phase • May have the anemia of chronic disease
35
Gouty Arthritis: Structures MC Involved
• The metatarsophalangeal joint of the great toe is frequently involved -Subcutaneous nodules: Ears & extensor surfaces
36
Gouty Arthritis: Signs/Symptoms
• Acute mono-or polyarticular pain: Described as throbbing, crushing or excruciating • Inflammatory response: Shiny, tense, hot, dusky red skin, exquisite tenderness • Subcutaneous or intraosseous nodules (20%) (tophi): Commonly impacts ears & Extensor surfaces
37
Gouty Arthritis: Precipitating Factors
Precipitating factors: • Primary pathology->hyperuricemia • Dietary choices: High purine foods, Fructose & Alcohol • Insulin resistance • Hydration • Certain medications
38
Does Psoriatic Arthritis contain subcutaneous nodules?
No
39
Gouty Arthritis: Lab Findings
• Increased serum uric acid levels: Not diagnostic, cardinal biochemical abnormality; • Leukocytosis with left shift – acute attack • Increased ESR: Acute attack
40
What factors can lower uric acid levels?
Aspirin, vitamin C may lower uric acid to below reference values
41
What factors can lower uric acid levels?
Aspirin, vitamin C may lower uric acid to below reference values
42
Chondrocalcinosis: Signs & Symptoms
• Acute pain & swelling of 1+ joints: Knee involved in 1/2 of all attacks (ankle, wrist & shoulder also common) • Inflammation, joint effusion, decreased ROM • Unexplained attacks of arthritis: acute or subacute • Fever possible
43
Chondrocalcinosis (CPPD): Most common areas affected
Knee: Most common, Pubic symphysis pubis 2nd most common; Similar to DJD
44
Chondrocalcinosis: Lab Findings
Synovial fluid analysis • Crystals are weakly positively birefringent • Leukocytosis with predominantly neutrophils (80-90%) • Elevated ESR
45
Chondrocalcinosis: X-Ray Findings
• Articular cartilage calcification • Periarticular calcification • Pyrophosphate arthropathy
46
Septic Arthritits is predominantly:
Monoarticular (90%)
47
Septic Arthritis: Infants
Irritability, fretfulness, fever, fails to move limbs spontaneously, tenderness or pain with passive movement
48
Septic Arthritis: Older Children & Adults
Acute joint pain, stiffness: Mc = knee (Followed by shoulder, wrist, hip, fingers, elbow)
49
Septic Arthtritis will have a ______ during the course of an infection?
Fever (90%)
50
Septic Arthritis: Other Symptoms
• Joint effusion, tenderness • Joint warmth/redness – present in <50% • Loss of joint motion • Tenosynovitis • Chills, malaise
51
Septic Arthritis: Lab Findings
• Leukocytosis with neutrophilia • Increased ESR/CRP
52
Septic Arthritis: Synovial Fluid Analysis
• Cloudy • >50,000/ul WBC/hpf • >90% Neutrophils • Synovial fluid: blood glucose less than 0.5 • Absence of crystals
53
Septic Arthritis: X-Ray Findings
• Soft tissue swelling • Joint displacement
54
Ankylosing Spondylitis: Signs & Symptoms
• Episodes of insidious onset of aching low back pain: MC • Subgluteal or LBP and/or stiffness • Duration >3 months • Morning stiffness (relieved by activity) • Often nocturnal recurrent back pain: Get up to “walk off” back pain • Pleuritic chest pain is often an early feature
55
Ankylosing Spondylitis: Lab Findings
• Anemia of chronic disease in 30% of cases • Increased ESR • Increased CSF protein • Increased incidence of HLA-B27 antigen
56
Reactive Arthritis: Urogenital Tract S/Sx
• Urethritis 7-14 days after exposure • Prostatitis, cervicitis (usually asymptomatic) possible
57
Reactive Arthritis: Eye Signs & Symptoms
• Conjunctivitis is the most common eye lesion • 30-50% of patients • usually bilateral • mild and non-infectious appearing • lasts only a few days • develops over the next few weeks, usually mild
58
Reactive Arthritis: Other Symptoms
• Joint pain and swelling – knees, ankles, feet • Enthesitis – Achilles tendon and plantar fascia • Sacroiliitis: Inflammation of the SI joint • Skin lesions similar to psoriasis possible • Enteritis possible • Fever, fatigue possible
59
Reactive Arthritis: Lab Findings
• Increased ESR/CRP • Leukocytosis and mild normo/normo anemia possible • 60-80% have +HLA-B27
60
Peripheral Arthritis: Areas Affected
• Affects the large joints of the arms and legs (knees, ankles, elbows, wrists) • Often migratory and asymmetrical
61
Axial Arthritis: Areas Affected
• SI joints and spinal involvement • Chronic lower back pain and stiffness, particularly in the morning or after periods of inactivity
62
Enteropathic Arthritis: Labs
• ESR/CRP elevations possible (corresponds w/ flare of IBD) • May have anemia of chronic disease • HLA-B27 – positive in some patients, more likely in those with spinal involvement
63
Lyme Disease: Progression
-Stage 1: Skin rash, flu-like symptoms -Stage 2: 1+ organ systems involved; Neurogenic or Cardiac -Stage 3: Arthritis (large joints), chronic neurologic symp.
64
Lyme Disease Lab Findings
-ELISA—>Western Blot (Confirmation) -IgM and IgG against Borrelia Burgdorferi -Elevated ESR -CRP: Monitors treatment -Leukocytosis possible
65
Osteoporosis: Signs/Symptoms
• may be asymptomatic • aching pain in the bones, especially the back • Acute pain, localized, aggravated by weight bearing
66
Those with osteoporosis have increased likelihood of:
Atraumatic & Crush Fractures
67
What areas are commonly affected by osteoporosis:
• Vertebra, upper femur, distal radius, proximal humerus, pubic ramus, ribs
68
Osteoporosis: Lab Findings
-Usually all normal • CBC, multi-panel chemistry tests usually normal • Normal serum calcium, phosphorus, ALP, protein ELP, ESR, urinary calcium • Following fracture – ALP may be transiently elevated
69
Paget’s Disease: Signs & Symptoms
• Most often the disorder is asymptomatic • Picked up on routine blood work • Increasing skull size: Hat too small & bitemporal skull enlargement with frontal bossing • Headaches • Decreasing auditory acuity
70
Paget’s Disease: Pain symptoms
• Bone pain: Mild to severe, Deep/aching, May be accentuated at night, Constant, unrelated to activity • Spine pain: LBP common & Can have radiculopathy • Acute bone pain suggests:Pathologic fracture & malignant degeneration
71
What enzyme is typically increased in Paget’s disease?
• **Serum alkaline phosphatase usually increased • Elevations will fluctuate throughout stages of life and disease course
72
How is serum calcium affected in Paget’s Disease?
• **Serum calcium normal, rarely increased
73
Paget’s Disease: Other Lab Findings
• Serum phosphorus normal
74
Osteomalacia & Rickets
• Bowing of long bones – softened bones • Vertical shortening of the vertebrae – d/t softened bone • Flattening of the pelvic bones – contracts the pelvic outlet
75
Osteomalacia & Rickets: Signs/Symptoms
• Bone pain (dull), tenderness, muscle weakness • Weight loss, anorexia, tetany • Other symptoms: Malnutrition or chronic renal disease
76
What is usually affected in osteomalacia & rickets?
Affecting the ribs and upper thighs; muscle weakness is usually proximal
77
What type of fractures are common in osteomalacia & Rickets?
• Pseudofractures – incomplete ribbon-like demineralizations appear in the cortex
78
Osteomalacia & Rickets: Lab Findings
• Serum calcium may be normal/decreased (never high) • Hypophosphatemia (low phosphates) • ALP is increased • Decreased serum Vitamin D and its metabolites • Increased serum PTH • Urinary calcium is low in all forms of the disease except those associated with acidosis
79
Which MSK disorders will have HLA-B27 antigens?
-Psoriatic arthritis: spondylitic-type arthropathy -Enteropathic Arthritis -Ankylosing Spondylitis -Reactive Arthritis “PEAR”
80
Septic Arthritis: How long before changes are seen on X-Rays?
• 10 days in the extremities • 21 days in the spine
81
Most sensitive test of Paget’s Disease
• Urine pyridinoline crosslinks
82
Rheumatoid Arthritis: Late X-Ray Findings
• Late: Deformities with subluxations; Bony destruction; Bony fusion; Complete destruction of joint space

Clinical Pathology II (10 decks)

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