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Flashcards in Musculo-Skeletal Pathology Deck (45)
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1

Onion-skin periosteal reaction. What disease is associated?

Ewing sarcoma of bone

2

This pathology involves the activation of a fibroblast growth factor receptor that inhibits chondrocyte proliferation (the receptor is always switched on). What is the receptor, and what is the pathology at hand?

Achondroplasia
Receptor: FGFR3
Associated with advanced paternal age and mutations occur sporadically, but IS transmitted AD.

3

This is the MC benign bone tumor, usually seen in young males (<25), where the bone looks like a big bone spur with a cartilage cap on it. Technically a hamartoma (Benign tumor of disorganization of tissue in its normal location). Very low chance of becoming malignant. What pathology is at hand?

Osteochondroma

4

This giant cell tumor is usually seen in Px 20-40yo, and the tumor is located MC on the distal fémur or or the proximal tibia, with a lucid “soap bubble” appearance on XR. It consists of osteoclast involvement.

Osteoclastoma

5

This tumor is the MC malignant bone tumor in children. MC in boys aged 10-20yo, with the MC XR features include Codman’s Triangle (where the tumor pushed up periosteum in the bone, forming a small triangle), and a Sunburst pattern on the bone. (Osteocod in the sun) What pathology is at hand?

Osteosarcoma

6

This malignancy occurs in young boys, aged <15, very aggressive, and tends to grow on the surface of cortical bone (shaft of long bones). XR shows destruction and disruption of the cortex, with an “onion skin” appearance. What is the pathology at hand, and what genetic association is present with this disease?

Ewing Sarcoma —> 11;22 translocation.

7

This disease shows localized disorder of the bony architecture showing increasing osteoblastic and osteoblastic activity resulting in disorganized bone remodeling. A patient will most likely refer increased “hat size” because the bone is getting thicker also referring to loss of hearing (due to thickening of auditory canal), and are at risk for an osteosarcoma. Ca2+, phosphate, and PTH levels are normal, with increased Alk Phos. What pathology is at hand?

Paget Disease of the bone - bone enlargement (head), bone pain, and arthritis

8

What is the triad of McCune-Albright syndrome?

Precocious puberty, Café-au-lait spots, fibrous dysplasia of bone

9

In this disease bone is replaced by fibroblasts, collagen, and irregular bony trabeculae. What disease is at hand?

Polyostotic fibrous dysplasia

10

The patient demonstrates failure of bone resorption causing thickened and dense bones. In addition, there is a genetic deficiency of carbonic anhydrase II. What disease is at hand?

Osteopetrosis

11

Cartilage cells are maintained by chondrocytes, which are derived from the same type of stem cells as adipocytes and osteoblasts. What is their stem cell origin?

Mesenchymal cells from the mesoderm

12

This pathology is the leading cause of knee pain in patients under the age of 45. It typically presents with anterior knee pain that is exacerbated by activity. Treatment involves strengthening the quadriceps, stretching, low stress on the knee, but maximize walking. What pathology is at hand?

Patellofemoral Syndrome

Differential DX- patellar tendinitis: pain upon palpation of the patella.

13

What is the difference between “housemaid knee” (from mopping on your knees), vs “Clergyman’s knee” (where you’re praying all day)?

Housemaid ‘s knee: inflammation of the Prepatellar bursa (prepatellar bursitis)

Clergyman’s knee: inflammation of the infraparellar bursa (infrapatellar bursitis)

14

A 38yo female patient refers pain beneath the calcaneus or in the medial arch, worse with first steps in the morning and after weight bearing exercise. Local point tenderness at the medial tubercle of the calcaneus. +/- heel spur on X-ray.

Plantar fasciitis

15

This pathology involves the contracture of one or more fingers due to a painless thickening and contracture of the flexor tendons of the palm. Usually affects the ring finger or the pinky, but the cause is unknown, may be genetic, aged over 40, being male, alcoholism, diabetes, and smoking. What pathology is at hand?

Dupuytren Contracture

16

What are the major differences between Osteoarthritis and Rheumatoid Arthritis.

Osteoarthritis is wear and tear disease - affects distal IPJ and Proximal IPJ. CF: pain with use.
Rheumatoid arthritis is systemic, and pain is usually in the mornings and improves with use. Also, assoc. w/pannus joints (affecting metacarpal phalangeal joints and proximal IPJ), no DIPs. Also they may present with Baker cysts (cysts behind the knee) and can have swan neck joints (distal IP finger flexion), or Boutonnière joints (distal IP finger extension), fever, fatigue, pleural effusion, pericarditis

17

What are the antibodies for Rheumatoid Arthritis?

(+) Rheumatoid factor is - IgM antibody against IgG (first labeled to rule out RA; patient might be positive with no symptoms at all because of low specificity). If positive though, the confirmatory antibody is:
(+)Anti-citrullinated protein antibody (ACPA) as it is more specific.

18

These diseases increase the chances of developing what disease?
-Lesch-Nyhan Syndrome
-Undergoing treatment for Leukemia or lymphoma
-Use of Thiazides or loop diuretics

Gout
-With increased consumption of purine rich food
-decreased excretion of uric acid (due to diuretic)

19

Px presents with asymmetrical joint inflammation, monoarticular joint pain - MC found at the first metatarsal phalangeal joint (podagra), and presence of tophi in other joints without inflammation. Pain presents in flairs. Negative bi-refringent to polarized light (yellow to parallel polarized light).

Gout

20

What is the MOA of alcohol excretion in the kidney, in relation to Gout?

Alcohol metabolites compete for the same excretion sites as uric acid. The kidney chooses to excrete the alcohol, thus raising levels of uric acid.

21

What is the difference between Gout and pseudo-gout? Where are the crystals MC found?

On the knee and they usually calcify the articulation cartilage- Pseudo-gout is made of Calcium pyrophosphate crystals (rhomboid shaped), and positive bi-refringent (blue, to parallel polarized light and yellow when perpendicular).
UA crystals are yellow to parallel polarized light

22

Seronegative Spondyloarthropathies are associated with what genetic alterations, and what pathologies are involved?

Negative Rheumatoid factor, and strong association with HLA-B27
-Psoriatic arthritis
-Ankylosing spondylitis
-Inflammatory Bowel Disease spondylitis
-Reactive Arthritis

23

This disease is associated w/inflammatory arthritis associated with psoriasis, it presents asymmetrical, involves DIP joints, spine, and sacroiliac joints. CF: sausage fingers with X-ray findings showing “pencil in cup” deformity.

Psoriatic Arthritis

24

This disease is a chronic inflammatory disease that involves the spine and sacroiliac joints. X-ray shows fusion of facet joints, fusion of sacroiliac joints, or fusion of intervertebral discs. Also associated with Uveitis, aortic regurgitation, conduction abnormalities, and CV disease (CHF).

Ankylosing spondylitis (ankylosis = fusion)
Spondylitis = spine

25

What GI diseases are associated with ankylosing spondylitis and polyarthritis?

Ulcerative colitis, and Crohn’s disease

26

This disease usually follows arthritis post infection - MC: Chlamydia, shigella, salmonella, yersinia, Campylobacter, Clostridium. The patient has an infection, then a reaction to that infection. What is the disease, and the classic triad?

Reactive Arthritis
Triad: conjunctivitis, urethritis, Arthritis
“Can’t see, can’t pee, can’t climb a tree!”

Don’t confuse with septic arthritis where N. Gonorrhea could present similar symptoms.

27

The following arthritis is caused by bacterial infection. CF: Polyaryicular, migratory arthritis, found in a asymmetrical pattern, with pustules on the skin.
Name the 3 MC microorganisms, characteristics, and Dx criteria.

Staph aureus
Streptococcus
Neisseria gonorrhoeae - CC: young Sexually active person that has a painful knee. Findings show Polyarticular, migratory arthritis, in an asymmetrical pattern. Can also cause pustules on the skin, synovitis, and tenosynovitis.

Dx: Arthrocentesis

28

What cardiac abnormality is associated with SLE?

Libman-Sacks endocarditis
—> they look like bacterial vegetations on heart valves, but the are sterile upon culture.

29

What are the diagnostic criteria for Systemic Lupus Erythematosus on the skin?

Skin: Malar rash, discoid rash, photosensitivity, painless oral ulcers.

30

What are the immune system markers associated with SLE?

Could be (+) for ANA (antinuclear antibodies), Antiphospholipid Ab (+), anti-dsDNA, anti-Smith, false (+) VDRL, anti-histone antibodies (+) for drug induced lupus