pathology

Question 1

name types of arthritis

Answer 1

osteoarthritis
rheumatoid arthritis
seronegative spondyloarthropathies
infective arthritis
crystal induced arthritis

Question 2

what are different types of seronegative spondyloarthropathies

Answer 2

Ankylosing spondylitis
Reactive arthritis, Enteritis associated arthritis
Psoriatic arthritis

Question 3

what joints does arthritis focus on

Answer 3

synovial joints

Question 4

primary cause of osteoarthritis

Answer 4

insidious
no cause
age related

Question 5

secondary causes of osteoarthritis

Answer 5

predisposing condition

excess weight bearing, deformity injury, systemic conditions

Question 6

features of osteoarthritis

Answer 6

aches and pains

usually hips, knees, lower lumbar and cervical vertebrae, PIP and DIP joints on fingers

Question 7

pathogenesis of osteoarthritis

Answer 7

degeneration of the cartilage and disordered repair
injury to chondrocytes and matrix
stimulate inflammatory changes in synovium and subchondral bone
repetitive injury and chronic inflammation

Question 8

presentation of rheumatoid arthritis

Answer 8

malasie, fever
msk pain
joint involvement - swollen, pain, warm
small joints before large joints

Question 9

progression of rheumatoid arthritis

Answer 9

Joint swelling, Decreased range of movement, Joint fusion (ankylosis)
Associated involvement of tendons and ligaments
Joint deformity
Unstable, (very) limited ROM
Synovial herniation – cysts eg Baker’s cyst
Joint effusions, peri-articular bone loss, loss of articular cartilage

Question 10

what does IFNg activate in rheumatoid arthritis

Answer 10

macrophages and synovial cells

Question 11

what does IL-17 recruit in rheumatoid arthritis

Answer 11

neutrophils and monocytes

Question 12

what does TNF and IL-1 stimulate production of in rheumatoid arthritis

Answer 12

proteases from synovium

Question 13

RANKL in rheumatoid arthritis

Answer 13

expressed on activated T cells and stimulates bone resorption

Question 14

what autoantibody in rheumatoid arthritis

Answer 14

IgM or IgA

Question 15

what are the acute phases of rheumatoid arthritis

Answer 15

pannus formation

hyperactive/reactive synovium

Question 16

what is potential extra-articular manifestations in rheumatoid arthritis

Answer 16

rheumatoid nodules
small vessel vasculitis
pyoderma gangrenosum

Question 17

features of ankylosing spondylitis

Answer 17

destructive arthritis
sacro-iliac and intervertebral joints
bony ankylosis

Question 18

two forms of crystal arthropathy

Answer 18

gout - urate metabolism

pseudo-gout - calcium pyroposphate

Question 19

synthesis of hyperurucaemia

Answer 19

from purine catabolism

reflects abnormal purine metabolism

Question 20

excretion of hyperurucaemia

Answer 20

renal filtration
resorbed in proximal tubule
limited excretion from distal tubule

Question 21

what happens in osteoporosis

Answer 21

decreased bone mass

risk of fracture

Question 22

what bone mass indicates osteopenia

Answer 22

1-2.5 SD

Question 23

what bone mass indicates osteoporosis

Answer 23

> 2.5 SD

Question 24

causes of secondary osteoporosis

Answer 24

endocrine disorders
GI disorders
drugs
miscellaneous - immobilisation

Question 25

main causes of osteoporosis

Answer 25

- age related - reduced physical activity - genetic factors - calcium - hormonal effects

Question 26

how does old age cause osteoporosis

Answer 26

reduced proliferation and biosynthetic capacity of osteoblasts response to growth factors attenuated

Question 27

what hormonal effects can cause osteoporosis

Answer 27

- post-menopausal - low oestrogen causes high bone turnover - monocytes release inflammatory mediators

Question 28

cause of osteomalacia

Answer 28

vit D deficiency

Question 29

what can vit D deficiency lead to

Answer 29

hypocalcaemia and PTH elevated

Question 30

what happens in osteomalacia

Answer 30

impaired mineralisation of bone matrix - bone remodelling - thick osteoid seams - bone is weakened

Question 31

what is avascular necrosis

Answer 31

- necrosis of bone and marrow | - the result of loss of effective vascular supply

Question 32

predisposing factors for AVN

Answer 32

- alcohol - corticosteroids, bisphosphonates - connective tissue disorders - decompression - sickle cell disease - infection, pregnancy, pancreatitis, radiation

Question 33

what does parathyroid hormone do

Answer 33

- activates osteoclasts - increased resorption of calcium by renal tubules - increased urinary phosphate excretion - increased synthesis of active forms of vit D

Question 34

what can hyperparathyroidism cause

Answer 34

- continued osteoclasis - osteoporosis - brown tumours - osteitis fibrosa cystica

Question 35

what is a brown tumour

Answer 35

mass of reactive tissue in osteoporotic bone prone to tumour

Question 36

what is Paget's disease of bone

Answer 36

abnormality of bone turn-over | -osteitis deformans

Question 37

what are the three stages of Paget's disease

Answer 37

- osteolytic - mixed - osteosclerotic

Question 38

what happens in osteolytic stage

Answer 38

resorption pits with large osteoclasts

Question 39

what happens in the mixed stage

Answer 39

osteoclasis and osteoblastic activity

Question 40

what is the net result of paget's disease

Answer 40

thick excess bone with abnormal reversal lines

Question 41

characteristic of soft tissue lesions

Answer 41

- present as lump or swelling - pain and discomfort - wide range of lesions

Question 42

what is a ganglion cyst

Answer 42

- lump near joint or tendon sheath - common at wrist - degenerative change with connective tissue - no epithelial lining - secondary inflammatory changes

Question 43

what is nodular fasciitis

Answer 43

-fast growing lump in soft tissue -self limiting disorder -cellular proliferation of fibroblastic and myofibroblastic cells -young adults

Question 44

what is myositis ossificans

Answer 44

- history of trauma - insertions of large muscles of arms and legs - cellular proliferation but with evidence of bone formation and zonation

Question 45

what is superficial fibromatoses

Answer 45

- non cancerous tumour - common - Dupuytren's - 60 yrs - idiopathic

Question 46

what is Dupuytren's

Answer 46

- thickening of the skin on your hand (palms) - firm grey-white tissue - nodules and fascicles - bland fibroblasts - dense collagen

Question 47

what is deep fibromatosis

Answer 47

- desmoid tumour - large infiltrative masses - do not metastasise

Question 48

what is tenosynovitis

Answer 48

- giant cell tumour of tendon sheath - digits and wrist - reactive proliferations - pigmented villonodular synovitis

Question 49

name benign tumours

Answer 49

``` Lipoma Haemangioma Leiomyoma Rhabdomyoma Chondroma Osteoma Neurofibroma / Schwannoma ```

Question 50

name malignant tumours

Answer 50

``` Liposarcoma Angiosarcoma Leiomyosarcoma Rhabdomyosarcoma Chondrosarcoma Osteosarcoma Neurofibrosarcoma / MPNST ```

Question 51

what are tumours derived from fat called

Answer 51

benign - lipomas | malignant - liposarcoma

Question 52

what are tumours derived from smooth muscle called?

Answer 52

leiomyomas

Question 53

what are tumours derived from skeletal muscle called

Answer 53

rhabdomyomas

Question 54

examples of benign tumours that arise from cartilage

Answer 54

- enchondroma - osteochondroma - chondromyxoid fibroma

Question 55

what is a chondrosarcoma

Answer 55

a malignant tumour that produces cartilage - bulky tumour - nodules of grey/white cartilaginous tissue with gelatinous matrix - locally invasive in bone and into muscle and fat

Question 56

what are the three types of chondrosarcoma

Answer 56

- dedifferentiated chondrosarcoma - clear cell chondrosarcoma - mesenchymal chondrosarcoma

Question 57

where are simple osteomas found

Answer 57

cranial bones

Question 58

what is Gardner's syndrome

Answer 58

multiple simple osteomas

Question 59

where are osteosarcomas found

Answer 59

long bones | -usually in children

Question 60

what is any malignant tumour that produced osteoid called? (unless proven otherwise)

Answer 60

osteosarcoma

Question 61

characteristics of Ewing's sarcoma

Answer 61

- children and adolescents - any soft tissue or bony location - destructive, rapidly growing and highly malignant

Question 62

name some causes of a pathological fracture

Answer 62

- osteoporosis | - tumours

Question 63

what does osteolytic mean

Answer 63

bone is resorbed and appear as radiolucent