Pathology Flashcards
(251 cards)
1
Q
What surrounds the entire skeletal muscle?
A
epimysium
2
Q
What surrounds the bundles of skeletal muscle fibres?
A
perimysium
3
Q
What surrounds the individual muscle fibres?
A
endomysium
4
Q
What are the 3 main indications for muscle biopsy?
A
- evidence of muscle disease (eg weakness, muscle symptoms, elevated CK)
- presence of neuropathy
- presence of vascular disorder (vasculitis)
5
Q
what is fasciculation?
A
uncontrolled twitching of muscle
6
Q
When CK level is higher than normal, in the ‘low’ classification, what type of disorder does this indicate?
A
neurogenic disorder
7
Q
when CK level is higher than normal, in the ‘intermediate’ classification, what type of disorder does this indicate?
A
inflammatory myopathy
8
Q
when CK level is higher than normal, in the ‘high’ classification, what type of disorder does this mean?
A
muscular dystrophy
9
Q
what are the 5 main groups of myopathies?
A
- muscular dystrophies
- inflammatory myopathies
- congenital myopathies
- secondary myopathies
- metabolic myopathies
10
Q
Why are ring fibres sometimes formed during muscle dystrophy?
A
condensation of the cytoplasm
11
Q
Why can there be enlarged nuclei and increased number of nuclei during muscle dystrophy?
A
due to attempted regeneration co-existing with the atrophy
12
Q
What type of inheritance is Duchenne’s Muscular Dystrophy (DMD)?
A
x-linked
13
Q
What muscles does Duchenne’s Muscular Dystrophy (DMD) mainly affect?
A
muscles of the pelvic girdle
14
Q
What type of inheritance is Becker’s Muscular Dystrophy (BMD)?
A
x-linked
15
Q
What muscles does Becker’s Muscular Dystrophy (BMD) mainly affect?
A
muscles of the pelvic girdle
16
Q
When is the onset of Duchenne’s Muscular Dystrophy (DMD)?
A
2 - 4 years old
17
Q
What is the life expectancy of someone with Duchenne’s Muscular Dystrophy (DMD)?
A
20
18
Q
What happens to the calves of patients with Duchenne’s Muscular Dystrophy (DMD)?
A
pseudohypertrophy
19
Q
What mutation causes Duchenne’s Muscular Dystrophy (DMD)?
A
Mutations in dystrophin gene on long arm of chromosome X
20
Q
What causes the different severities of Duchenne’s Muscular Dystrophy (DMD)?
A
mutations resulting in frame shift- severe
mutations resulting in altered binding- moderate to severe
mutations in middle rod- mild (Beckers)
21
Q
What does the mutation in the dystrophin gene in Duchenne’s Muscular Dystrophy cause? (in terms of basement membrane and actin and Ca++ entry)
A
changes anchorage of actin cytoskeleton to basement membrane
uncontrolled Ca++ entry into cells
22
Q
What does the change in anchorage of actin cytoskeleton to basement membrane in Duchenne’s Muscular Dystrophy do to the muscle fibres?
A
makes them more liable to tear
23
Q
What gene is mutated in Becker’s Muscular Dystrophy (BMD)?
A
dystrophin
variant of DMD
24
Q
compare disease progress of Beckers to Duchennes?
A
Beckers progression is much slower
25
What is myotonia?
inability to relax voluntary muscles after vigorous effort
26
What are inflammatory myopathies?
primary inflammation of muscle
27
What is polymyositis?
a chronic inflammatory myopathy
| autoimmune
28
compare inflammatory myopathies to muscular dystrophies in terms of pain?
no pain in dystrophies, pain is present in inflammatory myopahties
29
What autoimmune proteins are found in polymyositis?
antibodies to muscle antigens
30
what type of lymphocytes are mainly involved in polymyositis?
cytotoxic lympocytes
31
what is dermatomyositis?
polymyositis with skin changes
a chronic inflammatory myopathy
autoimmune
32
What type of skin changes are present in dermatomyositis?
upper body erythema
| swelling of eyelids with purple discolouration
33
what is the aetiology of polymyositis?
unknown
34
what is the aetiology of dermatomyositis?
unknown
| but 10% associated with underlying malignancy
35
what type of lymphocytes are mainly involved in dermatomyositis?
helper T cells
36
compare the histology of polymyositis and dermatomyositis?
no histological differences, need to use other tests eg fluorescent staining
37
What are neurogenic disorders of muscle?
stereotyped changes after nerve damage with subsequent re-innervation
(pathology in motor neuron not muscle)
38
What is motor neurone disease?
progressive degeneration of anterior horn cells causing denervation atrophy, fasciculation and weakness
39
What type of inheritance is spinal muscular atrophy?
autosomal recessive
40
compare motor neurone disease to spinal muscular atrophy?
same pathology but different aetiology
MND is sporadic
spinal muscular atrophy is inherited
41
What is myasthenia gravis?
an autoimmune disease causing weakness, proptosis, fatigue and dysphagia
42
What is proptosis?
bulging of the eye
43
who commonly gets myasthenia gravis?
women between 20 and 40
44
what are the main causes of myasthenia gravis?
thymoma or thymic hyperplasia
45
What antibodies are produces in myasthenia gravis?
antibodies to ACh recepto in post-synaptic cleft
46
What is rhabdomyolysis?
breakdown of skeletal muscle
47
what are the 4 major side effects of rhabdomyolysis?
- myoglobinuria (which causes acute renal failure)
- hyperkalaemia
- necrosis
- shock
48
what are the main causes of rhabdomyolysis?
massive trauma
pressure induced
mushroom poisoning
drug side effects
49
What is the main management of connective tissue disorders?
anti-inflammatory/immunosuppression therapy
50
what antibodies are produces in SLE?
antinuclear antibodies (ANAs), anti-ds DNA, anti- Ro, anti-RNP
51
what skin effects of SLE can be seen?
butterly rash
| discoid lupus erythematosus
52
what are the effects of SLE on the joints?
arthralgia
53
what are the effects of SLE on the kidneys?
glomerulonephritis
54
what are the effects of SLE on the central nervous system?
psychiatric symptoms
| focal neurological symptoms
55
what are the effects of SLE on the cardiovascular system?
pericarditis
myocarditis
necrotising vasculitis
56
what are the effects of SLE on the immune system?
lymphadenopathy
| splenomegaly
57
what are the effects of SLE on the lungs?
pleuritis
| pleural effusions
58
what are the effects of SLE on haematological system?
anaemia
leukopenia
thrombophilia
59
what hypersensitivity reaction is SLE?
```
type 3 (visceral lesions)- deposition of IgG
type 2 (haematological effects)- lysis of RBCs
```
60
What is polyarteritis nodosa?
inflammation and fibrinoid necrosis of small/medium arteries
61
what is the aetiology of polyarteritis nodosa?
unknown
| small association with Hep B carriage
62
where is the pain and stiffness most present in polymyalgia rheumatica?
shoulder and pelvid girdle
| no muscle weakness
63
what is the treatment for polymyalgia rheumatica?
steroids
| prednisolone 15mg for 18 months
64
who are the people most likely to get polymyalgia rheumatica?
elderly women
65
when is pain and stiffness usually at its worst in polymyalgia rheumatica?
morning
66
what is termporal arteritis?
giant cell arteritis of the temporal artery (vasculitis)
67
what is scleroderma?
excessive fibrosis of organs and tissues due to excessive collagen production
68
scleroderma is associated with CREST syndrome, what is this?
```
calcinosis
raynauds
oesophageal dysfunction
sclerodactyly
telangectasia
```
69
what is sclerodactyly?
thickening of skin on fingers and toes
70
what is telangectasia?
dilation of small capillaries so they appear like red or purple clusters on teh skin
71
what are the 4 main causes of death for patients with scleroderma?
- renal failure (secondary to malignant hypertension)
- severe respiratory compromise
- cor pulmonale
- cardiac failure/arrhymias (secondary to myocardial fibrosis)
72
What is the name of a cartilage capped bony projection arising on the external surface of the bone which contains a marrow cavity continuous with that of the underlying bone?
osteochondroma
| exostosis
73
who tends to develop osteochondroma?
males and females under 20
74
where do osteochondromas tend to develop?
epiphyses of long bones
75
what is the presumed cell of origin of osteochondromas?
chondrocytes
76
are osteochondromas benign or malignant?
benign
77
why can osteochondromas be surgically removed even if they are benign?
can sometimes cause pain or irritation
or if it's growing in size (may become malignant)
78
what is a chondroma?
benign hyaline cartilage tumour
79
where do chondromas arise?
medullary cavity of bones of hands and feet
| usually at metaphysis
80
who tends to get chondromas?
young adults
| men > women
81
What is Mafucci's syndrome?
multiple enchondromas associated with multiple haemangiomas
| premalignant
82
What is Ollier's Disease?
a rare developmental disorder involving multiple enchodromas of one extremity (usually unilateral)
(premalignant)
83
what type of inheritance is Ollier's disease
not hereditary or familial
84
compare maffucci's syndome to ollier's disease in terms of malignant transformation risk?
Maffucci's syndrome has a greater malignant transformation risk than Ollier's disease
85
What is the name of a benign osteoblastic tumour composed of a central core of vascular osteoid tissue (immature) and peripheral zone of sclerotic bone?
osteoid osteoma
86
who tends to get osteoid osteomas?
children and young adults
| M > F
87
where are osteoid osteomas found?
poximal femur,
diaphysis of long bones,
vertebrae
88
what is the distinct clinical picture of a person with an osteoid osteoma?
dull pain which is worse at night
| pain relieved by aspirin or NSAIDs
89
what is the name of a benign cartilage tumour arising in bone?
chondroblastoma
90
where are chondroblastomas found?
epiphysis of long bones
91
who tends to get chondroblastomas?
20 -30 year olds
92
what is the treatment for a chondroblastoma?
biopsy and curettage
| plus adjuvant liquid nitrogen
93
who tends to get giant cell tumours?
25-40 year olds
| F > M
94
where is the site of giant cell tumours?
metaphsis and epiphysis long bones, often around the knee and distal radius
can occur in pelvis and spine
can involve subchondral bone and joint
95
what is the presumed cell of origin of a giant cell tumour?
osteoclast
96
is a giant cell tumour benign or malignant?
benign
| but locally aggressve
97
what is the treatment for a giant cell tumour?
intralesional excision
| very aggressive lesions may need joint replacement
98
what happens to giant cell tumours when they are radiated?
undergo malignant transformation
99
what is the name of a benign, self-limited tumour that produces osteoid and bone?
osteoblastoma
100
are osteoblastomas benign or malignant?
benign
| but locally aggressive
101
where are osteoblastomas found?
metaphysis or diaphysis of long bones
102
what is the treatment for an osteoblastoma?
surgical resection by:
curettage
intralesional excition
en bloc resection
103
what is the name of a very rare tumour arising from notochord remnants?
chordoma
104
where are chordomas usually found?
midline
| often in sacral region or base of skull
105
who tends to get chordomas?
40+
| F > M
106
are chordomas benign or malignant?
benign
| but locally aggressive
107
what is the treatment for chordomas?
generally difficult to resect
radiation may be helpful
chemotherapy for late stage disease
108
what is the name of a malignant tumour of osteoblasts which form osteoid?
osteosarcoma
109
who tends to get osteosarcomas?
young adults
older patients with predisposing conditions (eg Pagets)
M > F
110
where are osteosarcomas usually found?
bones around the knee,ie particularly distal femur, proximal tibia
also proximal femur, proximal humerous and pelvis
111
what needs to be produced by an osteosarcoma for diagnosis?
osteoid producion is essential for diagnosis
112
what are the 3 histological variants of conventional osteosarcoma?
osteoblastic
chondroblastic
fibroblastic
113
what is the treatment of an osteosarcoma?
biopsy, CT, bone scan
pre-op chemo
surgical resection
post-op chemo
114
what tumour is composed of malignant chondrocytes?
chondrosarcoma
115
which is the most common primary malignant tumour of bone?
osteosarcoma
116
what is the treatment of a chondrosarcoma?
wide surgical excision
117
what are the 3 main types of malignant bone cancer?
osteosarcoma
chondrosarcoma
Ewing's Sarcoma
118
who tends to get Ewing's Sarcoma?
10 - 20 year olds
| M > F
119
what is Ewing's Sarcoma?
a primary malignant tumour of the primitive cells in the bone marrw
120
where does Ewing's Sarcoma occur?
metpahysis and diaphysis of:
1. femur
2. tibia
3. humerous
121
what is the treatment of Ewing's Sarcoma?
surgery
radiation therapy
chemotherapy
post-op adjuvant chemo
122
what is the name of the tumour caused by malignant proliferation of plasma cells in bone marrow?
multiple myeloma
123
who tends to get multiple myeloma?
elderly
124
what is the usual result of multiple myeloma?
bone destruction of axial skeleton
125
what is more common: primary bone tumours or secondary bone tumours?
secondary mets
126
what is the most common benign bone tumour?
osteochondroma
127
what type of inheritance is the hereditary disorder which causes multiple osteochondromas?
autosomal dominant
128
what are enchondromas caused by?
failure of normal endochondral ossification at the growth plate
129
why can enchondromas lead to pathological fractures?
because even though they are usually asymptomatic, they weaken the bone
130
what is the treatment for an enchondroma which has caused a fracture or is threatening to cause a fracture?
curettage (once one has healed)
| + filled with bone graft to strengthen bone
131
what is a simple bone cyst?
a single cavity, fluid filled, benign cyst in a bone
132
where are simple bone cysts generally found?
metaphysis of long bones particularly proximal femur and humerous
can be found in talus or calcaneous
133
why can simple bone cysts lead to pathological fractures?
because they weaken the bone
134
what is the treatment for a simple bone cyst?
curettage
| + filled with bone graft to strengthen
135
what is the probable cause of a simple bone cyst?
developmental defect
136
what is an aneurysmal bone cyst?
multiple fluid-filled chambers within a bone which contain blood or serum
137
what is the probable cause of an aneurysmal bone cyst?
small arteriovenous malformation
138
where do aneurysmal bone cysts occur?
metaphyses of long bones, flat bones and vertebral bodies
139
why do aneurysmal bone cysts cause pain?
because they are locally aggressive so cause cortical expansion and destruction
140
what is the treatment of an aneurysmal bone cyst?
curettage
| + filled with bone graft to strengthen
141
why are giant cell tumours of the bone painful?
destruction of cortex
142
despite being classified as benign, what typically malignant feature do they have?
can metastasise
usually causing benign pulmonary giant cell tumours
143
what is the characteristic sign of a giant cell tumour of the bone on an x-ray?
soap bubble appearance
144
what is the name of the genetic condition which results in lesions of fibrous tissue within bone and immature bone?
fibrous dysplasia
145
when does fibrous dysplasia tend to occur?
adolescence
146
compare monostatic fibrous dysplasia to polystatic fibrous dysplasia?
monostatic fibrous dysplasia- affects only one bone
| polystatic fibrous dysplasia- affects more than one bone
147
what deformity is typical of fibrous dysplasia if there is extensive involvement of the proximal femur?
shepherd's crook deformity
148
what can be used to reduce pain in fibrous dysplasia?
biphosphates
149
what should be done to treat pathological fractures caused by fibrous dysplasia?
internal fixation (for stability) and cortical bone graphs (for strength)
150
how do you treat osteoid osteomas?
many resolve spontaneously
| others require CT guided radio-frequency alation or en bloc resection
151
what are the red flag symptoms for bone cancer?
```
constant pain
worse at night
systemic symptoms (eg weight loss, loss of appetite, fatigue)
```
152
are osteosarcomas radiosensitive?
no
153
where are chondrosarcomas likely to be found?
pelvis
| proximal femur
154
compare osteosarcoma and chondrosarcoma in terms of mets rate??
osteosarcoma metastasizes faster than chondrosarcoma
155
are osteosarcomas responsive to adjuvant chemotherapy?
yes
156
are chondrosarcomas radiosensitive?
no
157
are chondrosarcomas responsive to adjuvant chemotherapy?
no
158
what are fibrosarcomas and malignant fibrous histiocytma?
fibrous malignant primary bone tumours which tend to occur in abnormal bone (eg bone infarcts, fibrous dysplasia and pagets disease)
159
which malignant bone cancer has the poorest prognosis?
Ewing's Sarcoma
160
are Ewing's Sarcomas radiosensitive?
yes
161
are Ewing's Sarcomas responsive to chemotherapy adjuvants?
yes
162
what is neo-adjuvant chemotherapy?
chemotherapy given before surgery
163
What are the 5 most common primary malignant tumours which commonly metastasize to bone?
1. breast carcinoma
2. prostate carcinoma
3. lung carcinoma
4. renal cell carcinoma
5. thyroid adenocarcinoma
164
what is the most common benign soft tissue tumour?
lipoma
165
what is a lipoma?
a neoplastic proliferation of fat
166
where do lipomas occur?
usually in the subcutaneous tissue,
| can occur in the muscle
167
what is an angiosarcoma?
malignant tumour that arises from blood vessels
168
what is a liposarcoma?
malignant tumour that arises from fat
169
what is a rhabdomyosarcoma?
a malignant tumour that arises from skeletal muscle
170
what is a synovial sarcoma?
a malignant tumout that arises from the synovial lining of joints or tendons
171
what is a ganglion cyst?
a synovial-fluid-filled swelling that occurs around a synovial joint or synovial tendon sheath
(outpouching of synovium lining)
172
why do ganglion cysts form?
as a result of herniation or out-pouching of a weak portion of joint capsule of tendon sheath
173
what is a juvenile Baker's cyst?
a ganglion cyst caused by a developmental weakness
174
what is an adults Baker's cyst?
a ganglion cyst caused by a build up of pressure within the joint capsule
175
what is a bursa?
a small fluid filled sac lined by synovium around a joint which prevents friction between tendons, bones, muscles and skin
176
what can cause bursitis?
repeated pressure/trauma
bacterial infection
gout
177
how do you treat an abscess?
incision and drainage
| will not resolve with antibiotics alone
178
what similar end result to osteochondritis and avascular necrosis share?
an area of bone undergoes localised necrosis
179
what is avascular necrosis?
ischaemic necrosis of bone
| predominantly in adults
180
why can alcoholism, steroid abuse and primary hyperlipidaemia lead to avascular necrosis?
alcoholism and steroid abuse alter fat metabolism and can result in mobilisation of fat into the circulation which can cause ischaemia
primary hyperlipidaemia causes fat to be in circulation as well
181
what is the treatment of early avascular necrosis? (ie before articular surface has collapse)
drilling under fluoroscopy to decompress bone
| prevents further necrosis and helps healing
182
what is the treatmend of late stage avascular necrosis? (ie articular surface has collapsed)
joint replacement
183
what does the modified beighton score clinically assess?
if the patient has joint hypermobility syndrome
184
what do patients with joint hypermobility syndrome usually present with? (if no underlying genetic syndrome)
arthralgia
| premature osteoarthritis
185
what are the 5 signs of inflammation?
```
rubor (red)
calor (hot)
dolor (pain)
tumor (swelling)
functio laesa (loss of function)
```
186
what is sequestrium?
dead and dying bone separated from normal bone
| a complication of osteomyelitis
187
what is involucrum?
new bone forming on the outside, just deep to the periosteum
| a complication of osteomyslitis
188
why is pus within a joint an emergency?
pus destroys articular cartilage
189
why is needle aspiration of a ganglion cyst not recommended?
recurrence is common
190
what is usually the first clinical sign of hp patholgoy?
loss of internal rotation
191
what do patients with avascular necrosis of the femoral head present with?
groin pain
192
what are the late signs of avascular necrosis of the femoral head on radiography?
sclerotic changes
hanging rope sign
irregularity of articular surface
193
why does a lytic zone form at the neck of a femoral head damaged by avascular necrosis?
lytic zone formed by granulation tissue (attempted repair)
194
what sign on x-ray suggest avascular necrosis and is due to the lytic zone?
hanging rope sign
195
what is morton's neuroma?
irritation of the plantar interdigital nerves (due to repeated trauma) causing neuromas to form
196
what are neuromas?
swollen and inflamed nerves
197
what do patients with morton's neuroma present with?
burning pain and tingling radiating into affected toes
198
who is more likely to get morton's neuroma- M or F?
females
199
which nerves are most commonly affected by morton's neuroma?
3rd interspace nerve is the most common followed by the 2nd interspace nerve
200
what test assesses for morton's neuroma?
mulders test
201
what is mudlers test?
squeezing the forefoot with your hand
| in a positive test symptoms may be reproduced or there will be a characteristic click
202
what is used for diagnosis of morton's neuroma?
Ultrasound
203
what is the conservative management of morton's neuroma?
metatarsal pad or insole
| steroid and local anaethetic injections
204
what is myositis ossificans?
ossification within a muscle after injury (can be after surgery)
205
what is pes planus?
loss of the medial longitudinal arch of the foot- flat foot
206
what is the ligament in the ankle which is most commonly sprained?
ATFL
| anterior talofibular ligament
207
what test assesses whether flat footedness is flexible or stiff?
jacks test- push big toe up
208
what tendon dysfunction is the most common cause of acquired flatfoot deformity?
tendon of posterior tibialis
209
what is the primary dynamic stabiliser of the medial longitudinal arch?
tibialis posterior tendon
210
who tends to get tibialis posterior dysfunction?
obese middle aged females
211
what pain and swelling is very typical to tibialis posterior dysfunction?
pain/swelling posterior to medial malleolus
212
what can happen to the big toes in tibialis posterior dysfunction?
can move laterally (hallux valgus)
213
what type of surfaces do patients with tibialis posteiror dysfunction not life?
uneven surfaces
214
what can happen to the heel of the foot in tibialis posterior dysfunction?
heel goes into valgus
215
what can happen to the heel of the foot of a patient with pes cavus?
moves into varus
216
what are the 4 main causes of plantar fasciitis?
- physical overload (excessive exercise or weight)
- seronegative arthropathy
- diabetes
- abnormal foot shape
217
what is the main treatment of plantar fasciitis?
```
conservative:
NSAIDs
night splint + taping
physio
steroid injections
```
218
how long does plantar fasciitis take to self-limit?
18-24 months
219
how does the incidence of hallux valgus change with age?
increases with age
220
is hallux valgus mainly unilateral or bilateral?
bilateral
221
what are the 5 main problems of hallux valgus?
```
transfer metatarsalgia
lesser toe impingement
pain
cosmesis of deformity
shoe difficulties
```
222
why does hallux valgus cause transfer metatarsalgia?
loss of function of big toe
lesser toes are used for power
these toes eventually become sore
223
what is hallux rigisus?
OA of 1st MTP joint
224
what is the commonest area for morton's neuroma and why?
between 3rd and 4th digit (because these are very mobile so are constantly rubbing against each other)
225
what is the first line treatment for morton's neuroma?
steroid injections
226
what type of condition is curly toes?
paediatric condition
227
if a swelling is 'fluctuant', what type of material is within it?
semi-solid material
228
what is an abscess?
a discreet collectin og pus
229
what is the management of bursitis? (which hasn't become secondarily affected)
NSAIDs
| analgesia
230
what is the management of bursitis that has become secondarily affected?
incision and drainage
| antibiotics
231
how many bursae are around the knee?
4 bursae
232
what actually is the bunion on the medial side of the foot formed by hallux valgus?
an inflamed bursa
233
why do bouchards and heberdens nodes occur?
chronic trauma
234
what arthritis are bouchards nodes present in?
OA or RA
235
what arthritis are heberdens nodes present in?
OA
236
what is myositis ossificans?
ossificaiton (calcification) of a muscle haematoma
| outside the bone, in a muscle
237
what usually happens before myositis ossificans?
large trauma (haematoma occurs)
238
when can you intervene with myositis ossificans?
only if symptoms demand
| and only once the ossification has matured (otherwise risk of recurrence)
239
what joints are most commonly affected by OA?
DIP joints
240
what are mucous cysts?
outpouching of synovial fluid from DIP joints
241
what condition are mucous cysts associated with?
osteoarthrtis
242
what is DeQuervain's tendonitis?
tendonitis of the tendons which control the thumb
243
when is ficklesteins test positive?
in Dequervain's tendonitis
244
in dupuytren's contractures what do the fibroblasts change in to?
myofibroblasts
245
what simple test is a way to determine if the dupuytren's contractures are severe enough to require surgery?
table top test
246
what is paronychia?
infection within the nail fold (essentially an abscess)
247
wat is tendinopathy?
disease of a tendon
248
what is tendonitis?
acute tendon injury accompanied by inflammation
249
what is tendonosis?
chronic tendon injury with damage to tendon at cellular level
250
what is tenosynovitis?
inflammation of the tendon sheath
251
what is enthesopathy?
inflammation of the tendon origin or the insertion
