Musculoskeletal System Path 2

Front 1

What are bone fractures caused by?

Back 1

trauma, metastasis, stress or malnutrition= increase in LDH

Front 2

What is a stress fracture?

Back 2

hx of prolonged marching, seen in small bones

Front 3

What is a compression fracture?

Back 3

when lumbar vertebrae of women suffering of osteoperosis

Front 4

What are the conditions that lead to compression fracture

Back 4

decrease in estrogen levels

Front 5

Who is most likely to suffer of compression fractures?

Back 5

- pregnant women
- post menapausal women
- cushings syndrome

Front 6

What is a callus composed of?

Back 6

Granulation tissue and osteiod deposits

Front 7

what is the xray findings of callus?

Back 7

straight white lines

Front 8

What are the causes of avascular necrosis?

Back 8

alcoholism, sickle cell anemia, hip fracture- loss of blood supply (head of femur)

Front 9

What is the cause of myositis ossificans?

Back 9

horse riding, trauma near joints

Front 10

what is the pathogenesis behind myositis ossificans?

Back 10

formation of metaplastic bone within area of trauma (blood or muscle undergo ossification)

Front 11

What are the early and late clinical fts. of myositis ossificans?

Back 11

Early- area is swollen and painful
Late- painless, hard, well demarcated mass

Front 12

What is seen in metastasis in bone?

Back 12

- increase in Alkaline Phospatase(ALP)
- mostly osteolytic (increase in Ca2+)

Front 13

What are the two cancers that you see bone metastasis?

Back 13

Prostate and Breast carcinoma- osteolytic and osteoblastic lesions- both lysis and building of bone

Front 14

What are the causes of Osteoarthritis?

Back 14

Degenerative joint disease
- NON inflammatory
- wear and tear due to aging
- degeneration of articular chondrocytes
- decreased local synthesis of type 2 collagen
- DM, obesity, Hip replacement, Ochronosis increase risk

Front 15

Where is osteoarthritis most likely found?

Back 15

weight bearing joints and DIP

Front 16

what are the types of healing in soft tissue?

Back 16

healing by
- fibrosis
- regeneration

Front 17

What are the two subtypes of fibrosis

Back 17

- primary intension
-secondary intension

and you get granulation tissue

Front 18

What happens in bone fracture healing?

Back 18

- Bone fracture
- Hematoma formation with inflammatory clot, then no infection can come in- neutrophils come in
- the previous hematoma area produces a matrix known as osteoid (produced by osteoblast)- callus
-forms a bump, which is remodeled by osteoclast

Front 19

How long does it take the callus to form

Back 19

2-3 weeks, can be seen in the xray

Front 20

What is an "open" fracture?

Back 20

it comes out of the skin

Front 21

what is a "closed" fracture?

Back 21

It;s enclosed within the skin

Front 22

What does simple fracture?

Back 22

just two pieces of bone, very clean cut

Front 23

What does compound fracture?

Back 23

multiple fractures, bone may come out of tissue

Front 24

Which bones do stress fractures affect?

Back 24

small bones

Front 25

What is the morphology of Osteoarthritis?

Back 25

- loss/ cracking of the cartilage
- causes articular surfaces to smooth out due to bones pressing against each other. Then the osteoid comes along and sees that the area is flattened, and grows bone known as osteophytes( in DIP- heberden's nodes)
- This then causes neovascularization
- Asymmetric subchondral cysts of synovial fluid (cysts on X ray)

Front 26

What are the c/f of osteoarthritis?

Back 26

creptites- pain increases with repetitive motion

Front 27

What is the cause of Rheumatoid Arthritis?

Back 27

Chronic inflammotroy disease affecting mainly synovial joints

Front 28

What is the gender predominance in Rheumatoid arthritis?

Back 28

More in females, age 20-40 yrs

Front 29

What is the genetic involvement of rheumatoid arthritis?

Back 29

HLA DR4 genetics + Viral mimicry

Front 30

What are the disease that lead to Rheumatoid arthritis

Back 30

EBM= EBV, borrelia, mycoplasma

Front 31

What is affected in Rheumatoid arthritis?

Back 31

joints of the wrist, hand, knee and ankle and PIP

Front 32

What is the pathogenesis behind Rheumatoid arthritis?

Back 32

- APC gene activation and presented to CD4 T cells
- CD4 T cells produce cytokines(IL2, INF-gamma)= pannus formation
- B cells produce Ig G(auto Ab against the synovium)
- formation of Ig M against Fc portion of Ig G= Rheumatoid factor

Front 33

What is pannus

Back 33

granulation tissue of synovium- bridges adjacent bones- fibrous ankylosis- bony anyklosis= fixed deformity

Front 34

What is the Clinical ft associated with Rheumatoid arthritis?

Back 34

- Boutenniere's swan neck
- fusirform sweeling( red and painful) symetric involvement
- morning stiffness

Front 35

What are the lab finings of Rheumatoid arthritis?

Back 35

- RF Ig M titre correlates with severity
- Increased ESR
- Synovial fluid contains neutrophils and fbrin (complement recruits neutrophils)= acute inflam
Anticyclic citri-nullated peptide

Front 36

What is the main antibody produced in rheumatoid arthritis?

Back 36

Anti cyclic citru-nullated peptide (anit ccp)- indicates patient is at risk for damage of joints

Front 37

What is the association of Rheumatoid arthritis?

Back 37

AA type Amyloidosis- atrophy of glomerular capillaries- secondary GN and NS(infection atheroma, thrombosis)
Sjorgen's disease, SLE, and primary biliary cirrhosis

Front 38

What is the cause of gout?

Back 38

seen in males more than in females
- caused by deposition of monosodium urate crystals in joints

Front 39

What are the etiologies of rheumatoid arthritis?

Back 39

- Idiopathetic
- Lesch Nyhan syndrome (defny of HPRT enzyme (X linked)
-Leukemia undergoing chemotherapy- increase in cell destruction
- alcoholic - heavy drinking

Front 40

What is the pathogenesis involved in Gout?

Back 40

- increased uric acid in the blood
- deposit of monosodium urate crystals in joints (increased temp due to inflammation will dissolve the crystal relief)
- chronicity leads to deposit of Tophi in kidney and joints- renal failure and chronic gouty arthritis

Front 41

What is the clinical ft s of gout?

Back 41

painful, inflamed great toe
previous consumption of alcohol predisposes to attacks
- Toes and knees and ankles are affected

Front 42

What is Tophi?

Back 42

calcification as on apex of the kidney- foreign body giant cells

Front 43

What are the lab values associated with Gout?

Back 43

Synovial fluid and urine show needle shaped crystals with negative birefringent uric acid crystals

Front 44

What is pseudo gout composed of?

Back 44

deposits of calcium pyrophosphate crystals in knee joint

Front 45

How would u describe a calcium pyrophosphate crystal?

Back 45

rhomboid, baosophilic crystals

Front 46

What are the risks of Pseudo Gout?

Back 46

Hypothyroidism, hypercalcemia, and excessive iron

Front 47

What is osteomylitis?

Back 47

inflammation of the bone or bone marrow

Front 48

What is the etiology of osteomylitis?

Back 48

Staph aureus- pyogenic bacteria
Salmonela with sickle cell anemia

Front 49

How does osteomyleitis spread?

Back 49

hematogenous spread- lytic lesion in the metaphysis of long bones and subperiosteal abcess/cyst leading to erosion of the cortical bone

Front 50

What are the complications of osteomylitis?

Back 50

- pass to joint causing septic arthrits and endocarditis
- formation of pus discharging sinus
- sq cell carcinoma of the sinus tract

Front 51

what are the clinical fts of osteomylitis?

Back 51

fever, pain, local warmth, leukocytosis and neutrophilia

Front 52

What is the cause of primary osteosarcoma?

Back 52

Deletion of CH13 Rb gene (Rb, primary osteosarcoma, Oat cell C of lung)
- mutation in p53(chromosome 17)
- over expression of MDM2 oncogene

Front 53

What is the pathogenesis behind primary osteosarcoma

Back 53

osteoblast becomes malignant
- metaphysis of knee joint (lower end of femur, upper ends of tibia/fibula) and jaw- produce Lace- like osteoid in teens

Front 54

What is the lab findings of primary osteosarcoma?

Back 54

xray shows codman triangle (periosteum lifted out as OS expands) or sun burst

Front 55

What is the complication of primary osteosarcoma?

Back 55

metastasis to the lungs

Front 56

What are the clinical ft.s primary osteosarcoma?

Back 56

bone pain, swelling and fracture

Front 57

What is the cause of secondary osteosarcoma?

Back 57

paget's disease, fibrous dysplasia (Albright-Mc Cune), previous irradiation or bone infarction (in adult)

Front 58

What is an endochondroma?

Back 58

a benign tumor arising from chondrocytes within bone marrow cavity (hyaline cartilage) multiple small tumors in small bones(hand, vertebrae)

Front 59

What is the pathogenesis behind endochrondroma?

Back 59

neoplastic chondrocytes in lacunare are cytologically benigh(show groupings of cells)

Front 60

What are the complications of Endochrondroma?

Back 60

1.)Olliers Disease- multiple enchondromas= chondrosarcoma
2.) Mafucci Syndrome multiple enchondromas + benign vascual tumors

Front 61

What is the pathogenesis behind chondrosarcoma?

Back 61

Multiple endochondromas- more coomon in females

Front 62

What are the gross findings of chondrosarcoma?

Back 62

large, bulky, glistening tumor

Front 63

What are the micro findings of chondrosarcoma?

Back 63

hyperchromatic nuclei, prominent nucleolus

Front 64

What are the xray findings of chondrosarcoma?

Back 64

"popcorn" or spotty calcification

Front 65

What is the genetic predisposition of Muscular dystrophy?

Back 65

X linked recessive

Front 66

What is the pathogenesis behind duchenne muscular dystrophy?

Back 66

complete abscence of Dystrophin (dilated cardiomyopathy)
- infiltration of fat into muscles- Pseudodystrophy

Front 67

What is the morphology of duchenne muscular dystrophy?

Back 67

variation in muscle size (degeneration of muscle, fibers, scattered chronic inflammatory cells, fibrosis and fat)

Front 68

What is the clinical ft s of duchenne muscular dystrophy?

Back 68

proximal muscle weakness (5-15y/old)- Gowers' maneuver

Front 69

What is the diagnosis of Duchenne Muscular dystrophy?

Back 69

Elevated CK-MM , muscle biopsy

Front 70

What is the pathogensis behind myasthenia gravis?

Back 70

Ab mediated destruction of Ach receptors

Front 71

What are the C/f of myasthenia gravis?

Back 71

Ptosis (weakness at the end of the day)

Front 72

What is the Morphology of Myasthenia Gravis?

Back 72

Thymoma (thymic hyperplasia)

Front 73

What is the MCC of conjunctivitis?

Back 73

Adenovirus

Front 74

What are the clincal ft.s of conjunctivitis?

Back 74

painful red eye, dryness occarionally, exudative due to superimposed infection

Front 75

What STD can cause conjunctivitis?

Back 75

Chlamydia trachomatis- more common in developing countries

Front 76

What is the clinical fts of a pt suffering of Chylamydia trachomatis?

Back 76

painful conjunctivitis, dryness and fibrous scar formation (lymphoid aggregates)= blindness
- Reiter's syndrome ( urethritis, conjunctivitis, arthritis)

Front 77

What are the ft s of Glaucoma?

Back 77

Increased intraoptic pressure= optic nerve cupping and loss of retinal ganglion cells= blindness

Front 78

When do you get Age related macular degeneration?

Back 78

common in elderly over 80 with no previous H/x

Front 79

What is the morphology of age-related macular degeneration?

Back 79

Hypo-pigmented area over macula

Front 80

What are the clinical ft.s of age related Macular degeneration?

Back 80

central vision lost, peripheral vision intact

Front 81

What could these three diseases cause, Malignant HTN, DM, severe myopia?

Back 81

Retinal degeneration

Front 82

What are the clinical ft.s of retinal degeneration?

Back 82

- flashes of light (extreme periphery)
sudden dramatic increase in no. of floaters(can be normal in myopia)

Front 83

What is the MC primary intraocular malignancy of children?

Back 83

Retinoblastoma

Front 84

If a child suffers of Retinoblastoma what does he/she have increased risk of developing

Back 84

Osteosarcoma

Front 85

What is associated with retinoblastoma?

Back 85

primary osteosarcoma and small cell carcinoma

Front 86

What are the two types of retinoblastoma?

Back 86

- familial form: all somatic cells inherit one mutant RB gene(deletion on ch 13) from a carrier parent *Two hit theory*
- Sporadic form- ONLY RETINAL cells acquire mutations at RB locus at birth

Front 87

What is the morphology of retinoblastoma?

Back 87

small, blue round cells with Flexner- Wintersteiner Rosettes

Front 88

What is a cholesteatoma?

Back 88

chronic otitis media

Front 89

What causes chronic otitis media?

Back 89

strep pneumoniae

Front 90

What are the associations of cholesteatoma?

Back 90

brain abscess

Front 91

What are the clinical ft s of cholesteatoma?

Back 91

- chronic inflammatory reaction surrounds keratinous cyst
- cystic lesions (1-4cm) contain keratinizing sq epithelium and cell debris

Front 92

What is otosclerosis?

Back 92

abnormal growth of bones of the middle ear resulting in conductive hearing loss