Pathology: Tbl 14: Musculoskeletal

Front 1

Calcified changes in a fractured bone can be seen:

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2-3 weeks following the injury

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These cells are derived from the same hematopoetic progenitor cells that give rise to monocytes and macrophages:

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Osteoclasts

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These cells are derived from osteoprogenitors:

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Osteoblasts

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Are regulated by cytokines and growth factors M-CSF, IL-1, and TNF

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Osteoclasts

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Have receptors that bind PTH, Vitamin D, Leptin, Estrogen, Cytokines, growth factor and extracellular matrix proteins

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Osteoblasts

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_________ express several factors that regulate the differentiation and function of osteoclasts.

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Osteoblasts

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Mobilizes calcium from bone by stimulating osteoclasts

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PTH

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Maintains skeletal calcium balance by promoting calcium absorption (intestines) and promoting bone resorption by increasing osteoclast number, and allows proper function of PTH to maintain serum calcium levels:

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Vitamin D

Front 9

Opposed PTH and tones down the amount of calcium in the blood, Inhibits calcium absorption in the intestines and inhibiting osteoclast activity in bones:

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Calcitonin

Front 10

Osteoporosis, osteomalacia, osteomyelitis, and aseptic necrosis all occcur more commonly in people with which condition?

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Sickle Cell Disease

Front 11

This category of synovial fluid aspirate has a yellowish color, negative culture, and a WBC of 200-2000.

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Group I (non-inflammatory)

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This category of synovial fluid aspirate has yellow to opalescent color, low viscosity, a negative culture and a WBC of 2000-100,000.

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Group II (Inflammatory)

Front 13

This category of synovial fluid aspirate has yellow to green color, often has a positive culture, variable viscosity and a WBC of > 100,000.

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Group III (Septic)

Front 14

Benign bone lesion found most commonly in long bones, has a radiolucent focus, nocturnal/cyclical pain releived by NSAIDs with dull pain and tenderness.

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Osteoid Osteoma

Front 15

This uncommon benign bone lesion is found in the vertebra or long bones, is larger, lesions may mechanically interfere with spinal cord or nerve roots producing neurologic deficits. It is not worse at night or releived by salicylates.

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Osteoblastoma

Front 16

Malignant bone lesion that is the most common primary bone cancer, primarily located in the metaphysis of the distal femur or proximal tibia. Has characteristic sun-burst appearance.

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Osteosarcoma

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This malignant tumor of the bone is caused by malignant tranformation of mesenchymal cells and has areas of rapid growth with pain swelling or fracture, commonly seen in the knee.

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Osteosarcoma

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This is a benign tumor in bone or cartilage that is primarily located in the metaphysis of the distal femur but can be found in the knee or shoulder. It is an outgrowth of bone capped with benign cartilage.

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Osteochondroma

Front 19

This the most common benign tumor in bone and cartilage and has metaphyseal widening or a 'trumpet shaped deformity'. Looks like a mushroom shaped growth plate of cartilage with medullary continuity.

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Osteochondroma

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Cartilage cyst found on bone marrow and affects the cartilage that lines the inside of bones.

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Endochrondroma

Front 21

This benign cyst has a primarily medullary location and can be found in the small tubular bones in the hands and feet. Is benign hyaline cartilage occuring within bone and has an increased risk for chondrosarcoma

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Endochondroma

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This tumor occurs in 25 y/o and 12% occur in the bones of the feet. Presents with pain, swelling and a mass near the joint.

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Chrondroblastoma

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This tumor has sheets of monomorphic pink chondroblasts with scant 'chicken wire' matrix. Is much more cellular than other cartilaginous tumors.

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Chondroblastoma

Front 24

Malignant mesenchymal tumor that produces cartilage matrix. Occurs mostly in males of age 30-60.

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Chrondrosarcoma

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This malignant tumor is found primarily in the central skeleton (pelvic bones, proximal femur, shoulder and ribs) with pain and swelling. Radiographically shows endosteal scaloping with flocculent densities.

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Chrondrosarcoma

Front 26

This malignant cartilage appears disorganized with myxoid and cartilaginous parts, cystic degeneration and anaplastic appearing cells.

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Chondrosarcoma

Front 27

This is a malignant bone lesion forming tumors of a neural phenotype with a common chromosome fusion gene (chromosome 11).

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Ewing Sarcoma/PNET

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Most common primary malignant bone sarcomas in children.

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Ewing Sarcoma/ PNET

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The malignant tumor has onion skin appearance on radiograph, is a painful enlarging mass with possible fever and anemia (mimics infection).

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Ewing Sarcoma/PNET

Front 30

This malignant tumor has small round blue cells, occurs in childhod, and may contain Homer Wright rosettes.

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Ewing Sarcoma/PNET

Front 31

This bone tumor is more common in females and is the most common bone tumor in young adults. Has slowly progressing pain with or without a mass.

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Giant Cell tumor

Front 32

This tumor forms a grossly brown-red mass filling the medullary space that can erode into the cortex or joint. It contains numerous osteoclast like 'giant cells' with more than 100 nuclei on a background of mononuclear cells.

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Giant Cell tumor

Front 33

Where do most of the lytic metastatic bone lesions arise from?

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Breast, lung and melanoma.
Thyroid, renal and GI occur but are less common.

Front 34

These result from the tumor production of substances like PTHrP, vit-D like steroids, etc. that elicit bone resorption.

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Lytic metastatic bone lesions.

Front 35

This type of primary cancer causes blastic metastatic bone lesions that can only be seen on bone scan early on which picks up on increased metabolic activity of osteoclasts.

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Prostate Cancer

Front 36

This is a non-inflammatory joint disease that occurs later in life. Is a progressive degeneration of articular cartilage esp in weight bearing joints.

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Osteoarthritis

Front 37

This causes a non-inflammatory pattern of pain, joint stiffness after inactivity (waking up) and resolves with movement but gets worse with extended movement. Causes enlargement of DIPs and PIPs.

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Osteoarthritis

Front 38

Name four common sites of osteoarthritis:

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1. Femoral head
2. Knee
3. Vertebra
4. Hands

Front 39

Synovial fluid is non-inflammatory and pain is caused by erosion and clefts in articular cartilage. Causes reactive bone formation at joint margins that leads to a slight increase in alk phos.

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Osteoarthritis

Front 40

This type of arthritis can be helped by analgesics (NSAIDS) and joint replacement.

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Osteoarthritis

Front 41

May see bone spurs and joint space narrowing but no fusion of joint.

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Osteoarthritis

Front 42

This is the node in osteroarthritis that occurs on the DIPs

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Heberden's Node

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This is the node in osteroarthritis that occurs on the PIPs.

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Bouchard's Nodes

Front 44

This type of arthritis has an HLA-DR4 association.

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Rheumatoid arthritis

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Caused by activation of B and T cells that leads to damage of synovial cells. Involves type III and IV reactions.

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Rheumatoid arthritis

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IgM autoantibody that has specificity for Fc portion of IgG

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Rheumatoid Factor

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Causes ulnar deviation, swan neck deformity, and morning stiffness.

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Rheumatoid arthritis

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Granulation tissue formed within synovial tissue by fibroblasts and inflammatory cells which proliferates and released cytokines that eventually destroy articular cartilage leading to joint fusion by scar tissue

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Pannus

Front 49

Name four disease modifying drugs used in rheumatoid arthritis

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1. Methotrexate
2. cyclosporine
3. corticosteroids
4. TNF alpha blockers

Front 50

Combination of rheumatoid arthritis, hematologic disease (anemia of chronic disease and autoimmune neutropenia) and splenomegaly.

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Felty's Syndrome

Front 51

This is the chemotactic agent for neutrophils and other leukocytes to enter the joint space in RA:

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C5a
TNF and IL-1 are also key players.

Front 52

This type of arthritis is associated with HLA-B27

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Juvenile idiopathic arthritis

Front 53

Commonly presents as infectious disease with fever, rash, polyarthritis, generalized lymphadenopathy, and neutrophilic leukocytosis

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Still's Disease (JIA)

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This type of JIA occurs 40% of the time and causes disabling arthritis

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Polyarticular JRA

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This type of JIA occurs 40% of the time and has arthritis limited to a few joints and uveitis with potential for blindness

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Pauciarticular JRA

Front 56

In this type of arthritis a positive RF is rare but a positive ANA is more common.

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JIA

Front 57

90% of the time this disease is associated with HLA-B27. It causes destruction of articular cartilage and resultant bony ankylosis, esp of sacroiliac and apophyseal joints.

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ankylosing spondyloarthritis

Front 58

This disease begins by targeting the sacroiliac joint in young men with bilateral sacrolitis with morning stiffness and decreased spine extension.

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ankylosing spondyloarthritis

Front 59

This dz eventually involves the vertebral column with fusion of the vertebrae (bamboo spine) causing forward curvature (kyphosis).

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Ankylosing Spondyloarthritis

Front 60

This test evaluates the degree of lumbar spine restriction to forward bending

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Schober test

Front 61

This is inflammatory lower back pain that takes over an hour to resolve in the morning but gradually improves with activity and movement of peripheral joints (hips, knees and shoulders)

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Ankylosing spondyloarthritis

Front 62

This disease is associated with restrictive lung disease, aortitis with aortic regurg, anterior uveitis (blurry vision) and is symptomatic in 20s-30s.

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Ankylosing Spondyloarthritis

Front 63

This is a reactive arthritis combined with non-gonnococal arthritis or cervicitis and conjunctivitits. 80% are HLA-B27 positive.

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Reiter Syndrome

Front 64

Achilles tendon periostitis is the confirmatory radiologic sign of this disease

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Reiter Syndrome

Front 65

Is caused by an autoimmune reaction intitated by prior infection of the GI tract (salmonella, shigella, campylobacter) - pts with chronic disease may have involvement of the spine indistinguishable from AS

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Reiter Syndrome

Front 66

This type of arthritis follows a GI infection by yersinia, salmonella, shigella, appears abruptly and tends to involve knees, ankles, and lasts for about a year and then generally clears. Campylobacter is the most common cause.

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Reactive enteritis- associated arthritis

Front 67

Chronic inflammatory arthropathy that affects the peripheral and axial joints and is related to HLA-B27 and HLA-C26. Radiographs show erosive joint disease. It is similar to RA but less severe and has frequent remissions

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Psoriatic Arthritis

Front 68

This type of arthritis occurs in ppl 30-50 y/o and causes sausage shaped DIP joints and excessive nail pitting. Involves large joints like ankles, knees, hips, and wrists.

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Psoriatic Arthritis

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In this disease of the joints sacroiliac and spinal disease occurs in 20-40% and may cause conjunctivitis and iritis.

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Psoriatic Arthritis

Front 70

This type of arthritis is commonly caused by staph aureus- joint destruction is rapid and irreversible without prompt debridement and antibiotics.

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Bacterial arthritis 'septic joint'

Front 71

Most common cause of bacterial arthritis in children under 2 y/o

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HiB

Front 72

Causes sudden development of acutely painful and swollen infected joints that has restricted ROM, fever, leukocytosis, and elevated SR.

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Bacterial Arthritis 'septic joint'

Front 73

arthritis, has infection involving a single joint (usually the knee) followed by the hip, shoulder, elbow, wrists, and sternoclavicular joints.

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Non-gonococcal bacterial arthritis

Front 74

Transmitted by the bite of the Ixodes tick and caused by borrelia burgdorferi (spirochete)

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Lyme arthritis

Front 75

Causes disabling arthritis usually involving the knee, bilateral bell's palsy, myocarditis and pericarditis

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Lyme arthritis

Front 76

How do you confirm Lyme disease as the cause of arthritis?

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ELISA with Western blot confirmation or PCR

Front 77

This type of arthritis can be cleared with doxycycline, amoxicillin, erythromycin, or ceftriaxone in adults or amoxicillin in kids.

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Lyme Arthritis

Front 78

Caused by overproduction or underexcretion of uric acid

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gout

Front 79

May be casued by inborn errors of metabolism involving purine metabolism (Lesch-Nyan or complete HGPRT deficiency)

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gout

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_________ in synovial fluid are proinflammatory and activate synovial cells, leukocytes and complement cascade (C5a). Presents with sudden onset of severe pain in bog toe, joint is hot, red and swollen and may have fever and tachycardia

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Gout

Front 81

Has negatively birefringent MSU needle-shaped crystals in synovial fluid

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Gout

Front 82

Name two drugs used to treat gout:

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1. Uricosuric agents
2. allopurinol

Front 83

Caused by deposition of calcium pyrophosphate in tissues- crystals are phagocytosed by neutrophils and show weakly positive birefringence and are polygonal to envelope shaped.

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Pseudogout

Front 84

This disease is frequently asymptomatic, but can also produce acute, subacute or chronic arthritis that can be confused with osteoarthritis or RA. Joint involvement may be monoarticular or polyarticular.

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Pseudogout

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Is treated with bisphosphonates (which inhibit osteoclasts) and calcium with vitamin D. Can also use elective estrogen receptor modifiers (SERM) to calm down osteoclasts .

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Osteoporosis

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Causes compression fractures of vertebral bodies, Colle's fracture of the distal radius, and Dowager's hump

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Osteoporosis

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Has wedge shaped pale yellow area of infact of medulla or subchondral bone- seen classically in the neck of the femur. Is more common in sickle cell disease and other connective tissue diseases.

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Osteonecrosis (avascular)

Front 88

This condition is associated with sickle cell disease, Lupus, Gaucher's, chronic steroid use and deep sea diving.

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Osteonecrosis (avascular necrosis)

Front 89

Subchondral type presents as gradual and painful deforming arthritis with collapse of joint cortex, flattening of the joint, and cartilage loss. The only treatment is joint replacement.

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Osteonecrosis (avascular Necrosis)

Front 90

This disease targets the pelvis, skull and femur. Presents with bone pain, headaches, hearing loss, and increased skull size. Can involve pathologic fractures, risk for developing osteogenic sarcomas and developing high output heart failure.

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Paget Disease

Front 91

This disease has three phases and causes the production of thick, weak bone with mosaic pattern of bone on biopsy

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Paget Disease

Front 92

This disease has an unknown cause but is suspected to be casued by a virus- causes osteoclastic resorption of bone leading to shaffy appearing lytic lesions. There is a later phase of increased osteoblastic bone formation and has markedly increased serum alk phos.

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Paget disease

Front 93

How do you treat paget disease?

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Give calcitonin and biphosphonates to prevent reabsorption of normal bone and monitor closely for sarcoma which is the feared outcome.

Front 94

This condition is most commonly caused by sepsis with subsequent spread to bone . Most often due to staph aureus. Neutophils enzymatically destroy bone and chronic disease produces reactive bone formation in periosteum (involucrum)

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Osteomyelitis

Front 95

TB osteomyelitis with hematogenous spread from a primary lung focus and lesions in the vertebral column

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Pott's Disease

Front 96

Most often due to a puncture of the foot with a nail

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Pseudomonas osteomyelitis

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Most common cause of osteomylitis in sickle cell patients

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salmonella

Front 98

Disease with loss of palisades of cartilage, excess of unmineralized matrix, distorted masses of matrix that project into the marrow cavity.

Back 98

Rickets

Front 99

Results from autonomous hyperplasia or a tumor of the parathyroid gland that causes osteoclastic bone resorption and affects the entire skeleton. Predisposes to fractures, deformities, casued by stress of weight bearing and joint pain.

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Primary Hyperparathyroidism

Front 100

Subperiosteal resorption produces thinned cortices and loss of lamina dura around teeth, X-rays reveal a pattern of radiolucency, causes decrease in bone density or osteopenia.

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Primary hyperparathyroidism

Front 101

Commonly caused by prolonged states of hypercalcemia resulting in hypersecretion of PTH leading to unabated osteoclastic bone resorption

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Secondary hyperparathyroidism