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101 Cards in this Set

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Calcified changes in a fractured bone can be seen:
2-3 weeks following the injury
These cells are derived from the same hematopoetic progenitor cells that give rise to monocytes and macrophages:
Osteoclasts
These cells are derived from osteoprogenitors:
Osteoblasts
Are regulated by cytokines and growth factors M-CSF, IL-1, and TNF
Osteoclasts
Have receptors that bind PTH, Vitamin D, Leptin, Estrogen, Cytokines, growth factor and extracellular matrix proteins
Osteoblasts
_________ express several factors that regulate the differentiation and function of osteoclasts.
Osteoblasts
Mobilizes calcium from bone by stimulating osteoclasts
PTH
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:
Vitamin D
Opposed PTH and tones down the amount of calcium in the blood, Inhibits calcium absorption in the intestines and inhibiting osteoclast activity in bones:
Calcitonin
Osteoporosis, osteomalacia, osteomyelitis, and aseptic necrosis all occcur more commonly in people with which condition?
Sickle Cell Disease
This category of synovial fluid aspirate has a yellowish color, negative culture, and a WBC of 200-2000.
Group I (non-inflammatory)
This category of synovial fluid aspirate has yellow to opalescent color, low viscosity, a negative culture and a WBC of 2000-100,000.
Group II (Inflammatory)
This category of synovial fluid aspirate has yellow to green color, often has a positive culture, variable viscosity and a WBC of > 100,000.
Group III (Septic)
Benign bone lesion found most commonly in long bones, has a radiolucent focus, nocturnal/cyclical pain releived by NSAIDs with dull pain and tenderness.
Osteoid Osteoma
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.
Osteoblastoma
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.
Osteosarcoma
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.
Osteosarcoma
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.
Osteochondroma
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.
Osteochondroma
Cartilage cyst found on bone marrow and affects the cartilage that lines the inside of bones.
Endochrondroma
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
Endochondroma
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.
Chrondroblastoma
This tumor has sheets of monomorphic pink chondroblasts with scant 'chicken wire' matrix. Is much more cellular than other cartilaginous tumors.
Chondroblastoma
Malignant mesenchymal tumor that produces cartilage matrix. Occurs mostly in males of age 30-60.
Chrondrosarcoma
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.
Chrondrosarcoma
This malignant cartilage appears disorganized with myxoid and cartilaginous parts, cystic degeneration and anaplastic appearing cells.
Chondrosarcoma
This is a malignant bone lesion forming tumors of a neural phenotype with a common chromosome fusion gene (chromosome 11).
Ewing Sarcoma/PNET
Most common primary malignant bone sarcomas in children.
Ewing Sarcoma/ PNET
The malignant tumor has onion skin appearance on radiograph, is a painful enlarging mass with possible fever and anemia (mimics infection).
Ewing Sarcoma/PNET
This malignant tumor has small round blue cells, occurs in childhod, and may contain Homer Wright rosettes.
Ewing Sarcoma/PNET
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.
Giant Cell tumor
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.
Giant Cell tumor
Where do most of the lytic metastatic bone lesions arise from?
Breast, lung and melanoma.
Thyroid, renal and GI occur but are less common.
These result from the tumor production of substances like PTHrP, vit-D like steroids, etc. that elicit bone resorption.
Lytic metastatic bone lesions.
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.
Prostate Cancer
This is a non-inflammatory joint disease that occurs later in life. Is a progressive degeneration of articular cartilage esp in weight bearing joints.
Osteoarthritis
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.
Osteoarthritis
Name four common sites of osteoarthritis:
1. Femoral head
2. Knee
3. Vertebra
4. Hands
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.
Osteoarthritis
This type of arthritis can be helped by analgesics (NSAIDS) and joint replacement.
Osteoarthritis
May see bone spurs and joint space narrowing but no fusion of joint.
Osteoarthritis
This is the node in osteroarthritis that occurs on the DIPs
Heberden's Node
This is the node in osteroarthritis that occurs on the PIPs.
Bouchard's Nodes
This type of arthritis has an HLA-DR4 association.
Rheumatoid arthritis
Caused by activation of B and T cells that leads to damage of synovial cells. Involves type III and IV reactions.
Rheumatoid arthritis
IgM autoantibody that has specificity for Fc portion of IgG
Rheumatoid Factor
Causes ulnar deviation, swan neck deformity, and morning stiffness.
Rheumatoid arthritis
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
Pannus
Name four disease modifying drugs used in rheumatoid arthritis
1. Methotrexate
2. cyclosporine
3. corticosteroids
4. TNF alpha blockers
Combination of rheumatoid arthritis, hematologic disease (anemia of chronic disease and autoimmune neutropenia) and splenomegaly.
Felty's Syndrome
This is the chemotactic agent for neutrophils and other leukocytes to enter the joint space in RA:
C5a
TNF and IL-1 are also key players.
This type of arthritis is associated with HLA-B27
Juvenile idiopathic arthritis
Commonly presents as infectious disease with fever, rash, polyarthritis, generalized lymphadenopathy, and neutrophilic leukocytosis
Still's Disease (JIA)
This type of JIA occurs 40% of the time and causes disabling arthritis
Polyarticular JRA
This type of JIA occurs 40% of the time and has arthritis limited to a few joints and uveitis with potential for blindness
Pauciarticular JRA
In this type of arthritis a positive RF is rare but a positive ANA is more common.
JIA
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.
ankylosing spondyloarthritis
This disease begins by targeting the sacroiliac joint in young men with bilateral sacrolitis with morning stiffness and decreased spine extension.
ankylosing spondyloarthritis
This dz eventually involves the vertebral column with fusion of the vertebrae (bamboo spine) causing forward curvature (kyphosis).
Ankylosing Spondyloarthritis
This test evaluates the degree of lumbar spine restriction to forward bending
Schober test
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)
Ankylosing spondyloarthritis
This disease is associated with restrictive lung disease, aortitis with aortic regurg, anterior uveitis (blurry vision) and is symptomatic in 20s-30s.
Ankylosing Spondyloarthritis
This is a reactive arthritis combined with non-gonnococal arthritis or cervicitis and conjunctivitits. 80% are HLA-B27 positive.
Reiter Syndrome
Achilles tendon periostitis is the confirmatory radiologic sign of this disease
Reiter Syndrome
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
Reiter Syndrome
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.
Reactive enteritis- associated arthritis
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
Psoriatic Arthritis
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.
Psoriatic Arthritis
In this disease of the joints sacroiliac and spinal disease occurs in 20-40% and may cause conjunctivitis and iritis.
Psoriatic Arthritis
This type of arthritis is commonly caused by staph aureus- joint destruction is rapid and irreversible without prompt debridement and antibiotics.
Bacterial arthritis 'septic joint'
Most common cause of bacterial arthritis in children under 2 y/o
HiB
Causes sudden development of acutely painful and swollen infected joints that has restricted ROM, fever, leukocytosis, and elevated SR.
Bacterial Arthritis 'septic joint'
arthritis, has infection involving a single joint (usually the knee) followed by the hip, shoulder, elbow, wrists, and sternoclavicular joints.
Non-gonococcal bacterial arthritis
Transmitted by the bite of the Ixodes tick and caused by borrelia burgdorferi (spirochete)
Lyme arthritis
Causes disabling arthritis usually involving the knee, bilateral bell's palsy, myocarditis and pericarditis
Lyme arthritis
How do you confirm Lyme disease as the cause of arthritis?
ELISA with Western blot confirmation or PCR
This type of arthritis can be cleared with doxycycline, amoxicillin, erythromycin, or ceftriaxone in adults or amoxicillin in kids.
Lyme Arthritis
Caused by overproduction or underexcretion of uric acid
gout
May be casued by inborn errors of metabolism involving purine metabolism (Lesch-Nyan or complete HGPRT deficiency)
gout
_________ 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
Gout
Has negatively birefringent MSU needle-shaped crystals in synovial fluid
Gout
Name two drugs used to treat gout:
1. Uricosuric agents
2. allopurinol
Caused by deposition of calcium pyrophosphate in tissues- crystals are phagocytosed by neutrophils and show weakly positive birefringence and are polygonal to envelope shaped.
Pseudogout
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.
Pseudogout
Is treated with bisphosphonates (which inhibit osteoclasts) and calcium with vitamin D. Can also use elective estrogen receptor modifiers (SERM) to calm down osteoclasts .
Osteoporosis
Causes compression fractures of vertebral bodies, Colle's fracture of the distal radius, and Dowager's hump
Osteoporosis
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.
Osteonecrosis (avascular)
This condition is associated with sickle cell disease, Lupus, Gaucher's, chronic steroid use and deep sea diving.
Osteonecrosis (avascular necrosis)
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.
Osteonecrosis (avascular Necrosis)
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.
Paget Disease
This disease has three phases and causes the production of thick, weak bone with mosaic pattern of bone on biopsy
Paget Disease
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.
Paget disease
How do you treat paget disease?
Give calcitonin and biphosphonates to prevent reabsorption of normal bone and monitor closely for sarcoma which is the feared outcome.
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)
Osteomyelitis
TB osteomyelitis with hematogenous spread from a primary lung focus and lesions in the vertebral column
Pott's Disease
Most often due to a puncture of the foot with a nail
Pseudomonas osteomyelitis
Most common cause of osteomylitis in sickle cell patients
salmonella
Disease with loss of palisades of cartilage, excess of unmineralized matrix, distorted masses of matrix that project into the marrow cavity.
Rickets
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.
Primary Hyperparathyroidism
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.
Primary hyperparathyroidism
Commonly caused by prolonged states of hypercalcemia resulting in hypersecretion of PTH leading to unabated osteoclastic bone resorption
Secondary hyperparathyroidism