Pathoma - 18 (MSK - Part 2)

eliot2014's version from 2016-01-21 23:37

Section 1

Question Answer
What is caissons disease?gas emboli
What bone tumor arises on the surface of facial bones?osteoma = benign bone tumor
With what syndrome is Osteoma associated?Gardner syndrome
Whats the triad of Gardner syndrome?1) osteoma 2) familial adematous polyposis 3) fibromatosis in retroperitoneum
Tumor of osteoblasts surrounded by a rim of reactive boneosteoid osteoma
What demographic most commonly gets osteoid osteoma?<25 years of age, more common in males
pt presents with bone pain that resolves with aspirin. diagnosis?osteoid osteoma
pt's x-ray of long bone reveals a bony rim with a radiolucent (nothing shows) coreosteoid osteoma
whats the difference btw osteoid osteoma vs. osteoblastoma?osteoid osteoma (< 2 cm) vs. osteoblastoma (> 2cm and bone pain that does NOT respond to aspirin)
wheres the medulla of the bone?middle/core part of the diaphysis
wheres the cortex of the bone?surface of the diaphysis
whats the most common benign tumor of bone?osteochondroma
what bone tumor arises from a LATERAL projection of growth plate METAPHYSISosteochondroma (bone is continuous with the marrow space)
Chondrosarcoma can arise from what benign tumor?osteochondroma
ewing sarcoma can be confused with what two diseases?lymphoma or chronic osteomyelitis
benign tumor of osteoblasts? MALIGNANT tumor of osteoblasts?benign: osteoid osteoma. malignant: osteosarcoma
Where does osteosarcoma like to target?metaphysis of long bone
x-ray shows bone mass with "sunburst" appearance and lifting of periosteumosteosarcoma
population most likely to geo osteosarcoma?teenagers
Risk factors for osteosarcoma?retinoblastoma, paget disease, and radiation exposure
Where does osteosarcoma commonly arise?metaphysis of long bones (usually the distal femur or proximal tibia)
How does osteosarcoma present?pathologic fracture or bone pain with swelling (the tumor weakens the bone)
sunburst appearance of bone on x-rayosteosarcoma
lifting of periosteum = codmans triangleosteosarcoma
what is the only bone tumor arising from epiphysis?giant cell bone tumor
Tumor composed of multinucleated giant cells and stromal cellsgiant cell tumor
bone tumor that presents as "soap bubble" appearance on x-raygiant cell bone tumor
soap bubble in epiphysisgiant cell tumor
From what germ layer is Ewing sarcoma derived?neuroectoderm
Onion skin appearance of the diaphysis of long bones on x-rayewing sarcoma
small round blue cells of bone tumorewing sarcoma
mutation seen in ewing sarcoma?t(11;22)
whats a periosteum?connective tissue that surrounds bone and has ability to produce new bone
cartilage tumors (both benign and malignant) like to to arise form?MEDULLA of bones
Chondroma like to arise in which bones?small bones of the hands and feet
Chondrosarcoma likes to arise from which bones?Medulla of the pelvis or central skeleton
which carcinoma produces BLASTIC bone lesions?prostatic carcinoma

Section 2

Question Answer
What is a joint?a connection between two bones
Solid joints do what?provide structural strenght
Example of solid jointcranial sutures
Synovial joints do what?have a joint space that allows for motion
Articular surface of adjoining bones is made from what?hyaline cartilage (type II collagen) that is surrounded by a joint capsule
What is the synovium?lining of the joint capsule that secretes fluid rich in hyaluronic acid to lubricate the joint and facilitate smooth motion
Another name for degenerative joint diseaseosteoarthritis (NOT osteoporosis)
What is osteoarthritis?Degeneration of articular cartilage
which hand joints are affected in osteoarthritis?DIP and PIP
which joints are affected in osteoarthritis?hips, lower lumbar spine, knees, DIP, and PIP
Pathologic features of OAJoint mice; eburnation (polishing) of subchondral bone (due to bone rubbing bone); osteophyte formation due to bone rubbing bone (Heberden nodes and Bouchard nodes)
Presentation of osteoarthritisjoint stiffness in the morning that worsens during the day (due to use)
What are joint mice in osteoarthritis?Cartilage that lines the articular surface gets disrupted. Disrupted fragments of CARTILAGE floating in joint space are joint mice
Heberden nodes of osteoarthritis affects what joints?DIP
Bouchard nodes of osteoarthritis affects what joints?PIP
what HLA is associated with rheumatoid arthritis?HLA-DR4
what is the hallmark of RA?synovitis leading to formation of PANNUS (inflamed granulation tissue, which will contract and cause deviation or fusion/ankylosis of joint)
Which arthritis is associated with morning stiff that IMPROVES with activity? worsens throughout day?improves-->Rheumatoid Arthritis (squeeze out the inflammatory debris with use). Worsens--> OA
Describe rheumatoid nodulescentral zone of necrosis surrounded by epitheloid histiocytes. Arise in skin and visceral organs
Clinical features of RAArthritis with morning stiffness that improves with activity; symmetric involvement of PIP joins (swan-neck deformity), wrists (radial deviation), elbows, ankles, and knees; fever, malaise, weight loss, and myalgia; Rheumatoid nodules; Vasculitis; Baker cyst (swelling of bursa behind knee); Pleural effusions, lymphadenopathy, and interstitial lung fibrosis
What are baker's cysts associated with?RA
what lung conditions are a/w with RA?pleural effusions and interstitial lung fibrosis
IgM autoantibody against Fc portion of IgGrheumatoid factor
Content of synovial fluid in RAneutrophils and high protein
what are 2 complications of RA = what type of anemia and amyloidosis?anemia of chronic disease and secondary amyloidosis
young male presents with lower back pain, uveitis and aortitis. diagnosis?ankylosing spondyloarthritis
whats the triad of Reiters Syndrome?arthritis, urethritis, conjunctivitis
what bacteria is most commonly a/w Reiters Syndrome?Chlamydia trachomatis> campylobacter, shigella, salmonella
sauage fingers and toes are associated which seronegative spondyloarthopathy?psoriatic arthritis
which hand joint is commonly affected in psoriatic arthritis?DIP
what is pseudogout made up of?calcium pyrophosphate dihydrate crystals
Seronegative spondyloarthropathies are characterized byHLA-B27 association; no rheumatoid factor; axial skeleton involvement
Infectious arthritis caused by which two bacteria?s. aureus and n. gonorrhoeae
Which joint commonly involved in infectious arthritis?knee
Causes of secondary goutleukemia, myeloproliferative disorders, Lesch-Nyhan syndrome, renal insufficiency
What can precipitate acute goutalcohol or meat
Acute gout presentat aspainful arthritis of the great toe (podagra)
Chronic gout leads todevelopment of tophi, renal failure
Tophi consist ofwhite, chalky aggregates of uric acid crystals with fibrosis and giant cell reaction in the soft tissue and joints
Pseudogout isdue to deposition of calcium pyrophosphate dihydrate (CPPD). Rhomboid shaped crystals with weakly positive birefringence

Section 3


Question Answer
anti-Jo-1 antibodydermatomyositis
What carcinoma is associated with dermatomyositis?gastric carcinoma
Pt cant climb chairs or has problem combing hairpolymyositis or dermatomyositis
rash of upper eyelidsheliotrope rash
heliotope rashdermatomyositis
What 2 conditions show MALAR RASH?SLE and dermatomyositis
positive ANA and anti-Jo-1 antibodydermatomyositis
biopsy of the muscle shows perimysial inflammation (CD4+ T-cell)dermatomyositis
treatment for dermatomyositiscorticosteroids
dermatomyositis on biopsyperimysial inflammation (CD4 T cells) with perifascicular atrophy on biopsy
polymyositis on biopsyendomysial inflammation (CD8 T cells) with necrotic muscle fibers seen on biopsy
dermatomyositis clinical featuresbilateral proximal muscle weakness, distal involvement can develop late in disease; heliotrope rash; malar rash may be present; Gottron papules (red papules on the elbows, knuckles, and knees)
endomysial inflammation (CD8+ T-cells) with necrotic muscle fibers on biopsypolymyositis
Gottron papules (what are they, what are they associated with)red papules on elbows, knuckles, and knees. Associated with Dermatomyositis
Whats the difference in inflammation locations btw dermatomyositis and polymyositis?dermatomyositis (perimysial inflammation) vs. polymyositis (endomysial inflammation)
Why is the dystrophin gene predisposed to higher rates of mutationit is very large in size
Death in DMD is most commonly fromrespiratory or cardiac failure.
Degenerative disorder characterized by muscle wasting and replacement of skeletal muscle by adipose tissueX-linked muscular dystrophy
thymic hyperplasia or thymoma is associated with what disorder?Myasthenia Gravis
what paraneoplastic syndrome is associated with lambert eaton syndrome?small cell lung carcioma
how come AChE inhibitors dont tx Lambert eaton syndrome?bc Ach is not really released...its a problem with Ca+2 channels being blocked
whats the characteristic cell of liposarcoma?lipoblasts
pathology report shows LIPOBLAST cellsliposarcoma
what is the most common benign soft tissue tumor in adultslipoma
What is the most common malignant soft tissue tumor in adultsliposarcoma
cardiac rhabdomyoma is associated with?tuberous sclerosis
kid presents with a tumor of malignant skeletal musclerhabdomyosarcoma
whats the characteristic cell of rhabdomyosarcoma?rhabdomyoblasts
most common malignant soft tissue tumor in childrenrhabdomyosarcoma
Rhamdomyoblasts are positive for what?desmin
whats the most common sites of rhabdomyosarcoma in adults?head and neck
5 year old girl presents with a malignant mass in her vaginarhabdomyosarcoma
whats a common site of rhabdomyosarcoma in young girlsVAGINA