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Pannus are found in which type of arthritis?
RA
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Eroding cartilage occurs in which type of arthritis?
RA
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Fibrous ankylosis are found in which type of arthritis?
RA
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Bony ankylosis are found in which type of arthritis?
RA
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Bony spurs are found in which type of arthritis?
Osteoarthritis
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Subchondral cysts are found in which type of arthritis?
Osteoarthritis
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Subchondral sclerosis are found in which type of arthritis?
Osteoarthritis
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Osteophytes are found in which type of arthritis?
Osteoarthritis
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Thinned fibrillated cartilages are found in which type of arthritis?
Osteoarthritis
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What is found underneath pannus in RA joint?
Immune cells
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What is the crystal composition found in gout?
Uric acid
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What is the crystal composition found in pseudogout?
Calcium pyrophosphate
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What is the shape of the crystal in gout?
Needle-like
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What is the shape of the crystal in pseudogout?
Rhomboid
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What is the most commonly affected joint in gout?
First MTP
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What is the most commonly affected joint in pseudogout?
Knee
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What is the first line of treatment for gout?
NSAID
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What is the first line of treatment for pseudogout?
NSAID
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What is the radiographic appearance of gout?
Rat-bite erosions
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What is the radiographic appearance of pseudogout?
White lines of chondrocalcinosis
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Is gout birefringent negative or positive?
Negative
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Is pseudogout birefringent negative or positive?
Weakly positive
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What is primary hyperparathyroidism?
autonomous hyperplasia or tumor of parathyroid gland
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What is secondary hyperparathyroidism?
Prolonged states of hypocalcemia resulting in compensatory hypersecretion of PTH
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What cells sense parathyroid hormone levels?
Osteoblasts
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What are the symptoms of hyperparathyroidism?
Osteoporosis, brown tumors, osteitis fibrosa cystica
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Is hyperparathyroidism reversible?
Yes, reduction in PTH levels to normal can reverse bone changes
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What is the characteristic of brown tumor?
- Microfracture with secondary hemoorhage
- Influx of macrophages
- Ingrowth of reactive fibrous tissue
- Brown is vascularity, hemorrhage, hemosidering
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What is another name of osteonecrosis?
Avascular necrosis
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What is osteonecrosis?
Infraction of bone and marrow due to ischemia
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What causes ischemia that leads to osteonecrosis?
Fractures, steroids, thrombosis, vessel injury, increased intraosseus pressure, venous hypertension
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What are some conditions associated with osteonecrosis?
- Alcohol abuse
- CT disorders
- Corticosteroid administration
- Chronic pancreatitis
- Bends
- Infection
- Pregnancy
- Sickle cell crisis
- Trauma
- Tumors
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What is the morphology of avascular necrosis (osteonecrosis)
- Subchondral infarcts
- Recognize pictures of a line underneath the articular cartilage
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What is achondroplasia?
Most common Disease of growth plate and major cause of dwarfism
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What causes achondroplasia?
- Defect in cell signaling leading to reduction in chondrocyte proliferation
- Point mutation in gene FGF receptor 3 gain-of-function mutation (related to increased paternal age)
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What happens when there is an over expression in FGFR3 (autosomal dominant mutation)?
Inhibits growth—cause of achondroplasia
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What are symptoms of achondroplasia?
- Infants with shortened proximal extremities
- Trunk of relative normal length
- Enlarged head with bulging forehead
- Not associated with longevity, intelligence or reproductive status
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What is another name for osteopetrosis?
- Marble bone disease
- Albers-schonberg disease
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What is osteopetrosis?
Rare hereditary group of disorders with reduced osteoclastic bone resorption resulting in diffuse symmetrical skeletal sclerosis
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What are the characteristics of osteopetrosis?
Bones are stonelike but very brittle (dissolvable), break like chalk
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What is the cause of osteoclast dysfunction in osteopetrosis?
Carbonic anhydrase deficiency
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What is the morphology of osteopetrosis?
- bones lack medullary canal, erlenmyfer flask deformity
- no room for hematopoietic marrow
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What are physiological results of osteopetrosis?
- Pancytopenia
- Extramedullary hematopoiesis
- Renal tubular acidosis with carbonic anhydrase (decreased tubular resorption- metabolic acidosis)
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True/false: osteopetrosis can be either autosomal recessive or autosomal dominant
True
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When does autosomal recessive osteopetrosis typically diagnosed?
- In utero/ soon after birth
- Pt survive to infancy but with cranial nerve problems
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What does autosomal dominant osteopetrosis typically diagnosed?
Adolescence to early adulthood
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What is a treatment for osteopetrosis?
Bone marrow transplant to provide progenitor cells
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Is osteogenesis imperfecta a Type 1 collagen disease?
Yes
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What is type 1 collagen disease?
Caused by deficiency in synthesis of type 1 collagen
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What is an example of type 1 collagen disease
Osteogenesis imperfecta (brittle bone disease)
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What is osteogenesis imperfecta?
Mutated genes coding for a1 and a2 chains of collagen
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What are the symptoms of osteogenesis imperfecta?
Prominent skeletal manifestations with joints, eyes, ears, skin and teeth affected as well
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Which subtype of osteogenesis imperfecta is lethal?
Type 2
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How is paget diagnosed from lab tests?
- Elevated serum alkaline phosphatase
- Increased urinary excretion of hydroxyproline
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What can be seen on a bone scan in osteogenesis paget?
Anterior bowing of femora and tibia
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What is characteristic of Paget?
- Chalkstick-like fractures in long bones of lower extremities
- Recognize the jigsaw puzzle histology picture
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What is primary gout?
Hyperproduction of uric acid or underexcretion of uric acid
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True/false: not all persons who have hyperuricemia have gout?
True
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What is a distinguishing clinical feature of gout?
Tophi
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What is another name for osteoarthritis?
Degenerative joint disease
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What are pathologic features of osteoarthritis?
- Often affects cervical or lumbar area
- Hand involvement
- Feet involvement
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What is the name for when osteophyte or bone spurs form in osteoarthritis that causes stiffness of vertebral column?
Lipping
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Heberden’s nodules in osteoarthritis involves which joint?
DIP joints
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Bouchard’s nodules involves which joint?
PIP joints
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What is osteoarthritis of the foot?
Bunions
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What type of joint is involved in RA?
Synovial joints
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Is RA symmetrical or asymmetrical involvement of joints?
Symmetrical
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What are rheumatoid nodules?
Subcutaneous nodules composed of central fibrinoid necrosis surrounded by macrophages and lymphocytes
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What is Reiter Syndrome?
Also known as reactive arthritis
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What are the symptoms of reactive arthritis?
- Seronegative polyarthritis
- Conjunctivitis/ uveitis
- Nonspecific urethritis
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What is osteosarcoma?
- Malignant bone tumor
- Common in boys 10-20 years
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Common locations for osteosarcoma?
- Knee
- Metaphysis of long bone
- Proximal humerus
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What are some x-ray findings of osteosarcoma?
- Bone destruction and neoplastic bone formation
- Periosteum produces a incomplete rim of reactive bone
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What is Ewing Sarcoma?
Uncommon malignant bone tumor
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What type of cells composes ewing sarcoma?
Small, round blue cells
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Where does ewing sarcom arise from?
- Primitive marrow elements
- Immature mesenchymal cells
- Tumor of long bones, mid-shaf or metaphyseal tumor
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What gene is involved in ewing sarcoma?
- Reciprocal translocation between chromosome 11 and 22
- Fusion protein EQS/FLI-1
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What is the genetic involvement in chondrosarcomas
Trisomy 7
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What is multiple myeloma?
- Malignant tumor of plasma cells
- Recruit osteoclasts that causes lytic bone lesions
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Which bones are commonly involved in multiple myeloma?
- Skull (punched out lesions)
- Spine
- Ribs
- Pelvis
- Femur
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What is characteristic of pathology finding in multiple myeloma?
- Amyloid deposits
- Sheets of plasma cells
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