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12. USMLE MSK II
Terms in this set (64)
in bone cancers in patients less than 30 y/o are they usually benign or malignant? older than 30 y/o?
what is the most common bone cancer overall? primary bone cancer?
metastasis (from breast usually); multiple myeloma, then osteogenic sarcoma, then chondrosarcoma, then Ewings
what is an osteoma? benign or malignant? where does it usually present?
new bone grows on top of old bone; benign; facial
what are the three malignant tumors? what is everything else?
osteosarcoma, ewings, chondrosarcoma
what does an osteoma present with?
gardners syndrome (FAP)
in what population does an osteoid osteoma present? how does the tumor often present symptomatically? where?
men less than 25 y/o; nocturnal pain relieved by NSAIDs; proximal tibia and femur
what is the histology of an osteoid osteoma?
presents in interlacing trabeculae of woven bone surrounded by osteoblasts, less than 2 cm
what benign bone tumor has the same morphology as an osteoid osteoma but is larger and found in vertebral column?
what is an osteoclastoma also known as? why?
giant cell tumor; its actually a reactive giant cell tumor and the cells look like osteoclasts
where does osteoclastoma present? in what age?
in epiphyses of distal femur and proximal tibia; 20-40 peak incidence
what is seen on xray is osteoclastoma? what is seen in histology?
double bubble/soap bubble; spindle shaped cells with multinucleated giant cells
what causes the arthritic like symptoms seen in a giant cell tumor?
locally aggressive benign tumor causes invasion in/near knee (arthritic like pain)
what is the mc benign bone tumor? in what age does it present?
osteochondroma; men <25 y/0
T/F malignant transformation from osteochondroma to chondrosarcoma is very common
why is an osteochondroma called "exostosis"- what presents on top? where in the bone?
in long bone metaphyses a mature bone outgrowth occurs with a cartilaginous cap
what is an endochondroma and where is it found in the bone? which bones?
benign cartilaginous neoplasm found in intramedullar bone; distal extremities
how do you differentiate enchondroma from chondrosarcoma?
enchondroma is usually distal extremities while chondrosarcoma is often proximally located
what are the three malignant bone tumors?
osteosarcoma, ewings sarcoma, chondro sarcoma
what is the mc primary bone tumor after MM?
what is the peak incidence of osteosarcoma? where in the bone does it usually present?
bimodal- 10-20 y/o and older; metaphysis of long bones
which bones is osteosarcoma usually found?
distal femur, proximal tibial region (femur)
what cancer does pagets disease predispose to? familial retinoblastoma? bone infarcts? radiation?
what is seen on xray in osteosarcoma?
malignant bone matrix elevates the periosteum to form a triangle like thing- codmans trianglea and a sunburst pattern from spiculated calcified malignant osteoid
what bone cancer does polyostotic fibrous dysplasia predispose to?
what malignant bone tumor presents as anaplastic small blue cells? in what age group is it most common?
ewings sarcoma; < 15 y/o
where in the bone does ewings commonly present? in which bones? which translocation is it associated with?
diaphysis of long bones, pelvis, scapula, ribs; 11; 22
which malignant sarcoma has a characteristic oninc skin appearance in the bone? where do you see this onion skin appearance? what is it?
Ewings; on radiography- around the bone, a periosteal reaction occurs that penetrates into the soft tissue!
what type of cancer is a chondrosarcoma? in what age groups is it most common? which bones?
malignant cartilaginous tumor ; 30-60; pelvis, spine, scapula, humerus, tibia, femur
which cancer can lead to a chondrosarcoma?
what cancer is it when there is an expansile glistening mass in the medullary cavity?
T/F osteoarthiritis is noninflammatory
true- no systemic symptoms
Does osteoarthirits improve with rest or exercise? at what point in the day is the pain the worst?
rest; end of day
what type of disorder is osteoarthiritis- ie of the bone or of what? what is the actual pathology?
joint disorder; destruction of articular cartilage d/t wear and tear of joints
what are three predisposing factors for osteoarthiritis?
age, obesity, joint deformity
how do subchondral cysts form in osteoarthiritis? in what disease is it seen
loss of hyaline cartilage causes bone to rub against each other and cause lesions where synovial fluid gets in and forms cysts; osteoarthiritis
what causes sclerosis of the bone in osteoarthirtis? what does this lead to?
bone rubbing against each other; eburnation (polished ivory like appearance of bone)
what are osteophytes? how do they form? in what disease? what do they cause?
bone spurs that form at margins of joints that are reactive bone formation; in osteoarthiritis; cause bone pain
T/F there is no ankylosis in osteoarthiritis
what are Heberdens and Bouchards nodes? what is the difference between the two? in what disease are they seen?
reactive osteophytes and hypertrophy of synovial fluid; Heberdens is DIP and Bouchards are PIP; osteoarthiritis
what causes bowleggedness in osteoarthiritis?
in knees, cartilage loss begins on medial aspect
what do the hyaline cartilage and the proteoglycans provide in joints?
the ability to deal with tensile stress and elasticity
what should you think when you hear pain in weight bearing joints after use?
what type of disease is rheumatoid arthiritis? what kind of necrosis is seen?
autoimmune type III hypersensitivity; fibrinoid necrosis
what types of joints are affected in rheumatoid arthiritis? how is the classic presesntation different from osteoarthiritis?
synovial joints; older women with morning stiffness that improves with use- symmetric joint and systemic symptoms
what systemic symptoms can you see in Rheumatoid arthiritis?
lung (fibrosis, pleuritis), CV (pericarditis, aorititis, vasculitis), heme (ACD, AIHA)
T/F Osteoarthiritis effects MIP but Rheumatoid doesnt
false- Rheumatoid doesnt have DIP involvement
what forms in the joints of rheumatoid patients? where does it form?
pannus formation in MCP and PIP
what is a pannus? in what disease does it form?
collection of granulation tissue, synovium, inflammatory cells, fibroblasts, cytokines; in rheumatoid arthiritis
what are the nodules that form in Rheumatoid arthiritis made of? where do they form?
subcutaneous; fibrinoid necrosis surrounded by palisading histiocytes
in what disease do you ulnar deviation? cervical subluxation?
both rheumatoid arthritis
what is it called when a synovial sack develops in the posterior knee joint? in what disease does this occur?
Baker's cyst; rheumatoid arthritis
which antibody is most sensitive in RA diagnosis? specific?
rheumatoid factor; anti CCP antibody
what is the rheumatoid factor? anti CCP antibody?
B cells are activated to produce IgM Abs with antigen as Fc region of IgG (so rheumatoid factor= anti IgG antibodies); anti CCP are antibodies to citrulline (a ribonucleoprotein) modified peptides
what is the HLA association of RA?
what is fibrous and bony ankylosis and where is it seen?
fusion of bone across joint; RA
what is a swan neck deformity? boutonnieres deformity? what diseases are they seen in?
flexion of DIP and extension of PIP; flexion of PIP and extension of DIP; both RA
in which disease would you note joint space narrowing in the MCP?
what is the classic triad of Sjorgens syndrome? what is it seen with commonly?
xeropthalmia, xerostomia, arthritis; RA
what is xeropthalmia? xerostomia?
dry eyes, conjuctivitis, "sand in my eyes"; dry mouth, dysphagia; dry mouth, dysphagia
what is the pathogenesis of Sjorgens syndrome?
autoimmune destruction of microsalivary and lacrimal glands
what are two clinical presentations of Sjorgens syndrome? what does it predispose to?
parotid enlargement, dental caries; increased risk of B cell lymphoma
how do you diagnose Sjorgens Syndrome? what antibodies are present?
diagnose with lip biopsy showing lymphoid destruction; autoantibodies to ribonucleoprotein antigens SS-A (Ro), SS-B (La)
how do you treat RA?
movement, NSAIDS, methotrexate, cyclosporine
what is Sicca syndrome? how is it different from Sjorgens?
dry eyes, mouth, nasal, vagina; chronic bronchitis and reflux esophagitis; no arthritis
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