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  #1  
Old 10-21-2012
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Question musculoskeletal case on fractures

A 38-year-old man presents to the emergency room with multiple arm and leg fractures following a minor fall. Physical examination reveals a slight weakness of facial muscles on the left. A complete blood count shows a mild anemia. X-ray studies reveal a generalized bony widening with partial obliteration of marrow spaces. The patient's disorder is most likely due to abnormal function of which of the following cell types?

A. Granulocytic stem cells.

B. Megakaryocytes.

C. Plasma cells.

D. Osteoblasts.

E. Osteoclasts

F. Extramedullary hematopoiesis.




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  #2  
Old 10-21-2012
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E. Osteoclasts
Osteopetrosis-genetic deficiency of carbonic anhydrase 2.
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Old 10-21-2012
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defective OSTEOCLASTS>>>>Osteopetrosis
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Old 10-21-2012
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E) osteoclasts
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osteoclast ...
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Old 10-22-2012
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Default my answer :)

E. Osteoclasts
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Old 10-22-2012
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Osteoclasts
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Old 10-22-2012
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Correct Answer E is right

yes, E .osteoclasts is the right answer..

the case presented here is marble bone disease aka osteopetrosis.......caused by due to abnormal function of osteoclast(bone resorption cells)....so bone formation cannot match with bone resorption..which ends up as no mature trabeculae meshwork and bone filled up by spongy tissue which tentatively break resulting in fractures...

bone mineralization remains normal in case of calcium,phosphate and alkaline phosphatase........
some of the cases are known to caused by genetic deficiency of carbonic anhydrase -2............(when i googled i got this)----> The absence of this enzyme causes defective hydrogen ion pumping by osteoclasts and this in turn causes defective bone resorption by osteoclasts, as an acidic environment is needed for dissociation of calcium hydroxyapatite from bone matrix......

so there wont be enough space for hematopoiesis which eventually result in anemia,thrombocytopenia,leukopenia----leading to extramedullary hematopoeisis

bone marrow transplant is the treatment..
and also erlenmeyer flask deformity of bones in x-ray is worth to remember(dont know how exactly look like)..

thanks.......
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Old 10-22-2012
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Question 2nd question

2Q) A 45 yr old female presented to a physician for evaluation of bilateral knee pain and distal fingers since a month....she complaints that she couldnt walk properly at times due to her pain..it started with swelling of her distal fingers which became sausage shaped 20 days back...on further examination physician finds a rash on her shin,which is silvery scaled and her bone x-ray presented with pencil in cup deformity....what additional findings can be seen in this pt..?

a) narrowing joint space with sharpened articular margins and thickened sclerotic bone
b) marginal bony erosions with irregular joint destruction and oligoarticular arthritis
c) punched out erosions with a rim of cortical bone and juxtaarticular arthritis.
d) subchondral collapse with necrosis
e)painful joints with negative birefringent crystal deposition...
f) fibrinoid necrosis with surrounding histiocytes in nodules presented
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Old 10-22-2012
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diagnosis is psoraitic arithiritis.
i guess its B as psorasis causes oligoarthritis.
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b) marginal bony erosions with irregular joint destruction and oligoarticular arthritis
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Old 10-22-2012
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A and D sound like osteoarthritic changes , punched out lesions are like lytic lesions which are more prone to occur in the middle of a bone , not around a joint ( psoriasis changes occur around a joint )... F is like small vessel vasculitis .. So leave us with B ??
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Old 10-22-2012
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P.S... Where else are elenmeyer flasks seen??
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Unhappy

Quote:
Originally Posted by alice View Post
P.S... Where else are elenmeyer flasks seen??


is it really high yield to know the other causes too..???

i cant even remember correctly that it's seen in osteopetrosis at times(couldnt get into my brain)...
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Old 10-22-2012
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Just one more cause .. Seen in Gaucher's disease also ...
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Correct Answer b is the answer

Quote:
Originally Posted by venky2600 View Post
2Q) A 45 yr old female presented to a physician for evaluation of bilateral knee pain and distal fingers since a month....she complaints that she couldnt walk properly at times due to her pain..it started with swelling of her distal fingers which became sausage shaped 20 days back...on further examination physician finds a rash on her shin,which is silvery scaled and her bone x-ray presented with pencil in cup deformity....what additional findings can be seen in this pt..?

a) narrowing joint space with sharpened articular margins and thickened sclerotic bone
b) marginal bony erosions with irregular joint destruction and oligoarticular arthritis
c) punched out erosions with a rim of cortical bone and juxtaarticular arthritis.
d) subchondral collapse with necrosis
e)painful joints with negative birefringent crystal deposition...
f) fibrinoid necrosis with surrounding histiocytes in nodules presented

yes, the correct answer is B) marginal bony erosions with irregular joint destruction and oligoarticular arthritis---

the case presented here is classic one of psoriatic arthritis with all findings of sausage shaped digits,pencil in cup deformity,HLAB-27 association...which is most common in males than females..,associated with psoriatic rash..can affect joints like knee as well as DIP jt.(also osteoarthritis can)...rheumatoid factor is usually negative
treatment involve steroidal injections into joints..

a) narrowing joint space with sharpened articular margins and thickened sclerotic bone ---------it is the osteoarthritis scenario due to wear and tear damage to articular cartilage due to repetitive stress

c) punched out erosions with a rim of cortical bone and juxtaarticular arthritis.----it is the case of rheumatoid arthritis ,pannus formation ,RF factor postive, atlantoaxial involvement(paraplegia) are other charectaristic features..
d) subchondral collapse with necrosis---it's the scenario of osteonecrosis which is usually presented with crescent sign(subchondral collpase)...most commonly affect jaw bone
e)painful joints with negative birefringent crystal deposition...---it's the case of gouty arthritis with podagra (MTPjt involvement of first toe) in acute conditions and tophi(soft tissue deposition of urate crystals) in chronic conditions are seen
f) fibrinoid necrosis with surrounding histiocytes in nodules presented-----it's again the scenario of rheumatoid arthritis--subcutaneous nodules(with fibrinoid necrosis and palisading histiocytes )

thanks
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Old 09-21-2015
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Post Erlenmeyer flask deformity

Quote:
Originally Posted by alice View Post
Just one more cause .. Seen in Gaucher's disease also ...
I think there are many other possible causes;
check the link below

http://radiopaedia.org/articles/erle...sk-deformity-1
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