Term
| What are the two major types of matrices in connective tissue? |
|
Definition
| Interstitium and basement membrane |
|
|
Term
| 2) What are the 4 classes of Extracellular macromolecules? |
|
Definition
2) Collagens
Elastin
Glycoprotein
Proteoglycans |
|
|
Term
| 3) What are the 3 types of cartilage |
|
Definition
|
|
Term
| 4) What is the cartilage matrix called? What is it made of? |
|
Definition
| 4) Chondroid – extracellular fluid, proteoglycans and collagen (60%) |
|
|
Term
| 5) What is the benefit of hyaline cartilage? |
|
Definition
| 5) Has the ability to repeatedly absorb energy without fracture of failure with resumption of the previous shape when unloaded |
|
|
Term
| 6) What are the 3 joint classifications? |
|
Definition
Fibrous (no movement)
Cartilaginous (minimal movement)
Synovial (freely moveable) |
|
|
Term
| What is articular cartilage made of |
|
Definition
|
|
Term
| 8) What is the tide line? What is its importance? |
|
Definition
8) Interface between calcified and uncalcifed portions
Precise biological marker to skeletal maturation (not present during skeletal growth) |
|
|
Term
| 9) What is the surface of the articular cartilage formed by? |
|
Definition
| 9) Lamina splendins – thin basophilic membrane |
|
|
Term
| 13) How do you tell articular from Peri-articular? |
|
Definition
13) Articular – diffuse deep pain, swelling
Periarticular – focal point tenderness, no swelling, pain on active ROM |
|
|
Term
| 11) Differentiate the two different methods of lubrication with synovial fluid |
|
Definition
11) Hyaluronic acid – heavy loads and slow movement
H2O – light loads and high speeds |
|
|
Term
| 15) Does ANA correlate with disease activity? |
|
Definition
|
|
Term
| 16) When are low levels of complement normally seen? |
|
Definition
| 16) Infections, autoimmune disease |
|
|
Term
| 17) What is CPK elevated in? |
|
Definition
| 17) Myositis, MI, rhabdomyaliysis, hepatitis, subdurals, trauma |
|
|
Term
|
Definition
| 18) Genetic marker for spondyloarthropathies |
|
|
Term
| 20) What does spikes or lows in SPEP suggest? |
|
Definition
|
|
Term
| what is the most serious consequence of osteoporosis? |
|
Definition
|
|
Term
|
Definition
|
|
Term
| what is severe osteoporosis considered? |
|
Definition
| T score of -2.5 SD and or fractures |
|
|
Term
| what is the role of vitamin D |
|
Definition
| essential for the absorption of calcium from the GI tract |
|
|
Term
|
Definition
| the biologically active form of vitamin D |
|
|
Term
| what is the first line treatment for osteoporosis? |
|
Definition
| BISPHONATES (alendronate, risedronate, Ibandronate) |
|
|
Term
| what is the MOA of Bisphosphonates in osteoporosis? |
|
Definition
| Classified as anti-resorptive meds - they bind to hydroxyapatite crystals in the bone inhibiting crystal dissolution, aggregation, and formation (apoptosis of osteoclasts) |
|
|
Term
| what the two approved bisphosphonates for osteoporosis? |
|
Definition
1. alendronate
2. risedronate |
|
|
Term
| when is calcitonin prescribed? |
|
Definition
| prescribed to women who are at least 5 years post menopause and are unable to tolerate or refuse other osteoporosis meds |
|
|
Term
| what is Raloxifene? what is used for? |
|
Definition
selective estrogen receptor modulator (SERM) that acts as an estrogen agonsist on bone (antagonist on boobs and uterus)
- for postmenopausal osteoporosis |
|
|
Term
|
Definition
parathyroid hormone (1-34)(PTH)
- first in a new class of bone formation agents that works by increasing the number of OSTEOBLASTS results in new bone formation |
|
|
Term
|
Definition
| a combination therapy of HRT and bisphosphonate treatment |
|
|
Term
| what disease is characterized by excessive resorption and abnormal remodeling of the bone? |
|
Definition
|
|
Term
| Is Paget's more common in males or females? |
|
Definition
|
|
Term
| what are the cardinal features of Paget's? |
|
Definition
soft bones, enlarged bones
- enlarged skull
-tinnitus
-bowed legs |
|
|
Term
| what is the serological marker that is used to diagnose Paget's? |
|
Definition
| Abnormal Serum Alkaline PHosphatase (SAP) --> reflects rapid new bone tunrover |
|
|
Term
| what will a urine test indicate in Paget's disease? |
|
Definition
| indicates the SPEED at which new bone is taking place |
|
|
Term
| what is the treatment for Paget's? |
|
Definition
| Bisphonates --> regulate the bone building process so as to produce more normal bone growth (ex: alendronate or etidronate) |
|
|
Term
| what joint is usually excluded in RA? |
|
Definition
|
|
Term
| what joints are usually excluded in OA? |
|
Definition
| MCPs, wrists shoulders, and elbows |
|
|
Term
| what is a type A synoviocyte |
|
Definition
|
|
Term
| what is a type B synoviocyte? |
|
Definition
|
|
Term
| what is the primary target tissue of RA? |
|
Definition
| SYNOVIUM (the antigen of RA) |
|
|
Term
| what is the key player in synovial inflammation in RA? |
|
Definition
| TUMOR NECROSIS FACTOR ALPHA |
|
|
Term
| what parts of the hand are involved in RA? |
|
Definition
1. wrist involvement
2. MCP joint
3. PIP joint
--> the hand joints must be involved! |
|
|
Term
| how many of guidelines must be present for RA to be considered? how long? |
|
Definition
| 4/7 or more for at least 6 weeks (6 wks makes it chronic) |
|
|
Term
| what serological marker is most sensitive for RA? |
|
Definition
anti-CCP
(Rheum factor can be negative, it's just a determination of prognosis) |
|
|
Term
| what is the atlanto-axis (C1-C2) subluxation called in RA? |
|
Definition
|
|
Term
| what are the RA manifestations in the Knee? |
|
Definition
-Effusion
-Baker's cysts
-contracture |
|
|
Term
| what does a DAS28 score of >5.1 indicate? |
|
Definition
|
|
Term
| what does DAS28 score of less than 3.2 indicate? |
|
Definition
|
|
Term
| what does a DAS28 score of <2.6 indicate? |
|
Definition
|
|
Term
|
Definition
| a measure of disease activity in RA |
|
|
Term
| what is the most common pattern of prognosis with RA? |
|
Definition
|
|
Term
| what is the criteria for RA remission? what is the sed rate for remission? |
|
Definition
5/6 or more for at least 2 months.
- SED RATE: <30 mm/hr (Female); <20 mm (males) |
|
|
Term
| what is the most common cause of death with RA? |
|
Definition
1. infections
2. cardiovascular death |
|
|
Term
| what is class of Steinbrocker's RA classification is the ability to perform self-care & vocational, but limited avocational activities? |
|
Definition
|
|
Term
| what Class of steinbrocker's RA classification is the ability to perform self-care and all vocational and avocational activities |
|
Definition
|
|
Term
| what class of Steinbrocker's RA classification is the inability to perform ADL's |
|
Definition
|
|
Term
| what class is steinbrocker's RA classification the ability to perform self-care, but limited in BOTH vocational and avocational activities |
|
Definition
|
|
Term
| what is the first-line treatment fro RA? |
|
Definition
|
|
Term
| what must the patient do in order for methotrexate to be fully effective in RA treatment? |
|
Definition
| must be taken on an empty stomach! |
|
|
Term
| what are the most common side effects of methotrexate? |
|
Definition
1. nausea
2. LFT abnormalities (elevations)
3. mouth sores ... |
|
|
Term
| what is methotrexate classified as? |
|
Definition
| a DMARD (disease modifiying anti-rheumatic drug) |
|
|
Term
|
Definition
tumor necrosis factor--> a biologic (must be used with methotrexate)
ex: Infliximab, etanercept (enbrel), adalimumab (humira) |
|
|
Term
| What is the most common form of childhood arthritis? |
|
Definition
| juvenile rheumatoid arthritis |
|
|
Term
| what are 3 distinct clinical presentation patterns of Juvenile RA? |
|
Definition
1. Systemic (sJRA)
2. Polyarticular (poJRA)
3. Pauciarticular (paJRA)
4. Psoriatic arthritis (pJIA)
5. Enthesitis-related arthritis (eJIA) -->HLA-B27+
6. Undifferentiate (uJIA) |
|
|
Term
| what is positive in 85% of cases of juvenile RA |
|
Definition
| ANA positivity in paJRA (pauciarticular) |
|
|
Term
| what is the gelling phenomenon? |
|
Definition
| difficulty initiating movement after sitting or inactive for awhile with OA. a problem "getting started" |
|
|
Term
| what are seen the hands of OA patients? |
|
Definition
1. Heberden's Nodes (nodes closest to DIPs)
2. Bouchards Nodes (nodes closest to the PIPs or middle of the finger's) |
|
|
Term
| X-ray reveals Bony sclerosis, loss of cartilage, and osteophytes...what are you thinking? |
|
Definition
|
|
Term
| what is DISH?when is it seen? |
|
Definition
DISH = diffuse idiopathic skeletal hyperostosis
- ossification of the longitudinal ligaments of spine that produces syndesmophytes
- the thoracic ant. longitudinal ligament is ossified but does not fuse --> the intervertebral disk space is preserved |
|
|
Term
| what is Glucoseamine &CS04? |
|
Definition
used for tx in OA
- provides clinical benefit in the synovial fluid by strengthening cartilage and aiding glycosaminoglycan synthesis
- available as oral or injectable
-need both for maximal joint relief |
|
|
Term
| what are Cox-2 drugs used in tx of OA? |
|
Definition
|
|
Term
|
Definition
| by the appearance of negatively (yellow) birefringent needle-shaped crystals |
|
|
Term
| what do you never give for tx of acute gout? |
|
Definition
| Never give Allopurinol!! (urate lowering drug, only for long term tx) |
|
|
Term
| what is the treatment for acute gout? |
|
Definition
1. colchicine
2. nsaids: Indocin
3. steroids |
|
|
Term
| what syndrome is characterized as a sex-linked disorder of HGPRT enzyme deficiency causing accumulation of uric acid in all tissues? |
|
Definition
|
|
Term
| Pt. presents biting his lip and fingers, with neurologic and behavior issue with urine urate/Cr ratio >2 (high)...what are you thinking? |
|
Definition
|
|
Term
| how do you treat Lesch-Nyhan Syndrome? |
|
Definition
| Urate lowering drugs (allopurinol), benzodiazepines |
|
|
Term
| how do you treat chronic gout? |
|
Definition
|
|
Term
| You notice chondrocalcinosis (x-ray) and positively birefingent (blue) rod crystal on wet mount...what are you thinking? |
|
Definition
|
|
Term
| where are degenerative changes in pseudogout seen that are NOT present in OA? |
|
Definition
| DJD changes at 2nd and 3rd MCPs |
|
|
Term
| what is the classic triad of Gonoccoal infection? |
|
Definition
1. dermatitis
2. migratory polyarthalgias
3. tenosynovitis |
|
|
Term
| what joint is most commonly affected by Disseminated Gonoccoal infection? |
|
Definition
|
|
Term
| what is the initial tx for Disseminated Gonoccocoal infection? |
|
Definition
| Ceftriaxone + Azithromycin (clamydia co-exists) |
|
|
Term
| what is the most common cause of non-gonoccoal arthritis? |
|
Definition
|
|
Term
| What is the treatment for Non-gonoccoal arthritis? |
|
Definition
vancomycin (initial)
then PCN 4-6 weeks
- repeated joint aspiration |
|
|
Term
| what is viral arthritis related to? MC causes? |
|
Definition
- failure of own's own immune system to control the virus or molecular mimicry
Most common causes: Human Parovirus B-19 |
|
|
Term
| Pt. presents with symmetrical arthritis, malaise, flu-like state with high titers of anti-IgM abs to B-19 virus...what are you thinking? |
|
Definition
| Viral Arthritis secondary to Human Parvovirus B-19 |
|
|
Term
| Pt. presents with erythematous wheal with central clearing? what are you thinking...what is this called? |
|
Definition
Erythema Chronicum Migran
LYME DISEASE! |
|
|
Term
| What is a serious complication of not treating Non-gonoccoal arthritis? |
|
Definition
|
|
Term
| How do you diagnose Lyme disease? |
|
Definition
1. ELISA
2. western blot --> to confirm |
|
|
Term
| how do you treat stage 1 lyme disease? |
|
Definition
| oral antibiotic for 3 weeks (ex: doxycycline, amoxicillin, E-mycin if preggers) |
|
|
Term
| how do you treat stage II and stage III lyme disease? |
|
Definition
| IV antibiotic for 3 or 4 weeks (IV ceftriaxone, PEN G, cefotraxime) |
|
|
Term
| what is the hallmark of ankylosing sonpdylitis (AS)? |
|
Definition
|
|
Term
| Pt. presents with enthesopahty, back pain that is worse in the AM & better with exercise, uveitis, bowel disease...what are you thinking? |
|
Definition
|
|
Term
| what is the diagnosis for AS? |
|
Definition
|
|
Term
| Pt. presents with generalized fatigue, rashes, stiffness and swelling over joints, RRR, and conjunctivitis, and a "Pencil in cup" deformity on X-ray ...what are you thinking? |
|
Definition
|
|
Term
| what syndrome is characterized by Oligoarthitis, Urethritis, Conjunctivitis |
|
Definition
|
|
Term
| what is strongly associated with Reiter's syndrome |
|
Definition
| antigenic stimulation (strong HIV association) |
|
|
Term
| Patient comes in with generalized rash, small joint swelling, symmetrical pain, and positive IgM parvovirus titers...what are you thinking? |
|
Definition
|
|
Term
| how you treat parvovirus B19 virus? |
|
Definition
| None, self-limiting (2-4 week resolution) |
|
|
Term
| what is the most widely used treatment for Enteropathic arthritis? |
|
Definition
|
|
Term
| what is the nucleus for mineralization of osteoid |
|
Definition
|
|
Term
| what are the precursors to osteoclasts that lie in lucunae and are involved in the chemical exchange pathway? |
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
| what is type 3 cartilage? |
|
Definition
| blood vessels, parenchymal cells |
|
|
Term
| what is type 4 cartilage? |
|
Definition
|
|
Term
|
Definition
|
|
Term
| what functions as the "glue" binding the extracellular matrix components together? |
|
Definition
|
|
Term
| what type of cartilage lines the joints? |
|
Definition
|
|
Term
| what type of cartilage is a mixture of cartilage and fibrous tissue? (ex: pubic symphysis) |
|
Definition
|
|
Term
| What type of cartilage is ONLY found in the ligamentum nuchae of the human C-spine |
|
Definition
|
|
Term
| what type of cartilage allows for the ability to repeatedly absorb energy with failure? what is it related to? |
|
Definition
Hyaline cartilage
-related to the degree of proteoglycans polymerization |
|
|
Term
| where are crystals deposited, what type of cartilage? |
|
Definition
| ONLY deposited on the surface of type II cartilage |
|
|
Term
| what type of joint allows for NO movement? |
|
Definition
Fibrous (synarthroidal)
-ex: cranium, distal Tib-Fib |
|
|
Term
| what type of joint allows for minimal movement? example? |
|
Definition
Cartilaginous (amphiarthrodial)
Ex: pubic symphysis |
|
|
Term
| what of joint allows for free movement? |
|
Definition
| synovial (ex: elbow, knee) |
|
|
Term
| what is a biological marker of skeletal maturation? |
|
Definition
|
|
Term
| what is the primary purpose of synovial fluid? |
|
Definition
| promote ROM and reduce friction |
|
|
Term
| what are the two methods of lubrication? |
|
Definition
1. boundary lubrication: hyaluronic acid
2. weeping lubrication: H20 |
|
|
Term
| what lubrication is more efficient under heavy loads and slows movement? |
|
Definition
| Boudary Lub: Hyaluronic acid |
|
|
Term
| what lubrication is more efficient under light loads and high speed? |
|
Definition
|
|
Term
| what is the appearance of normal synovial fluid? |
|
Definition
|
|
Term
| what does the appearance of monosodium urate crystals signify? |
|
Definition
|
|
Term
| what does the appearance of calcium pyrophosphate signify? |
|
Definition
|
|
Term
| what should be done prior to a steroid injection into the joint? |
|
Definition
| drain joint fluid COMPLETELY! |
|
|
Term
| what is the associated cause of fibromyalgia? |
|
Definition
| central sensitization--> due to abnormal levels of Substance P & Glutamate (GABA) in spinal fluid |
|
|
Term
| Pt. presents with decreased ADLs, cognitive difficulties, chronic fatigue X1 years after a diagnosis of Herpes...what are you thinking |
|
Definition
|
|
Term
| WBC's >3000...Inflammatory or noninflammatory? |
|
Definition
|
|
Term
| how is Chronic fatigue syndrome differentiate from other disorders? |
|
Definition
| presence of cognitive dysfunction (short-memory loss) |
|
|
Term
| what do you notice on PE with Chronic fatigue syndrome? |
|
Definition
1. crimson crescents (purple discoloration on both tonsils pillars without pharyngitis)
2. shotty adenopathy |
|
|
Term
| what may polymyalgia rheumatic occur with? |
|
Definition
|
|
Term
| what is diagnostic of polymyalgia rheumatica? |
|
Definition
| the quick response to prednisone (they feel almost immediate relief within 24-48hrs) |
|
|
Term
| what is the gold standard blood test for polymyalgia rheumatica? |
|
Definition
1. ESR
2. C-reactive protein
SIGNIFICANTLY ELEVATED |
|
|
Term
| Which muscles does PMR usually affect? |
|
Definition
|
|
Term
| what is the treatment for PMR? |
|
Definition
low dose corticosteroids, 10-15 mg of prednisone
(note: NSAIDS do not work) |
|
|
Term
| what is the major criteria to diagnose a pt. with joint hyper-mobility syndrome? |
|
Definition
1. Beighton score of 4/9 and greater
2. arthalgia > 3 monts in 4 joints or more |
|
|
Term
| what are the two types of bursae? |
|
Definition
1. deep (subacromial and iliopsoas) --> btw bone and overlapping muscle
2. superficial ( olecranon and prepatellar) between bones and tendon |
|
|
Term
| what is the mainstay tx for TMJ? |
|
Definition
| NSAIDs and benzodiazepines |
|
|
Term
| what is caused by a compression of the neurovascular structures in the area just about the first rib and behind the clavicle? |
|
Definition
|
|
Term
| what are the three facets affected by Thoracic Outlet syndrome? |
|
Definition
-brachial plexus (95%)
-subclavian vein (4%)
-subclavian artery(1%) |
|
|
Term
| what special tests are useful for diagnosing Thoracic outlet syndrome? |
|
Definition
1. adson maneuver
2. wright test
3. roos stress test** |
|
|
Term
| Pt presents with pain on inhale that he describes as sharp or pressure-like. On PE you notice edema and swelling, and pain with palpation of ribs 2-5....what are you thinking? |
|
Definition
|
|
Term
| Pt. presents with pain on inspiration that is sharp, pressure-like. On PE you notice no edema or swelling but pain with palpation of ribs 2-5...what are you thinking? |
|
Definition
|
|
Term
| What type of RSD is type 1? |
|
Definition
| excessive sympathetic reaction of joints and periarticular soft tissue |
|
|
Term
| what is a type of RSD is type 2 |
|
Definition
Causalgia
-caused by partial nerve injury |
|
|
Term
| what will be in the history of RSD patients? |
|
Definition
| they will give a history of minor trauma or surgery (typically) |
|
|
Term
| Pt. presents c/o pain to abnormal stimuli that she describes as burning, throbbing, and shooting. She has hair and nail atrophy with anhydrosis. Her skin looks discolored...what are you thinking? |
|
Definition
| Reflex Sympathetic Dystrophy (RSD) |
|
|
Term
| What is the best imaging for Reflex sympathetic dystrophy (RSD)? what will you see? |
|
Definition
Bone Scan bitch!
on radiography you will see regional osteopenia |
|
|
Term
| where is calcium stored in the bone? |
|
Definition
| Hydroxyapatite crystals in & on collagen fibers |
|
|
Term
| where is calcium excreted from? |
|
Definition
75% from bowel
25% from kidney |
|
|
Term
| where is phosphate excreted? |
|
Definition
|
|
Term
| Calcium is LOW and vitamin D levels are high. How does this affect phosphate absorption in the bowel? |
|
Definition
| Phosphate absorption in the bowel is increased |
|
|
Term
| Calcium is High. How does this affect phosphate absorption in bowel? |
|
Definition
| phosphate absorption is decreased |
|
|
Term
| what is the most-active form of vitamin D? what is it's purpose? |
|
Definition
1,25(OH)2 Vitamin D3
-primary target is the gut where it helps transport calcium across the gut and into ECF |
|
|
Term
| where is calcitonin secreted from? |
|
Definition
|
|
Term
| what is the main effect of calcitonin? |
|
Definition
inhibit osteoclastic resorption of bone
(puts calcium from blood to bone during hypercalcemia) |
|
|
Term
| 23 y/o patients presents with pain starting at elbow that has now migrated to your PIPs...what are you thinking? |
|
Definition
| Disseminated Gonoccal arthritis |
|
|
Term
| where does disseminated gonoccal arthritis NOT affect? |
|
Definition
|
|
