Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

4. MSK exam > Martin: Joints > Flashcards

Martin: Joints Flashcards

(55 cards)

Start Studying
1
Q

Which joints are most commonly affected in osteoarthritis in men vs. women?

A
  • Men = hips
  • Women = hands and knees
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What are 3 characteristic morphological findings of osteoarthritis?

A
  • Hunks of dead cartilage sloughed into the joint –> ‘joint mice’
  • Subchondrondal bone exposed and rubbed smooth = eburnation
  • Microfractures and cysts develop
  • Mushroom-shaped osteophytes (bony outgrowths)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Deep, achy pain that worsens with use, morning stiffness, crepitus, and limitation of ROM is characteristic of what?

A

Osteoarthritis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What are the prominent osteophytes which may form at the PIP and DIP joints of pt with osteoarthritis called?

A
  • PIP = Bouchard’s nodes
  • DIP = Heberden node
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Which joint disease may progress to deformity with time and which may progress to fusion?

A
  • OA may progress to joint deformity, not fusion
  • RA progresses to fusion
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

OA is a disease of what vs. RA?

A
  • OA = disease of cartilage
  • RA = disease of synovium
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Which inflammatory cells may initiate the autoimmune response in RA and how?

A

CD4+ T helper cell by reacting with an arthritogenic agent, perhaps microbial or a self-antigen

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What are the most important cytokines isolated from the inflammed joint in person with RA; what is their role in the disease?

A
  • IFN-γ from TH1 cells activate macrophages and resident synovial cells
  • IL-17 from TH17 cells recruit neutrophils and monocytes
  • TNF and IL-1 from macrophages stimulate resident synovial cells to secrete proteases that destro__y hyaline cartilage
  • RANKL on activated T cells stimulate bone resportion
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Which cytokine has been most firmly implicated in the pathogenesis of RA?

A

TNF

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Many of the autoantibodies produced in the lymphoid organs and in the synovium of pt with RA are specific for what?

A

Citrullinated peptides (CCPs)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What are 2 genetic factors associated with RA?

A

HLA-DRB1 alleles & PTPN22 gene

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What are 5 characteristic histologic features of RA?

A
  • Synovial cell hyperplasia and proliferation
  • Dense inflammatory infiltrates of CD4+ cells, B cells, plasma cells, dendritic cells, and macrophages
  • ↑ vascularity due to angiogenesis
  • Fibrinopurulent exudate on synovial and joint surfaces
  • Osteoclastic activity in underlying bone –> periarticular erosions ad subchondral cysts
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Which characteristic mass of edematous synovium, inflammatory cells, granulation tissue, and fibroblasts growing over articular cartilage is seen in joints affected by RA?

A

Pannus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

With time in RA, the pannus bridges apposing bones to form what?

A

Fibrous ankylosis, which eventually ossifies and results in fusion of the bones, called bony ankylosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Which skin lesions are commonly seen in RA, what is their morphology?

A
  • Rheumatoid nodules: firm, non-tender, and round arising in subcutaneous tissue
  • Resemble necrotizing granulomas w/ central zone of fibrinoid necrosis + prominent rim of macrophages, lymphocytes and plasma cells.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Where are rheumatoid nodules most commonly seen?

A

Extensor surfaces at pressure points

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

How may the blood vessels of patient with RA be affected and which vessels specifically?

A
  • Risk of acute necrotizing vasculitis of small and large arteries
  • May involve the pleura, pericardium or lung evolving into chronic fibrosing process
  • Obliterating endarteritis —> peripheral neuropathy, ulcers, and gangrene may occur
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Inflammation in the tendons, ligaments, and occassionally adjacent skeletal muscle accompanying RA produces what characteristic findings in the hands?

A
  • Radial deviation of the wRrist
  • UlNar deviation of the fiNgers
  • Boutonniere: deformity of finger –> hyperextension of DIP w/ flexion of PIP
  • Swan-neck: hyperextension of PIP, flexion of DIP
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Diagnosis of RA, especially with presence of multisystem involvement, is supported by what 3 findings?

A
  • Characteristic radiohgraphic findings
  • Sterile, turbid synovial fluid w/ ↓ viscosity, poor mucin clot formation, and inclusion-bearing neutrophils
  • Combo of rheumatoid factor and anti-CCP antibody
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

How do the joints being affected differ between OA and RA?

A
  • OA: usually large, weight bearing joints
  • RA: symmetrical pattern w/ small joints affected first
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

How does activity affect the pain in OA vs. RA?

A
  • OA = worse with activity
  • RA = improves with activty, worse with rest
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What may develop in the knee as increased intra-articular pressure causes herniation of synovium in some pt’s with RA?

A

Baker cyst of the posterior knee

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Which heterogenous group of disorders present with arthritis before age 16 and persist for at least 16 weeks?

Study These Flashcards
A

Juvenile idiopathic arthritis (JIA)

24
Q

What are the 4 features unifying the seronegative spondyloarthropathies?

Study These Flashcards
A
  • Changes in ligamentous attachments rather than synovium
  • Involvment of the SI joint +/- others
  • Absence of RF
  • Association of HLA-B27
25
What joints involved in ankylosing spondylitis and typical presentation?
- Destruction of articular cartilage and bony ankylosis, typically of **sacroiliac** and **apophyseal joints** - Involvement of **SI joint** & **vertebrae** becomes _symptomatic_ in **2nd - 3rd decade** of life as **LBP** and **spinal immobility**
26
Who is most affected by reactive arthritis and at what age?
- **Men** in their **20s** or **30s** - Also affects pt's with **HIV**
27
Reactive arthritis most often follows what?
- **GU infection** --\> *Chlamydia* - **GI infection** --\> *Shigella, Salmonella, Yersinia, or Campylobacter*
28
What are the common early sx's of reactive arthritis and which joints are most often affected?
- **Early sx's** = joint stiffness + LBP - **Ankles, knees**, and **feet** are affected _most_ often; frequently **_asymmetric_**
29
What are the extra-articular manifestations that may be seen with reactive arthritis?
- **Conjunctivitis** - Cardiac conduction abnormalities - **Aortic regurgitation**
30
What is the typical presenation of enteric associated arthritis, joints involved, and how does it differ in course from reactive arthritis?
- Appears **_abruptly_** tends to involve **knees** and **ankles**; sometimes the **wrists, fingers****,**and**toes** - **Lasts** for about a **year** vs. **reactive arthritis** which wax and wanes for about **6 weeks**
31
Sx's of psoriatic arthritis typically manifest when and predominantly consist of what?
- Between **ages 30-50 y/o** - Predominantly a **peripheral arthritis** of **hands** and **feet** - **DIP** joints affected 1st, **asymmmetric** distribution --\> **"pencil in cup"** deformity
32
Gonococcal arthritis has a predilection for which sex; how does the presenation differ from other casuses of suppurative arthritis?
- Mainly **sexually active women** - Presents in a more **subacute fashion**
33
What is the classic presentation of suppurative arthritis and what are the systemic findings?
- Sudden development of **acutely painful** and **swollen joint** w/ _restricted_ **ROM** - **Fever** + **leukocytosis** + ↑ **ESR**
34
90% of nongonococcal cases of suppurative arthritis involve how many joints and which joints are most frequently affected?
**Single joint**, _most commonly_ the **knee** \> hip \> shoulder \> elbow \> wrist \> SC joint
35
Pt's with deficiency of complement MAC (C5, C6, C7) are at greater risk for suppurative arthritis from which organism?
Gonoccocal infections
36
How is suppurative arthritis diagnosed?
**Joint aspiration** yielding **purulent fluid** in which **causal agent** is identified
37
Which joints are most often affected in Lyme Arthritis and what is course of the disease?
- Primarily **_large joints_** --\> **knee** \> **shoulder** \> **elbow** and **ankles** - **1-2 joints** at a time, attacks last **few weeks** to **months**, _migration_ to **new sites**
38
How may lyme arthritis be diagnosed?
- **Spirochetes** identified in joints w/ arthritis in about 25% of cases - **Serologic testing** for **anti-*Borrelia*** **antibodies**
39
Hyperuricemia is a plasma urate level of what?
**\>6.8 mg/dL**
40
Which syndrome is due to a complete absence of HGPRT interrupting the purine salvage pathway resulting in hyperuricemia?
**Lesch-Nyhan syndrome** --\> **Mental retardation** + **Self-mutilation + 2' gout**
41
Describe the inflammatory response following the precipitation of MSU crystals into joints and contribution to gout.
- **Inflammasome** recognizes crystals --\> activates **caspase-1** ---\> prod. of **IL-1β** ---\> accumulation of **neutrophils** + **MΦ's** in joint - **Urate crystals** may also _activate_ **complement** --\> **chemotactic** complement byproducts
42
Describe how the solubility of MSU in a joint is modulated by both temperature and the chemical composition of the fluid?
- **Synovial fluid** is _inherently_ a **poorer** solvent for MSU than plasma - **Lower temp.** of peripheral joints also **favors** precipitation
43
How long does it take a patient with hyperuricemia to typically develop gout?
**20-30 years**
44
What are the 4 distinct morphological changes in gout?
1) Acute arthritis 2) Chronic **tophaceous** arthritis 3) **Tophi** in various sites 4) **Gouty nephropathy**
45
What is the pathognomonic hallmark of gout; where are they seen?
- **Tophi** = large aggregations of urate crystals surrounded by intense inflammatory rx of foreign body **_giant cells_** - Articular cartilage, ligaments, tendons, and bursae; sometimes soft tissues (earlobes, fingertips) or kidneys
46
Which drug may reduce the excretion of urate and contribute to the development of gout?
**Thiazide diuretics**
47
Which heavy metal toxicity may contribute to gout?
**Lead toxicity** --\> **saturnine gout**
48
Where do MSU crystals deposit in kidney and what are some of the complication which arise with gouty nephropathy?
- Deposit in the **renal medullary interstitium** or **tubules** - Complications = **uric acid nephrolithiasis** + **pyelonephritis**, particularly when urates induce **urinary obstruction** - **20%** of **chronic** gout --\> death due to **renal failure**
49
When does gout vs. pseudo-gout typically develop and in whom?
- **Gout** = more common in **men** and **_after_** age **30** - **Pseudo-gout** = both sexes **equally** affected and occurs in pt's **\>50 y/o** becoming more common w/ ↑ age
50
Secondary form of pseudo-gout is associated with what underlying conditions?
- **Previous joint damage** - **Hyperparathyroidism** - **Hemochromatosis** - **Hypomagnesemia** - **Ochronosis** - **Diabetes**
51
What do the crystals of pseudo-gout form and how are they seen histologically?
- Form **chalky, white, friable** deposits - Seen histologically as **oval blue-purple aggregates** - Individual crystals are **rhomboid** and **_positively_** birefringent
52
Where is a common location for ganglion cyst's to arise, how to they appear, and arise as a result of what?
- Around **joints** of **wrist** - **Firm, fluctuant****, pea-sized _translucent_** nodule - Arise as result of **cystic** or **myxoid degeneration** of CT; hence the **cyst wall** _lacks_ a **cell lining**
53
What is a synovial cyst and what is a common example of one?
- **Herniation** of the synovium thru a **joint capsule** or **massive** enlargement of a bursa - **Baker cyst** seen in **popliteal space** in setting of **RA**
54
What is the triad of reactive arthritis?
1. Urethritis: can't pee 2. Conjunctivitis: can't see 3. Arthritis: can't climb a tree
55
What is a common finding in the hands of someone with psoriatic arthritis?
Nail pits May also have a scaly rash

4. MSK exam (21 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions