Module 9 Flashcards

Question

Pathology of MD

Answer 1

A metabolic defect, a deficit of dystrophin (a muscle cell membrane protein), leads to degeneration and necrosis of the cell. Skeletal muscle fibers are replaced by fat and fibrous connective tissue, which leads to the hypertrophic appearance of the muscle (as noted in the illustration). Muscle function is gradually lost.

Answer 2

is a chronic musculoskeletal disorder characterized by pain and stiffness affecting muscles, tendons, and surrounding soft tissues.

Answer 3

Duchenne’s muscular dystrophy is an X-linked recessive genetic disorder. Males possess the X chromosome; normal females do not.

Answer 4

A metabolic defect, a deficit of dystrophin (a muscle cell membrane protein), leads to degeneration and necrosis of the cell. Skeletal muscle fibers are replaced by fat and fibrous connective tissue, which leads to the hypertrophic appearance of the muscle (as noted in the illustration). Muscle function is gradually lost.

Answer 5

Specific tender or trigger points have been identified in tendons and ligaments in the neck, shoulder, trunk, and limbs. These points may be used in diagnosis. No obvious signs of inflammation or tissue degeneration are present. The cause is unknown but seems to be related to altered central neurotransmission. The incidence is higher in women age 20 to 50, often with a history of prior trauma or osteoarthritis. Aggravating factors include sleep deprivation, stress, and fatigue.

Answer 6

No one regimen of medication has proved successful for the treatment of fibromyalgia. The following treatments are used: Stress reduction Regular exercise Rest as needed Local applications of heat or massage as needed Low doses of antidepressants Nonsteroidal anti-inflammatory drugs New drugs (for example, Lyrica, which has been approved for fibromyalgia to mediate the pain pathway)

Answer 7

Myositis is a general term referring to severe inflammation and subsequent damage to the muscles Includes: polymyositis, dermatomyositis, juvenile myositis, inclusion body myositis, and toxic myositis Symptoms: muscle fatigue, chronic muscle pain/soreness, difficulty swallowing/breathing, elevations in muscle enzymes, Diagnosis: blood tests, MRI, EMG, and muscle biopsy Treatments: typically involve immunosuppressant medications

Answer 8

The primary defect in osteoarthritis is the damage and eventual loss of articular cartilage. The surface of the cartilage becomes rough and worn, interfering with the ease of joint movement. Tissue damage releases enzymes from the cells, which accelerates the breakdown of cartilage. Eventually, the subchondral bone may be exposed and damaged, and cysts and osteophytes may develop. Pieces of osteophytes and cartilage break off into the synovial cavity, causing further irritation. The joint space becomes narrower (seen with x-ray). Secondary inflammation may occur in response to altered movement and stress on the joint.

Answer 9

Two forms of osteoarthritis exist: primary and secondary. Knees and hands are more commonly affected in women; hips are more commonly affected in men.

Answer 10

Primary osteoarthritis is the most common form. This disease: Appears insidiously with age and without apparent initiating cause Usually affects only a few joints Usually develops because of injury or excessive wear and tear

Answer 11

Secondary osteoarthritis occurs in fewer than 5% of the cases. This disease: Occurs in youths Typically follows some predisposing condition, such as a previous traumatic injury, developmental deformity, or underlying systemic disease Often involves one or several predisposed joints

Answer 12

Undue stress on joint should be minimized and adequate rest and additional support provided to facilitate movement. Ambulatory aids (canes, walkers) are helpful. Orthotic inserts in shoes may be recommended to reduce the risk for deformities. Physiotherapy, massage therapy, and occupational therapy are common, recommended treatments. Glucosamine-chondroitin compounds may be helpful to some individuals. Injection of synthetic synovial fluid, glucocorticoids, analgesics, or NSAIDs are used for the treatment of pain. Surgical joint replacement is performed in more severe cases, such as with a hip replacement (illustrated in the radiograph).

Answer 13

Rheumatoid arthritis (RA) is considered an autoimmune disorder that results in a chronic systemic inflammatory disease. RA has a higher incidence in women than men. Incidence increases in older individuals. Chronic, symmetric inflammation of the joints is characteristic of this condition. The extra-articular manifestations vary.

Answer 14

The condition varies from mild to severe. Remissions and exacerbations lead to progressive damage to the joints. The progression of the condition is as follows: The condition begins with synovitis. Inflammation recurs, and synovial cells proliferate. Pannus forms; granulation tissue from the synovium spreads over articular cartilage. Cartilage erosion, by enzymes from pannus, creates an unstable joint. Fibrosis occurs. Pannus between bone ends becomes fibrotic; calcification follows, and joint space is destroyed. Ankylosis (joint fixation) and deformity develop.

Answer 15

Acute inflammation results in disuse atrophy of muscles. Bone alignment shifts depending on how much cartilage has been eroded. Muscle spasm occurs because of inflammation and pain. Contractures and deformity with subluxation develop.

Answer 16

Systemic effects are believed to arise from the circulating immune factors resulting in: Marked fatigue, depression, and malaise Anorexia Low-grade fever Iron deficiency anemia with low serum iron levels that, if it results from rheumatoid arthritis, is resistant to iron therapy

Answer 17

Although rheumatoid arthritis is considered to be an autoimmune disorder, the exact nature of the condition has not been fully determined. A genetic factor is present with a definite familial predisposition. There seems to be a link to several viral infections. Rheumatoid factor (RF) is not present in all patients with RA. RA is more common in women than in men. Incidence increases with age.

Answer 18

Rheumatoid arthritis is subtle at onset, often just showing mild general aching and stiffness. Inflammation may be first apparent in the fingers or wrist, eventually involving more and more joints. Joints appear red and swollen, often sensitive to touch and very painful. Joint stiffness occurs following rest and eases with mild activity. Joint movement eventually is impaired by swelling and pain. Daily activities become difficult. The joint eventually becomes fixed and deformed. Systemic effects result, as discussed on an earlier screen.

Answer 19

Evaluation of RA is by physical examination, x-ray, and serologic tests for RF and circulating immune complexes. Treatment varies from conservative to surgical. Treatment involves a balance between rest and moderate activity. Physical and occupational therapy are an important part of the treatment regimen. For pain control, high doses of anti-inflammatory agents may be required. In severe cases, glucocorticoids may be prescribed. Other drugs such as gold compounds and immunosuppressants are used in more resistant cases. The use of cold and heat can be effective; splints and assistive devices may be required in acute episodes. Surgical intervention may be needed to remove pannus, replace damaged tendons, reduce contractions, or replace joints.

Answer 20

Juvenile rheumatoid arthritis (JRA) differs from the adult form. The onset is more acute and the systemic effects are more marked, but rheumatoid nodules are absent. JRA occurs in several forms: The first form, or Still's disease (systemic form), results in fever, rash, lymphadenopathy, hepatomegaly, and joint involvement. The second form causes polyarticular inflammation similar to the adult form. The third form involves four or fewer joints but causes uveitis of the eye.

Answer 21

Infectious (septic) arthritis develops in a single joint. Blood-borne bacteria such as gonococcus or staphylococcus are usually the source of the infection; however, anaerobic organisms can be the source as well. The joint is red, swollen, and painful, with decreased range of movement. In some cases, there is a history of trauma, surgery, or spread from a nearby infection. Immediate, aggressive antimicrobial treatment is necessary to prevent excessive cartilage destruction and fibrosis of the joint. Lyme disease (manifestation shown in illustration) is characterized by a migratory arthritis. The knee and other large joints are most often involved.

Answer 22

Gouty arthritis is a form of joint disease that results from uric acid and urate crystals in the joints, causing an acute inflammatory response. The condition is common in men older than 40 years. Sudden increases in serum uric acid levels usually cause a gout attack (hyperuricemia). Gout often affects a single joint such as the big toe. The inflammation causes redness, swelling, and severe pain. Treatment consists of reducing serum uric acid levels by drugs and dietary changes, depending on the underlying cause.

Answer 23

Ankylosing spondylitis is a chronic progressive inflammatory joint disease characterized by stiffening and fusion of the spine (as noted in the radiograph of the lumbar spine) and sacroiliac joints. The disease usually develops in persons between ages 20 and 30. Symptoms vary in severity. Remissions and exacerbations are common. The cause is not fully determined. Ankylosing spondylitis seems to be an autoimmune disorder with a genetic basis.

Answer 24

The vertebral joints first become inflamed, followed by fibrosis and calcification of fusion of the joints. The result is fixation of the joints and loss of mobility. Inflammation begins in the lower back at the sacroiliac joints and progresses up the spine. Kyphosis develops as a result of postural changes necessitated by rigidity (as demonstrated in illustration). Osteoporosis is common. Lung expansion may be limited at this stage because the calcification of the costovertebral joints reduces rib movement.

Answer 25

The most common signs and symptoms of early AS are low back pain and stiffness. Pain is often more marked when lying down and may radiate to the legs, similar to sciatic pain. Discomfort is relieved by walking or mild exercise. Some individuals develop systemic signs such as fatigue, fever, weight loss, or uveitis. Treatment focuses on pain relief and maintenance of mobility via pain-relieving drugs, daily exercise, and sleeping in a supine position.

Answer 26

Bursitis—inflammation of the bursae associated with bones, muscles, tendons, and ligaments of various joints. Most common causes of this inflammation are repetitive motions or positions. Treatments include cold compresses, pain relievers, anti-inflammatory drugs, physical therapy, antibiotics in cases of infections. Synovitis—inflammation of the synovial membrane lining the joint. Causes include infection or uric crystals indicating gout. Treatment includes use of anti-inflammatory drugs and treatment for underlying causes such as in cases of infection. Tendinitis—irritation or inflammation of the tendon. Can be caused by a single, sudden trauma, it is more likely the result of repetitive motions/actions. Treatments include rest, application of ice and pain relievers, anti-inflammatory drugs, physical therapy.

Answer 27

These joint disorders all have systemic effects. Rheumatoid arthritis causes fever, fatigue, and anorexia. Juvenile arthritis forms cause uveitis, fever, rash, lymphadenopathy, hepatomegaly, and joint involvement. Ankylosing spondylitis can cause osteoporosis and restrict lung expansion.