Musculoskeletal Arthritis

Question 1

osteoarthritis

Answer 1

older patients

progressive erosion/degen or articular cartilage

morning stiffness

Question 2

Rheumatoid arthritis

Answer 2

Chronic inflammatory disorder

Autoimmune HLA DRB1

Juxta-articular osteopenia/narrowing joint space

Question 3

What are the RA critieria (7 Items)

Answer 3

Morning stiff

Arthritis in 3+ joints

Arthritis of hand joints

Symmetric arthritis

Rheumatoid nodules

Positive Serum RF+

Radiographic Changes

Question 4

What does the synovium look like in RA

Answer 4

Thickened, hyperplastic

Question 5

Histology of RA

Answer 5

dense perivascular inflammatory cells

lymphoid aggregates

Question 6

What is gout

Answer 6

tissue accumulation of uric acid

Question 7

What are tophi

Answer 7

large aggregations of urate crystals with inflammatory reaction

Question 8

What is pseudogout

Answer 8

Sporadic and idiopathic aggregation of calcium phosphate

Question 9

What organisms can cause infectious arthritis

Answer 9

Suppurative bacteria

TB

Lyme Disease

Parvovirus B19, Rubella, HCV

Question 10

Clinical Presentation of Infective Arthritis

Answer 10

Sudden onset of pain Usually happens at a single joint

Question 11

What are the two classes of muscle diseases?

Answer 11

Denervation (Neurogenic Change)

Myopathy (Primary muscle disease)

Question 12

What is a motor unit?

Answer 12

The lower motor nerve and the muscle fibers it innervates

Question 13

What determines the muscle fiber type?

Answer 13

The motor unit neuron

Question 14

What type is slow twitch, weight bearing movement?

Answer 14

Type I

Question 15

What type is fast twitch, puposeful movement?

Answer 15

Type II

Question 16

What is a motor neuron disease?

Answer 16

Any disease affecting motor neurons Upper Lower Combined

Question 17

What is a primary motor neuron disease?

Answer 17

Idipathic or inherited

Question 18

Secondary motor neuron disease?

Answer 18

Infectious Toxic Metabolic

Question 19

Multisystem motor neuron disease?

Answer 19

Motor neuron disease + other disease process

Question 20

What does ALS stand for?

Answer 20

Amyotrophic Lateral Sclerosis

Question 21

What is the average age of ALS onset? Are men or women affected more?

Answer 21

60 years Men 1.5:1

Question 22

What are the clinical symptoms of ALS

Answer 22

Early: Asymmetric hand weakness

Late: Progressive muscle weakness spreading to respiratory muscles

Question 23

What happens microscopically to ALS patients

Answer 23

Anterior spinal nerve roots shrink and atrophy

Brain is normal but if it is affected it would be pre-frontal gyrus

Question 24

Why is it called Lateral Sclerosis?

Answer 24

Because there is degeneration of the myelinated fibers in the corticospinal tracts (lateral to the grey matter)

Question 25

What are some clues to look for when performing a muscle tissue biopsy?

Answer 25

Fiber size variation Degeneration/myonecrosis +/- regeneration Hypertrophic Fibers Vacuoles or intracytoplasmic deposits Late: Fibrosis and fatty infiltration

Question 26

What are some general myopathic findings

Answer 26

Degeneration Regeneration Fibrosis

Question 27

What is the issue with Duchenne Muscular Dytrophy?

Answer 27

Dystrophin is completely absent

Question 28

What is the cause of Becker MD?

Answer 28

Dystrophin is reduced

Question 29

Clinical signs of MD

Answer 29

Proximal weakness Calf pseudohypertrophy CK elevated early, and then drops as muscle is destroyed Death from respiratory and cardiac failure

Question 30

Why are boys affected by MD and not girls?

Answer 30

The gene affected is X linked

Question 31

When looking at histology for dystrophinopathies what does the normal control look like?

Answer 31

Honey comb with a solid border

Question 32

What does the DMD look like?

Answer 32

Faded honeycomb missing the dark border

Question 33

What does BeckerMD look like?

Answer 33

Openings with cell nuclei will be present

Question 34

What are the typical indicators for inflammatory myopathy?

Answer 34

Proximal weakness Pain Elevated CK

Question 35

What work up is critical to the diagnosis?

Answer 35

Rheumatological

Question 36

Answer 36

Polymyositis

Question 37

Answer 37

Dermatomyositis

Question 38

Answer 38

McArdles Disease

Question 39

What myopathy is induced by steroids

Answer 39

Type II Fiber Atrophy

Question 40

What myopathy is induced by Statin Drugs

Answer 40

Sinble myocyte necrosis with no inflammation

Question 41

What myopathy is induced by Colchicine

Answer 41

Toxic Vacuolar Myopathy

Question 42

What myopathy is induced by alcohol

Answer 42

Rhabdomyolysis

Question 43

What is Critical Illness Myopathy?

Answer 43

ICU/Steroids/vent with neuromuscular block

Question 44

What Causes This?

Answer 44

Carnitine palmityl transferase deficiency

Question 45

Which parent would you inherit a mitochondrial myopathy from?

Answer 45

Mom

Question 46

What special sense organ could be affected by mitochondrial myopathies?

Answer 46

Eye

Question 47

This "hot" myopathy is caused by Ion channels and a RYR1 gene mutation

Answer 47

Malignant hyperthermia

Question 48

What can trigger malignant hyperthermia?

Answer 48

Anaesthesia....and it happen to totally healthy people who have never had surgery before

Question 49

What are the clinical signs of Myasthenia Gravis?

Answer 49

Muscle weakness Women younger than 40 Weakness is worsened by exercise but helped by rest Drooping eyelids Double vision Labored breathing

Question 50

What causes myasthenia gravis?

Answer 50

Immune mediated loss of Ach receptors post-synaptically

Question 51

What disease is caused by antibody response to presynaptic voltage gated Ca receptors?

Answer 51

Lambert Eaton Syndrome

Question 52

How can you DDx lamber eaton from Mya Gravis?

Answer 52

In Eaton syndrome Ach agents will not improve symptoms because the signal is being stopped before it ever gets to the NMJ