Orhto: 41-80

Question 1

Butterfly photosensitive rash, inflammatory arthritis and what are features typical for new onset SLE

Answer 1

Ulcer at the hard palate

Question 2

decreased levels of what might be seen in SLE

Answer 2

Decreased levels of complement due to loss of self tolerance and autoantibody production in SLE (leads to formation of circulating immune complexes)

Question 3

Drugs that induce lupus like syndrome are likely to undergo what type of processing

Answer 3

Acetylation by the Liver (this also makes slow acetylators more susceptible to lupus like syndrome from these drugs

Question 4

Name 8 drugs that are associated with osteoportoic fractures and thier possible mechanism

Answer 4

• Anticonvulsants inducing CYP 450: INC Vitamin D catabolism
• Aromatase inhibitors: Dec Estrogen
• Medroxyprogesterone: Dec Estrogen
• GnRH agonists: dec Testosterone and estrogen
• Proton Pump Inhibitors: Dec Calcium absorption
• Glucocorticoids: dec bone formation
• Unfractionated heparin: Dec bone formation
• Thiazolidinediones: dec bone fromation

Question 5

Describe the effects of ankylosing spondylitis on the sacroiliac joints and axial skeleton

Answer 5

Morning stiffness and low backpain

Characterized by destruction of articular cartilage with reslting stiffness and fusion of axial joints

Sacroiliac joints tender to palpation and the spine may have dec range of motion

X ray may reveal erosions, sclerosis, narrowing, and ulimately fusion of the sarcroiliac joints

Spine x rays reveal sclerosis, ligametn calcification and vertebral fusion

Question 6

WHat are the common HLA B27 disorders

Answer 6

PAIR

• Psoriatic arthritis
• Ankylosing spondylitis
• IBD
• Reactive arthritis

Question 7

What is rheumatoid factor

Answer 7

Immunoglobulin IgM

against the self IgG

Question 8

What are 2 ways to measure osteoclast activity and one way to measure osteoblast activity

Answer 8

OSteoclast activity

• Urinary hydroxyproline: Hydroxyproline is also a breakdown product of collagen (not an ideal mareker becasuse common meats have cause high urine hydroxyproline
• Urinary deoxypryidinoline: pyidinoline covalently cerosslinks collagen (most commonly used method to asses osteoclast activity)

Osteoblast

• Bone specific alkaline phosphatase (can be differentiated by electrophoreseis and mAB from liver version; ALSO bone specific alkaline phosphatase is easily denatured by heat

Question 9

A patient is given a drug and reacts with fever pruritic skin rash and arthralgias 7-14 days post administration.

What is he experiencing and what are some phsyiological characteristics.

Answer 9

Acute serum sickness

Caused by tissue deposition of circulating immuune complexes (TYPE III HYPERSENSITIVITY)

(thus will likely have decreased serum complement)

Affected tissues show small vessel vascultitis with fibrinoid necrossi and NEUTROPHIL infiltration

Question 10

Patients with increased levels of IgE in their serum are typically prone to what

Answer 10

Typically found in atopic individuals

Prone to IgE mediated hypersensitivity reactions (TYPE 1)

These reactions characterized by vasodialtion, tissue edema and inflamamtory infiltration (baso/mast)

Question 11

How do thiazide diuretics affect calcium concentration

Answer 11

They inhibit the NaCl Cotransporter in the distal convoluted tubule due to a drop in the intracellular sodium that increases the movement of the 3sodium in (to tubule cells) 2 calcium out (into blood) channel on the cellua

Question 12

If you have a resting membrane potential of -70 and ion Equilibrium potentials of

• Na= +60mV
• K= -90mV
• Cl=-75mV
• Ca=+125mV
• Mg=0mV

What ions would most likely flow into the cell after their ion channels open and why?

Answer 12

-70 is the charge inside the cell

Ions driven into Cell

• Na: given its equilibrium is +60 it wants to increas the -70 of the cell to get it closer to that, since sodium is a positively charged molecule it will flow INTO the cell to increase the cells charge
• Calcium: Same as above
• Chloride: It’s equilibrium point is -75, lower then that of the cell, but since Cl is a negative ion it will also go INTO the cell but to try to lower its potential
  
  • (note potassium also wants a lower potential, but since it is a positive ion it has to flow out in order to try to make that happen)

Question 13

What cell maintains short term release and deposition of calcium in the matrix of bone (calcium homeostasis) and where does it lie

Answer 13

Osteocyte

Lies in a lacunae connected to other osteocytes through canalicculie/gap junction

Question 14

Clinical manifestations in reactive arthritis are due to what?

What woulld be found when aspirating the joint?

Answer 14

Immune complexes involving bacterial antigens

Howerver it is not disseminated infection Joint aspirates are STERILE

(ie it is reactive not infectious arthritis)

Question 15

What is keratoderma blennorhagicum

Answer 15

extraarticualr vesiculopustualar waxy keritanized lesions on the soles palms and trunk in 15% of reactive arthrtiis cases

Question 16

What condition is C1 inhibitor deficiency associated with

Answer 16

Hereditary angioedema

c1 inhibior normally degrades c1 and prevents excessive ccomplement activation and inflammation

Question 17

What condition would be associated with Hepatitis B and what would you see on tissue biopsy

Answer 17

Polyarteritis Nodosa (in up to 30% of cases)

segmental transmural inflamation of the arterial wall with fibrinoid necrosis

Question 18

In what arteries would you tend to see Polyarteriitis Nodosa

what organs are most affected?

Answer 18

Seen in small to medium arterries of ANY organ EXCEPT FOR THE LUNG

Organs (kidney heart, gi, liver most common)

Renal: Glomerulonephritis, Hypertension

Nervous: periph neuropathy, monnoneurtisis multiplex

GI: mesenteric ischemnia/bowel infaction, bleeding

MSK, Myositis, arthritis

Question 19

What joints are affected in Rheumatoid arthtis

Answer 19

PIP, MCP, MTP

Commonly see cervical spine involvement with SUBLUXATION, and cord compression

SPARES DIP

(c reactive protein and esr associated with disease activity)

Question 20

What artery supplies the blood to the femoral neck and head

Answer 20

The medial circumlex artery off of the femoral artery

(can be damaged in femoral neck fractures)

Question 21

Which artery is of concern in children with regards to the femur, but is not much of a conrern in adults

where is it found

Answer 21

The artery of the ligamentum teres/ the acetabular branch of the obturator

Supplies blood to the emoral head proximal to the epiphyseal growth plate

Question 22

Matrix metalloproteinase activity is responsible for what at the site of wound healing?

What about the in the event of unusually pronounced MMP activity

Answer 22

Mainly function to degrade collagen and other proteins of the extracellualr matrix, it encourages myofibroblast accumulation at the wound edges and scar tissue remodeling

unusually pronounced MMP activity could result in excessive wound contraction

Question 23

What is the terminolgy actin containing fibroblasts reffering to and what do the do

Answer 23

Myofibroblasts

responsible for contraction of scar tissue

Question 24

What is Wound dehiscence

Answer 24

rupturing of a previously closed wound

from insusfficient granlation or scar tissue, indaquate contraction or excessive stress

most commonly in abdominal wounds subject to inc intraabdominal pressure

Question 25

What is the mechanism of cholchice

Answer 25

Inhibit microtubule polymerization by bining to the tubulin protein that helps form microtubule aggregations This disrupts cytoskeletal dependent functions like chemotaxis phagocytosis and degrtanulation Should not be used in the elderly or those with renal dysfunction

Question 26

what do the suffix names of these biological agents mean their action is mab cept nib

Answer 26

Mab: Monoclonal antibody Cept: receptor molecule (ie it is a receptor molecule-etancercept) Nib: kinase inhibitor

Question 27

A patient presents with malar rash, photosensitivity, and raynauds What does one of the associated markers for this disease do with regard to cellualr function

Answer 27

SLE- Anti smith antibody Smith protien complexes with smal nuclear RNA (snRNA) in the cytoplasm and forms small nuclear ribonucleoprotiens (snRNPs) snRNA made by RNA pol II (also makes mRNA) cobines to make the snRNP the snRNPs and other proteins come togetehr TO FORM SPLICESOMES WHICH REMOVE INTRONS

Question 28

wHAT IS MONONEURITIS MULTIPLEX

Answer 28

assymetric multifocal neuropathy

Question 29

What is lofgren syndrom

Answer 29

Commonly associated with Sarcoidosis Triad of Erythema nodosum, arthralgias, and bilateral hilar lymphadenopathy

Question 30

Child between 1-4 comes in with arm held close to body elbow exteneded (or slightly flexed) and forearm pronated. He appears in little distress until attpems are made to move the elbow What ligament is involved and how is this fixed Why is the child between 1-4

Answer 30

This is radial head subluxation (nursemaids elbow) occuring from a sharp pull on the hand when the forearm is pronated and the elbow is extended This causes the ANNULAR LIGAMENT to tear from its radial attachmetn and slip over it Reduction accomplished by fully supinating forearm followed by fully flexing the elbow (occurs from 1-4 because by age 5 the ligament is thick and strong)

Question 31

What MSK disorder is associated with Giant Cell Arteritis and what would you tend to see with GCA

Answer 31

Associated with Polymyalgia Rheumatica (about half with GCA have it) GCA almost exclusively seen in those over 50 (usually norther european descent) GCA confers a higher risk for Throacic artery aneurysms (not berry aneurysms) See focal granulomatous inflammation centered on the media with intimal thicening and elastic lamina fragmentation Histologically it is identical to takayasu which typically involves aotrtic arch of youngerpatients

Question 32

Where do you tend to see these substances pathologically Calcium oxylate Calcium Pyrophosphate Calcium hydroxyapatite

Answer 32

* Calcium Oxylate: Sqare crystal which is one of the most common constitiuents of renal calculi * Calcium pyrophosphate: rhomboid shaped cyrstal seen in psuedogout joints * Calcium Hydroxyapatitie: calcific tendonitis from depostion of that in periarticular soft tissues particularly tendons an dmost commonly those of the rotator cuff

Question 33

Pain in the lower right knee of a 13 year old boy, relieved by rest but reproduced when knee is straightened while seated. Evaluation reveals avusion of the secondary ossification center of the tibia due to repetitive muscle conttraciton. What is this and where is the pathology located/related to

Answer 33

Osgood Schlatter disease (OSD) Overuse injury of the secondary ossification center of the tibial tubercle commonly seen in young athletes after recent growth spurt see pain and swelling at tibial tubercle insertion of patellar ligament Reptitive contraction fo the quad and chronic avulsion cause proximal patellar tendon to seperate from the tubercule and the healing process CAUSES CALLUS FROMATION AND THE TUBRECLE TO BECOME ELEVATED AND PROMINENT

Question 34

After a midline clavicle fracture, which directions would the medial and lateral fragments be pulled and why?

Answer 34

* Medial Fragment: * Pulled superiorly and posteriorly * Due to the sternocleidomastoid muscle * Lateral Fragment: * Pulled inferiorly and anteriorly * Due to the weight of the arm and the pectoralis major

Question 35

What is the triad of McCune Albright Syndrome and what mutation causes it

Answer 35

MAS results from a MOSAIC somatic mutation during embryogenesis in the GNAS gene for the stimulatory alpha subunit of G protein; causing constant activation Triad: * Large unilateral Cafe au Lait Macules with Irregular (coast oof maine) border: (caused by g protien stimulating activity in melanocytes) * Autonomous endocrine function: most commoonly precouious puberty (secondary sex development in girls before age 8 for example) * Polyostotic Fibrous dysplasia: due to increased proliferation of fibroblaast like cells, inc secretion of IL 6 and activation of osteoclasts (the polyosttotic referws to lesions in many bones though typically UNILATERAL)