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364 Osteoarthritis Flashcards

1
Q

Which joint is spared by osteoarthritis?

A

Wrist

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2
Q

The most potent risk factor for OA

a. Cigarette smoking
b. Sports Injury
c. Age
d. Obesity

A

c. Age

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3
Q

The chief cytokine synthesized by the synovium and chondrocytes is:

a. TNF alpha
b. Interleukin-1
c. MMP-13
d. ADAMTS-4

A

b. Interleukin-1

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4
Q

The pathologic sine qua non of osteoarthritis is:

a. hyaline articular cartilage loss
b. pannus formation
c. osteophyte formation
d. “moth-eaten” bone lesion

A

a. hyaline articular cartilage loss

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5
Q

An extremely common cause of chronic knee pain specifically located medial and inferior to the knee:

a. Trochanteric bursitis
b. Iliotibial band friction syndrome
c. Prepatellar bursitis
d. Anserine bursitis

A

d. Anserine bursitis

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6
Q

The initial analgesic of choice for patients with OA in knee, hip, or hands is:

a. Naproxen
b. Celecoxib
c. Acetaminophen
d. Tramadol

A

c. Acetaminophen

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7
Q

The only conventional NSAID that appears safe from a cardiovascular perspective is:

a. Rofecoxib
b. Naproxen
c. Ibuprofen
d. Mefenamic acid

A

b. Naproxen

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8
Q

Non-inflammatory arthritis such as OA is likely if the synovial WBC count is:

a. <1000 per uL
b. 1500 per uL
c. <2000 per uL
d. >1000 per uL

A

a. <1000 per uL

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9
Q

Which of the following is not indicated as part of the diagnostic workup for OA?

a. Synovial fluid study
b. Xray
c. MRI
d. All of the above are indicated

A

c. MRI

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10
Q

The molecule that gives cartilage its compressive stiffness is:

a. Type 2 collagen
b. Aggrecan
c. Lubricin
d. Hyaluronic acid

A

b. Aggrecan

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11
Q

Which of the following joints is usually spared or unaffected in osteoarthritis?

a. Cervical spine
b. First metatarsal phalangeal joint (MTP)
c. Lumbar spine
d. Ankle

A

d. Ankle

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12
Q

True or false. Valgus (knock-kneed) malalignment predisposes to rapid cartilage loss in the lateral compartment of the knee.

A

True

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13
Q

True or false: 2Polymorphism within the growth differentiation factor 5 gene (GDF5) is an emerging evidence that genetic mutations can confer a high risk of OA

A

True

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14
Q

True or false. Osteophytes grow larger on the side of the joint subject to most loading stress

A

True

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15
Q

True or false. Cartilage loss in a joint is not accompanied by pain because cartilage is aneural

A

True

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16
Q

True or false. The severity of x-ray changes in OA correlates poorly with pain severity

A

True

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17
Q

True or false. The simplest effective treatment for many patients is to avoid activities that precipitate pain.

A

True

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18
Q

True or false. Weight bearing joints such as knees and hips can be unloaded by using a cane in the hand opposite to the affected joint for partial weight bearing

A

True

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19
Q

The strongest predictor of continued exercise in a patient is a previous personal history of successful exercise

A

True

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20
Q

True or false. There is no evidence that repeated glucocorticoid injections into the joint are dangerous.

A

True

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21
Q

True or false. Synovial fluid lubrication depends on the presence of the mucinous glycoprotein molecule called lubricin

A

True

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22
Q

Most common type of arthritis

A

osteoarthritis

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23
Q

major risk factor for osteroarthritis

A

obesity

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24
Q

commonly affected joints in OA

A

cervical, lumbosacral spine, hip, knee, and first metatartsal phalangeal joint (MTP)

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25
Q

in the hands, which joints are affected

A

DIP and PIP and base of the thumb are often affected

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26
Q

joints usually spared

A

wrist, elbow and ankle

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27
Q

reason why the ankle is spared in OA

A

articular cartilage in ankle is resistant to loading stresses

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28
Q

universal structural changes in OA

A

cartilage loss and osteophytes

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29
Q

pathologic sine qua non of OA

A

hyalaine articular cartilage loss

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30
Q

substances serving as lubrication of the joints

A

hyaluronic acid and lubricin

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31
Q

serves as protector against friction induced cartilage wear

A

synovial fluid

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32
Q

where does the earliest chances of OA occur

A

cartilage and abnormalities here can accelerate disease development

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33
Q

major macromolecule in the cartilage which provides cartilage its tensile strength

A

Type 2 collagen

34
Q

two major macromolecules in the cartilage

A

Type 2 collagen and aggrecan

35
Q

gives cartilage its compressive stiffness

A

aggrecan

36
Q

critical enzymes in the breakdown of cartilage matrix

A

metalloproteinases esp ADAMTS-5

37
Q

most important cytokine in OA which stimulates production of proteinases and suppresses cartilage matrix synthesis

A

Interleukin 1 beta

38
Q

how come articular cartilages are avascular

A

there angiogenesis inhibitors present in the cartilage

39
Q

two major factors contributing to the development of OA

A

joint vulnerability and joint loading

40
Q

True or false. Young joint with competent protectors a major acute injury or long term overloading can precipitate to OA

A

true.

41
Q

True or false. A vulnerable joint with dysfunctional joint protectors can develop OA with minimal levels of overloading

A

true.

42
Q

most potent risk factor for OA

A

age

43
Q

True or false. OA is not heritable.

A

False. It is a highly heritable disease but its heritability is joint specific

44
Q

genetic mutation associated with OA

A

growth differentiation factor 5 (GDF5)

45
Q

most common OA among chinese

A

knee OA

46
Q

3 uncommon developmental abnormalities in childhood that can lead to OA later in life

A

congenial dysplasia, Legg- Perthes disease, and slipped capital femoral epiphysis

47
Q

a milder form of congenital dislocation predominantly affected girls

A

acetabular dysplasia

48
Q

fulcrum of the longest level arm in the body

A

knee

49
Q

location of cartilage loss. Varus or bow legged

A

high risk of cartilage loss in the medial or inner compartment of the knee

50
Q

location of cartilage loss. Valgus or knock-kneed

A

high risk of cartilage loss in the lateral compartment of the knee

51
Q

True or false. The relationship of weight to the risk of disease is linear so that with each increase in weight there is a commensurate increase in risk

A

True.

52
Q

True or false. OA remains a focal disease with nonuniform loss of cartilage

A

True.

53
Q

important radiographic hallmark of OA

A

osteophytes

54
Q

In malaligned joints, where does the osteophytes grow

A

osteophytes grow larger on the side of the joints subject to most loading stress

55
Q

Sources of pain in OA

A

synovial inflammation, joint effusion, bone marrow edema

56
Q

True or false. Joint from OA is activity related

A

true.

57
Q

where does pain come from it is trigged by climbing the stairs

A

patellofemoral compartment which is not active until knee is bent by 35 degrees

58
Q

most common cause of chronic knee pain in persons over age 45

A

OA

59
Q

extremely common cause of chronic knee medial and distal to the knee

A

anserine bursitis

60
Q

pain isolated to the area lateral to the hip joint

A

trochanteric bursitis

61
Q

True or false. MRI is indicated as part of diagnostic workup in OA.

A

false.although it may reveal extent of pathology, it is not indicated

62
Q

mainstay treatment in OA

A

altering loading across the painful joint and improving the function of joint protectors

63
Q

ways of lessening focal load in the joints

A

avoid overloading the joint, improve strength of muscles bridging the joint; redistribute the load with a brace or a splint, cane or crutch

64
Q

how much load is increased to the knee per pound increase in weight

A

each pound of weight increases the load across the knee by 3 to 6 fold

65
Q

what is arthrogenous inhibition

A

contraction of muscles bridging the joint is inhibited by a nerve afferent feedback loop emanating in a swollen and stretched joint capsule

66
Q

major challenge to an exercise prescription

A

adherence

67
Q

strongest predictor of a patient’s continued exercise

A

previous personal history of successful exercise

68
Q

true or false. Nonpharmacologic approaches is the mainstay treatment in OA while pharmacologic therapy is adjunct

A

True

69
Q

initial analgesic of choice for patients with OA in knees, hips or hands

A

acetaminophen or paracetamol

70
Q

Maximum dosage of acetaminophen

A

up to 1 gram TID

71
Q

most common side effect of NSAIDs

A

upper gastrointestinal toxicity

72
Q

only conventional NSAID safe from cardiovascular perspective but has GI toxicity

A

naproxen

73
Q

dosage of celecoxib not associated with increased cardiac risk

A

Celecoxib 200 mg per day or less

74
Q

True or false.Topical NSAID when absorbed through the skin plasma concentrations are an order of magnitude lower than the same amount of drug administered orally or parenterally

A

True.

75
Q

true or false. Repeated glucocorticoid injections into the joint are dangerous

A

false. No evidence of harm

76
Q

true or false. Hyaluronic acid injection have efficacy versus placebo

A

false. Controversy exists regarding its efficacy

77
Q

high efficacious operations for knee or hip OA who has failed medical treatment and remains in pain with limitations in physical function

A

total knee or total hip arthroplasty

78
Q

Most

A

Hip
Lumbar vertebra
Knee

79
Q

True or false. Osteoarthritis is joint failure

A

True

80
Q

Provide tensile strength in joint

A

Type II collagen

81
Q

What are risk factors for OA

A

Joint vulnerability and joint loading

82
Q

Has influence in joint shape

A

GDF5 gene polymorphism

rheumatology (15 decks)

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