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Tobias Volume I MS > Arthritis > Flashcards

Arthritis Flashcards

1
Q 
What product of chondrocytes is suspected to have a significant effect on pathogenesis of osteoarthritis? 
•	NO
•	COX
•	LOX
•	TXA2
A

NO

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2
Q

What are the 7 radiographic features of arthritis?

A 
Osteophytosis 
Enthesophytosis
Effusion
Soft tissue swelling 
Subchondral sclerosis 
Intra-articular mineralization 
Subchondral cyst
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3
Q

What is the total cell count, % mononuclear cells and % neutrophils in a NORMAL jt?

A

T <2 x 10^9
M 94-100
N 0-6

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4
Q

What is the total cell count, % mononuclear cells and % neutrophils in OSTEOARTHRITIS?

A

T 2-5 x 10^9
M 88-100
N 0-12

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5
Q

What is the total cell count, % mononuclear cells and % neutrophils in RHEUMATOID arthritis?

A

T 8-38 x 10^9
M 20-80
N 20-80

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6
Q

What is the total cell count, % mononuclear cells and % neutrophils in NONEROSIVE IMPA?

A

T 4-370 x 10^9
M 5-85
N 15-95

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7
Q

What is the total cell count, % mononuclear cells and % neutrophils in INFECTIVE ARTHRITIS?

A

T 40-267 x 10^9
M 1-10
N 90-100

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8
Q

Which is true?
• Mitratapide is a microsomal triglyceride transfer protein inhibitor for weight suppression and appetite suppressant.
• Dirlotapide is only a microsomal triglyceride transfer protein inhibitor for weight suppression.
• Strong evidence indicates that the proinflammatory cytokines IL-1, TNF, and IL-10 may play a key role in OA.
• Arachidonic acid is produced by the action of phospholipase A2 on cell membrane phospholipid.
• The amount of drug necessary to inhibit 75% of activity of each enzyme is recorded and expressed as a ratio of COX-2:COX-1.

A

D true

A (Dirlotapide for weight suppression+ appetite suppressant)
B (Mitratapide = weight only)
C (not IL-10 → IL-6)
E (50%)

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9
Q

What is a potent chemotactic agent (leukotriene) that attracts neutrophils and inflammatory cell?

A

• LTB4

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10
Q

Which of the following statements is true regarding NSAIDs in dogs?
• These medications are best given with food: Deracoxib, mavacoxib, robenacoxib
• These medications are licensed in the US: Carprofen, Deracoxib, etodolac, firocoxib, ketoprofen, meloxicam, robenacoxib
• These medications are COX-2 selective: robenacoxib, carprofen, etodolac, meloxicam
• These medications are approved for cats in the US: meloxicam, robenacoxib, etodolac
• These medications can be given regularly once a day: tolfenamic acid, tepoxalin, robenacoxib

A

A False- robenacoxib best given without food
B TRUE
C Etodolac is primarily COX-1
D Per internet robenacoxib too, tobias only says meloxicam
E tolfenamic acid (for 3 days, then off for 4 days), tepoxalin (once a day for 28 days), robenacoxib

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11
Q

What is not a potential effect of NSAIDs?
• Impaired platelet activity
• Decreased blood flow to the gastric mucosa
• Impaired renal blood flow and ion transport
• Increased degradation of canine articular cartilage

A

D Studies contradictrory: inhibits ex vivo synthesis of proteoglycans (aspirin), other stimulation proteoglycan synthesis
May decrease degradation canine cartilage extracellular matrix molecules

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12
Q

Which of the following is FALSE regarding analgesics for osteoarthritis
A. Gabapentin is excreted by the kidneys and patients with renal disease may require less frequent dosing due to slower elimination
B. Acetaminophen should never be used in cats
C. Renal and gastric acetaminophen toxicity in dogs has not been reported until 5x the recommended dosage is reached
D. Codeine is a prodrug which once metabolized approximately 5-10% of codeine is converted to morphine

A

C (should be 10x)

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13
Q

Which of the following is true regarding nutritional management of osteoarthritis?
A. Nutraceutical is any part of a food that provides medical or health benefits including the treatment and prevention of a disease
B. Chondroitin sulfate shows approximately 5% bioavailability in a dog after a single dose.
C. Diets enhances with Omega-3 fatty acids have been shown to produce a 5.6% increase in PVF between 0 and 90 days in dogs with osteoarthritis
D. All of the above

A

D all

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14
Q

Which is true concerning Immune Mediated Polyarthritis (IMPA)?

a. B-cell and T-cell react to each other and form immune complexes.
b. Synoviocytes B secrete TNF-a and other cytokines.
c. Only B cells are essential to the disease process
d. Only T cells are essential to the disease process?

A

A true

B False = A (macs)

BOTH B and T cells are essential to the disease.

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15
Q 
Which cytokine is NOT involved in IMPA?
•	a.    TNFa
•	b.    IL-6
•	c.     IL-8
•	d.    IL-15
•	e.    IL -17
A

C IL-8 – not mentioned

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16
Q

T/F: rheumatoid factors present in serology is a 100% specific for rheumatoid arthritis in canines?

A

(False, not really specific)

17
Q

Which of the following is appropriately matched?
• Type 2 IMPA = idiopathic,
• Type 3 IMPA = GI associated
• Type 1 IMPA = paraneoplastic
• Type 4 IMPA = Associated With Infection Remote from the Joint

A 
A type I = idiopathic (50%)
D (2 = remote infec) (25%)
B TRUE (15%)
C(4= paraneoplastic)
18
Q

Which is FALSE concerning rheumatoid arthritis?
• It is characterized by a deforming symmetric polyarthritis
• It is associated with synovitis of joints and tendon sheaths
• There is articular cartilage loss and erosion of juxta-articular bone
• All patients have IgM rheumatoid factor

A

D (most)

19
Q

Which is not a criteria for diagnosing RA?
• Symmetric joint swelling
• Subcutaneous nodules over bony prominences, or extensor surfaces, or in juxta-articular regions
• Positive agglutination test for serum rheumatoid factor
• Mucin-rich precipitate from synovial fluid

A

D (mucin-poor)

20
Q

Which is true?
• Feline Rheumatoid Arthritis (RA) is common.
• The stifle is the most common joint affected by RA.
• RA is an erosive IMPA
• Feline chronic progressive polyarthritis is an erosive IMPA.

A

C

A (uncommon)
B (tarsus, carpi)
D (both erosive and nonerosive forms)

21
Q

Which of the following statements is false?
• Bacterial infective arthritis is usually spread hematogenously
• Antibiotic therapy begun within 24 hours of infection will decrease collagen loss, but not loss of glycosaminoglycan
• Pyrexia is commonly found in patients with infective arthritis.
• A culture of synovium is no more likely to yield a positive culture result

A

C ( a minority have pyrexia)

D (per new tobias, however controversial)

22
Q

true/ false regarding diagnosing bacterial infective arthritis?
• Presence of 3 criteria: typical history and clinical signs, synovial fluid consistent with bacterial infective arthritis, positive bacteriologic culture

A

true

>50 x 10^9 and greater than 40% neutrophils is suspicious

23
Q

Bacterial infective arthritis can be ruled out once there is no response to an single broad spectrum antibiotic, evidenced by no change in cell counts in synovial fluid

A

false (have to try 3 broad spectrum before concluding IMPA)

24
Q

Erosive changes are common in the early stages of infection

A

false (10-14 in uncontrolled infection)

25
Q

True/false: Time frame for sampling may affect the cell count. A chronic case may have lower cell counts close to 40-100 x 10^9

A

true

26
Q

True or false: If the cell count has not returned to normal and the neutrophil percentage is above 3%, antibiotic therapy should be continued.

A

true?

27
Q

What is false about IMPA

a. It can occur at any age
b. Small breed, young male dogs are predisposed
c. It is one of the most common causes of pyrexia of unknown origin
d. They can present as acute or chronic cases

A

B (false, any age, any sex, any breed)

28
Q

What chemistry’s are generally elevated with IMPA?
a. BUN, creatinine, ALP, ALT, AST
b. BUN, creatinine only
c. ALP, ALT, AST only
D. The premise if false, all of the above are generally WNL.

A

A: BUN, creat, ALP, ALT, AST

29
Q

What changes occur in aggrecan molecules that result in OA?

A

Shorter aggrecan molecules contain fewer chondroitin sulfate chains but greater quantities of keratin sulfate = less ability to imbibe water → reducing compressive stiffness
Aggrecan degrdation later: ADAMTS-4, ADAMTS-5

30
Q

True/false: synonium is a lining with fibroblasts and macrophages

A

true

31
Q

true/false: ABeta fibers are silent nociceptors and respond to mechanical stimuli of the joint

A

False: C- fibers

Tobias Volume I MS (16 decks)

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