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Millers > BS 2 > Flashcards

BS 2 Flashcards

1
Q

Articular hyaline cartilage:
How get nutrition
Top 3 components

A

Diffusion nutrition from synovial fluid
- Avascular (why doesn’t heal)
Components: H2O, PG, collagen (type 2 = car-two-lage)

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2
Q

Describe collagen structure

A

3 alpha collagen chains in a triple helix

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3
Q

Where do you find type X cartilage

A

Fracture callus
Hypertrophic zone growth plate
Calcified tidemark of articular cartilage

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4
Q

What are 2 genetic disorders that affect type 2 collagen of cartilage?

A

Achond - lethal kind

Spondyloepiphyseal dysplasia (SED-C) - congenita
- Mentally normal
- Proportional dwarfism (trunk + limbs)

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5
Q

What is the structure of PG

A

HA backbone
Protein core
Chondroitin + keratan sulfate

Overall negative charge molecule

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6
Q

Diastrophic dysplasia:
Inheritance
Mutated protein
Clinical presentation

A

AR
Sulfate transporter mutation - can’t get sulfate into cells to make PG (chondroitin and keratin sulfate)

Presentation
- Dwarfism
- Hitchhiker thumb
- Cauliflower ear

“If your sulfate transporter isn’t working, you have to hitchhike”

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7
Q

What is the only cell in cartilage? What TF controls it?

A

Chondrocytes - SOX9

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8
Q

What are the layers of cartilage from superficial to deep

A

Tangential - chondrocytes lay flat
- Most H2O + lubricin, least PG
Transitional/radial
Deep zone
Tidemark - contains Ca2+ cartilage (type X)
Subchondral bone
Cancellous bone

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9
Q

What are the 2 types of cells in synovium

A

Type A = mArcophAge like cells
- Removes debris from joint
- From bone marrow (hematopoietic)

Type B = fiBroBlast like cells
- Mesenchymal derived
- Make synovial fluid - lubricin, etc

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10
Q

What molecule is responsible for synovial fluid viscosity

A

Hyaluronic acid

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11
Q

Name molecules in synovial fluid

A

Hyaluronic acid
Lubricin

HA binds lubricin
Lubricin works via boundary lubrication

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12
Q

How does cartilage change with OA

A

Wet - increase H2O
Decrease modulus of elasticity (stress strain curve has lower slope)

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13
Q

How does cartilage change with aging

A

Less H2O - dry
Brittle = increased mod of elasticity
Increased decorin

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14
Q

What signaling molecules are upregulated in OA

A

IL 1beta
MMPs
ADAMTS

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15
Q

What is an antimicrobial peptide over expressed in psoriasis patients

A

Cathelicidins
Increased keratin in wound helaing

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16
Q

While interleukin causes the liver to bump CRP + ESR

A

IL 6

17
Q

Name the class of drug + specific mechanism
Etanercept
Infliximab
Adalimumab

A

TNF alpha blockers

Etanercept - receptor fusion protein
Infliximab - chimeric IgG Ab
Adalimumab - mAb

18
Q

Mechanism of anakinra

A

IL 1 receptor blocker

19
Q

Mechanism of tocilizumab

A

IL6 receptor antibody

20
Q

Rituximab mechanism

A

Ab to CD 20 antigen (B cell inhibitor)

21
Q

What does each nomenclature mean
-mab
-ximab
-zumab
-cept

A

-mab = mAb
-ximab = chimeric mAb (mouse+human)
-zumab = humanized mAb
-cept = fusion of a receptor to Fc part of IgG

22
Q

What is the first cell recruited to fracture hematoma?

A

Neutrophils - “inflam phase”

23
Q

Why cytokines do macrophages release

A

IL1/6
TNF alpha
VEGF
M-CSF

24
Q

What cell mediates osteolysis?
What cytokine is release that stimulates osteoclasts?

A

Macrophages - osteolysis
RANKL - osteoclasts - dissolve bone

25
Q

What is tabetic arthropathy? Describe clinical presentation

A

Tabes dorsalis aka neurosyphilis
Joint changes before neuro diagnosis
XRs look WAY worse than the sx
Will also have unsteady gait, bloody effusion w/ neg infx wu

26
Q

Diagnose:
Neuropathic arthritis XR
Loss of pain/temp sensation in a capelike distribution

A

Syrinx causing neuropathic arthritis
Often middle aged
Often shoulder or elbows affected - 1 joint

27
Q

What is black cartilage disease
Inheritance

A

Alkaptonuria
AR
Homogentisic acid oxidase
Excess homogentisic acid deposited in joints - tints matrix black
Predisposes to Ca deposition in cartilage (chondrocalcinosis) and early OA (young joint replacement)

28
Q

Name that arthritis:
Viking heritage
FHx arthritis + liver disease
Hyperpig skin
Chondrocalcinosis on XRs w/ +crystals on aspirate

Screening test
Trt

A

Hemochromatosis w/ CPPD
- Hereditary excess iron absorption
“Viking curse”
Bronze DM - cirrhosis, DM, skin pigmentation

Screen w/ transferrin + ferratin tests

Trt: blood letting for iron control

29
Q

Describe the crystals:
Gout
CPPD

A

Gout - yellow, urate, needle, neg birefringe
CPPD - blue, post birefringe

30
Q

Tumoral calcinosis:
2 causes
What kind of crystals are deposited

A

Too much blood PO4

  1. Renal failure - can’t excrete
  2. Familial tumoral calcinosis - low FDF23 = can’t excrete

Ca hydroxyapatite

31
Q

What diseases are these HLAs associated with
HLA B27
HLA DR3
HLA DR4

A

HLA B27 - ank spond, JRA
HLA DR3 - SLE
HLA DR4 - RA

32
Q

Describe the pathophys of RA

A

Genetically susceptible person - HLA DR4/DW4
Some antigen trigger
B cells make auto Abs vs RF, aCCP
CD4 T cells infiltrate around jt tissues
- Release TNFa, IL 1/6
Inflam cells proliferate synovium = pannus

33
Q

What cells are in RA pannus

A

CD4 T cells
Macrophages - TNFa, IL1/6
Fibroblast (type B) - MMPs, proteases, RANK-L

34
Q

What 2 Abs are diagnostic for RA?

A

RF = IgM to IgG

Anti-CCP = anti cyclic citrullinated peptide Abs
- Most sensitive + specific for RA

35
Q

HST rxn
Type 1 - cell type and example
Type 2 - “ “

A

Type 1 - IgE mediated, mast cells release histamine
Ie latex allergy

Type 2 - IgM or IgG mediated
Ie myasthenia gravis, transfusion reaction (ABO mismatch)

36
Q

SLE:
Pathophys
3 Abs

A

Ag-Ab immune complex deposition - T3 HST rxn
Sensitive: ANA
Specific:
Anti-dsDNA
Anti-Sm (=RNA)

37
Q

Sjogren:
Pathophys
2 Abs
Other immune cell involvement

A

CD4 T cells infiltrate saliva and lacrimal glands
- Dry mouth/eyes

Abs vs ribonucleoproteins: SS-A(Ro) + SS-B(La)

Increased IgA

38
Q

Scleroderma:
Pathophys
3 Abs

A

CD4 T cells activate fibroblasts
More type 1 collagen deposition
Calcinosis

ANA+
Localized = CREST = anticentromere Ab
Diffuse = anti-DNA topoisomerase I Ab

39
Q

What is the triad of reactive arthritis (Reiter’s syndrome)
Cause
Trt

A

Cant see - conjunctivitis
Cant pee - urethritis
Cant bend the knee - arthralgia
“Red eyes, burning pee, joint effusions and pain”

Chlamydia
Diarrheal causes: Shigella, salmonella

Trt - supportive, treat underlying bug if possible

Millers (29 decks)

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