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Connective Tissue Flashcards

1
Q

How does Gout look under the microscope?

A

Needle shaped crystals

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2
Q

Drugs that cause gout

A

(-) uric acid excretion: diuretics, low dose aspirin, ACEi, cyclosporine.
(+) production: Chemo
Rapid decline: Allopurinol, probenecid

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3
Q

Gout by hyperuricemia can be caused by:

A

-OH
-meat/seafood
-CKD
-drugs

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4
Q

Vitamin D metabolism

A

1.Sun activates 7-dehydrocholesterol -> Cholecalciferol
2. Liver dehydrolates it to 25-hydroxyVitD
3. Kidneys transforms it to 1,25-hydroxyVitD (active form)

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5
Q

Pt from Africa with bone pain which improves with exposure to sun. Think of

A

Vit D deficiency (rel with osteomalacia)

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6
Q

Paget disease phases and findings

A
  1. (Initial) Osteolytic: Osteoclast-dominant.
  2. Mixed: Osteoclast-osteoblast codominace. Areas of disorganized lamellar and woven bone
  3. Osteosclerotic: Osteoblast-dominant. Mosaic pattern of lamellar bone. Haphazardly oriented sections separated by prominent cement lines.
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7
Q

Osteonecrosis risk factors and signs

A

-SLE and Glucocorticoid user
-Chronic pain of groin, thigh or buttocks. Reduced motion pain

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8
Q

Differences between polymyositis and dermatomyositis

A

Poly: Endomisial inflam. No vascular involvement.
Derm: perifascicular inflam. Vasculopathy

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9
Q

Acute Reumatic Fever features

A

Migratory arthritis, fever, pancarditis (mitral regurgitation), history of recent strepto A pharyngitis. Positive Anti-streptolysin O titer

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10
Q

50 yo male, unable to straighten ring or little finger with similar family history. Think of

A

Depuytren contracture = progressive fibrosis of palmar fascia

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11
Q

Achilles Tendinitis presents with

A

Severe pain at the post aspect of the heel

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12
Q

Drugs that increase risk of osteoporosis and fx?

A

Anticonvulsants that activate P450, Aromatase inhibitors, GnRH agonists, glucocorticoids, Proton pump inhibitor, unfractioned heparin.

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13
Q

Rickets features

A

Frontal bossing, craniotabes, costochondral widening from overgrowth (rachitic rosary).

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14
Q

Rigor morris occurs due to

A

Failure of detachment of Myosin head from actin filament

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15
Q

Giant cell (temporal) arteritis is characterized by

A

-affecting >50yo
-affects arteries of head and neck
-Granulomatous inflammation
-Fragmentation of internal elastic lamina
-Rel to pain and stiffness I shoulders and hips (polymyalgia) and isquemic optic neuropathy

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16
Q

RA affects small joints but long term it also affects

A

Cervical spine causing spinal instability

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17
Q

What type of arthritis affects the sacroiliac joints and the Thoracic spine

A

Sacroiliac: seroneg spondyloarthropathies
Thoracic spine: osteoarthritis and spondyloarthritis

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18
Q

To prevent recurrent gout attacks, treat with

A

-Xanthine oxidase inhibitors (allopurinol, febuxostat)
-Uricosuric drugs (probenecid) are 2nd line but contraindicated in case of renal stones

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19
Q

To treat acute gout attacks, treat with

A

Cyclooxygenase inhibitors (NSAIDs), colchicine or glucocorticoids if not tolerated

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20
Q

Paget’s disease presents as

A

Old male pt
Deformity of long bones (pain) and skull (hearing loss)

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21
Q

Which factors are essential for osteoclastic differentiation?

A

Macrophage colony-stimulating factor (M-CSF)
Receptor activator of nuclear factor kappa-B ligand (RANK-L)

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22
Q

Landing on knee will likely injure which ligament?

A

Posterior ceuciate

23
Q

Humeral neck fx can lead to

A

Disruption of retrograde blood flow from corcunflex arteries causing avascular necrosis

24
Q

Gluteus medius main actions

A

Hip abduction
Pelvis stabilization during ambulation
Damages lead to gait instability (Trendelenburg +) weakness of abduction

25
Gluteus medius muscle inserts in
Greater trochanter of femur
26
Iliopsoas insertion and function
Lesser trochanter of femur Hip flexor
27
Lyme disease phases
1.Early localized (days to weeks): flu-like sts, cutaneous eruption, erythema 2.Early dissemination (weeks to months): CNS problems (facial palsy), cardiac problems (nodal block) 3.late Lyme disease (months to years): asymmetric arthritis, encephalopathy
28
Lyme disease is treated with
Doxycycline or penicillin-type atb (ceftriaxone). Last one prevents progression
29
Drug induced Lupus E features
-arthralgia and serositis -cutaneous, renal and neurologic complications are not common -Antihistone antibody (+) -anti-dsDNA (-)
30
Drug induced Lupus is usually triggered by
Isoniazid, procainamide, hydralazine. All have phase ll acetylation in liver
31
Which NSAIDs are a better option when there’s gastric ulcer history?
Specific Cox-2 inhibitors.
32
Cox-1 vs Cox-2
Cox-1: in Charge of gastric mucosal protection, platelet aggregation, (+) renal perfusion Cox-2: (+) renal perfusion, vasodilation, tissue repair, inflammation, (+) pain sensitivity.
33
Sclerosis pathophysiology
1. Vascular **Endothelial cells** produce endothelin-1 -> vasoconstriction, fibroblast activation and facilitates lymphocytes migration 2. **T-lymphocytes**-> increase cytokines->fibroblast activation 3.**fibroblasts**-> produce collagen -> skin thickening
34
Repetitive extension of the spine (like in gymnastics) can lead to
-Spondylolisthesis (vertebrae displacement -Spondylolysis (fracture) Most commonly of pars interarticularis due to stress of vertebral post arch
35
Osteoporosis morphological characteristics
Trabecular bone thinning with loss of interconnecting bridges. Later on cortical bone is also affected
36
Ankylosing spondylitis presentation and dg
Pt <40yo, back/neck pain worsened by prolonged rest and improved by activity, stiffness Dg with X-ray of pelvis (bony fusion) or Spinal x-ray (bridging syndesmophytes, bamboo spine) **HLA-B27 is not dg**
37
RA confirmation
Anti-cyclic citrulinated peptide (Anti-CCP) Highly specific. Measured via ELISA
38
What happens to muscle fibers when there’s reinnervation after denervation?
They go from forming checkerboard pattern (normal) to grouping together per type (two color patches).
39
Type I muscle fibers vs Type ll
Type I: slow, use oxidative phosphorylation, high myoglobin content, look red Type ll: fast, use anaerobic glycolysis, low myoglobin, look pale
40
Most common carpal bone fx and complications
Scaphoid’s Nonunion, avascular necrosis (retrograde blood flow interruption)
41
Dupuytren contracture
Progressive fibroproliferative disease of palmar fascia, draws fingers into flexion (ring finger)
42
Guyon canal sd
Compression of ulnar nerve typically due to fx of the hook of hamate (bone at base of little finger)
43
Sjögren features
Xerostomia, keratoconjunctivitis sicca. Anti-Ro (+) Periductal lymphocytic infiltrates of labial glands (inflammation of exocrine glands)
44
Deltoid flattening and insensitivity after blow to the arm is usually due to
Anterior shoulder dislocation (glenohumeral joint) Most common dislocation. Axiliary N injury
45
A spiral Fx midshaft humerus commonly hurts
Radial nerve, Deep brachial artery
46
Redial nerve injury will affect which functions?
Forearm extension at elbow Hand extension (causes wrist drop) Sensibility to dorsal had, forearm and upper arm
47
Lateral epicondylitis vs medial
Lateral: due to repetitive wrist extension (tennis player’s elbow). Extensor carpi, radialis brevis and extensor digotorum insert in lat epicondyle Medial: due to repetitive flexion (golf’s elbow).
48
RA pathogenesis
1.Rheumatoid agents-> activate T cells -> produce cytokines -> synovial hyperplasia-> increase HIG-1 -> angiogenesis -> synovium expansion-> pannus-> bony ankylosis, **periarticular** bone erosions (in arthrosis they’re marginal)
49
Which muscle in responsible for displacement in a distal clavicle fx?
Deltoid (originates on distal clavicle and inserts on humerus)
50
Which muscle stabilizes glenohumeral joint
Teres minor
51
Post and ant cruciate ligaments attach to
Post to the Medial femoral condyle (antlat surface) Ant to the lat femoral condyle (postmedial surface)
52
Scoliosis features
-Dystrophin gene deletion -affects mainly males (x-linked disease) -Ambulation difficulties: clumsy march,waddling -Gower sign: needs hands to stand up -calf pseudohypertrophy: fibrofatty muscle replacement (advanced) -Wheelchair bound by age 12
53
CKD causes decrease of vitD due to
-FGF23 increase -> inhibits 1-alpha-hydroxylase -reduced GFR (less precursor reaches kidney) -less renal mass and 1-alpha-hydroxylase

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