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NMSP Exam 2 > Joint and Soft Tissue Path > Flashcards

Joint and Soft Tissue Path Flashcards

1
Q

what is the cause of primary osteoarthritis?

A

aging

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2
Q

what can cause secondary osteoarthritis?

A 
joint deformity
trauma
morbid obesity
DM
hemochromatosis
thyroid disease
acromegaly
Charcot
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3
Q

describe osteoarthritis

A

disease of cartilage: “wear and tear”

evening stiffness
crepitus
limited ROM
worse with use
joints are hard and bony
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4
Q

what joints are primarily affected in osteoarthritis?

A

women:
PIP = Bouchards nodes
DIP = Heberden nodes
knees

men:
hips

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5
Q

what is the progression of osteoarthritis?

A
  1. increased water content and decreased proteoglycans causes cracks in matrix
  2. hunks of cartilage are sloughed off = joint mice
  3. subchondral bone rubs together = eburnation
  4. bone prevents stress by forming subchondral cysts
  5. osteophytes form causing neuro deficits
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6
Q

describe rheumatoid arthritis

A

autoimmune proliferative and inflammatory synovitis

morning stiffness
better with use

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7
Q

what genetic factors predispose someone to RA?

A

HLA-DRB1

PTPN22 gene

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8
Q

what cytokines are associated with RA?

A 
IFN
IL17
IL1
TNF
CCP
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9
Q

what test would you order for suspected RA?

A

rheumatoid factor
anti-cyclic citrullinated peptide (CCP) antibodies
ESR
CRP

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10
Q

what is the typical presentation of RA?

A 
20-40 y/o F
boutonniere deformity OR swan neck deformity
ulnar deviated fingers
radial deviated wrist 
joints are warm, soft and tender
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11
Q

what will be seen on histo with RA joint?

A

pannus: edematous, thickened, hyperplastic synovium
synovial hypertrophy with vili
lymphoid aggregates

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12
Q

what joints are primarily affected in RA?

A

MCP

PIP

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13
Q

what will be seen on histo with a rheumatoid nodule?

A

central necrosis

palisading histiocytes

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14
Q

what are some systemic manifestations of RA?

A

benign pericarditis
granulomatous inflammation of the aorta

increased LFTs
nodular hyperplasia of the liver

secondary Sjogrens
scleritis

pulmonary disease

peripheral neuropathy
cervical vertebral subluxation

vasculitis

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15
Q

describe seronegative spondyloarthropathies

A

autoimmune T cell response due to environmental factors in predisposed individuals

pathologic changes in ligamentous attachments

associated with HLA-B27

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16
Q

what is ankylosing spondylitis?

A

degeneration of vertebrae and sacroiliac joints

possible peripheral joint involvement

affects 20-30 y/o

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17
Q

what are complications of ankylosing spondylitis?

A

uveitis
aortitis
amyloidosis

18
Q

what is reactive arthritis?

A

triad of sx:
arthritis
urethritis/cervicitis
conjunctivitis

19
Q

who is likely to develop reactive arthritis?

A

MEN 20-30s
previous GI or GU infection
HIV infection

20
Q

what joints are affected in reactive arthritis?

A

ankles
knees
feet
spine

21
Q

what cardiac abnormalities are seen in reactive arthritis?

A

cardiac conduction abnormalities

aortic regurgitation

22
Q

what is enteritis associated arthritis?

A

sudden arthritis in knees and ankles lasting about 1 yr

occurs after Yersinia, Salmonella, Shigella or Campylobacter infection

23
Q

what is the etiology of enteritis assoc. arthritis?

A

lipopolysaccharides of outer cell membrane stimulate immunological response

24
Q

what is psoriatic arthritis?

A

arthritis affecting the ligaments and tendons of peripheral and axial joints

only 10% of cases associated with psoriasis

25
Q

what is the presentation of psoriatic arthritis?

A

radiographic “pencil in cup” deformity at DIP
nail pitting
onycholysis

26
Q

describe infectious arthritis

A

microorganisms seed joints via hematogenous spread

can cause soft tissue abscess or osteomyelitis

rapid joint destruction causing permanent deformity

27
Q

what organisms can cause infectious arthritis in healthy adults?

A

s. aureus
strep spp.
neisseria gonorrhea

28
Q

what organism causes infectious arthritis in healthy young children?

A

H. flu

29
Q

what is the presentation of infectious arthritis?

A 
acutely painful, swollen joint 
restricted ROM
fever
leukocytosis
increased ESR
30
Q

what is the presentation of gonococcal infectious arthritis?

A 
sexually active woman 
complement deficiency
tenosynovitis
vesicular pustules
negative synovial fluid culture and gram stain
31
Q

how do you diagnose septic arthritis?

A

aspiration = purulent fluid

32
Q

how is Lyme disease-associated arthritis different from typical septic arthritis?

A

develops days or weeks after skin lesion

33
Q

what is gout?

A

transient attacks of acute arthritis due to crystallization of monosodium urate within joints

urate precipitation signals cytokines to recruit leukocytes

34
Q

what factors predispose someone to gout?

A 
age > 30 y/o
genetics
alcohol consumption
obesity
thiazide diuretics
lead toxicity
35
Q

what diseases can cause secondary gout?

A

leukemia
CKD
Lesche-Nyhan syndrome

36
Q

what is the presentation of gout?

A

excruciating joint pain
localized hyperemia
warmth

50% in first metatarsophalangeal joint

37
Q

what is calcium pyrophosphate crystal deposition?

A

pseudo-gout or chondrocalcinosis

causes chalky, white friable deposits

sporadic, hereditary or secondary

38
Q

what factors can cause secondary CPPD?

A 
previous joint damage
hyperparathyroidism
hemochromatosis
hypothyroidism
DM
ochronosis
39
Q

what will be seen on histo in CPPD?

A

oval blue-purple aggregates

+ birefringent, rhomboid crystals

40
Q

what is a ganglion cyst?

A

cyst on the joint capsule or tendon sheath

due to cystic or myxoid degeneration

lacks cell lining

41
Q

what is the presentation of a ganglion cyst?

A

firm, fluctuant, pea-sized translucent nodule on the wrist

42
Q

what is a synovial cyst?

A

herniation of synovium through joint capsule

ex: baker’s cyst

NMSP Exam 2 (14 decks)

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