Joint Pathology Flashcards
1
Q
Articular (hyaline) cartilage of a joint contains this type of collagen
A
Type II
2
Q
Degeneration of articular cartilage caused by ‘wear and tear’
A
Osteoarthritis
3
Q
This is also called degenerative joint disease
A
Osteoarthritis
4
Q
Osteoarthritis involves this type of joint
A
Synovial joints
5
Q
In Osteoarthritis, continued physical stress erodes cartilage and this is exposed
A
Subchondral bone
6
Q
The earliest change in this condition is splits along the planes of vertical orientation of type II collagen
A
Osteoarthritis
7
Q
In Osteoarthritis, the earliest change is splits along these planes
A
Vertical orientation of type II collagen
8
Q
Joint Mice or Loose bodies are when pieces of cartilage break away from the surface, and are seen in this condition
A
Osteoarthritis
9
Q
This describes when intact pieces of cartilage may break away from surface in Osteoarthritis
A
Joint Mice or Loose Bodies
10
Q
Bony eburnation (no hyaline cartilage) is seen in this condition
A
Osteoarthritis
11
Q
Fibrillation of cartilage and chondrocyte clustering is seen in this condition
A
Osteoarthritis
12
Q
Friction causes eburnation in this condition
A
Osteoarthritis
13
Q
Loss of articular cartilage causing eburnation is seen in this condition
A
Osteoarthritis
14
Q
Crepitus may present in this condition
A
Osteoarthritis
15
Q
Osteophytes may occur in this condition due to reactive bone formation at edges, leading to decreased ROM
A
Osteoarthritis
16
Q
Reactive articular bone formation may cause sclerosis in this condition
A
Osteoarthritis
17
Q
Subchondral bone cysts may form in this condition
A
Osteoarthritis
18
Q
Osteophytes (bone spurs) may form in this condition and be palpable
A
Osteoarthritis
19
Q
Loss of joint space may occur in these two conditions
A
Osteoarthritis and Rheumatoid arthritis
20
Q
Osteophytes at DIP joints
A
Heberden nodes
21
Q
Osteophytes at PIP joints
A
Bouchard nodes
22
Q
Heberden nodes are seen in this joint
A
DIP
23
Q
Bouchard nodes are seen in this joint
A
PIP
24
Q
Heberden and Bouchard nodes are seen in this condition
A
Osteoarthritis
Due to osteophytes and interphalangeal joints
25
Autoimmune disorder of synovium resulting in joint damage
Rheumatoid arthritis
26
Are males or females more likely to have Rheumatoid arthritis?
Females 3:1
27
How old is the typical patient with Osteoarthritis?
Symptoms usually begin in 50's
(middle age / older)
28
How old is the typical patient with Rheumatoid arthritis?
30-40 years
(middle age / younger)
29
These act as neoantigens in Rheumatoid arthritis
Citrullinated peptides (modified Arg residues)
30
Citrullinated peptides (modified Arg residues) may act as neoantigens in this condition
Rheumatoid arthritis
31
Rheumatoid arthritis is associated with this gene
HLA-DR4
32
HLA-DR4 gene is associated with this condition
Rheumatoid arthritis
33
In this condition, RF-IgG complexes deposit in synovium and CD4 cells stimulate macrophage release of TNF
Rheumatoid arthritis
34
In Rheumatoid arthritis, macrophage release of TNF stimulates these cells
Synovial cells = proteases degrade cartilage
35
Condition where synovitis is seen
Rheumatoid arthritis
36
IgM against Fc receptor of IgG
Rheumatoid Factor
37
This serologic marker for Rheumatoid arthritis is a specific type of citrullinated peptide that is found in 40% of patients
Anti-Sa
38
Anti-Sa is seen in about 40% of patients with this
Rheumatoid arthritis
39
This serologic marker for Rheumatoid arthritis is more specific and seen earlier than Rheumatoid Factor
Anti-cyclic citrullinated peptide antibodies
40
Proliferative synovitis results from this condition and forms a pannus
Rheumatoid arthritis
41
In Rheumatoid arthritis, proliferative synovitis results and forms this
Pannus
edematous synovium and granulation tissue
42
This is uncommon but may occur late in Rheumatoid arthritis when pannus becomes fibrotic or even ossifies
Joint fuses = fibrous or bony Ankylosis
43
Condition characterized by stiffness in the morning for <30 minutes
Osteoarthritis
44
Condition characterized by prolonged morning stiffness
Rheumatoid arthritis
45
Parts of the body that are most affected in Osteoarthritis
Men: hips
Women: hands, knees
46
Parts of the body most affected in Rheumatoid arthritis
Small bones of hands/feet
47
What joints are most affected in Rheumatoid arthritis, MP, PIP, or DIP?
MP and PIP
DIP is spared
48
Condition that is also associated with systemic signs/symptoms, such as serositis (SOB), amyloidosis, anemia, vasculitis
Rheumatoid arthritis
49
Severe form of RA that is characterized by anemia, leukopenia, splenomegaly
Felty syndrome
50
Felty syndrome is a severe form of this condition that is characterized by anemia, leukopenia, splenomegaly
Rheumatoid arthritis
51
Caplan syndrome is caused by patients with this condition having accelerated lung fibrosis with coal workers lung, silicosis, asbestosis
Rheumatoid arthritis
52
Condition in patients with RA involving accelerated lung fibrosis with coal workers lung, silicosis, asbestosis
Caplan syndrome
53
Soft tissue masses of forearm, elbows, occiput
Firm, non-tender subcutaneous masses
Central necrosis with palisading histiocytes (macrophages)
Rheumatoid nodules (seen in RA)
54
Idiopathic arthritis for more than 6 months in a child less than 16 years old
Juvenile rheumatoid arthritis
55
Serological tests for juvenile rheumatoid arthritis
Seropositive for ANA and/or RF
56
Most common pediatric rheumatic disorder
Usually polyarticular, large joints, associated with systemic disease
Juvenile rheumatoid arthritis
57
Group of RF negative arthritides in genetically susceptible individuals
Seronegative Spondyloarthropathies
58
Condition that causes enthesitis (inflammation of tendinous insertions)
Seronegative Spondyloarthropathies
59
Group of conditions including ankylosing spondylitis, reactive arthritis, and psoriatic arthritis
Seronegative Spondyloarthropathies
60
Are Seronegative Spondyloarthropathies RF positive?
No
61
Is Juvenile rheumatoid arthritis RF positive?
Yes, can be +/- ANA
62
Vertebral and sacro-iliac joint inflammation with fusion
Ankylosing Spondylitis
63
Is Ankylosing Spondylitis more common in males or females?
Males
64
What age do patients with Ankylosing Spondylitis present?
20-40 year old (young adult)
65
Ankylosing Spondylitis involves inflammation and fusion of these joints
Vertebral and sacro-iliac
66
Gene associated with Ankylosing Spondylitis
HLA-B27
67
HLA-B27 is associated with these 3 conditions
Ankylosing Spondylitis
Reactive Arthritis
Psoriatic Arthritis
(all are Seronegative Spondyloarthropathies)
68
3 conditions that are Seronegative Spondyloarthropathies
Ankylosing Spondylitis
Reactive arthritis
Psoriatic arthritis
69
A patient with severe hip/back pain and uveitis may have this condition
Ankylosing Spondylitis
70
Does Ankylosing Spondylitis affect tendinous insertions or synovium?
Tendinous insertions
71
Late stage patients with Ankylosing Spondylitis often have this disease
Restrictive lung disease
May also have aortitis or uveitis
72
Nonseptic arthritis following GI/GU infection in genetically susceptible individual
Reactive arthritis
73
Gene associated with Reactive arthritis (aka Reiter syndrome)
HLA-B27
74
This is also called Reiter syndrome
Reactive arthritis
75
This condition may progress to ankylosing spondylitis type syndrome
Reactive arthritis
76
Does Reactive arthritis affect tendinous insertions or synovium?
Synovial space
77
Molecular mimicry mechanism is proposed for this condition, where bacterial particles and/or anti-bacterial antibodies are in synovial space
Reactive arthritis
78
Condition involving arthritis and conjunctivitis following GI or urethral infections
Reactive arthritis
79
A patient who just had a GI infection and now has sudden onset of joint pain and conjunctivitis may have this condition
Reactive arthritis
80
Dysuria, arthritis, and conjunctivitis are the classic triad of this condition
Reactive arthritis
81
What is the classic triad of Reactive arthritis?
Dysuria
Arthritis
Conjunctivitis
82
Who is more likely to have Reactive arthritis, males or females?
Males
83
What parts of the body does Reactive arthritis most often effect?
Knees, ankles, feet
("oligoarthritic")
84
Condition with sudden onset of arthritis, in knees, ankles and feet especially, that waxes and wanes and may be chronic
Reactive arthritis
85
Psoriatic arthritis is associated with this gene
HLA-B27
86
Psoriatic arthritis affects this joint in particular
Sacro-iliac joints
87
Arthritis caused by bacterial joint infection
Septic arthritis
88
Most common source of spread in Septic arthritis
Hematogenous
89
Most common organism that causes Septic arthritis in adults
S. aureus
90
Most common organism that causes Septic arthritis in pediatrics
H. influenzae
91
Most common site of Septic arthritis
Knee
92
Patients with this have the highest risk of Septic arthritis
Rheumatoid arthritis
93
Patients with RA may take TNF inhibitors, which causes an increase of infections with this, which could cause Septic arthritis
Mycobacterium tuberculosis
94
Patients with Sickle Cell Anemia are more likely to get Septic arthritis from this organism
Salmonella
95
Patients with primary immunoglobulin deficiency are more likely to get Septic arthritis from this organism
Mycoplasma
96
Patients with alcoholism are more likely to get Septic arthritis from this organism
Pneumococcus
97
Condition characterized by red, symmetric joint, swelling, joint effusion, pain, decreased ROM
Is an orthopedic emergency
Septic arthritis
98
Immune complex mediated arthritis
Gonococcal arthritis
99
Gonococcal arthritis mainly affects patients of this age
Young adults
100
Who is more likely to get Gonococcal arthritis, males or females?
Females, 3:1
101
Condition involving migratory polyarthritis, fever and rash on distal extremities, and negative blood and synovial culture
Gonococcal arthritis
102
Acute episodic arthritis or chronic arthritis due to monosodium urate crystal deposition
Gout
103
Gout is acute episodic arthritis or chronic arthritis due to deposition of this
Monosodium urate crystals
104
Monosodium urate crystals are deposited in gout, and are formed during this process
Purine catabolism
105
Rarely, cases of gout are due to overproduction of uric acid, such as during this
Tissue destruction (e.g. due to chemotherapy)
106
Most causes of gout are due to this
Underexcretion of uric acid (decreased renal excretion)
107
What reaction does xanthine oxidase catalyze?
Xanthine to Uric acid
108
Condition involving rapid onset of warm, tender, red joints, MP joint of great toe is most common
Gout
109
Most common site of arthritis in gout
MP joint of great toe
110
Who is more likely to have gout, males or females?
Males
111
Type of drug that is a risk factor for gout
Thiazide diuretics
112
Chronic gout may cause proliferative synovitis, leading to formation of this
Pannus
113
In acute gout episodes, MSU crystals deposit here
In periarticular tissues
Synovium, surrounding soft tissues
114
Chronic gout may lead to joint destruction similar to this condition
Rheumatoid arthritis
115
Collection of MSU crystals in soft tissues seen in chronic gout
Gouty tophus
116
Chronic renal failure due to crystal deposition in interstitium seen in chronic gout
Nephrolithiasis due to uric acid stones
Urate nephropathy
117
Gouty tophus and Urate nephropathy may occur in patients with this condition
Chronic gout
118
This exhibits negative birefringence under polarized light
Yellow under parallel light
Gouty tophus
119
Chalky material deposited in soft tissues, seen in chronic gout
Gouty tophus
120
X-linked recessive HGPRT deficiency
Lesch-Nyhan syndrome
121
What is the inheritance pattern of Lesch-Nyhan syndrome?
X-linked recessive
122
Lesch-Nyhan syndrome is a deficiency of this
HGPRT
123
Condition characterized by mild mental retardation, self-mutilation and spasticity
Lesch-Nyhan syndrome
124
Calcium pyrophosphate deposition disease
Pseudogout
(aka chondrocalcinosis)
125
Other name for Pseudogout
Chondrocalcinosis
126
In this condition, degradation of articular cartilage produce calcium pyrophosphate crystals
These form crystal aggregates which deposit in tissues and damage joints
Pseudogout
127
What is the typical age of a patient with Pseudogout?
Older/elderly
128
Blue crystalline deposits with little inflammatory reaction are histologically seen in this condition
Pseudogout
129
Rhomboid crystals with positive birefringence are seen in this condition
Pseudogout
130
Condition involving acute arthritis lasting several days, limited to 1-2 joints, usually spares MTP joint
Pseudogout
131
Pseudogout involves this many joints
Limited to 1 or 2 joints
132
Does Gonococcal arthritis involve multiple joints?
Yes - migratory polyarthritis is seen
133
Does Septic arthritis involve multiple joints?
No - is usually monoarticular
134
In a synovial fluid analysis, a syringe lubricated with this is inserted into joint space to aspirate fluid
Anticoagulant
135
Are leukocytes high in Osteoarthritis?
No - are non-inflammatory
136
Are leukocytes high in Rheumatic arthritis?
Yes, is inflammatory
137
Femoral head displacement relative to femoral neck
Often with mild trauma or unrecognized trauma
Slipped capital femoral epiphysis
138
What is the typical age of a patient with Slipped capital femoral epiphysis?
10-16 years
139
Is Slipped capital femoral epiphysis more common in males or females?
More common in boys - especially with obesity
140
A teenage overweight male who presents with groin or knee pain could have this condition
Slipped capital femoral epiphysis
141
Where might a patient experience pain in Slipped capital femoral epiphysis?
Pain at hip but often referred to groin or knee
Will have a limp
142
Line along superior side of femoral neck that should cross plane of growth plate which is no longer seen in Slipped capital femoral epiphysis
Klein's line
143
Overuse injury at patellar insertion at tibial tuberosity
Osgood-Schlatter disease
144
What age is the typical patient with Osgood-Schlatter disease?
Child / adolescent
With increased activity of knee
145
Osgood-Schlatter disease is due to overuse of this action
Knee extension
146
Osgood-Schlatter disease involves this part of the body
Patellar tendon insertion
