Joints and Connective Tissue Flashcards by Frankie Aguinot

All of the following are common in idiopathic osteoarthritis (OA)
of the knee except:

A) Age > 50
B) Bony tenderness
C) Stiffness
D) Erythrocyte sedimentation rate (ESR) > 40

D) Erythrocyte sedimentation rate (ESR) > 40

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All of the following are common in idiopathic osteo of the knee except:

A) Palpable warmth
B) Negative rheumatoid factor (or low titer)
C) Bony enlargement
D) Bony tenderness

A) Palpable warmth

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Rheumatoid arthritis (RA):

A) Is primarily a noninfl ammatory disorder of weight
B) Primarily affects the distal interphalangeal (DIP) joints
C) Is more prevalent in females than in males
D) Is also known as “wear and tear” arthritis

C) Is more prevalent in females than in males

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A reasonable fi rst line of treatment in osteoarthritis (OA) of the knee is:

A) Intra-articular injections
B) Oral steroids
C) Acetaminophen and/or nonsteroidal anti-infl ammatory drugs
(NSAIDs)
D) Colchicine

C) Acetaminophen and/or nonsteroidal anti-infl ammatory drugs
(NSAIDs)

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All of the following are true in systemic lupus erythematosus
(SLE) except:

A) Avascular necrosis typically occurs in small joints
B) Low-dose steroids can be used to manage SLE
C) Arthritis is not necessary to diagnose SLE
D) Antimalarial drugs can be used for symptom control

A) Avascular necrosis typically occurs in small joints

large joints

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Which of the following is true of gouty arthritis?

A) Calcium pyrophosphate dihydrate crystals are found in joint fl uid
B) Female predominance
C) Allopurinol can be used during an attack
D) Tophi (deposits of uric acid crystals) may be pres

D) Tophi (deposits of uric acid crystals) may be pres

Tophi can be seen in gout. Calcium pyrophosphate
dihydrate crystals are seen in pseudogout. Gout has a male
predominance. Allopurinol is used to lower serum uric acid and
prevent or decrease attacks, but is not used for an acute attack

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Which of the following is true about rheumatoid arthritis (RA)?

A) Asymmetric and nonerosive
B) Symmetric and erosive
C) Asymmetric and erosive
D) Symmetric and nonerosive

B) Symmetric and erosive

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Which of the following are characteristic of rheumatoid arthritis
(RA)?

A) Morning stiffness
B) Symmetric arthritis
C) Arthritis of the hand joints
D) All of the above

D) All of the above

D) Morning stiffness lasting more than 1 hour, arthritis of three or more joints simultaneously affected with soft
swelling, arthritis of the hand joints including the wrist/metacarpophalangeal joint/proximal interphalangeal joint,
symmetric arthritis of the same joints on both sides of the body,
rheumatoid nodules (subcutaneous no
surfaces), positive serum rheumatoid factor, and radiographic
changes such as erosions/joint space narrowing are all
characteristics of rheumatoid arthritis. Not all are necessary for
diagnosis.

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What causes a Boutonnière deformity?

A) Rupture of the extensor hood at the proximal interphalangeal joint (PIP), which causes subluxation of the lateral bands of the extensor
hood
B) Flexor synovitis
C) Ligamentous laxity
D) Rupture of the fl exors with subluxation causing hyperextension
the PIP

A) Rupture of the extensor hood at the proximal interphalangeal joint (PIP), which causes subluxation of the lateral bands of the extensor
hood

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What tendons are affected by de Quervain’s synovitis?

A) Extensor carpi radialis longus (ECRL) and extensor carpi radialis
brevis (ECRB)
B) Abductor pollicis longus (APL) and extensor pollicis brevis (EPB)
C) Extensor pollicis longus (EPL) and EPB
D) Extensor digiti minimi (EDM) and extensor carpi ulnaris (ECU)

B) Abductor pollicis longus (APL) and extensor pollicis brevis (EPB)

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Which of the following are characteristics of osteoarthritis (OA)?

A) Dull, aching pain better with activity
B) Joint stiffness lasting < 30 minutes and improving as the day
progresses
C) Typically involves the metacarpophalangeal (MCP) joints in the
hands
D) Infrequently involves the spine

B) Joint stiffness lasting < 30 minutes and improving as the day
progresses

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Which of the following is not a characteristic radiographic
finding in osteoarthritis (OA)?

A) Asymmetric narrowing of the joint space
B) Erosive changes seen on x-ray
C) Subchondral bony sclerosis
D) Osteophytosis

B) Erosive changes seen on x-ray

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Which of the following is not a characteristic radiographic fi
nding in rheumatoid arthritis (RA)?

A) Erosion of the ulnar styloid
B) Marginal bony erosions
C) Asymmetric joint involvement
D) Uniform joint space narrowing

C) Asymmetric joint involvement

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What is the most common form of childhood arthritis?

A) Osteoarthritis
B) Juvenile rheumatoid arthritis
C) Rheumatic fever
D) Ankylosing spondylitis

B) Juvenile rheumatoid arthritis

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Which of the following is a characteristic of gout?

A) Negative birefringence crystals noted on microscopy of joint
aspiration
B) Positive birefringence crystals noted on microscopy of joint
aspiration
C) Chondrocalcinosis
D) Affects hyaline cartilage

A) Negative birefringence crystals noted on microscopy of joint
aspiration

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Which of the following is not associated with HLA
serology?

A) Reiter’s syndrome (reactive arthritis)
B) Ankylosing spondylitis
C) Psoriatic arthritis
D) Osteoarthritis

D) Osteoarthritis

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Which joint/area of the body is affected fi rst in ankylosing
spondylitis (AS)?

A) Lumbar spine
B) Sacroiliac joint
C) Cervical spine
D) Thoracic spine

B) Sacroiliac joint

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Which of the following is not true about ankylosing spondylitis
(AS)?

A) Onset is usually late adolescence or early adulthood
B) It is three times more common in men than in women
C) It can be associated with HLA-B27
D) The sacroiliac joint is usually not involved

D) The sacroiliac joint is usually not involved

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Which of the following is not a common disease complication of
ankylosing spondylitis (AS)?

A) Iritis/uveitis
B) Infl ammatory bowel disease
C) Osteoporosis
D) Dementia

D) Dementia

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What is the position of a swan-neck deformity of the fi
typical in rheumatoid arthritis?

A) Hyperextension of the proximal interphalangeal joint
hyperextension of the distal interphalangeal joint (DIP)
B) Hyperextension of the PIP with fl exion of the DIP
C) Flexion of the PIP with fl exion of the DIP
D) Flexion of the PIP with hyperextension of the DIP

B) Hyperextension of the PIP with fl exion of the DIP

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What is the “gold standard” for diag
arthritis (RA)?

A) Ultrasound
B) Magnetic resonance imaging (MRI)
C) Plain radiograph
D) Bone scan

C) Plain radiograph

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Which of the following is not a part of rehabilitation of the hand
in a patient with rheumatoid
arthritis?

A) Resting the involved joints
B) Heavy exercise of the involved joints
C) Joint protection instructions
D) Splinting regimens

B) Heavy exercise of the involved joints

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What is a characteristic fi nding in polymyositis?

A) Skin abnormalities
B) Proximal muscle weakness
C) Distal muscle weakness
D) Ligamentous laxity

B) Proximal muscle weakness

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Which of the following is not a subtype of juvenile rheumatoid
arthritis?

A) Chronic
B) Systemic
C) Pauciarticular
D) Polyarticular

A) Chronic

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Which of the following is characteristic of pseudogout? A) Negative birefringence B) Positive birefringence C) Caused by calcium pyrophosphate crystals D) Both B and C

D) Both B and C

Which of the following is not a characteristic symptom or sign in systemic lupus erythematosus (SLE)? A) Asymmetric joint pain B) Pain disproportionate to swelling C) Fatigue and fever D) Erosive arthritis

D) Erosive arthritis

What is the name for an abnormal fi brous hyperplasia and contracture of the palmar fascia that causes a fl exion contracture of the metacarpophalangeal (MCP) and proximal interphalangeal (PIP) joints? A) Charcot joint C) De Quervain’s tenosynovitis D) Trigger fi nger

B) Dupuytren’s contracture

Which of the following is not a typical severe side effect leading to rehabilitation hospitalization in patients with rheumatic diseases? A) Decline in activities of daily living (ADLs) B) Steroid myopathy C) Vasculitis D) Pressure ulcers

D) Pressure ulcers

Which physical modality has demonstrated improvement in patients with rheumatic diseases by increasing activity of synovial collagenase in the joint? A) Ultrasound B) Superfi cial heat C) Diathermy D) Massage

B) Superfi cial heat

Which of the following is associated most strongly with obesity in women? A) Hip osteoarthritis B) Rheumatoid arthritis C) Knee osteoarthritis D) Lupus

C) Knee osteoarthritis

What is the most appropriate treatment for pain relief for osteoarthritis of the base of the thumb (carpometacarpal and metacarpophalangeal joints)? A) Massage B) Transcutaneous electrical nerve stimulation (TENS) C) Range of motion exercises D) Thumb spica splint

D) Thumb spica splint

What is the most serious complication of osteoarthritis (OA) of the cervical spine? A) Radiculopathy B) Myelopathy C) Osteoporosis D) Chronic pain

B) Myelopathy

A swan neck deformity is noted in your patient. Which condition is most likely, and which area would have a hyperfl exion deformity? A) Osteoarthritis, proximal interphalangeal joint (PIP) B) Rheumatoid arthritis, proximal interphalangeal joint (PIP) C) Osteoarthritis, distal interphalangeal joint (DIP) D) Rheumatoid arthritis, distal interphalangeal joint (DIP)

D) Rheumatoid arthritis, distal interphalangeal joint (DIP)

A Boutonnière deformity is noted in your patient. Which condition is most likely, and which area would have a hyperfl exion deformity? A) Osteoarthritis, proximal interphalangeal joint (PIP) B) Rheumatoid arthritis, proximal interphalangeal joint (PIP) C) Osteoarthritis, distal interphalangeal joint (DIP) D) Rheumatoid arthritis, distal interphalangeal joint (DIP)

B) Rheumatoid arthritis, proximal interphalangeal joint (PIP)

How many tender points need to be present for the diagnosis of fi bromyalgia? A) 7 B) 9 C) 11 D) 13

C) 11 According to the American College of Fibromyalgia Diagnostic Criteria, 18 specifi c tender points and 9 bilateral sites are used in the diagnosis of fi bromyalgia. Out of 18 tender points, 11 must be present for more than 3 months duration. The bilateral tender point sites include the occiput, lower cervical, trapezius, supraspinatus, second rib, lateral epicondyle, gluteal, greater trochanter, and knee.

Pseudogout commonly involves which of the following areas? A) Knee B) Toe C) Elbow D) Fingers

A) Knee A) Pseudogout commonly involves the knee and wrist as opposed to gout, which usually affects the big toe (termed podagra). Pseudogout is infl ammation caused by calcium pyrophosphate crystals. Gout is infl ammation caused by monosodium urate monohydrate crystals. Both can be diag with aspirated synovial fl uid. Pseudogout presents with acute joint swelling and pain commonly in the knee, but can also affect the wrist, shoulders, and hip.

Gout commonly involves which of the following areas? A) Knee B) Toe C) Elbow D) Fingers

B) Toe

Later stage of rheumatoid arthritis affects which type of joint? A) Amphiarthrodial joint B) Synarthrodial C) Diarthrodial joint D) None of the above

C) Diarthrodial joint

In rheumatoid arthritis, which of the following is considered to be the most destructive element? A) Infi ltration of T lymphocytes B) Formation of pannus C) Activation of synoviocytes D) None of the above

B) Formation of pannus Rheumatoid arthritis is an infl ammatory primarily affects synovial joints. Infl ammation of the capsule around the joints, known as the synovium, is the fi rst step in this destructive disease. Overtime, synovial cells are destroyed, causing hyperplasia. Neutrophils, macrophages, a cell lymphocytes are activated to increase the infl ammatory response. Pannus develops when the infl ammation causing fIbrin deposits develops into granulation tissue.

All of the following statements are true except: A) Pseudogout is caused by a buildup of uric acid in the bloodstream B) Pseudogout is caused by the formation of calcium pyrophosphate C) The big toe is the most common joint involved in gout D) Swelling, warmth, pain, and redness of the joint are common symptoms of gout

A) Pseudogout is caused by a buildup of uric acid in the bloodstream

Where are Bouchard’s nodes found? A) Distal interphalangeal joint (DIP) B) Proximal interphalangeal joint C) Metacarpophalangeal joint D) Intermediate phalanges

B) Proximal interphalangeal joint The DIP is the location for Heberden’s nodes. Bouchard’s nodes and Heberden’s nodes are formed when osteophytes, also known as calcific spurs, develop in the cartilage of the articular joint. Bouchard’s and Heberden’s nodes are seen osteoarthritis. Metacarpophalangeal (MCP) joints are joints formed between the metacarpal bones and the proximal ends of the phalanges. Arthritis in the MCP joint is commonly found in patients with rheumatoid arthritis.

Which of the following is not a criterion for rheumatoid arthritis according to the American College of Rheumatology (ACR)? A) Involvement of three or more joints B) Nodules present C) Asymmetric involvement D) Morning stiffness

C) Asymmetric involvement

Which of the following synovial fl uid laboratory values is not consistent with an infl ammatory arthritis? A) WBC > 3,000 B) 70% polymorphonuclear leukocytes C) Decreased erythrocyte sedimentation rate (ESR) D) Low viscosity

C) Decreased erythrocyte sedimentation rate (ESR)

Reiter’s syndrome, or reactive arthritis, is made up of a triad of symptoms. Which of the following is not involved in Reiter’ssyndrome? A) Urethritis B) Conjunctivitis C) Arthritis D) Pericarditis

D) Pericarditis

What type of hypersensitivity reaction is noted in systemic lupus erythematosus (SLE)? A) Type I B) Type II C) Type III D) Type IV

C) Type III

The Wright-Schober test is used in which of the following conditions? A) Ankylosing spondylitis (AS) B) Systemic lupus erythematosus C) Reiter’s syndrome D) Dermatomyositis

A) Ankylosing spondylitis (AS)

Which of the following sports would be contraindicated in a patient with ankylosing spondylitis? A) Archery B) Badminton C) Bicycling D) Table tennis

C) Bicycling

Which of the following radiographic features is not seen in patients with rheumatoid arthritis? A) Narrowing of the joint space B) Increased bone density C) Marginal erosion of bone D) Joint fusion

B) Increased bone density

Antihistone antibodies are present in which of the following conditions? A) Rheumatoid arthritis B) Sjögren’s syndrome C) Polymyositis D) Drug-induced lupus

D) Drug-induced lupus

Massage, manipulation, and traction are all examples of which type of therapy? A) Relaxation B) Hydrotherapy C) Mobilization D) Immobilization

C) Mobilization

Which condition is associated with the following features: heliotrope rash, Gottron’s papules, and shawl sign? A) Dermatomyositis B) Inclusion body myositis C) Osteoarthritis D) Fibromyalgia

A) Dermatomyositis

Which condition is associated with the following features: heliotrope rash, Gottron’s papules, and shawl sign? A) Dermatomyositis B) Inclusion body myositis C) Osteoarthritis D) Fibromyalgia

A) Dermatomyositis

All of the following are true regarding rheumatoid arthritis except: A) 85% of cases are rheumatoid factor (+) B) Rheumatoid nodules are present C) More common in males D) Infl ammation of the synovial capsule

C) More common in males

Which specifi c autoantibody is associated with systemic lupus erythematosus (SLE)? A) Anti-Smith B) Anti-sci-70 C) Anticentromere D) Anti-Jo-1

A) Anti-Smith

What type of collagen defi ciency is present in osteogenesis imperfecta? A) Type 1 collagen B) Type 2 collagen C) Type 3 collagen D) Type 4 collagen

A) Type 1 collagen

Which of the following conditions is associated with formation of abnormal fi brillin? A) Osteogenesis imperfecta B) Scleroderma C) Marfan syndrome D) Ehlers–Danlos syndrome

C) Marfan syndrome

In Duchenne muscular dystrophy, which protein is absent? A) Fibrillin B) Dystrophin C) Huntington D) Sarcoglycan

B) Dystrophin

Which of the following is not a seronegative arthritis? A) Psoriatic arthritis B) Rheumatoid arthritis C) Reactive arthritis D) Ankylosing spondylitis

B) Rheumatoid arthritis

Which of the following is elevated in Paget’s disease? A) Calcium B) Phosphate C) Aminotransferase D) Alkaline phosphatase

D) Alkaline phosphatase

Fibroblast growth factor receptor 3 mutation causes which of the following conditions? A) Paget’s disease B) Achondroplasia C) Osteogenesis imperfecta D) Osteoporosis

B) Achondroplasia Achondroplasia is an autosomal dominant genetic disorder caused by a mutation in the fi broblast growth factor receptor 3 (FGFR3). It is the most common form of dwarfi sm.

Which contracture is caused by forearm injuries leading to lack of blood supply to the region? A) Dupuytren’s contracture B) Capsular contracture C) Volkmann’s contracture D) None of the above

C) Volkmann’s contracture

Pain on ulnar deviation of the wrist with the thumb grasped in the fi st is a positive sign for which of the following conditions? A) Carpal tunnel syndrome B) Rheumatoid arthritis C) Medial epicondylitis D) De Quervain’s tenosynovitis

D) De Quervain’s tenosynovitis

Symmetric erosive destruction of multiple joints is more likely to be seen in which of the following arthropathies? A) Osteoarthritis B) Reactive arthritis C) Rheumatoid arthritis (RA) D) Gout

C) Rheumatoid arthritis (RA)

A patient presenting with fl exion contracture of the metacarpophalangeal (MCP), hyperextension of the proximal interphalangeal (PIP) joint, and the fl exion of the distal interphalangeal (DIP) joint is seen in which of the following diseases? A) Osteoarthritis B) Gout C) Psoriatic arthritis D) Rheumatoid arthritis

D) Rheumatoid arthritis

A painful joint is aspirated and is found to contain calcium pyrophosphate dehydrate crystals. These joint crystals are pathognomonic of which of the following conditions? A) Gout B) Pseudogout C) Psoriatic arthritis D) Osteoarthritis

B) Pseudogout

Which of the following disorders is caused by a fi brillin defect? A) Osteogenesis imperfecta B) Rheumatoid arthritis C) Marfan syndrome D) Scleroderma

C) Marfan syndrome Marfan syndrome is an autosomal dominant condition caused by FBN1 gene mutation located on chromosome 5. Excess

Which of the following is the leading cause of morbidity and mortality in patients with Marfan syndrome? A) Arachnodactyly B) Pneumothorax C) Ectopia Lentis D) Aortic disease

D) Aortic disease

Which of the following antibodies is tested in patients suspected of having systemic lupus erythematosus (SLE)? A) Anticentromere B) Antigliadin C) P-ANCA D) Anti-Smith

D) Anti-Smith SLE is a chronic infl ammatory disorder involving multiple organs of the body, including skin, lungs, kidneys, and joints. Antibody testing for SLE usually includes antinuclear antibodies (ANA), antiphospholipid, anti-dsDNA, and anti wing iation anti-Smith

Which of the following pulmonary conditions is often seen in patients with systemic sclerosis? A) Interstitial lung disease B) Pneumothorax C) Aspiration pneumonia D) Chronic obstructive pulmonary disease (COPD)

A) Interstitial lung disease

Which of the following is an acute phase protein s to tissue injury? A) Antinuclear antibody (ANA) B) C-reactive protein (CRP) C) C-ANCA D) Anticentromere

B) C-reactive protein (CRP)

Which of the following organisms is commonly responsible for infl ammatory polyarthritis? A) Parvovirus B-19 B) Haemophilus infl uenzae C) Streptococcus pneumoniae D) Neisseria gonorrhoeae

A) Parvovirus B-19

Which of the following is the most destructive element of rheumatoid arthritis? A) Joint erosion B) Pannus formation C) Crystalline formation D) Rheumatoid nodules

B) Pannus formation

Which of the following pediatric conditions leads to fragile bones resulting in multiple fractures? A) Juvenile rheumatoid arthritis B) Sickle cell disease C) Osteogenesis imperfecta D) Osteoarthritis

C) Osteogenesis imperfecta Osteogenesis imperfecta, also known as brittle bone disease, is caused by gene mutations of alpha chains of type 1 collagen and posttransitional modifi cation of type 1 collagen. Type 1 collagen is an i protein for ligament, tendon, sclera, and bone. Dysfunctional type 1 collagen results in defective quality and fragility of bone seen in patients with osteogenesis imperfecta.

Which of the following is not part of the CREST syndrome? A) Telangiectasia B) Scleroderma C) Raynaud’s phenomenon D) Calcinosis

B) Scleroderma B) The CREST syndrome comprises calcinosis, Raynaud’s phenomenon, esophageal dysmotility, sclerodactyly, and telangiectasia.

In which of the following disorders would patients have a negative rheumatoid factor (RF)? A) Mixed connective tissue disease B) Rheumatoid arthritis C) Scleroderma D) Sjögren’s syndrome

C) Scleroderma

Which of the following organisms has been identifi ed as the cause of Lyme disease? A) Borrelia burgdorferi B) Streptococcus pyogenes C) Neisseria meningitidis D) Babesia microti

A) Borrelia burgdorferi

What is the most common cause of neuropathic arthropathy? A) Osteoarthritis B) Septic arthritis C) Systemic lupus D) Diabetes

D) Diabetes Most commonly seen in patients with diabetes mellitus, Charcot foot is a term given to neuropathic arthropathy causing painless soft-tissue swelling, bony fragments, and joint the ankle.

Which of the following is not a feature of fi bromyalgia? A) Pain in all four quadrants B) CREST syndrome C) Pain in 11 to 18 tender points D) Symptoms for at least 3 months

B) CREST syndrome

Which of the following is the most common benign tumor composed of adipocytes? A) Focal nodular hyperplasia B) Neuroblastoma C) Hemangioma D) Lipoma

D) Lipoma

Which of the following is not a type of connective tissue fi ber? A) Ependymal B) Collagen C) Elastic D) Reticular

A) Ependymal

Which of the following conditions causes calcifi cation of connective tissue? A) Fibrodysplasia ossifi cans progressiva B) Hajdu–Cheney syndrome C) Fetal hydantoin syndrome D) Hurler disease

A) Fibrodysplasia ossifi cans progressiva

What is the most common cause of acute nontraumatic monoarthritis in young adults? A) Septic arthritis B) Gonococcal arthritis C) Gout D) Rheumatoid arthritis

B) Gonococcal arthritis

Pain relieved by activity is a feature of which of the following types of arthritis? A) Osteoarthritis B) Rheumatoid arthritis C) Septic arthritis D) Gouty arthritis

B) Rheumatoid arthritis

Ankylosing spondylitis is associated with which of the following HLA allele? A) HLA-B47 B) HLA-B27 C) HLA-DR4 D) HLA-B72

B) HLA-B27

Which of the following is not a feature of Scheuermann kyphosis? A) Vertebral body wedging of at least 5 degrees B) Flattening of curvature with extension C) Involvement of at least three vertebral bodies D) Anterior wedging

B) Flattening of curvature with extension

Heberden’s nodes are a common feature in which of the following disease processes? A) Rheumatoid arthritis B) Septic arthritis C) Osteoarthritis D) Gouty arthritis

C) Osteoarthritis

What is the term given to the enlargement of the gastrocnemius semimembranosus bursa? A) Baker’s cyst B) Septic arthritis C) Gout D) Pseudogout

A) Baker’s cyst A) The gastrocnemius-semimembranosus bursa between the tendons of the medial head of the gastrocnemius and the semimembranosus muscles. The distention of this bursa is called a Baker’s cyst. Although usually asymptomatic, the rupture of a Baker’s cyst can cause acute pain in the back of th knee.

Class II and Class III RA

inflammatory septic

non-inflammatory types of connective tissue dse

osteoarthritis (degenerative) metabolic: lipid storage, hemochromatosis, ochronosis, hypogammaglobulinemia

name 7 critieria for RA and how many needed for diagnosis

4 needed of ``` morning stiffness arthritis of 3 or more joints . symmetric . rheumatoid nodule . serum rheumatoid factor . radiograhic changes ```

ESR correlation CRP

ESR - degree of synovial iflmmartion | CRP: degreee of inflammation

most common place for RA

cervical spine, transverse ligament of C1

adhesive capsulitis found in

shoulder RA

differentiate between stage III and IV of RA

fibrous or bony ankylosis

criteria for remission of RA

at least 2 months ``` . no fatigue . no join pain . no tnederness . no soft tissue swelling . EST <30 mm/hr ```

stage vs class in RA

Stage: degree of profression Class: functional ability

what is the most common joint disorder

osteoarthritis

inflammatory myopathies usually affect (proximal, distal) muscles

proximal

grotton's papules

dermatomyositis

Joints and Connective Tissue Flashcards

(100 cards)