Joints and Connective Tissue Flashcards
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
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
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
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)
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
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
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
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.
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
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)
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
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
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
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
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
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
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
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
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
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
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
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
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
Which of the following is not a subtype of juvenile rheumatoid
arthritis?
A) Chronic
B) Systemic
C) Pauciarticular
D) Polyarticular
A) Chronic
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