MSK path IX

Question 1

what is OA

Answer 1

degeneration of cartilage causing structural and functional failure of synovial joints
failure/disordered repair

Question 2

what occurs in early OA

Answer 2

chondrocytes proliferate and the collagent II fibers cleaved causes fissures and clefts

Question 3

what are joint mice

Answer 3

parts of cartilage that slough into joint in OA

Question 4

what cap the osteophytes in OA

Answer 4

fibrocartilage and hyaline

Question 5

what is eburnated articular surface in OA

Answer 5

friction on bone causing smoothign surface

Question 6

Sx OA

Answer 6

deep achy pain that worsens with use
morning stiffness, crepitus
limited ROM
impingement on spinal foramina by osteophytes

Question 7

what occurs with radiculopathy from OA

Answer 7

muscle spasms, radicular pain, muscle atrophy and neurologic deficits

Question 8

joints commonly involved in OA

Answer 8

hips knees, lower lumbar and cervical vertebrae, PIPs DIPs, first CMC and first TMT

Question 9

heberden nodes

Answer 9

prominent osteophyes at DIP joints

common in women

Question 10

Dx OA

Answer 10

radiographically because can see osteophytes

Question 11

red ragged bloody clots in joint capsule

Answer 11

RA

Question 12

RA

Answer 12

chronic inflammatory disorder of autoimmune origin
may affect many tissues and organs principally attacks joints producing nonsuppurative proliferatice and inflammatory synovitis

Question 13

what do hands look like in RA

Answer 13

ulnar deviation

Question 14

What is common genetically in RA

Answer 14

HLA susceptibility

Question 15

what cells are involved in RA

Answer 15

T ell B cell and Macrophages

Question 16

What cells initiate immune response in RA

Answer 16

CD4 T cells

reacti with arthritogenic agent

Question 17

what specified Tx is helpful in RA and why

Answer 17

TNF antagonists because TNF somehow involved in RA

Question 18

What is in the synovium of RA

Answer 18

germinal centers with secondary follicles and many plasma cells (autoAb)

Question 19

synovium in RA

Answer 19

thick edema
hyperplastic
synovial cell hyperplasia, dense inflammatory infiltrates
increased vasculaity
fibrinopurulent exudate
osteoclastic activity in underlying bone

Question 20

what is pannus

Answer 20

mass of edematous synovium, inflammatory cells, granulation tissue and fibroblasts that grows over articular cartilage and causes its erosion

Question 21

what is it called when pannus bridges opposing bones

Answer 21

fibrous anklyosis leads to boney ankylosis when it fuses

Question 22

blue cells with hoff bodies

Answer 22

plasma cells

Question 23

are plasma cells normal in synovium

Answer 23

no

Question 24

what are RA subcutaneous nodules

Answer 24

parts of skin subject to pressure
firm nontender and round to oval
in subcutaneous tissue

Question 25

what do RA subcutaneous nodules look like microscopically

Answer 25

necrotizing granulomas with central zone fibrinoid necrosis with rim of macrophages, lymphocytes and plasma cells

Question 26

increased RF in RA patient

Answer 26

higher risk for vasculitis

Question 27

acute necrotizing vasculitis with RA involves what and can lead to what

Answer 27

small and large aa | neuropathies, ulcers and gangrene

Question 28

leukocytoclastic vasculitis can cause what

Answer 28

purpura, cutaneous ulcers, nail bed infarction | ocular changes like uveitis and keratoconjunctivitis

Question 29

palisade necrozing granuloma need to test for?

Answer 29

TB | can be rheumatoid nodule in lung

Question 30

Sx RA

Answer 30

slow malaise, fatigue, generalized MSK pain

Question 31

what mediates pain in RA

Answer 31

IL1 and TNF

Question 32

joint progression in RA

Answer 32

small joints first | symmetrically

Question 33

what part of skeleton is usually spared in RA

Answer 33

lumbosacral and hips

Question 34

Dx RA

Answer 34

characteristic radiographic finding sterile turbid synovial fluid with poor mucin clot combination of RF and anti CCP Ab

Question 35

ehy does the synovial fluid of RA joint have poor mucin clot

Answer 35

all the inflammatory products break it downw

Question 36

what are the inclusion breaing neutrophils in RA synovial fluid

Answer 36

tart cells

Question 37

anti CCP Ab is best used for what

Answer 37

RA screening!!

Question 38

What is Juvenile idiopathi arthritis

Answer 38

unknown cause arthritis before age 16 and persist for >6 weeks

Question 39

differences of RA and JIA

Answer 39

``` JIA: oligoarthritis unilateral systemic disease more frequent large joints affected more RF and nodules usually absent ANA sero + ```

Question 40

ANA + means what

Answer 40

autoimmune

Question 41

seronegative spondylarthropathies have what

Answer 41

assoc with HLA B27 no RF involve SI joints

Question 42

anklyosing spondylitis

Answer 42

destruction of cartilage and bony anklyosis of SI and apophyseal joints

Question 43

what are apophyseal joints

Answer 43

between tuberosities and processes

Question 44

when does anklyosing spondylitis become Sx

Answer 44

20-30 years because of low back pain and spinal immobility

Question 45

what peripheral joints are involved in anklyosing spondylitis sometimes

Answer 45

hips, knees, shoulders

Question 46

HLA with anklyosing spondylitis

Answer 46

B27

Question 47

What is reactive arthritis

Answer 47

reiter syndrome arthritis, nongonococcal urethritis or cervicitis conjunctivitis

Question 48

HLA assoc with reactive arthritis

Answer 48

HLA B27 and HIV individuals

Question 49

age of reactive arthritis

Answer 49

20s 30s

Question 50

prior infection that can trigger reactive arthritis

Answer 50

chlamydia, shigella, salmonella, yersinia, campylobacter