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PAS 753 (Molecular Pathophysiology) > Musculoskeletal > Flashcards

Musculoskeletal Flashcards

1
Q

define arthritis

A

a group of conditions characterized by inflammatoy changes to varous joints of the bodyh

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2
Q

four types of arthritis

A

auto immune

osteo

gout

septic/infectious

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3
Q

two types of auto immunte arthritis

A

rheumatoid arthritis

lupus

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4
Q

what percent of the population has RA

what is the gender ratio

when do most people get RA

A

1%

female 3:1

80% between 35-64

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5
Q

HLA-DR4 is associated with what

is this correlated to incidence

A

RA

no, only 10-15 percent of twins with HLA-DR4 will have concordant RA

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6
Q

pathophy of RA

A

autoimmune response causes inflammation of the synovial membranes of multiple joints

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7
Q

trigger of RA

A

unknow, suspected infectious agent or smoking

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8
Q

what is the only behavioral risk factor of RA

A

smoking

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9
Q

four non-joint manifestations of RA

is there an effect on lifespan

A

anemia, pleura, eye, skin

life span is shortened, mechanism unknown

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10
Q

2/3 of RA patients will present with what

A

fatigue, malise, generalized weakness, vague joint complaints

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11
Q

when wil acute synovitis occur in RA

what is the delay between onset of RA and diagnosis

A

weeks to months after diagnosis

9 months

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12
Q

what is the hallmark symptom of RA

A

early morning stiffness lasting more than one hour

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13
Q

what joints are most commonly affected by RA

A

MP, PIP, knees

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14
Q

T/F periodic swelling of joints, with rednesss and pain are common with RA

A

true

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15
Q

pannus formation

A

inflammatory response to inflammation from RA causes destruction of cartilage and erosion of bone

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16
Q

ulnar deviation is typical of what type of arthritis

A

RA

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17
Q

what joints can be affected by RA

A

almost any joint except those of the thorax but including the neck

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18
Q

what is the prognosis of RA

what percent untreated people will have disability

what percent will have a work disability

A

it depends, there is a fluctuation of disease

80% will have disability within 12 years

50% will have work disability within 10 years

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19
Q

medications used in treatent of RA

A

NSAIDs

physical therapy

glucocorticoids

DMARDs

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20
Q

treatment strategy for RA

A

relieive pain with NSAIDs and physical therapy

prevent joint damage with disease modifying drugs

possibly repair damage

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21
Q

what has changed recently in RA treatment

A

DMARDs have allowed for early intervention with aggressive treatment, if patients can afford them

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22
Q

which type of arthritis is more common (and the most common cause of disability in the US)

A

Osteoarthritis

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23
Q

three risk factors for OA

A

age, joint loading/repetitive stress, obestity

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24
Q

what is the intial pathophysiology of OA

how does that progress

A

thickening followed by atrophy and damage to cartiliage which causes loss of cartilage and inflammation

the entire joint wil become involved and cause bone erosion

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25
though wear and tear is involved, what drives the ongoing damage
chronic inflammation
26
OA symptoms
pain on use that is worse with activity and improved with rest \<15 of stiffness each morning
27
differentiating factor between RA and OA
OA effects the hips and spine, RA doesn't, though it can effect many joints
28
OA treatment types
anti-inflammatory/analgesia cartilage repair surgical reduce joint loading
29
three examples of antiinflammtory/analgesic treatment of OA
NSAID, joint injections, heat therapy
30
methods to stimulate cartiliage repair in OA
glucosamine/chondroitin, chondroctye transplantation
31
surgical repair of OA
joint replacement
32
three ways to limt joint trauma in OA
reduce joint loading, change types of exercise, strengthen muscles
33
what is injected into a joint for OA
local anesthetic, glucocortcoids, hyaluronic acid
34
how many joints does gout usually effect
one
35
what is the cause of gout
a disorder which causes an accumulation of uric acid from gout and protein metabolism
36
T/f all gout will havy hypernuricema
true, but not all hyperuricemia will have gout
37
what joint is most commonly effected by gout
the big toe
38
tophus
a nodular deposit of urate monohydrate crystals that cuases a foreign body reaction
39
renal involvement of gout
urate crystals can deposit in the glomeruli and cause renal failure
40
gout treatment strategies
reduce acid production through diet reduce inflammation enhaance excretion
41
diet management of gout
decrease protein stop chemo allopurinol
42
what medication is used to treat gout by reducing inflammation
colchicine
43
what treatment that works on gout won't be very helpful in other cases of arthritis
colchicine will reduce pain only in gout, not OA and RA
44
how long does an acute gout flare last do they recur? when wil gout cause joint deformity
several days to weeks yes, in months or years later only in early onset or untreated goiut
45
what causes septic arthritits
bacteria infection of a joint from bloood or direct joint inoculation
46
three bacteria agents that will cause septic arthritis
gonorrhea, staph, strep, TB
47
when would a septicemia cause arthritis
a systemic infection, comonly in immuno suppressed patients or IV drug usres
48
when is direct inoculation a common cause of septic arthritis
complication of joint injection or post surgical
49
treatment of septic arthritis
intravenous abx removal of hardware
50
what is the prognosis of septic arthritis
usually good unless there are major ortho complication like after joint replacement
51
four types of primary bone cancer
multiple myeloma osteosarcoma chondrosarcoma ewing sarcoma
52
three types of secondary bone cancer
mets from lung, breaks, prostate
53
what is the most common type of primary bone cancer
multiple myeloma
54
what is more common, secondary or primary bone cancer
secondary
55
describe multiple myeloma in three bullets
most common form of bone cancer comes from a single plasma cell produces large amounts of antibodies
56
what is the most common symptom of multiple myeloma
bone pain in the back or ribs that is worse with movement and beter at rest
57
three consequences of bone marrow failure found in multiple myeloma
anemia bacterial infection increased bleeding
58
what is the radiographic hallmark of multiple myeloma
punch out lesions
59
how is mutiple myeloma diagnosed
Xray anemia high IgG or Ig components bone marrow biopsy with plasma cell prolifferation
60
T/F multiple myeloma bones are prone to fracture
true
61
what is the treatment for multiple myeloma
aggressive chemo, possibly bone marrow transplant
62
what is the process of a bone marrow transplant
destroy bone marrow with radiation and chem transplant hematogenous stem cells
63
what is the median survival time for multiple myeloma three causes of death
4-6 up from 3 years renal failure, infection, complications from chemo
64
what is the second most common primary bone cancer is it common overall? when does it most commonly strike
osteosarcoma no 60% in the first two decades
65
three subtypes of osteosarcoma
osteoblastic fibroblastic chondroblastic
66
where does osteosarcoma start what is the msot common complaint what is the risk of untreated cancer
in a long bone bone pain with pathologic fracture mets to other bones or the lungs
67
specific radiograhpic findings on xray
sunburt or codmans triangle lesion tthat needs to be surgically or needle biopsy
68
common treatment of osteosarcoma
amputation or excision of the tumor chemo
69
prognosis of osteosarcoma
good with treatment, greater than 10 years at 60-80% without, death in months
70
what causes osteosarcoma in older patients
radiation or transformation from pagets disease
71
osteoporosis
loss of calcium from overactive osteoclasts that results in a demineralization of bone with a normal bone matrix
72
what is the main complication of osteoporosi
increased risk of fracture
73
four common of osteoporosis
cushings hyperparathyroidism chronic renal disease involutional
74
what is the most common type of osteoporosis
involutional
75
two common drugs that cause osteoporosis
glucocorticoids or heparin
76
what is the most common bone disorder in the US what is the gender bias
involutional osteoporosis
77
why are men at less risk of involutional osteoporosis
men start with a higher bone density
78
four risk factors for osteoporosis
genetics smoking low calcium intake early menopause
79
clinical features of osteoporosis
wrist, hip, or vertebrae fracture loss of height due to fracture chronic back pain
80
how is bone density measured
DEXA
81
treatment of osteoporosis
Ca supplements estrogen selective estrogen modulators (SERMs) bisphosphates
82
what is the paradox of osteoporosis treatment
there are approved drugs to improve bone density and reduce fractures BUT there are significant risks
83
risks of osteoporosis treatment
estrogens: heart disease and breast cancer bisphosphonates: jaw osteonecrosis SERMs: hot flashes Ca supps: renal caliculi
84
two types of myalgia for our test
fibromyalgia polymyalgia rheumatica
85
how common is fibromyalgia what is the gender/age bias
common, 3-10% usually women ages 20-50
86
clinical findings of fibromyalgia
chronic diffuse pain fatigue, sleep disorders, headache increased pain sensation
87
what is the advantage of SERM treatment in osteoporosis
selectively effects estrogen receptors in bone
88
four theories for the cuase of fibromyaligia
virus, depression, sleep disorders, central sensitiization
89
central sensization theory of fibromyalgia
genetic defect in CNS pain signalling the involves cytokines and neurotransmitters (glutamate, dopamine)
90
how is fibromyalgia diagnosed
physical exam with trigger points widespread pain for longer than 3 montsh
91
treatment for fibromyalgia
antidepressants lifestyle adjustment (stress reduction, exercise, normal sleep)
92
polymyalgia rheumatica also has...
pain and stiffness of the shoulder and pelvic muscles causing difficulty combing hair or rising from a chair due to pain, not weakness also has a low grade fever, weight loss, and malaise
93
what age is most common for polymyalgia rheumatica
always after age 50, mean 72
94
what is the etiology of PR
autoimmune disorder with elevated ESR
95
common treatment of PR
predinsone should produce recovery in 72 hrs or its something else conitinue low does steroids for 6-12 montsh
96
special hazard of PR
connection with giant cell arteritis in 1/3 of patients what can cause sudden blindness due to occluding the opthalmic arteries
97
because of the risk of giant cell arteries, what should all new onset myalgia patients get
sed rate (ESR)

PAS 753 (Molecular Pathophysiology) (17 decks)

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