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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
Q

though wear and tear is involved, what drives the ongoing damage

A

chronic inflammation

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26
Q

OA symptoms

A

pain on use that is worse with activity and improved with rest

<15 of stiffness each morning

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27
Q

differentiating factor between RA and OA

A

OA effects the hips and spine, RA doesn’t, though it can effect many joints

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28
Q

OA treatment types

A

anti-inflammatory/analgesia

cartilage repair

surgical

reduce joint loading

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29
Q

three examples of antiinflammtory/analgesic treatment of OA

A

NSAID, joint injections, heat therapy

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30
Q

methods to stimulate cartiliage repair in OA

A

glucosamine/chondroitin, chondroctye transplantation

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31
Q

surgical repair of OA

A

joint replacement

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32
Q

three ways to limt joint trauma in OA

A

reduce joint loading, change types of exercise, strengthen muscles

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33
Q

what is injected into a joint for OA

A

local anesthetic, glucocortcoids, hyaluronic acid

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34
Q

how many joints does gout usually effect

A

one

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35
Q

what is the cause of gout

A

a disorder which causes an accumulation of uric acid from gout and protein metabolism

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36
Q

T/f all gout will havy hypernuricema

A

true, but not all hyperuricemia will have gout

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37
Q

what joint is most commonly effected by gout

A

the big toe

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38
Q

tophus

A

a nodular deposit of urate monohydrate crystals that cuases a foreign body reaction

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39
Q

renal involvement of gout

A

urate crystals can deposit in the glomeruli and cause renal failure

40
Q

gout treatment strategies

A

reduce acid production through diet

reduce inflammation

enhaance excretion

41
Q

diet management of gout

A

decrease protein

stop chemo

allopurinol

42
Q

what medication is used to treat gout by reducing inflammation

A

colchicine

43
Q

what treatment that works on gout won’t be very helpful in other cases of arthritis

A

colchicine will reduce pain only in gout, not OA and RA

44
Q

how long does an acute gout flare last

do they recur?

when wil gout cause joint deformity

A

several days to weeks

yes, in months or years later

only in early onset or untreated goiut

45
Q

what causes septic arthritits

A

bacteria infection of a joint from bloood or direct joint inoculation

46
Q

three bacteria agents that will cause septic arthritis

A

gonorrhea, staph, strep, TB

47
Q

when would a septicemia cause arthritis

A

a systemic infection, comonly in immuno suppressed patients or IV drug usres

48
Q

when is direct inoculation a common cause of septic arthritis

A

complication of joint injection or post surgical

49
Q

treatment of septic arthritis

A

intravenous abx

removal of hardware

50
Q

what is the prognosis of septic arthritis

A

usually good unless there are major ortho complication like after joint replacement

51
Q

four types of primary bone cancer

A

multiple myeloma

osteosarcoma

chondrosarcoma

ewing sarcoma

52
Q

three types of secondary bone cancer

A

mets from lung, breaks, prostate

53
Q

what is the most common type of primary bone cancer

A

multiple myeloma

54
Q

what is more common, secondary or primary bone cancer

A

secondary

55
Q

describe multiple myeloma in three bullets

A

most common form of bone cancer

comes from a single plasma cell

produces large amounts of antibodies

56
Q

what is the most common symptom of multiple myeloma

A

bone pain in the back or ribs that is worse with movement and beter at rest

57
Q

three consequences of bone marrow failure found in multiple myeloma

A

anemia

bacterial infection

increased bleeding

58
Q

what is the radiographic hallmark of multiple myeloma

A

punch out lesions

59
Q

how is mutiple myeloma diagnosed

A

Xray

anemia

high IgG or Ig components

bone marrow biopsy with plasma cell prolifferation

60
Q

T/F multiple myeloma bones are prone to fracture

A

true

61
Q

what is the treatment for multiple myeloma

A

aggressive chemo, possibly bone marrow transplant

62
Q

what is the process of a bone marrow transplant

A

destroy bone marrow with radiation and chem

transplant hematogenous stem cells

63
Q

what is the median survival time for multiple myeloma

three causes of death

A

4-6 up from 3 years

renal failure, infection, complications from chemo

64
Q

what is the second most common primary bone cancer

is it common overall?

when does it most commonly strike

A

osteosarcoma

no

60% in the first two decades

65
Q

three subtypes of osteosarcoma

A

osteoblastic

fibroblastic

chondroblastic

66
Q

where does osteosarcoma start

what is the msot common complaint

what is the risk of untreated cancer

A

in a long bone

bone pain with pathologic fracture

mets to other bones or the lungs

67
Q

specific radiograhpic findings on xray

A

sunburt or codmans triangle

lesion tthat needs to be surgically or needle biopsy

68
Q

common treatment of osteosarcoma

A

amputation or excision of the tumor

chemo

69
Q

prognosis of osteosarcoma

A

good with treatment, greater than 10 years at 60-80%
without, death in months

70
Q

what causes osteosarcoma in older patients

A

radiation or transformation from pagets disease

71
Q

osteoporosis

A

loss of calcium from overactive osteoclasts that results in a demineralization of bone with a normal bone matrix

72
Q

what is the main complication of osteoporosi

A

increased risk of fracture

73
Q

four common of osteoporosis

A

cushings

hyperparathyroidism

chronic renal disease

involutional

74
Q

what is the most common type of osteoporosis

A

involutional

75
Q

two common drugs that cause osteoporosis

A

glucocorticoids or heparin

76
Q

what is the most common bone disorder in the US

what is the gender bias

A

involutional osteoporosis

77
Q

why are men at less risk of involutional osteoporosis

A

men start with a higher bone density

78
Q

four risk factors for osteoporosis

A

genetics

smoking

low calcium intake

early menopause

79
Q

clinical features of osteoporosis

A

wrist, hip, or vertebrae fracture

loss of height due to fracture

chronic back pain

80
Q

how is bone density measured

A

DEXA

81
Q

treatment of osteoporosis

A

Ca supplements

estrogen

selective estrogen modulators (SERMs)

bisphosphates

82
Q

what is the paradox of osteoporosis treatment

A

there are approved drugs to improve bone density and reduce fractures

BUT

there are significant risks

83
Q

risks of osteoporosis treatment

A

estrogens: heart disease and breast cancer
bisphosphonates: jaw osteonecrosis

SERMs: hot flashes

Ca supps: renal caliculi

84
Q

two types of myalgia for our test

A

fibromyalgia

polymyalgia rheumatica

85
Q

how common is fibromyalgia

what is the gender/age bias

A

common, 3-10%

usually women ages 20-50

86
Q

clinical findings of fibromyalgia

A

chronic diffuse pain

fatigue, sleep disorders, headache

increased pain sensation

87
Q

what is the advantage of SERM treatment in osteoporosis

A

selectively effects estrogen receptors in bone

88
Q

four theories for the cuase of fibromyaligia

A

virus, depression, sleep disorders, central sensitiization

89
Q

central sensization theory of fibromyalgia

A

genetic defect in CNS pain signalling the involves cytokines and neurotransmitters (glutamate, dopamine)

90
Q

how is fibromyalgia diagnosed

A

physical exam with trigger points

widespread pain for longer than 3 montsh

91
Q

treatment for fibromyalgia

A

antidepressants

lifestyle adjustment (stress reduction, exercise, normal sleep)

92
Q

polymyalgia rheumatica

also has…

A

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
Q

what age is most common for polymyalgia rheumatica

A

always after age 50, mean 72

94
Q

what is the etiology of PR

A

autoimmune disorder with elevated ESR

95
Q

common treatment of PR

A

predinsone should produce recovery in 72 hrs or its something else

conitinue low does steroids for 6-12 montsh

96
Q

special hazard of PR

A

connection with giant cell arteritis in 1/3 of patients what can cause sudden blindness due to occluding the opthalmic arteries

97
Q

because of the risk of giant cell arteries, what should all new onset myalgia patients get

A

sed rate (ESR)

PAS 753 (Molecular Pathophysiology) (17 decks)

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