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1- Step up Rhem/Ortho > Orhto: 41-80 > Flashcards

Orhto: 41-80 Flashcards

1
Q

Butterfly photosensitive rash, inflammatory arthritis and what are features typical for new onset SLE

A

Ulcer at the hard palate

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2
Q

decreased levels of what might be seen in SLE

A

Decreased levels of complement due to loss of self tolerance and autoantibody production in SLE (leads to formation of circulating immune complexes)

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3
Q

Drugs that induce lupus like syndrome are likely to undergo what type of processing

A

Acetylation by the Liver (this also makes slow acetylators more susceptible to lupus like syndrome from these drugs

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4
Q

Name 8 drugs that are associated with osteoportoic fractures and thier possible mechanism

A
  • Anticonvulsants inducing CYP 450: INC Vitamin D catabolism
  • Aromatase inhibitors: Dec Estrogen
  • Medroxyprogesterone: Dec Estrogen
  • GnRH agonists: dec Testosterone and estrogen
  • Proton Pump Inhibitors: Dec Calcium absorption
  • Glucocorticoids: dec bone formation
  • Unfractionated heparin: Dec bone formation
  • Thiazolidinediones: dec bone fromation
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5
Q

Describe the effects of ankylosing spondylitis on the sacroiliac joints and axial skeleton

A

Morning stiffness and low backpain

Characterized by destruction of articular cartilage with reslting stiffness and fusion of axial joints

Sacroiliac joints tender to palpation and the spine may have dec range of motion

X ray may reveal erosions, sclerosis, narrowing, and ulimately fusion of the sarcroiliac joints

Spine x rays reveal sclerosis, ligametn calcification and vertebral fusion

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6
Q

WHat are the common HLA B27 disorders

A

PAIR

  • Psoriatic arthritis
  • Ankylosing spondylitis
  • IBD
  • Reactive arthritis
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7
Q

What is rheumatoid factor

A

Immunoglobulin IgM

against the self IgG

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8
Q

What are 2 ways to measure osteoclast activity and one way to measure osteoblast activity

A

OSteoclast activity

  • Urinary hydroxyproline: Hydroxyproline is also a breakdown product of collagen (not an ideal mareker becasuse common meats have cause high urine hydroxyproline
  • Urinary deoxypryidinoline: pyidinoline covalently cerosslinks collagen (most commonly used method to asses osteoclast activity)

Osteoblast

  • Bone specific alkaline phosphatase (can be differentiated by electrophoreseis and mAB from liver version; ALSO bone specific alkaline phosphatase is easily denatured by heat
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9
Q

A patient is given a drug and reacts with fever pruritic skin rash and arthralgias 7-14 days post administration.

What is he experiencing and what are some phsyiological characteristics.

A

Acute serum sickness

Caused by tissue deposition of circulating immuune complexes (TYPE III HYPERSENSITIVITY)

(thus will likely have decreased serum complement)

Affected tissues show small vessel vascultitis with fibrinoid necrossi and NEUTROPHIL infiltration

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10
Q

Patients with increased levels of IgE in their serum are typically prone to what

A

Typically found in atopic individuals

Prone to IgE mediated hypersensitivity reactions (TYPE 1)

These reactions characterized by vasodialtion, tissue edema and inflamamtory infiltration (baso/mast)

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11
Q

How do thiazide diuretics affect calcium concentration

A

They inhibit the NaCl Cotransporter in the distal convoluted tubule due to a drop in the intracellular sodium that increases the movement of the 3sodium in (to tubule cells) 2 calcium out (into blood) channel on the cellua

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12
Q

If you have a resting membrane potential of -70 and ion Equilibrium potentials of

  • Na= +60mV
  • K= -90mV
  • Cl=-75mV
  • Ca=+125mV
  • Mg=0mV

What ions would most likely flow into the cell after their ion channels open and why?

A

-70 is the charge inside the cell

Ions driven into Cell

  • Na: given its equilibrium is +60 it wants to increas the -70 of the cell to get it closer to that, since sodium is a positively charged molecule it will flow INTO the cell to increase the cells charge
  • Calcium: Same as above
  • Chloride: It’s equilibrium point is -75, lower then that of the cell, but since Cl is a negative ion it will also go INTO the cell but to try to lower its potential
    • (note potassium also wants a lower potential, but since it is a positive ion it has to flow out in order to try to make that happen)
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13
Q

What cell maintains short term release and deposition of calcium in the matrix of bone (calcium homeostasis) and where does it lie

A

Osteocyte

Lies in a lacunae connected to other osteocytes through canalicculie/gap junction

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14
Q

Clinical manifestations in reactive arthritis are due to what?

What woulld be found when aspirating the joint?

A

Immune complexes involving bacterial antigens

Howerver it is not disseminated infection Joint aspirates are STERILE

(ie it is reactive not infectious arthritis)

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15
Q

What is keratoderma blennorhagicum

A

extraarticualr vesiculopustualar waxy keritanized lesions on the soles palms and trunk in 15% of reactive arthrtiis cases

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16
Q

What condition is C1 inhibitor deficiency associated with

A

Hereditary angioedema

c1 inhibior normally degrades c1 and prevents excessive ccomplement activation and inflammation

17
Q

What condition would be associated with Hepatitis B and what would you see on tissue biopsy

A

Polyarteritis Nodosa (in up to 30% of cases)

segmental transmural inflamation of the arterial wall with fibrinoid necrosis

18
Q

In what arteries would you tend to see Polyarteriitis Nodosa

what organs are most affected?

A

Seen in small to medium arterries of ANY organ EXCEPT FOR THE LUNG

Organs (kidney heart, gi, liver most common)

Renal: Glomerulonephritis, Hypertension

Nervous: periph neuropathy, monnoneurtisis multiplex

GI: mesenteric ischemnia/bowel infaction, bleeding

MSK, Myositis, arthritis

19
Q

What joints are affected in Rheumatoid arthtis

A

PIP, MCP, MTP

Commonly see cervical spine involvement with SUBLUXATION, and cord compression

SPARES DIP

(c reactive protein and esr associated with disease activity)

20
Q

What artery supplies the blood to the femoral neck and head

A

The medial circumlex artery off of the femoral artery

(can be damaged in femoral neck fractures)

21
Q

Which artery is of concern in children with regards to the femur, but is not much of a conrern in adults

where is it found

A

The artery of the ligamentum teres/ the acetabular branch of the obturator

Supplies blood to the emoral head proximal to the epiphyseal growth plate

22
Q

Matrix metalloproteinase activity is responsible for what at the site of wound healing?

What about the in the event of unusually pronounced MMP activity

A

Mainly function to degrade collagen and other proteins of the extracellualr matrix, it encourages myofibroblast accumulation at the wound edges and scar tissue remodeling

unusually pronounced MMP activity could result in excessive wound contraction

23
Q

What is the terminolgy actin containing fibroblasts reffering to and what do the do

A

Myofibroblasts

responsible for contraction of scar tissue

24
Q

What is Wound dehiscence

A

rupturing of a previously closed wound

from insusfficient granlation or scar tissue, indaquate contraction or excessive stress

most commonly in abdominal wounds subject to inc intraabdominal pressure

25
Q

What is the mechanism of cholchice

A

Inhibit microtubule polymerization by bining to the tubulin protein that helps form microtubule aggregations

This disrupts cytoskeletal dependent functions like chemotaxis phagocytosis and degrtanulation

Should not be used in the elderly or those with renal dysfunction

26
Q

what do the suffix names of these biological agents mean their action is

mab

cept

nib

A

Mab: Monoclonal antibody

Cept: receptor molecule (ie it is a receptor molecule-etancercept)

Nib: kinase inhibitor

27
Q

A patient presents with malar rash, photosensitivity, and raynauds

What does one of the associated markers for this disease do with regard to cellualr function

A

SLE- Anti smith antibody

Smith protien complexes with smal nuclear RNA (snRNA) in the cytoplasm and forms small nuclear ribonucleoprotiens (snRNPs)

snRNA made by RNA pol II (also makes mRNA) cobines to make the snRNP the snRNPs and other proteins come togetehr TO FORM SPLICESOMES WHICH REMOVE INTRONS

28
Q

wHAT IS MONONEURITIS MULTIPLEX

A

assymetric multifocal neuropathy

29
Q

What is lofgren syndrom

A

Commonly associated with Sarcoidosis

Triad of Erythema nodosum, arthralgias, and bilateral hilar lymphadenopathy

30
Q

Child between 1-4 comes in with arm held close to body elbow exteneded (or slightly flexed) and forearm pronated. He appears in little distress until attpems are made to move the elbow

What ligament is involved and how is this fixed

Why is the child between 1-4

A

This is radial head subluxation (nursemaids elbow) occuring from a sharp pull on the hand when the forearm is pronated and the elbow is extended

This causes the ANNULAR LIGAMENT to tear from its radial attachmetn and slip over it

Reduction accomplished by fully supinating forearm followed by fully flexing the elbow

(occurs from 1-4 because by age 5 the ligament is thick and strong)

31
Q

What MSK disorder is associated with Giant Cell Arteritis and what would you tend to see with GCA

A

Associated with Polymyalgia Rheumatica (about half with GCA have it)

GCA almost exclusively seen in those over 50 (usually norther european descent)

GCA confers a higher risk for Throacic artery aneurysms (not berry aneurysms)

See focal granulomatous inflammation centered on the media with intimal thicening and elastic lamina fragmentation

Histologically it is identical to takayasu which typically involves aotrtic arch of youngerpatients

32
Q

Where do you tend to see these substances pathologically

Calcium oxylate

Calcium Pyrophosphate

Calcium hydroxyapatite

A
  • Calcium Oxylate: Sqare crystal which is one of the most common constitiuents of renal calculi
  • Calcium pyrophosphate: rhomboid shaped cyrstal seen in psuedogout joints
  • Calcium Hydroxyapatitie: calcific tendonitis from depostion of that in periarticular soft tissues particularly tendons an dmost commonly those of the rotator cuff
33
Q

Pain in the lower right knee of a 13 year old boy, relieved by rest but reproduced when knee is straightened while seated.

Evaluation reveals avusion of the secondary ossification center of the tibia due to repetitive muscle conttraciton.

What is this and where is the pathology located/related to

A

Osgood Schlatter disease (OSD)

Overuse injury of the secondary ossification center of the tibial tubercle commonly seen in young athletes after recent growth spurt

see pain and swelling at tibial tubercle insertion of patellar ligament

Reptitive contraction fo the quad and chronic avulsion cause proximal patellar tendon to seperate from the tubercule and the healing process CAUSES CALLUS FROMATION AND THE TUBRECLE TO BECOME ELEVATED AND PROMINENT

34
Q

After a midline clavicle fracture, which directions would the medial and lateral fragments be pulled and why?

A
  • Medial Fragment:
    • Pulled superiorly and posteriorly
    • Due to the sternocleidomastoid muscle
  • Lateral Fragment:
    • Pulled inferiorly and anteriorly
    • Due to the weight of the arm and the pectoralis major
35
Q

What is the triad of McCune Albright Syndrome

and what mutation causes it

A

MAS results from a MOSAIC somatic mutation during embryogenesis in the GNAS gene for the stimulatory alpha subunit of G protein; causing constant activation

Triad:

  • Large unilateral Cafe au Lait Macules with Irregular (coast oof maine) border: (caused by g protien stimulating activity in melanocytes)
  • Autonomous endocrine function: most commoonly precouious puberty (secondary sex development in girls before age 8 for example)
  • Polyostotic Fibrous dysplasia: due to increased proliferation of fibroblaast like cells, inc secretion of IL 6 and activation of osteoclasts (the polyosttotic referws to lesions in many bones though typically UNILATERAL)

1- Step up Rhem/Ortho (2 decks)

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