Path/Pathophys

Question 1

What is the primary cause of death in patients with acute rheumatic fever?

Answer 1

Pancarditis

Question 2

Which organisms can cause a reactive arthritis?

Answer 2

Shigella

Yersinia

Chlamydia

Campylobacter

Salmonella

“ShY ChiCS”

Question 3

How does reactive arthitis present?

Answer 3

Following a Genitourinary (chlamydia) or GI (campylobacter, salmonella) infection:

Conjunctivitis

Urethritis

Arthitis

“cant see, pee or climb a tree”

Question 4

Seronegative Spondyloarthropathies

1. What are they characterized by? (3)
2. What are the 3 types?

Answer 4

1.

(1) Lack of rehumatoid factor (2) axial skeleton involvement,
(3) HLA-B27 involvelment

2.

Ankylosing Spondyloarthritis: involves sacroilliac joints+spine

Reactive Arthritis

Psoriatric Arthritis

Question 5

What type of cells and cytokines are mainly responsible for the pathogenesis of Rheumatoid Arthritis?

Answer 5

CD4+ T-cells

• IL-1: enhances T-cell response
• TNF-alpha: stimulates proliferation of inflammatory cells

Question 6

Contracture

1. What is it?
2. How is it caused?

Answer 6

1.

Excessive wound contraction that can produce deformities

2.

Occurs due to excessive metalloproteinase activity

Question 7

A patient presents with proximal muscle weakness who cant climb up the stairs or comb his hair.

Muscle biopsy reveals CD8+ lymphocyte infiltration.

What is the most likely diagnosis?

Answer 7

Polymyositis

Question 8

An immigrant presents with chronic progressive back pain, fever and there is radiographic evidence of vertebral bone destruction and fluid collection.

What caused this?

Answer 8

Tuberculosis –> Pott Disease

Question 9

A patient with polycythemia vera presents with join pain, what would be the most likely finding in this patients synovial fluid?

Answer 9

Needle-shaped negative birefrigent crystals (GOUT)

(myeloproliferative disorders increase uric acid production)

Question 10

What would most likely be seen on biopsy of the lip mucosa in a patient with Sjogren Syndrome?

Answer 10

Lymphocytic Infiltration

Question 11

What are the most common complications of Sjogren Syndrome?

Answer 11

Non-hodgkin Lymphoma

Dental Carries (due to mouth dryness)

Corneal Damage (due to eye dryness)

Question 12

A patient presents with knee pain and swelling.

X-ray reveals a large lytic lesion.

Histology of the mass is shown below.

What is the likely diagnosis?

Answer 12

Osteosarcoma

Question 13

A patient presents with proximal muscle weakness (unable to climb stairs or comb hair) and a rash. A picture of her hands are shown below.

What is the most likely diagnosis?

What is this condition associated with?

Answer 13

Dermatomyositis

• proximal muscle weakness (like polymyositis)
• malar rash involving nasolabial folds
• Gottron papules on fingers (seen in photo)

Associated with underlying adenocarcinoma

Question 14

Ankylosing Spondylitis

1. What is it?
2. How can progression of the disease be monitored?

Answer 14

1. It is a type of seronegative spondyloarthtitis

(lack of Rh factor, HLA-B27, axial skeleton involvement)

Occurs due to fusion of Sacroilliac joints + spine

Presents as low back pain due to vertebra fusion (bamboo spine)

2. Via expansion of the Chest wall

Question 15

Osteoporosis most commonly affects which part of the bone?

How does the bone present?

Answer 15

Trabecular Bone

Trabecular thinning and perforation

Question 16

Which part of the spine is most likely to be affected in a patient with Rheumatoid Arthritis?

Answer 16

Cervical Spine

can lead to spinal instability and cord compression

Question 17

A patient presents with multiple medical problems.

Examination of the patients hand is shown in the picture below.

What is the most likely cause of this patients hand findings?

Answer 17

This patient has Finger Clubbing due to prolonged hypoxia

Most commonly due to Bronchiectasis

Question 18

What autoantibodies are associated with Polymyositis/dermatomyositis?

Answer 18

ANA (non-specific)

anti-Jo-1 (Specific) –> against tRNA synthetase

Question 19

What autoantibody is most specific for rheumatoid arthritis?

Answer 19

anti-cyclic citrullinated peptide antibody (most specific)

Note: will also have: IgM antibody that targets IgG Fc region

Question 20

CREST Syndome

1. how does it present?
2. what antibody is present?

Answer 20

Calcinosis –> calcium deposits in soft tissue

Reynauds —> cyanosis due to cold or stress

Esophageal Dysmotility —> can caused GERD

Sclerodactyl —> thickening of skin of hands+feet

Telangiectasis –> dilated blood vessels

anti-centromere antibodies

Question 21

How would the following be altered in a patient with Paget Disease

1. Calcium
2. Phosphorus
3. Alkaline Phosphatase

Answer 21

1. no change
2. no change
3. elevated

(in Paget, there is only elevated alkaline phosphatase)

Question 22

A patient presents with proximal muscle weakness, dry mouth and impotence.

1. What is the most likely diagnosis?
2. Why/how does it occur?
3. What is it associated with?

Answer 22

1. Lambert-Eaton Syndrome
2. Autoanitobodies to presynaptic calcium channels
3. Small-cell lung cancer

Question 23

Fibromyalgia

1. Classic presentation
2. Initial Treatment

Answer 23

1.

Widespread muscle pain

Fatigue

Impaired attention/concentration

2. Exercise

Question 24

A patient comes in complaining of knee pain.

Synovial fluid analysis is shown in the picture below.

1. What is the diagnosis?
2. What forms the crystals?

Answer 24

1. Pseudogout –> rhomboid shaped crystals
2. Calcium pyrophosphate

Question 25

In a patient with osteoporosis, which letter in the picture below would best represent its levels of PTH and Calcium? (NOTE: C is normal)

Answer 25

C **In osteoporosis serum calcium, phosphate, PTH and alkaline phosphatase are _all normal_**

Question 26

A patient presents with difficulty hearing. She has a history of several bone fractures. Her eyes are pictured below. 1. What is the most likely **diagnosis**? 2. What is the **cause** of this disease?

Answer 26

1. **_Osteogenesis Imperfecta_** 2. Occurs due to **defective synthesis of type 1 collagen by osteoblasts**

Question 27

Is pregnancy possible in Turner Syndrome? If yes, how?

Answer 27

Yes it is possible **_In-vitro fertilization (IVF) i_**s the most promising way to induce preganany Note: Giving estogen and progesterone is also helpful

Question 28

**_Retinoblastoma_** 1. What is it? 2. What mutation occurs? 3. What is it highly associted with?

Answer 28

1. Cancer of the retina 2. Mutations of BOTH Rb genes ("double hit") 3. Osteosarcoma

Question 29

What roles to **Tropomyosin and Troponin C** play in muscle contraction?

Answer 29

**_Tropomyosin_ blocks the the myosin-binding site** on the actin filament untill **calcium binds _troponin C_**, which then shifts tropomyosin exposes the actinbinding site

Question 30

Which letter corresponds to the area where there will only be **thick filaments?**

Answer 30

**_E_** **(the H Band)** "The **_H_** band is **_H_**eavy"

Question 31

Whats the difference between the **H band** and the **A band**?

Answer 31

The **_H band_** contains only thick filaments The **_A band_** cotains the H band plus an area of overlap between myosin (thick) and actin (thin)