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UWorld - Musculoskeletal > Path/Pathophys > Flashcards

Path/Pathophys Flashcards

1
Q

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

A

Pancarditis

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2
Q

Which organisms can cause a reactive arthritis?

A

Shigella

Yersinia

Chlamydia

Campylobacter

Salmonella

“ShY ChiCS”

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3
Q

How does reactive arthitis present?

A

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

Conjunctivitis

Urethritis

Arthitis

“cant see, pee or climb a tree”

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4
Q

Seronegative Spondyloarthropathies

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

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

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5
Q

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

A

CD4+ T-cells

  • IL-1: enhances T-cell response
  • TNF-alpha: stimulates proliferation of inflammatory cells
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6
Q

Contracture

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

1.

Excessive wound contraction that can produce deformities

2.

Occurs due to excessive metalloproteinase activity

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7
Q

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?

A

Polymyositis

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8
Q

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

What caused this?

A

Tuberculosis –> Pott Disease

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9
Q

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

A

Needle-shaped negative birefrigent crystals (GOUT)

(myeloproliferative disorders increase uric acid production)

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10
Q

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

A

Lymphocytic Infiltration

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11
Q

What are the most common complications of Sjogren Syndrome?

A

Non-hodgkin Lymphoma

Dental Carries (due to mouth dryness)

Corneal Damage (due to eye dryness)

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12
Q

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?

A

Osteosarcoma

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13
Q

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?

A

Dermatomyositis

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

Associated with underlying adenocarcinoma

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14
Q

Ankylosing Spondylitis

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

  1. Via expansion of the Chest wall
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15
Q

Osteoporosis most commonly affects which part of the bone?

How does the bone present?

A

Trabecular Bone

Trabecular thinning and perforation

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16
Q

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

A

Cervical Spine

can lead to spinal instability and cord compression

17
Q

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?

A

This patient has Finger Clubbing due to prolonged hypoxia

Most commonly due to Bronchiectasis

18
Q

What autoantibodies are associated with Polymyositis/dermatomyositis?

A

ANA (non-specific)

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

19
Q

What autoantibody is most specific for rheumatoid arthritis?

A

anti-cyclic citrullinated peptide antibody (most specific)

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

20
Q

CREST Syndome

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

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

21
Q

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

  1. Calcium
  2. Phosphorus
  3. Alkaline Phosphatase
A
  1. no change
  2. no change
  3. elevated

(in Paget, there is only elevated alkaline phosphatase)

22
Q

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?
A
  1. Lambert-Eaton Syndrome
  2. Autoanitobodies to presynaptic calcium channels
  3. Small-cell lung cancer
23
Q

Fibromyalgia

  1. Classic presentation
  2. Initial Treatment
A

1.

Widespread muscle pain

Fatigue

Impaired attention/concentration

2. Exercise

24
Q

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?
A
  1. Pseudogout –> rhomboid shaped crystals
  2. Calcium pyrophosphate
25
Q

In a patient with osteoporosis, which letter in the picture below would best represent its levels of PTH and Calcium?

(NOTE: C is normal)

A

C

In osteoporosis serum calcium, phosphate, PTH and alkaline phosphatase are all normal

26
Q

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?
A

1.

Osteogenesis Imperfecta

2.

Occurs due to defective synthesis of type 1 collagen by osteoblasts

27
Q

Is pregnancy possible in Turner Syndrome?

If yes, how?

A

Yes it is possible

In-vitro fertilization (IVF) is the most promising way to induce preganany

Note: Giving estogen and progesterone is also helpful

28
Q

Retinoblastoma

  1. What is it?
  2. What mutation occurs?
  3. What is it highly associted with?
A
  1. Cancer of the retina
  2. Mutations of BOTH Rb genes (“double hit”)
  3. Osteosarcoma
29
Q

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

A

Tropomyosin blocks the the myosin-binding site on the actin filament untill calcium binds troponin C, which then shifts tropomyosin exposes the actinbinding site

30
Q

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

A

E

(the H Band)

“The H band is Heavy”

31
Q

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

A

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)

UWorld - Musculoskeletal (1 decks)

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