Path/Pathophys Flashcards
What is the primary cause of death in patients with acute rheumatic fever?
Pancarditis
Which organisms can cause a reactive arthritis?
Shigella
Yersinia
Chlamydia
Campylobacter
Salmonella
“ShY ChiCS”
How does reactive arthitis present?
Following a Genitourinary (chlamydia) or GI (campylobacter, salmonella) infection:
Conjunctivitis
Urethritis
Arthitis
“cant see, pee or climb a tree”
Seronegative Spondyloarthropathies
- What are they characterized by? (3)
- What are the 3 types?
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
What type of cells and cytokines are mainly responsible for the pathogenesis of Rheumatoid Arthritis?
CD4+ T-cells
- IL-1: enhances T-cell response
- TNF-alpha: stimulates proliferation of inflammatory cells
Contracture
- What is it?
- How is it caused?
1.
Excessive wound contraction that can produce deformities
2.
Occurs due to excessive metalloproteinase activity
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?
Polymyositis
An immigrant presents with chronic progressive back pain, fever and there is radiographic evidence of vertebral bone destruction and fluid collection.
What caused this?
Tuberculosis –> Pott Disease
A patient with polycythemia vera presents with join pain, what would be the most likely finding in this patients synovial fluid?
Needle-shaped negative birefrigent crystals (GOUT)
(myeloproliferative disorders increase uric acid production)
What would most likely be seen on biopsy of the lip mucosa in a patient with Sjogren Syndrome?
Lymphocytic Infiltration
What are the most common complications of Sjogren Syndrome?
Non-hodgkin Lymphoma
Dental Carries (due to mouth dryness)
Corneal Damage (due to eye dryness)
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?

Osteosarcoma

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?
Dermatomyositis
- proximal muscle weakness (like polymyositis)
- malar rash involving nasolabial folds
- Gottron papules on fingers (seen in photo)
Associated with underlying adenocarcinoma
Ankylosing Spondylitis
- What is it?
- How can progression of the disease be monitored?
- 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)
- Via expansion of the Chest wall
Osteoporosis most commonly affects which part of the bone?
How does the bone present?
Trabecular Bone
Trabecular thinning and perforation
Which part of the spine is most likely to be affected in a patient with Rheumatoid Arthritis?
Cervical Spine
can lead to spinal instability and cord compression
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?

This patient has Finger Clubbing due to prolonged hypoxia
Most commonly due to Bronchiectasis
What autoantibodies are associated with Polymyositis/dermatomyositis?
ANA (non-specific)
anti-Jo-1 (Specific) –> against tRNA synthetase
What autoantibody is most specific for rheumatoid arthritis?
anti-cyclic citrullinated peptide antibody (most specific)
Note: will also have: IgM antibody that targets IgG Fc region
CREST Syndome
- how does it present?
- what antibody is present?
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
How would the following be altered in a patient with Paget Disease
- Calcium
- Phosphorus
- Alkaline Phosphatase
- no change
- no change
- elevated
(in Paget, there is only elevated alkaline phosphatase)
A patient presents with proximal muscle weakness, dry mouth and impotence.
- What is the most likely diagnosis?
- Why/how does it occur?
- What is it associated with?
- Lambert-Eaton Syndrome
- Autoanitobodies to presynaptic calcium channels
- Small-cell lung cancer
Fibromyalgia
- Classic presentation
- Initial Treatment
1.
Widespread muscle pain
Fatigue
Impaired attention/concentration
2. Exercise
A patient comes in complaining of knee pain.
Synovial fluid analysis is shown in the picture below.
- What is the diagnosis?
- What forms the crystals?
- Pseudogout –> rhomboid shaped crystals
- Calcium pyrophosphate
In a patient with osteoporosis, which letter in the picture below would best represent its levels of PTH and Calcium?
(NOTE: C is normal)

C
In osteoporosis serum calcium, phosphate, PTH and alkaline phosphatase are all normal
A patient presents with difficulty hearing.
She has a history of several bone fractures.
Her eyes are pictured below.
- What is the most likely diagnosis?
- What is the cause of this disease?
1.
Osteogenesis Imperfecta
2.
Occurs due to defective synthesis of type 1 collagen by osteoblasts
Is pregnancy possible in Turner Syndrome?
If yes, how?
Yes it is possible
In-vitro fertilization (IVF) is the most promising way to induce preganany
Note: Giving estogen and progesterone is also helpful
Retinoblastoma
- What is it?
- What mutation occurs?
- What is it highly associted with?
- Cancer of the retina
- Mutations of BOTH Rb genes (“double hit”)
- Osteosarcoma
What roles to Tropomyosin and Troponin C play in muscle contraction?
Tropomyosin blocks the the myosin-binding site on the actin filament untill calcium binds troponin C, which then shifts tropomyosin exposes the actinbinding site
Which letter corresponds to the area where there will only be thick filaments?

E
(the H Band)
“The H band is Heavy”

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