PMR 10 - joint & connective tissue disorders Flashcards

Question

What is a characteristic finding in polymyositis? a. Skin abnormalities b. Proximal muscle weakness c. Distal muscle weakness d. Ligamentous laxity

Answer 1

B) Polymyositis is characterized by proximal muscle weakness (hips are affected first, then the shoulders), dysphagia, and elevated muscle enzymes. Dermatomyositis has dermatological abnormalities in addition to the other listed symptoms.

Answer 2

A) The subtypes of rheumatoid arthritis are systemic, pauciarticular, and polyarticular. Pauciarticular involves 1 to 4 joints, poly articular involves 25 joints, and systemic is characterized by a systemic onset. Age of onset is less than 16, and duration of disease is equal to or more than 6 weeks.

Answer 3

D) Pseudogout is caused by calcium pyrophosphate crystals and exhibits positive birefringence when a polarizer is used. The crystals line up parallel to the polarizer and are yellow.

Answer 4

D) SLE is associated with a nonerosive arthritis.

Answer 5

B) Dupuvtren's contracture is an abnormal fibrous hyperplasia and contracture of the palmar fascia that causes a flexion contracture of the MCP and PIP joints. It is more common in white men age 50 to 70. It is associated with alcoholism, pulmonary tuberculosis, epilepsy, and diabetes mellitus. It is painless, but can cause functional problems.

Answer 6

D) Typical reasons for hospitalizing rheumatic disease patients include a decline in ADLs, steroid myopathy, tetraparesis, vasculitis, severe anemia, uncontrolled inflammation, and amputation. Pressure ulcers are not common in rheumatic disease patients.

Answer 7

B) Heating the joint to therapeutic levels increases the activity of synovial collagenase obtained from a rheumatoid joint. Superficial heat is commonly used by patients for selftreatment in those with rheumatic diseases.

Answer 8

C) Osteoarthritis (OA) of the knee is associated with obesity in women. OA has not been shown to be the result of osteochondritis dissecans or athletic activity.

Answer 9

D) A thumb spica splint immobilizes the two joints of the thumb. Although it may interfere with some activities of daily living (ADLs), it does provide consistent pain relief.

Answer 10

B) Cervical myelopathy (spinal cord compression) is the most serious complication of OA of the cervical spine. Although nerve roots can become impinged because of osteophytes (radiculopathy) as well, it is not as serious as spinal cord compression. Cervical myelopathy from 0A usually requires surgical intervention. Chronic pain can be associated with OA, but is not as serious as myelopathy.

Answer 11

D) Rheumatoid arthritis is an autoimmune disease resulting in inflammation in tissue and joints. The disease affects the digits of the hand. Swan neck deformity is caused by a rupture of the lateral retinaculum of the extensor tendon at the proximal interphalangeal joint, resulting in hyperextension of the proximal interphalangeal joint and hyperflexion of the distal interphalangeal joint. Osteoarthritis results from generalized wear and tear on the body with progressive degeneration of joints, including cartilage, bone, synovium, muscles, and ligaments. Rheumatoid arthritis is more commonly found in women, whereas osteoarthritis has more equal sex distribution. Rheumatoid arthritis is commonly diagnosed as early as age 20, whereas osteoarthritis affects those above age 40. Answer choices A and C are incorrect because swan neck deformity is seen in rheumatoid arthritis. Answer choice B is incorrect because hyperflexion of the PIP would result in Boutonnière deformity. This is caused by chronic synovitis of the joint, resulting in elongation and eventual rupture of the central slip tendon.

Answer 12

B) Rheumatoid arthritis is an autoimmune disease resulting in inflammation in tissue and joints. The disease affects the digits of the hand. Boutonnière deformity is caused when the PIP is slowly forced into flexion by chronic synovitis of the joint from rheumatoid arthritis. This causes an elongation of the central slip, ultimately leading to rupture. Subsequent volar displacement of the lateral bands below the axis of the PIP rotation creates increased tension on the DIP extensor mechanism, leading to hyperextension and limited flexion of the DIP. Osteoarthritis results from generalized wear and tear on the body with progressive degeneration of joints, including cartilage, bone, synovium, muscles, and ligaments. Rheumatoid arthritis is more commonly found in women, whereas osteoarthritis has more equal sex distribution. Rheumatoid arthritis is commonly diagnosed as early as age 20, whereas osteoarthritis affects those above age 40. Answer choices A and C are incorrect because Boutonnière deformity is seen in rheumatoid arthritis. Answer choice D is incorrect because hyperflexion of the DIP would result in swan neck deformity.

Answer 13

C) According to the American College of Rheumatology Fibromyalgia Diagnostic Criteria, 18 specific tender points and 9 bilateral sites are used in the diagnosis of fibromyalgia. Out of 18 tender points, 11 must be present for more than 3 months duration. The bilateral tender point sites include the occiput, lower cervical, trapezius, supraspinatus, second rib, lateral epicondyle, gluteal, greater trochanter, and knee.

Answer 14

A) Pseudogout commonly involves the knee and wrist as opposed to gout, which usually affects the big toe (termed podagra). Pseudogout is inflammation caused by calcium pyrophosphate crystals. Gout is inflammation caused by monosodium rate monohydrate crystals. Both can be diagnosed with aspirated synovial fluid. Pseudogout presents with acute joint swelling and pain commonly in the knee, but can also affect the wrist, shoulders, and hip.

Answer 15

B) Gout is an inflammatory arthritis most commonly found in the metatarsophalangeal joint at the base of the big toe, also termed podagra. Gout is caused by elevated levels of uric acid in the blood, which crystallizes into monosodium rate monohydrate crystals. These crystals are deposited into joints, most commonly the great toe. Causes include genetic predisposition, medications such as diuretics, increased alcohol consumption, and high purine diets. During an acute gouty attack, the great toe can become red, tender, and swollen. Acute gouty attacks can be treated with nonsteroidal anti-inflammatory drugs (NSAIDs), colchicine, and steroids. For long-term prevention, xanthine oxidase inhibitors such as allopurinol would be indicated.

Answer 16

C) Diarthrodial joints are freely moveable joints that are held together by a joint capsule. The composition of diarthrodial joints includes type 2 hyaline cartilage, subchondral bone, synovial membrane, synovial fluid, and joint capsule. Examples include the knee and shoulder. Rheumatoid arthritis first commonly affects the small joints of the hands. In later stages, it affects larger joints such as the knee and shoulder, both of which are diarthrodial joints. An amphiarthrodial joint is a slightly movable joint such as the spinal joints. A synarthrodial joint is an immovable joint such as sutural joints.

Answer 17

B) Rheumatoid arthritis is an inflammatory disorder that primarily affects synovial joints. Inflammation of the capsule around the joints, known as the synovium, is the first step in this destructive disease. Overtime, synovial cells are destroyed, causing hyperplasia. Neutrophils, macrophages, and B- and T-cell lymphocytes are activated to increase the inflammatory response. Pannus develops when the inflammation causing fibrin deposits develops into granulation tissue.

Answer 18

A) Hyperuricemia is found in gout, not pseudogout. Pseudogout is inflammation caused by calcium pyrophosphate crystal deposition. The exact mechanism is unknown, but aging is the only true risk factor. The onset is between ages 60 and 70. Gout is inflammation caused by monosodium rate monohydrate crystals. Both can be diagnosed with aspirated synovial fluid. Pseudogout is an acute form of the broader calcium pyrophosphate dihydrate deposition disease, L presenting with acute joint swelling and pain commonly in the knee, but can also affect the wrist, shoulders, hip, elbows, and metacarpophalangeal (MCP) joints.

Answer 19

B) The DIP is the location for Heberden's nodes. Bouchard's nodes and Heberden's nodes are formed when osteophytes, also known as calcific spurs, develop in the cartilage of the articular joint. Bouchard's and Heberden's nodes are seen in osteoarthritis. Metacarpophalangeal (MCP) joints are joints formed between the metacarpal bones and the proximal ends of the phalanges. Arthritis in the MCP joint is commonly found in patients with rheumatoid arthritis.

Answer 20

C) The ACR criteria state that rheumatoid arthritis involves the same area on both sides of the body. Involvement of three or more joints, presence of nodules, and morning stiffness are all seen in rheumatoid arthritis. Morning stiffness, arthritis of three or more joints, arthritis of the hand joints, and symmetric arthritis must be present for more than 6 weeks to qualify under the ACR guidelines. Radiographic changes and serum rheumatoid factor are included in the criteria. Four of the above mentioned criteria must be present.

Answer 21

C) Joint fluid analysis in a patient with an inflammatory arthritis would consist of a white blood cell count greater than 3,000 cells/mm3, greater than 70% polymorphonuclear leukocytes, lower viscosity due to its inflammatory nature, and elevated ESR. ESR is a sign of inflammation and as such, ESR would be elevated in inflammatory arthritis. The differential diagnosis for inflammatory arthritis includes rheumatoid arthritis, systemic lupus ery them atosus, gouty arthritis, Reiter's disease, pseudogout, and psoriatic arthritis. Decreased ESR would be found in noninflammatory arthritis, most commonly in osteoarthritis. Inflammatory arthritis patients usually have an acute onset, whereas noninflammatory arthritis patients usually have a slow, progressive, and degenerative course.

Answer 22

D) Reactive arthritis is an autoimmune condition developed in response to a recent infection, particularly after a genital infection with Chlamydia trachomatis or after an episode of gastroenteritis by Campylobacter species. The triad of symptoms includes urethritis, conjunctivitis, and arthritis. The mechanism of action is unknown, but it is assumed to involve the migration of bacterial antigens into the affected triad sites which proceed to cause an inflammatory response. This syndrome is usually self-limiting, but if symptoms are more severe, a course of steroids and immunosuppressants may be indicated. Of the answer choices, pericarditis is not a finding in Reiter's syndrome. Patients with rheumatic fever, an inflammatory disease after a streptococcal infection affecting the heart, joint, skin, and brain, can develop pericarditis. Patients with systemic lupus erythematosus can develop antigen-antibody complexes in the pericardium, causing inflammation or pericarditis.

Answer 23

C) Type I hypersensitivity reaction is immediate with IgE as a mediator. Examples include asthma and anaphylaxis. Type Il is also known as cytotoxic, or antibody-dependent, with IgM or IgG as mediators. Examples of type il hypersensitivity reaction include thrombocytopenia and erythroblastosis fetalis. Type Ill is also known as immune complex with laG as a mediator. Examples include rheumatoid arthritis and systemic lupus erythematosus. SLE is an autoimmune connective tissue disease. The immune system attacks the patient's own cells and tissues, causing inflammation and damage to the tissue. Type IV is also known as delayed-type or cell-mediated, with T-cells as a mediator. Examples include multiple sclerosis and chronic transplant rejection.

Answer 24

A) The Wright-Schober test is used to measure the ability to flex the lower back in a patient with AS. AS is a chronic inflammatory L condition of the spine and sacroiliac joint that leads to osseous formation in the spine. The test is conducted with the examiner identifying the fifth lumbar vertebrae (L5), marking 5 cm below this point, and another point 10 cm above L5. The examiner instructs the patient to attempt to touch his or her toes. Lumbar flexion should increase the distance between the two points by more than 5 cm. If the distance between the two points does not increase by 5 cm, flexion is limited and the test is considered positive.

Answer 25

C) Owing to the loss of joint and spinal motion in patients with ankylosing spondylitis, these patients should engage in range of motion exercises, including stretching and strengthening. Spinal extension exercises help decrease the severity of the condition. Sports that promote spinal extension are favored, including archery, badminton, and table tennis. Sports that require spinal flexion should be avoided in this group, including golf, bicycling, and bowling. Ninety percent of patients with ankylosing spondylitis are HLAB27 positive.

Answer 26

B) Radiographic findings of rheumatoid arthritis include osteopenia. All of the other answer choices can be seen in radiographs of patients with rheumatoid arthritis. Patients with osteoarthritis show no signs of osteopenia on radiographs.

Answer 27

D) Drug-induced lupus is a lupus-like syndrome without involvement of the central nervous system or kidneys. Certain drugs, including hydralazine, procainamide, isoniazid, chlorpromazine, methyldopa, and quinidine, have been linked to drug-induced lupus. Upon discontinuing the offending drug, symptoms usually resolve. Antihistone antibodies are present, which can help identify the problem. Rheumatoid arthritis is an autoimmune disease resulting in inflammation in tissue and joints. Sjögren's syndrome is an autoimmune disease involving lymphocyte infiltration and destruction of lacrimal and salivary glands. Patients with Sjögren's syndrome usually have dry eyes and dry mouth. Polymyositis is an inflammatory myopathy that results in symmetrical proximal muscle weakness.

Answer 28

C) Mobilization therapy aids in pain control and range of motion of joints and muscles. It includes massage, manipulation, and traction. Manipulation involves moving the stiff joints in their normal range of motion. Traction is the constant, steady pull of the joint or muscle. Relaxation therapy involves techniques that are taught to help release the tension formed in the muscles and ioints of the body. Hydrotherapy consists of patients relaxing the muscles and joints in warm water.

Answer 29

A) Dermatomyositis is a term used to describe polymyositis with the addition of a characteristic heliotrope rash, Gottron's papules, and shawl sign. A heliotrope rash is a butterfly rash around the eyes, bridge of the nose, and cheeks. Gottron's papules are papular, erythematous, scaly lesions over the metacarpophalangeal joints, proximal interphal angel joints, and distal interphal angel joints. Shawl sign is a rash on the shoulders and upper back, elbows, and knees. Similar to polymyositis, there is symmetric proximal muscle weakness sparing the distal musculature. Creatine kinase (CK) levels are markedly elevated, indicating muscle breakdown. The rash usually precedes the muscle weakness.

Answer 30

C) Rheumatoid arthritis is more common in females than in males. Rheumatoid arthritis is an inflammatory disorder that primarily affects synovial joints. Inflammation of the capsule around the joints, known as the synovium, is the first step in this destructive disease. Nodules are present in about 50% of patients with rheumatoid arthritis and are located most commonly over the pressure points of joints.

Answer 31

A) Indirect immunofluorescence pattern assists in determining the type of antibody present in the serum. Anti-dsDNA and anti-Smith antibodies are specific for SLE. Anti-sci-70 or antitopoisomerase and anticentromere antibodies are specific for scleroderma. Antisci-70 or antitopoisomerase antibody is specific for diffuse scleroderma. Anticentromere antibody is specific for limited scleroderma. Anti-Jo-1 antibody is associated with polymyositis and/or dermatomyositis.

Answer 32

A) Osteogenesis imperfecta, or brittle bone disease, is an autosomal dominant disorder caused by a gene mutation producing type 1 collagen. Type 1 collagen is the most abundant collagen in the body, found in scar tissue during healing. The bone mass in individuals with this disorder is diminished. Patients classically have blue sclera because of the lack of type 1 collagen formation in the eye allowing the choroidal veins to be seen.

Answer 33

C) Marfan syndrome is an autosomal dominant connective tissue disorder. There is a defect in the fibrillin protein. Fibrillin is normally found in connective tissue and is necessary for formation of elastic fibers. Patient's with Marfan syndrome exhibit long fingers and toes (arachnodactyly), dislocation of the lens in either or both eyes (ectopia lentis), skeletal deformities such as pectus excavatum and scoliosis. The most potentially fatal effect is cardiac involvement, especially with aortic root dilatation and aortic dissection.

Answer 34

B) Duchenne muscular dystrophy is an X-linked recessive muscle disease caused by an absence of the muscle protein dystrophin, leading to rapid muscle weakness. The first sign and symptom of Duchenne muscular dystrophy is progressive muscle weakness in the proximal muscles of the lower extremities. This can result in a positive Gower's sign (the child has to use hands and arms to stand up because of weakness of hip and thigh muscles). Levels of creatine kinase are very elevated. The prognosis is poor, with affected individuals having life expectancy less than 25 years of age. A less severe form of muscular dystrophy is Becker's muscular dystrophy. Becker's muscular dystrophy is caused by deficient dystrophin production, causing a slower progression of proximal muscle weakness. Fibrillin is deficient in patients with Marfan syndrome. Fibrillin is normally found in connective tissue and is necessary for formation of elastic fibers.

Answer 35

B) A seronegative arthritis is an arthritis in which the rheumatoid factor is negative. Of the choices, psoriatic arthritis, reactive arthritis and ankylosing spondylitis are all rheumatoid factor negative. Psoriatic arthritis is often a milder inflammatory arthritis that develops in approximately 30% of patients who already suffer with psoriasis. During flares, the arthritic symptoms may worsen. Reactive arthritis is an autoimmune condition developed in response to a recent infection, particularly after a genital infection with Chlamydia trachomatis or after an episode of gastroenteritis by Campylobacter species. The triad of symptoms includes urethritis, conjunctivitis, and arthritis. Ankylosing spondylitis is a chronic inflammatory condition of the spine and sacroiliac joint with osseous formation. Rheumatoid arthritis is an autoimmune disease, usually with a positive rheumatoid factor, resulting in inflammation in tissue and joints.

Answer 36

D) Paget's disease is a disease of bone. The bones are broken down and regenerated, causing them to weaken. Arthritic pain is common near sites of bone weakening, especially when subchondral bone is involved. Paget's disease commonly involves the pelvis, vertebrae, skull, tibia, and femur. Patients are usually asymptomatic; diagnosis is made by increased alkaline phosphatase levels or patchy appearance of bones on X-ray. The skull can become enlarged, and patients may complain of increased hat size over time. In addition, if the temporal bone is involved, headaches and hearing loss can occur from cranial nerve palsies.

Answer 37

B) Achondroplasia is an autosomal L dominant genetic disorder caused by a mutation in the fibroblast growth factor receptor 3 (FGFR3). It is the most common form of dwarfism. This mutation leads to impaired cartilage maturation in the growth plate, resulting in shortened bone, shortened stature, and a prominent forehead. The frequency is approximately 1 case in 15,000 to 40,000 births worldwide. No evidence of receptor mutation is linked with Paget's disease of bone, a disease of bone where bone is broken down and regenerated, causing bones to weaken. Osteogenesis imperfecta, or brittle bone disease, is an autosomal dominant disorder caused by a mutation in the gene producing type 1 collagen. Osteoporosis is caused when there is an imbalance between bone formation and bone resorption, leading to weak and fragile bones.

Answer 38

C) Volkmann's contracture is contracture of the flexor muscles due to ischemia in the volar aspect of the forearm. It usually occurs after a forearm injury. Forearm fractures and supracondylar fractures leading to compartment syndrome secondary to swelling can lead to ischemia of the affected region. Extended episodes of ischemia will cause necrosis of the muscle fibers causing them to scar and shorten. Usually, the deep muscles of the forearm, flexor digitorum profundus, and flexor pollicis longs are involved. Capsular contracture is the formation of capsular collagen fibers due to an abnormal immune response to artificial materials in the body (such as breast implants or prosthetic devices). Dupuytren's contracture is a flexion contracture caused by thickening of the connective tissue in the palmar fascia resulting in flexion of the fingers, particularly the fourth and fifth digits.

Answer 39

D) A positive Finkelstein's test (as described in the stem above) is suggestive of de Quervain's tenosynovitis, which is a tendonopathy of the extensor pollicis brevis and abductor pollicis longus tendons. This syndrome is commonly seen in new mothers and repetitive movements that involve repetitive ulnar or radial deviation of the wrist. De Quervain's tenosynovitis may also be seen in patients with rheumatoid arthritis.

Answer 40

C) RA usually presents as morning stiffness in multiple joints. RA is caused by autoimmune destruction of unknown etiology. Current American College of Rheumatology criteria for rheumatoid arthritis include morning stiffness lasting for at least 1 hour, involvement of three or more joints, involvement of at least one joint in the hand, symmetric involvement of joints, rheumatoid nodules, positive rheumatoid factor, and radiographic evidence of erosions or decalcification of joints. At least four of the seven criteria must be met for diagnosis.

Answer 41

D) Swan neck deformity is commonly seen in patients with rheumatoid arthritis, but can also be seen in patients with Ehlers-Danlos syndrome.

Answer 42

B) Pseudogout is an arthropathy caused by a collection of positively birefringent crystals of calcium pyrophosphate dihydrate crystals. Symptoms are usually noted in the knee, but can be present in other joints as well. Inflammation and limited range of motion of the involved joint are noted.

Answer 43

C) Marfan syndrome is an autosomal dominant condition caused by FBN1 gene mutation located on chromosome 5. Excess linear growth of long bones, arachnodactyly, and joint laxity are common skeletal findings. Cardiac conditions such as aortic root dilation and mitral valve pathology may be noted. Ectopia lentis seen in 50% to 80% of patients with Marfan syndrome.

Answer 44

D) Aortic root disease causing aortic dilatation, aortic dissection, and regurgitation is the main cause of morbidity and mortality in patients with Maran syndrome. Approximately 60% to 80% of adult patients with Marfan syndrome have aortic root dilatation, and the American Heart Association recommends an echocardiograph at the time of diagnosis.

Answer 45

D) SLE is a chronic inflammatory disorder involving multiple organs of the body, including skin, lungs, kidneys, and joints. Antibody testing for SLE usually includes antinuclear antibodies (ANA), antiphospholipid, anti-dsDNA, and anti-Smith antibodies. Complement levels C3 and C4 are monitored for response to therapy.

Answer 46

A) Interstitial lung disease is reported in more than 75% of patients with systemic sclerosis. A 5-fold increase in lung neoplasm is also noted in patients with systemic sclerosis.

Answer 47

B) CRP is an acute phase reactant that plavs a role in host defense with both inflammatory and anti-inflammatory actions. Serum CRP levels increase within 4 to 6 hours and normalize in 7 days.

Answer 48

A) A cute inflammatory polyarthritis is a self-limiting viral arthritis that presents with morning stiffness and symmetrical joint involvement of the upper extremities lasting a few weeks. Viruses commonly noted to cause polyarthritis include parvovirus B-19, Rubella, alphavirus, and hepatitis B and C viruses.

Answer 49

B) Pannus is a tissue derived from synovial membrane that causes destruction of cartilage and bone. Multinucleated cells with osteoclastic characteristics have been identified in the pannus-bone interface. This destruction can lead to instability of joints and eventual fibrosis, becoming the leading cause of morbidity in patients with rheumatoid arthritis.

Answer 50

C) Osteogenesis imperfecta, also known as brittle bone disease, is caused by gene mutations of alpha-1 and alpha-2 chains of type 1 collagen and posttransitional modifi cation of type 1 collagen. Type 1 collagen is an important structural protein for ligament, tendon, sclera, and bone. Dysfunctional type 1 collagen results in defective quality and fragility of bone seen in patients with osteogenesis imperfecta.

Answer 51

B) The CREST syndrome comprises calcinosis, Raynaud's phenomenon, esophageal dysmotility, sclerodactyly, and telangiectasia.

Answer 52

C) RFs are antibodies against the Fc part of the lgG and are not commonly seen in patients with scleroderma. Although the sensitivity of rheumatoid factor in rheumatoid arthritis is close to 90%, it is nonspecific because elevated levels of RF are found in Sjögren's syndrome, mixed connective tissue disease, systemic lupus erythematosus, and myositis.

Answer 53

C) Vitamin C deficiency leads to impaired collagen synthesis, resulting in pathological manifestations in tissues and organs containing collagen.

Answer 54

A) Lyme disease is a tick-borne illness caused mostly by B. burgdorferi in the United States. The early stage of Lyme disease involves formation of erythema migrans, a characteristic skin lesion that develops within 2 weeks to a month of exposure. Later stages can involve neurological and cardiac symptoms along with persistent arthritis involving large joints such as the knee.

Answer 55

D) Most commonly seen in patients with diabetes mellitus, Charcot foot is a term given to neuropathic arthropathy causing painless soft-tissue swelling, bony fragments, and joint effusion in the ankle. Although the pathophysiology of this process is unknown, current theories suggest that diabetic neuropathy causes lack of proprioception and results in ligamentous laxity, bone destruction, and instability. Other causes of Charcot joint are syphilis and syringomyelia.

Answer 56

B) Diagnosis of fibromyalgia syndrome according to the American College of Rheumatology (ACR) classification requires widespread pain in all four quadrants of the body, pain in 11 to 18 tender points, and symptoms lasting for at least 3 months. The syndrome is most commonly seen in women 20 to 60 years old. Triggers include physical activity, inactivity, sleep disturbance, and emotional stress.

Answer 57

D) Lipomas are lobules of adipocytes found in subcutaneous tissue, deep soft tissue, or surfaces of bone. These lesions are usually painless, unless compressing against adjacent tissue or nerves resulting in neurological or functional deficits.

Answer 58

A) Collagenous fibers are the most abundant of the connective tissue fibers and are found in vessels, cartilage, gut, skin, bone, tendons, and ligaments. Elastic fibers form the extracellular matrix and can stretch up to 1.5 times their length. Reticular fibers provide a framework and are found in the liver, marrow, and lymphatic organs.

Answer 59

A) Fibrodysplasia ossifi cans progressiva is an autosomal dominant disorder of connective tissue characterized by bone formation within connective tissue. Trauma usually precipitates the ossification of connective tissue, including minor trauma r such as intramuscular injections or bruises. Attempts to remove the calcified bone from the connective tissue result in further ossification.

Answer 60

B) Disseminated gonococcal infection can lead to gonococcal arthritis. This may present initially as tenosynovitis and eventually lead to destruction of the articular cartilage and fibrosis of the joint. Culture from synovial fluid is important for early diagnosis and to determine sensitivity to antibiotic therapy.

Answer 61

B) Morning stiffness is a feature of nearly all types of arthropathies, but rheumatoid arthritis has classically been noted to have morning stiffness lasting longer than an hour and relieved by movement.

Answer 62

B) The human leukocyte antigen is synonymous with the major histocompatibility complex and describes a group of genes on chromosome 6. Ankylosing spondylitis is a chronic inflammatory disease of the axial skeleton commonly associated with HLA-B27.

Answer 63

B) Scheuermann kyphosis occurs in early adolescence and is defined as anterior wedging of at least 5 degrees involving at least three vertebral bodies. Forward bending, extension, or lying supine does not resolve this rigid kyphosis that usually involves the thoracic or thoracolumbar spine.

Answer 64

C) Heberden's nodes are osteoarthritis enlargements in the distal interphalangeal joints and appear in more than half of patients with osteoarthritis. Repeated trauma causes these osteophyte formations to develop and may cause joint stiffness and tenderness.

Answer 65

A) The gastrocnemius-semimembranosus bursa is found between the tendons of the medial head of the gastrocnemius and the semimembranosus muscles. The distention of this bursa is called a Baker's cyst. Although usually asymptomatic, the rupture of a Baker's cyst can cause acute pain in the back of the knee.