Rheumatology/ Orthopedics and Sports Flashcards
How do PPIs affect osteoporosis?
Longterm PPI use may be associated with increased osteoporosis risk, most likely do to a decreased absorption of Ca2+ (acidic environment is needed)
What key structures form from the third pharyngeal pouch?
Thymus and inferior parathyroid glands
What are the (5) general dz types associated with clubbing?
- Lung dzs (oft associated with hypoxia)
- Heart dzs (especially cynotic congenitals dzs and bacterial endocarditis)
- IBD
- Hyperthyroidism
- Malabsorption
For an otherwise health child, what is the most common cause of osteomyelitis?
Staph aureus
Flattening of deltoid muscle + acromial prominence, suggests what type of injury?
Anterior humerous dislocation (most common type of shoulder dislocation)
Tx of Giant cell (temporal) arteritis
Tx with high dose corticosteroids (to prevent blindness), and then get a biopsy
Name the muscles of the rotator cuff and what each one does
SITS
Supraspinatus- abducts arm initially (before deltoid takes over)
Infraspinatus (laterally rotates arm)
Teres minor (adducts and laterally rotates arm)
Subscapularis (medially rotates and adducts arm)
Diffuse muscle pain + fatigue +neuropsych disturbances, w/ negative labs = what dz?
Fibromyalgia
Thin (actin) filaments of the I band are bound to structural proteins, where? Thick (myosin) filaments?
Thin: Z-line
Thick: M-line
Osgood-Schlatter Dz
- Presentation
- Etiology
- Focal pain + swelling at the tibial tuberosity
- Repetitive quadriceps contractions in adolescent (quads are attached to the tibial tuberositt, via the patella)
Why is raloxifene usually a better choice than tamoxifen for tx of osteoporosis in women?
Unlike tamoxifen, raloxifene has does not have agonist activity in the uterus (which inc. risk of endometrial hyperplasia/CA)
Function of the Posterior Cruciate Ligament
How is its integrity tested?
Prevents posterior displacement of the tibia relative to the femur. Tested via the posterior draw test.
Tx of acute gout vs chronic gout
acute: NSAIDs (1st line), glucocorticoids, or colchicine (GI issues due to inhibition of microtubule formation)
chronic: Xanthine oxidase inhibitors
What is the foundation of management for RA? Why are anti-inflammatory drugs often used?
DMARDs (Dz-modifying antirheumatic drugs) such as methotrexate and sulfasalazine are the most key tx.
DMARDs take weeks to kick in so short-term tx with anti-inflammatory tx is often used in the meantime.
Bisphonates have a chemical structure similar to _____________
Pyrophosphate
Consequences of chronic gout
Tophi (uric acid crystals in the soft tissues/joints), or renal failure due to uric acid deposition in tubules
Ankylosing Spondylitis
- What is it?
- Presentation
- Chronic inflammatory condition assc. wtih HLA-B27 serotype
- Low back pain + stiffness in a young man. Fusion of axial joints (hence bamboo spine)
What specifc joints are most commonly fused in Ankylosing Spondylitis?
What are potential complications of AS? (3 systems)
Fusion of the sacroiliac and apophyseal joints of the spine are most commonly affected
Complications:
- Respiratory: limited chest wall expansion leading to hypoventilation
- CV: ***most common!!!– aortitis, leading to dilation of the aortic ring and aortic insufficiency
- Uveitis (blurred vision, photophobia, conjunctival erythema, etc.)
What role does NFK-B play in osteoclast differentiation?
RANK-L is the receptor for activated NFK-B
Complications of Paget dz (2)
- High Output cardiac failure
- Osteosarcoma
Describe the mechanism with which Sarcoidosis can lead to hypercalcemia
1-a hydroxylase expression in activated macrophages, leads to PTH independent Vit D activation and subsequent inc. intestinal absorption of Ca2+
The valgus stress test indicates injury where?
Injury with the MCL (test ability to passively abduct knee)
Other than the small joints of the hand, what other joints/bones are often affected by RA?
The cervical spine
Describe the biopsy specimen associated giant cell arteritis. What other dz is this identical to?
Scattered, focal granulomatous inflammation centered on the media with :
- intimal thickening
- elastic lamina fragmentation
- giant cell formation (not granulomatous)
Same histo as Takayasu arteritis
Describe the pathology of Good Pasture Syndrome
It is a Type II hypersensitivity, in which there are antibodies to the glomerulus basement membrane and alveolar basement membrae
Between (Na+, K+, Cl-, and Ca2+):
Which are mostly located intracellularly? Extracellularly?
Intracellular: K+
Extracellular: Na+, Cl-, Ca2+
What is the role of protein A in staph aureus?
Protein A is a virulence factor found in the peptidoglycan wall of Staph Aureus that binds the Fc portion of IgG, leading to impaired complement activation, opsonization, and phagocytosis.
McCune-Albright Syndrome
Name the triad of clinical features
- Fibrous dysplasia (multiple osteolytic-appearing lesions of the hip/ pelvis)
- Cafe-au-lait spots
- Endocrine abnormalities (precocious puberty, hyperthyroidism, etc.)
McCune-Albright Syndrome
Pathogenesis
Mutation in the GNAS gene which leads to constitutive activation of the G protein/cAMP/ adenylate cyclase signaling cascade
Describe the pathogenesis of Polymyositus
Over-expression of MHC-I on the sarcolemma leads CD8+ infiltration, and subsequent myocyte damage
Polymyositus
Presentation
Symmetrical proximal muscle weakness
Which ligament is most commonly involved in a lateral ankle sprain?
Anterior talofibular ligament