Rheumatology/ Orthopedics and Sports

Question 1

How do PPIs affect osteoporosis?

Answer 1

Longterm PPI use may be associated with increased osteoporosis risk, most likely do to a decreased absorption of Ca2+ (acidic environment is needed)

Question 2

What key structures form from the third pharyngeal pouch?

Answer 2

Thymus and inferior parathyroid glands

Question 3

What are the (5) general dz types associated with clubbing?

Answer 3

1. Lung dzs (oft associated with hypoxia)
2. Heart dzs (especially cynotic congenitals dzs and bacterial endocarditis)
3. IBD
4. Hyperthyroidism
5. Malabsorption

Question 4

For an otherwise health child, what is the most common cause of osteomyelitis?

Answer 4

Staph aureus

Question 5

Flattening of deltoid muscle + acromial prominence, suggests what type of injury?

Answer 5

Anterior humerous dislocation (most common type of shoulder dislocation)

Question 6

Tx of Giant cell (temporal) arteritis

Answer 6

Tx with high dose corticosteroids (to prevent blindness), and then get a biopsy

Question 7

Name the muscles of the rotator cuff and what each one does

Answer 7

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)

Question 8

Diffuse muscle pain + fatigue +neuropsych disturbances, w/ negative labs = what dz?

Answer 8

Fibromyalgia

Question 9

Thin (actin) filaments of the I band are bound to structural proteins, where? Thick (myosin) filaments?

Answer 9

Thin: Z-line

Thick: M-line

Question 10

Osgood-Schlatter Dz

1. Presentation
2. Etiology

Answer 10

1. Focal pain + swelling at the tibial tuberosity
2. Repetitive quadriceps contractions in adolescent (quads are attached to the tibial tuberositt, via the patella)

Question 11

Why is raloxifene usually a better choice than tamoxifen for tx of osteoporosis in women?

Answer 11

Unlike tamoxifen, raloxifene has does not have agonist activity in the uterus (which inc. risk of endometrial hyperplasia/CA)

Question 13

Function of the Posterior Cruciate Ligament

How is its integrity tested?

Answer 13

Prevents posterior displacement of the tibia relative to the femur. Tested via the posterior draw test.

Question 14

Tx of acute gout vs chronic gout

Answer 14

acute: NSAIDs (1st line), glucocorticoids, or colchicine (GI issues due to inhibition of microtubule formation)

chronic: Xanthine oxidase inhibitors

Question 15

What is the foundation of management for RA? Why are anti-inflammatory drugs often used?

Answer 15

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.

Question 16

Bisphonates have a chemical structure similar to _____________

Answer 16

Pyrophosphate

Question 17

Consequences of chronic gout

Answer 17

Tophi (uric acid crystals in the soft tissues/joints), or renal failure due to uric acid deposition in tubules

Question 18

Ankylosing Spondylitis

1. What is it?
2. Presentation

Answer 18

1. Chronic inflammatory condition assc. wtih HLA-B27 serotype
2. Low back pain + stiffness in a young man. Fusion of axial joints (hence bamboo spine)

Question 19

What specifc joints are most commonly fused in Ankylosing Spondylitis?

What are potential complications of AS? (3 systems)

Answer 19

Fusion of the sacroiliac and apophyseal joints of the spine are most commonly affected

Complications:

1. Respiratory: limited chest wall expansion leading to hypoventilation
2. CV: ***most common!!!– aortitis, leading to dilation of the aortic ring and aortic insufficiency
3. Uveitis (blurred vision, photophobia, conjunctival erythema, etc.)

Question 20

What role does NFK-B play in osteoclast differentiation?

Answer 20

RANK-L is the receptor for activated NFK-B

Question 21

Complications of Paget dz (2)

Answer 21

1. High Output cardiac failure
2. Osteosarcoma

Question 22

Describe the mechanism with which Sarcoidosis can lead to hypercalcemia

Answer 22

1-a hydroxylase expression in activated macrophages, leads to PTH independent Vit D activation and subsequent inc. intestinal absorption of Ca2+

Question 23

The valgus stress test indicates injury where?

Answer 23

Injury with the MCL (test ability to passively abduct knee)

Question 24

Other than the small joints of the hand, what other joints/bones are often affected by RA?

Answer 24

The cervical spine

Question 25

Describe the biopsy specimen associated _giant cell arteritis_. What other dz is this identical to?

Answer 25

Scattered, focal granulomatous inflammation centered on the media with : 1. intimal thickening 2. elastic lamina fragmentation 3. giant cell formation (not granulomatous) Same histo as **Takayasu arteritis**

Question 26

Describe the pathology of _Good Pasture Syndrome_

Answer 26

It is a Type II hypersensitivity, in which there are antibodies to the glomerulus basement membrane and alveolar basement membrae

Question 27

Between (Na+, K+, Cl-, and Ca2+): Which are mostly located intracellularly? Extracellularly?

Answer 27

Intracellular: K+ Extracellular: Na+, Cl-, Ca2+

Question 28

What is the role of protein A in *staph aureus*?

Answer 28

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.

Question 29

_McCune-Albright Syndrome_ Name the triad of clinical features

Answer 29

1. **Fibrous dysplasia** (multiple osteolytic-appearing lesions of the hip/ pelvis) 2. **Cafe-au-lait spots** 3. **Endocrine abnormalities** (precocious puberty, hyperthyroidism, etc.)

Question 30

_McCune-Albright Syndrome_ Pathogenesis

Answer 30

Mutation in the GNAS gene which leads to constitutive activation of the G protein/cAMP/ adenylate cyclase signaling cascade

Question 31

Describe the pathogenesis of _Polymyositus_

Answer 31

Over-expression of MHC-I on the sarcolemma leads CD8+ infiltration, and subsequent myocyte damage

Question 32

_Polymyositus_ Presentation

Answer 32

**Symmetrical** proximal _muscle weakness_

Question 33

Which **ligament** is most commonly involved in a _lateral ankle sprain_?

Answer 33

Anterior **talofibular ligament**