RHEUMATOLOGY REVIEW- short

Question 1

Sports: in general, no increased risk; exercise may be _________ in OA

Answer 1

protective

Question 2

Cartilage in early Osteoarthritis MMPS

Answer 2

Increased metalloproteinases

Question 3

Osteoarthritis Factors

Answer 3

Interleukin-1
Nitric oxide
Prostaglandins
Complement activation
Adipokines

Question 4

Rheumatoid Arthritis (RA)– A systemic, inflammatory, autoimmune disorder of unknown etiology that results predominantly in a peripheral, ____________ which can result in cartilage and bone destruction

Answer 4

symmetric synovitis

Question 5

Rheumatoid Arthritis– Disease susceptibility and severity associated with shared epitope (QKRAA; in antigen binding groove) in subtypes of __________

Answer 5

HLA-DR4 and HLA-DR1;

Question 6

Rheumatoid Arthritis– RF-IgG immune complexes are _____________

Answer 6

pathogenic

Question 7

____________: modulation and amplification of local immune response through antigen recognition (query altered proteoglycans or collagen; citrullinated peptides)

Answer 7

CD4+ memory T cells- Rheumatoid Arthritis

Question 8

Gout– The result of tissue deposition of monosodium urate (MSU) crystals due to hyperuricemia (MSU ___________ of extracellular fluids)

Answer 8

supersaturation

Question 9

Hyperuricemia: over-production or under-excretion of uric acid; ______________ (90%)

Answer 9

underexcretors

Question 10

Uric acid is a product of ___________ metabolism:

Answer 10

purine

Question 11

Humans lack _________ which oxidizes uric acid into allantoin

Answer 11

uricase

Question 12

Overproduction of uric acid (X-linked):
PRPP synthetase ___________
HGPRT deficiency (complete: Lesch-Nyhan)

Answer 12

overactivity

Question 13

Crystal arthritis is diagnosed by arthrocentesis and crystal identification by polarized microscopy (MSU crystals: ______________)

Answer 13

needle-shaped, negatively birefringent

Question 14

_________ promotes phagocytosis by PMNs
IgG: not specific anti-crystal antibodies
Apolipoprotein B-coating inhibits phagocytosis

Answer 14

IgG-coating

Question 15

Overproduction of uric acid (X-linked):
PRPP synthetase overactivity
HGPRT __________ complete: Lesch-Nyhan)

Answer 15

deficiency

Question 16

Crystal arthritis is diagnosed by ___________ and crystal identification by polarized microscopy (MSU crystals: needle-shaped, negatively birefringent)

Answer 16

arthrocentesis

Question 17

IgG-coating promotes phagocytosis by PMNs
IgG: not specific anti-crystal antibodies
______________ inhibits phagocytosis

Answer 17

Apolipoprotein B-coating inhibits

Question 18

Seronegative Spondyloarthropathies- Axial arthritis: spine, SI joints (__________); morning (am) stiffness

Answer 18

sacroiliitis

Question 19

Seronegative Spondyloarthropathies

_______- ligamentous-, tendinous-, fibrous-osseous junctions

Answer 19

Enthesitis:

Question 20

Seronegative Spondyloarthropathies Synovium: increased expression of_________

Answer 20

TNFalpha

HLA-B27 genetic association; neg RF and ANA

Question 21

Chance of developing AS:
2% if HLA-B27 positive
20% if HLA-B27 positive with a ___________

Answer 21

first-degree relative with AS

Question 22

Asymmetric, oligoarticular, lower ext arthritis

Answer 22

Reactive Arthritis- Bacterial environmental triggers transported to the joints inside monocytes (Chlamydia can be latent):

Question 23

Systemic Lupus Erythematosus (SLE)- Fundamental defect is the _________________, resulting in an autoimmune process; T cell and B cell process

Answer 23

misdirected recognition of self as foreign

Question 24

Systemic Lupus Erythematosus (SLE)- Antibody responses toward autoantigens are antigen-driven and ___________

Answer 24

require CD4+ T cells

Question 25

Chance of developing AS:
2% if ____________
20% if HLA-B27 positive with a first-degree relative with AS

Answer 25

HLA-B27 positive

Question 26

Loss of T cell tolerance permitting autoreactive B cell stimulation: ? central or ________________ abnormality in self-reactive lymphocyte deletion or anergy

Answer 26

peripheral

Question 27

Systemic Lupus Erythematosus (SLE)- Association with HLA-DR3 and ___________ (greatest risk)

Answer 27

C4A null allele

Question 28

Systemic Lupus Erythematosus (SLE)- Fundamental defect is the misdirected recognition of self as foreign, resulting in an autoimmune process; _________________

Answer 28

T cell AND B cell process

Question 29

Loss of T cell tolerance permitting autoreactive B cell stimulation: ? central or peripheral abnormality in ____________ lymphocyte deletion or anergy

Answer 29

self-reactive

Question 30

SLE: > 95% patients have + ANAs
Not specific for SLE: can occur in other CTDs
Antibodies are directed to _____________

Answer 30

multiple nuclear antigens

Anti-dsDNA antibodies: renal disease
Anti-histone antibodies: SLE and drug-induced lupus
Antibodies to non-DNA, non-histone nuclear antigens:

Question 31

SLE- Anti-phospholipid antibodies: block prothrombin activation in the clotting cascade; associated with increased ___________;

Answer 31

clotting

Question 32

Vasculitis: Immune complexes: inflamm→ PAFs→ ↑vascular permeability→ IC deposition; ___________

Answer 32

palpable purpura

Question 33

Cytoplasmic ANCA (c-ANCA):

Answer 33

Proteinase-3 (PR3) in primary granules of PMNs

Associated with generalized GPA (Wegener’s)

Question 34

Perinuclear ANCA (p-ANCA):

Answer 34

Myeloperoxidase (MPO) in primary granules of PMNs

Associated with microscopic polyangiitis (MPA)

Question 35

ANCA Vasculitis

Answer 35

Antineutrophil Cytoplasmic Antibodies (ANCAs):

Question 36

Vasculitis: Immune complexes: inflamm→ PAFs→ ↑____________→ IC deposition; palpable purpura

Answer 36

vascular permeability

Question 37

Anti-synthetase Syndrome

Answer 37

PM or DM presenting with:
Interstitial lung disease (ILD): 60%

Anti-Jo-1 = anti-histadyl-tRNA synthetase
Not pathologic or myotoxic antibodies

Question 38

Endomysial distribution of inflammatory cells (CD8+ T cells) surrounding and invading muscle fibers

Answer 38

Polymyositis

Question 39

Perivascular (CD4+ T cells) and perifascicular inflammatory infiltrate

Answer 39

Dermatomyositis