S3_L1: Introduction to Osteoarthritis and Rheumatoid Arthritis Flashcards
TRUE OR FALSE: Synovial joints are the most common type of joint found in the human body. Only synovial (true) joints will have an arthritis.
A. Both statements are true
B. Both statements are false
C. Only the 1st statement is true
D. Only the 2nd statement is true
A. Both statements are true
Synovial joints are characterized by the presence of a fluid-filled (1)_______ contained within a (2)_______
- joint cavity
- fibrous capsule
Synovial joints are covered by a thin layer of ________
hyaline cartilage
The following statements are true about the Articular Capsule, EXCEPT:
A. connective tissue surrounds the bone
B. connects one bone to another
C. continuous with the periosteum of articulating bones
D. consist of the fibrous and synovial layer
E. None of the above
A. connective tissue surrounds the bone
NOTE: It surrounds the joint
Match the following layers of the articular capsule to its corresponding description.
- highly vascularized
- holds together the articulating bones
- absorbs and secretes synovial fluid
- blends with ligaments
- AKA as the synovium
A. Fibrous layer
B. Synovial layer
- B
- A
- B
- A
- B
What do you call the white fibrous tissue that makes up the fibrous layer of the articular capsule?
capsular ligament
Enumerate the three main features of a synovial joint.
- articular capsule
- articular cartilage
- synovial fluid
What is the main function of the fibrous layer?
Support
Match the following cell types found in the synovial layer.
- produce synovial fluid
- unknown function and origin
- located in superficial layer
- derived from macrophages
- intermediate cell type
A. type A cells
B. type B cells
C. type C cells
- B
- C
- A
- A
- C
Match the following cell types found in the synovial layer.
- has a phagocytic function
- non-fixed cells with antigen presenting ability
- fibroblast like cells
- serve as multipotent precursor
- produce hyaluronic acid, fibronectin, collagen
A. type A cells
B. type B cells
C. type C cells
- A
- A
- B
- C
- B
TRUE OR FALSE: The main function of the synovial layer is to mediate nutrient exchange between blood and joint fluid
True
The synovial fluid (1)_____ the articular cartilage and provides (2)______ through (3)_____
- lubricates
- nourishment
- diffusion
Synovial fluid is made from an ultrafiltrate of ____
blood plasma
The Synovial fluid consists the following, EXCEPT:
A. hyaluronic acid
B. prostaglandins
C. leukotrienes
D. collagenases
E. None
C. leukotrienes
Determine which content of the synovial fluid is being described.
Reduces friction between opposing surfaces of cartilage
A. hyaluronic acid
B. prostaglandins
C. lubricin
D. collagenases
E. proteinase
C. lubricin
Determine which content of the synovial fluid is being described.
Lubricate the surface between synovium and cartilage
A. hyaluronic acid
B. prostaglandins
C. lubricin
D. collagenases
E. proteinase
A. hyaluronic acid
Determine which content of the synovial fluid is being described.
Increase the viscosity and elasticity of articular cartilage
A. hyaluronic acid
B. prostaglandins
C. lubricin
D. collagenases
E. proteinase
A. hyaluronic acid
Determine which content of the synovial fluid is being described.
Responsible for the boundary layer lubrication
A. hyaluronic acid
B. prostaglandins
C. lubricin
D. collagenases
E. proteinase
C. lubricin
The articular cartilage (Hyaline) has two main roles:
- minimizes ______ upon joint movement
- absorbs _______
- friction
- shock/load
The following are functions of the synovial fluid, EXCEPT:
A. Lubrication
B. Friction Minimization
C. Shock absorption
D. Nutrient distribution
E. None
B. Friction Minimization
Articular cartilage is relatively (1)_____, and is reliant upon the passive (2)_____ of nutrients from the synovial fluid.
- avascular
- diffusion
TRUE OR FALSE: Accessory Ligaments consist of bundles of thin irregular connective tissue. It highly adapted for resisting shock.
A. Both statements are true
B. Both statements are false
C. Only the 1st statement is true
D. Only the 2nd statement is true
B. Both statements are false
NOTE: These are dense regular connective tissue, highly adapted for resisting strain.
This is a a small sac lined by synovial membrane, and filled with synovial fluid.
Bursae
TRUE OR FALSE: Bursae afford joints greater freedom of movement, whilst protecting the articular surfaces from friction induced degeneration
True
A bursa can become inflamed following (1)_____ or (2)_____ of the joint
- infection
- irritation by overuse
This law states that the nerves supplying a joint also supply the muscles moving the joint and the skin covering their distal attachments
Hilton’s Law
This is a joint disorder featuring inflammation is frequently accompanied by pain.
Arthritis
Joint pain is referred to as _______
arthralgia
Arthritis leads to the following impairments, EXCEPT:
A. Chronic pain
B. Loss of function
C. Deformities
D. Decrease in overall QOL
E. None
E. None
TRUE OR FALSE: Arthritis is the most common cause of disability
True
The following characterizes an articular arthritis, EXCEPT:
A. “locking”
B. crepitation
C. instability
D. hypermobility
E. None
D. hypermobility
What kind of pain characterizes an articular arthritis?
deep or diffuse pain
The following characterizes a NON-articular arthritis, EXCEPT:
A. pain on active ROM
B. pain on passive ROM
C. focal tenderness adjacent to articular structures
D. crepitus
E. None
B. pain on passive ROM
Enumerate the four cardinal signs of inflammation
Erythema (rubor)
Warmth (calor)
Pain (dolor)
Swelling (tumor)
What is the 5th cardinal sign of inflammation?
loss of function
The following are signs and symptoms of inflammatory disorders, EXCEPT:
A. Endocrinopathy
B. Cardiac failure
C. Depression
D. Anemia
E. None
E. None
The following are signs and symptoms of inflammatory disorders, EXCEPT:
A. Evening stiffness
B. Fever
C. Rash
D. Weight loss
E. None
A. Evening stiffness
The following are signs and symptoms of inflammatory disorders, EXCEPT:
A. hyperalbuminemia
B. thrombocytosis
C. fatigue
D. poor nutrition
E. None
A. hyperalbuminemia
Determine if the following is an inflammatory disorder or not.
- Neoplasm
- Pseudogout
- Fibromyalgia
- Reiter’s syndrome
- Systemic lupus erythematosus
A. Inflammatory disorders
B. Non-inflammatory disorders
- B
- A
- B
- A
- A
The following is true about the s/sx of non-inflammatory disorders, EXCEPT:
A. intermittent stiffness
B. gel phenomena
C. morning stiffness
D. pain without synovial swelling or warmth
E. None
C. morning stiffness
TRUE OR FALSE: Non-inflammatory disorders have intermittent stiffness that is is precipitated by brief periods of rest, usually lasts <60 min, and is exacerbated by activity
True
Determine in which category is a disease frequently occurs more.
- RA
- SLE
- Fibromyalgia
- Gout
- Spondyloarthropathies
A. Male
B. Female
- B
- B
- B
- A
- A
Determine in which category is a disease frequently occurs more.
- Sarcoidosis
- Polymyalgia rheumatica
- SLE
- Giant cell arteritis
- Wegener’s granulomatosis
A. Whites
B. Black
- B
- A
- B
- A
- A
Determine in which category is a disease frequently occurs more.
- OA
- RA
- Psoriatic arthritis
- Fibromyalgia
- SLE
A. Children
B. Young adults
C. Middle Age
D. Elderly
- D
- C
- A
- C
- B
Determine the onset of the following diseases.
- OA
- RA
- septic
- fibromyalgia
- gout
A. Abrupt
B. Insidious
- B
- B
- A
- B
- A
Determine the evolution of the following diseases.
- OA
- Lyme arthritis
- Viral arthritis
A. Chronic
B. Intermittent
C. Migratory
D. Additive
- A
- B
- C
Determine the evolution of the following diseases.
- RA
- Rheumatic fever
- Psoriatic arthritis
A. Chronic
B. Intermittent
C. Migratory
D. Additive
- D
- C
- D
Determine the duration of the following diseases.
- infectious
- RA
- reactive
- fibromyalgia
- crystal induced
A. Acute
B. Chronic
- A
- B
- A
- B
- A
An acute duration for arthritis is _____ weeks
less than 6
Articular disorders are classified based on the number of _____ involved
joints
How many joints are involved when the term oligoarticular or pauciarticular is used?
2 or 3
Nonarticular disorders may be classified as either (1)______ or (2)______
- focal
- widespread
TRUE OR FALSE: Diuretics can cause gout
True
Determine which radiographic test is being described.
- provides detailed visualization of the axial skeleton
- provides images with fine anatomic detail and contrast resolution to visualize bone marrow and soft tissue periarticular structures
- preferred technique when evaluating complex musculoskeletal disorders
A. Plain X-ray
B. CT scan
C. MRI
D. Ultrasound
- B
- C
- C
Determine which radiographic test is being described.
- Used for the diagnosis of synovial cysts
- Useful when there is a history of trauma
- Use to find calcification and joint space narrowing
A. Plain X-ray
B. CT scan
C. MRI
D. Ultrasound
- D
- A
- A
Determine which radiographic test is being described.
- can image vessels, nerve, muscle, pannus, and bone marrow
- useful in the diagnosis of low back pain syndromes, sacroiliitis, osteoid osteoma, and stress fractures
- good for checking soft tissues
A. Plain X-ray
B. CT scan
C. MRI
D. Ultrasound
- C
- B
- C
TRUE OR FALSE: A CT scan is used when there is a history of monarticular involvement.
An X-ray is used when there is a history of a chronic infection.
A. Both statements are true
B. Both statements are false
C. Only the 1st statement is true
D. Only the 2nd statement is true
D. Only the 2nd statement is true
This radiographic tool is good for detailed joint viewing or conditions like metastatic lesions or infection and their area
Positron emission tomography (PET)/CT or single photon emission CT (SPECT/CT)
Normal volume of synovial fluid is about ______ ml
3.5
Synovial fluid reaches up to Can reach up to ______ml if inflamed
25
Determine the color analysis of the synovial fluid.
- noninflammatory
- inflammatory
- inflammatory effusions
A. Red/Brown/Xanthochromic
B. Deeper yellow
C. Yellow-clear
D. Yellow-cloudy
E. White/Cloudy/Milky
- C
- D
- B
Determine the color analysis of the synovial fluid.
- hemorrhagic
- crystals
- septic
A. Red/Brown/Xanthochromic
B. Deeper yellow
C. Yellow-clear
D. Yellow-cloudy
E. White/Cloudy/Milky
- A
- E
- E
In a synovial fluid analysis, what is the viscosity of a non-inflammatory group 1?
A. Low
B. Variable
C. High
C. High
In a synovial fluid analysis, what is the viscosity of a hemorrhagic group 4?
A. Low
B. Variable
C. High
B. Variable
In a synovial fluid analysis, what is the viscosity of a normal fluid analysis?
A. Low
B. Variable
C. High
C. High
In a synovial fluid analysis, what is the viscosity of septic group 3?
A. Low
B. Variable
C. High
B. Variable
In a synovial fluid analysis, what is the viscosity of inflammatory group 2?
A. Low
B. Variable
C. High
A. Low
In a synovial fluid analysis, what is the color of inflammatory group 2?
A. Clear
B. Yellow
C. Dirty Yellow
D. Red
B. Yellow
In a synovial fluid analysis, what is the color of non-inflammatory group 1?
A. Clear
B. Yellow
C. Dirty Yellow
D. Red
B. Yellow
In a synovial fluid analysis, what is the clarity of non-inflammatory group 1?
A. Transparent
B. Translucent
C. Opaque
D. Bloody
A. Transparent
In a synovial fluid analysis, what is the clarity of septic group 3?
A. Transparent
B. Translucent
C. Opaque
D. Bloody
C. Opaque
In a synovial fluid analysis, what is the clarity of a normla synovial fluid?
A. Transparent
B. Translucent
C. Opaque
D. Bloody
A. Transparent
In a synovial fluid analysis, what is the clarity of a normla synovial fluid?
A. Transparent
B. Translucent
C. Opaque
D. Bloody
A. Transparent
Depending on the clinical scenario, synovial fluid is analyzed for: (1-4)
- Cell count
- Crystals
- Culture and sensitivity
- Cytology
Determine the condition part of each synovial fluid analysis group.
- Trauma
- Gonococcal arthritis
- Systemic Lupus Erythematosus
A. Group 1 - Non-inflammatory
B. Group 2 - Inflammatory
C. Group 3 - Septic
D. Group 4 - Hemorrhagic
- D
- C
- B
Determine the condition part of each synovial fluid analysis group.
- Tumors
- Hemophilia
- Osteoarthritis
A. Group 1 - Non-inflammatory
B. Group 2 - Inflammatory
C. Group 3 - Septic
D. Group 4 - Hemorrhagic
- D
- D
- A
Determine the condition part of each synovial fluid analysis group.
- Spondyloarthropathies
- Pseudogout
- Lyme’s disease
A. Group 1 - Non-inflammatory
B. Group 2 - Inflammatory
C. Group 3 - Septic
D. Group 4 - Hemorrhagic
- B
- B
- B
In chronic inflammation the number of red blood cells usually is ________
low
This counts measure the number and quality of red blood cells.
Hematocrit (HCT) and hemoglobin (Hgb)
Infection may ______ WBC
increase
Platelet count measures the number of (1)_____ that help the blood to (2)______.
- “sticky” cells
- clot
Low platelet can cause ______
bleeding
This is a laboratory work-up that measures the amount of inflammation present
Erythrocyte sedimentation rate (ESR)
This is a laboratory work-up that measures how fast red blood cells cling together, fall, and settle toward the bottom of a glass tube in an hour’s time, like sediment.
Erythrocyte sedimentation rate (ESR)
This is a laboratory work-up that measure the amount of muscle damage
Muscle enzyme tests: CPK
This is a laboratory work-up that measures kidney function
creatinine test
This is a laboratory work-up that measures the amount of uric acid in the blood
uric acid test
TRUE OR FALSE: Medications used in the treatment of arthritis can damage the liver
True
Creatinine is a normal waste product of the _______.
muscles
The NV for females in a uric acid test is (1)_____, while males should have (2)_____
- less than 6
- less than 7
This measures whether a certain amount of abnormal antibody called rheumatoid factor is in the blood.
Rheumatoid factor (RF)
This is known as the removal of a small piece of tissue, to be examined under a microscope
Biopsy
This is a kind of biopsy usually are done to aid the diagnosis of lupus, vasculitis, psoriatic arthritis or other forms of arthritis that involve the skin.
Skin biopsies
This is a kind of biopsy used to look for signs of damage to the muscle fibers. This information can help confirm the diagnosis of polymyositis or vasculitis.
Muscle biopsies
This is a kind of biopsy are done to check for signs of damage from a disease such as lupus.
Kidney biopsies
This test detects the presence of certain “genetic markers” or traits in the blood that is always present in a certain condition.
Human leukocyte antigen (HLA) tissue typing tests
The following is true about Osteoarthritis, EXCEPT:
A. Known as degenerative joint disease
B. Most commonly affected joints are the hips, knees, DIP, thoracic spine
C. Caused by previous affectation to joint like sepsis, trauma, inflammatory conditions
D. Caused by combination of repetitive mechanical stress and genetic predisposition
E. None
B. Most commonly affected joints are the hips, knees, DIP, thoracic spine
NOTE: It is the PIP and cervical or lumbar spine
The following is true about Osteoarthritis, EXCEPT:
A. Most common cause of pain
B. Most disabling musculoskeletal disorder
C. Most common of the rheumatic disease
D. Most common inflammatory arthritis
E. None
D. Most common inflammatory arthritis
TRUE OR FALSE: Osteoarthritis is Greater in men than women in patients > 45 years old. When <45 y/o, it is greater in women.
A. Both statements are true
B. Both statements are false
C. Only the 1st statement is true
D. Only the 2nd statement is true
B. Both statements are false
TRUE OR FALSE: Women experience more serious and disabling symptoms and report more problems with morning stiffness, joint swelling and night pain
True
TRUE OR FALSE: African-Americans have greater rates and severity of knee arthritis than white while OA of hip is higher in European whites than African Americans
True
Osteoarthritis has 2 distinct pathologic features:
- Progressive destruction of _______
- Formation of _____ at the margin of the joint
- articular cartilage
- bone
Cartilage has (1)_____ and (2)______ properties
- viscoelastic
- compressive
Primary osteoarthritis is caused by __________that cause failure of an otherwise normal joint
excessive loads
In a normal cartilage, there is a balance between (1)_____ and (2)______ activity
- catabolic (breakdown)
- anabolic (production)
TRUE OR FALSE: Osteoarthritic joint has the ability to replicate and produce new chondrocytes but they produce collagen, proteoglycan and hyaluronan that do not aggregate well and are not adequately stabilized in extracellular matrix
True
What do you call osteophytes that develop around periphery of joints?
marginal osteophytes
What do you call osteophytes that develop from degenerating joint surface?
central osteophytes
TRUE OR FALSE: OA is essentially a clinical diagnosis. Plain radiographs in the initial workup to help confirm the diagnosis in moderate to advanced OA, but they are not sensitive in detecting early disease.
A. Both statements are true
B. Both statements are false
C. Only the 1st statement is true
D. Only the 2nd statement is true
A. Both statements are true
TRUE OR FALSE: MRI is more sensitive than plain x -ray in detecting OA changes
True
What does a radiographic grade III mean for OA?
A. No features of OA
B. Minute osteophyte; doubtful significance
C. Definite osteophyte; normal joint space
D. Moderate joint space reduction
E. Joint space greatly reduced, subchondral sclerosis
D. Moderate joint space reduction
What does a radiographic grade 0 mean for OA?
A. No features of OA
B. Minute osteophyte; doubtful significance
C. Definite osteophyte; normal joint space
D. Moderate joint space reduction
E. Joint space greatly reduced, subchondral sclerosis
A. No features of OA
What does a radiographic grade IV mean for OA?
A. No features of OA
B. Minute osteophyte; doubtful significance
C. Definite osteophyte; normal joint space
D. Moderate joint space reduction
E. Joint space greatly reduced, subchondral sclerosis
E. Joint space greatly reduced, subchondral sclerosis
What does a radiographic grade I mean for OA?
A. No features of OA
B. Minute osteophyte; doubtful significance
C. Definite osteophyte; normal joint space
D. Moderate joint space reduction
E. Joint space greatly reduced, subchondral sclerosis
B. Minute osteophyte; doubtful significance
What does a radiographic grade II mean for OA?
A. No features of OA
B. Minute osteophyte; doubtful significance
C. Definite osteophyte; normal joint space
D. Moderate joint space reduction
E. Joint space greatly reduced, subchondral sclerosis
C. Definite osteophyte; normal joint space
TRUE OR FALSE: Inflammatory markers (CRP, ESR) can be used to rule out inflammatory arthritis, such as rheumatoid arthritis.
True
TRUE OR FALSE: Inflammatory markers are usually normal in osteoarthritis.
True
TRUE OR FALSE: In osteoarthritis, pain is the earliest symptom. It is often relieved by activity and worsened by prolonged rest.
A. Both statements are true
B. Both statements are false
C. Only the 1st statement is true
D. Only the 2nd statement is tr
C. Only the 1st statement is true
These are osteoarthritic nodules of the distal interphalangeal joints (DIPs).
Heberden’s nodes
These are osteoarthritic nodules at proximal interphalangeal joints (PIPs).
Bouchard’s nodes
_______ is associated with increase of knee OA at the patellofemoral compartment and tibiofemoral compartment
Obesity
During walking and stair climbing hip and knee load is ____ the body weight
4x
Obesity may be associated with fatigue of ______ cause decreased shock absorption and increase load of knee
quadriceps
TRUE OR FALSE: Weight loss can be an effective form of preventing onset or progression of osteoarthritis
True
Determine which type of exercise is being described.
- initial approach for strengthening in patients who cannot tolerate repetitive joint motion
- increase shear forces at joints, which may exacerbate osteoarthritis.
- closely mimic the many synergistic movements and firing patterns required for everyday functional tasks
A. closed kinetic chain
B. open kinetic chain
C. Isometric exercises
D. Isotonic exercises
E. Isokinetic exercises
- C
- A
- B
Determine which type of exercise is being described.
- involve constant speed of motion throughout the joint range during muscle contraction, whereas the amount of resistance may vary throughout the range
- refers to joint movement through its ROM, against a constant weight or resistance
- allow the patient to strengthen more specifically just one movement at one joint
A. closed kinetic chain
B. open kinetic chain
C. Isometric exercises
D. Isotonic exercises
E. Isokinetic exercises
- E
- D
- A
Determine which type of exercise is being described.
- are infrequently used because of equipment requirements and uncertain correlation to functional activities
- involve contraction of muscles while they are at a fixed length
- consists of concentric and eccentric contractions
A. closed kinetic chain
B. open kinetic chain
C. Isometric exercises
D. Isotonic exercises
E. Isokinetic exercises
- E
- C
- D
(1)______ contraction is more stressful than (2)______ but also results in greater strength gains.
- Eccentric
- concentric
Which 2 kinds of exercises are the most beneficial exercises in patients with osteoarthritis?
isotonic and closed-chain