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Seronegative spondylitis & MSK Flashcards

1
Q

Osteoarthritis is thought to result from chronic mechanical stress +/- a decrease in [molecule]

A

Osteoarthritis is thought to result from chronic mechanical stress +/- a decrease in proteoglycans

Loss of mucopolysaccharides
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2
Q

Osteoarthritis is associated with decreased proteoglycans which results in decreased cartilage elasticity and [X-ray finding]

A

Osteoarthritis is associated with decreased proteoglycans which results in decreased cartilage elasticity and decreased joint space and subchrondral sclerosis
* It will affect the entire joint including the articular cartilage, synovium, and subchondral bone

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3
Q

Non-modifiable risk factors of osteoarthritis include _ ;
Modifiable risk factors include _

A

Non-modifiable risk factors of osteoarthritis include age, trauma, family history, female sex
Modifiable risk factors include obesity, overuse

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4
Q

Osteoarthritis is better with [use/rest]

A

Osteoarthritis is better with rest
* Pain increases with activity

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5
Q

Morning stiffness that lasts > 30 minutes is more likely [RA/ osteoarthritis]

A

Morning stiffness that lasts > 30 minutes is more likely RA
* Osteoarthritis stiffness will last less than 30 minutes

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6
Q

Osteoarthritis will be [symmetry], commonly of the [joints]

A

Osteoarthritis will be asymmetric, commonly of the hands, hips, knees
* Contrast this to RA which is symmetric

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7
Q

Osteoarthritis may present with nodes of the DIP called _ or of the PIP called _

A

Osteoarthritis may present with nodes of the DIP called Heberden nodes or of the PIP called Bouchard nodes
* Heberden are “high” and Bouchard are “below”

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8
Q

The first line diagnostic test for OA is _

A

The first line diagnostic test for OA is x-ray
* Irregular joint space narrowing, subchondral sclerosis, osteophyte formation, subchondral cysts

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9
Q

OA arthrocentesis will show [inflammatory/ non-inflammatory] synovial joint fluid

A

OA arthrocentesis will show non-inflammatory synovial joint fluid
* WBC < 2000/mm3

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10
Q

Gout is a joint disease that involves a precipitation of _ crystals

A

Gout is a joint disease that involves a precipitation of monosodium urate crystals
* The crystals deposit into the tissues and result in an inflammatory crystalline arthropathy

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11
Q

Gout is caused by either _ or _

A

Gout is caused by either increased uric acid production or decreased excretion
* Most commonly will see patients with underexcretion (kidney issues)

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12
Q

Risk factors of gout include:

A

Risk factors of gout include:
* Male sex
* High purine diet
* Tumor lysis syndrome
* CKD
* Genetic predisposition

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13
Q

Individuals with a defective HGPRT enzyme like in [condition] or lysosomal storage disease _ , are at an increased risk of gout

A

Individuals with a defective HGPRT enzyme like in Lesch-Nyhan or lysosomal storage disease Von Gierke , are at an increased risk of gout
* These lead to increased denovo purine synthesis

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14
Q

Name some medications that increase risk for gout:

A

Name some medications that increase risk for gout:
* Thiazide & loop diuretics
* Aspirin
* Niacin

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15
Q

Gout classically presents with acute pain of the [joint]

A

Gout classically presents with acute pain of the first MTP joint
* This is called podagra
* Typically remains mono-articular

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16
Q

Gout sx may include _ ; often precipitated by a trigger of increased uric acid levels, trauma, dehydration

A

Gout sx may include swelling, warmth, erythema, TTP, reduced ROM ; often precipitated by a trigger of increased uric acid levels, trauma, dehydration
* Symptoms may wake patient at night

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17
Q

_ are stone-like deposits of uric acid which are a late manifestation of chronic gout

A

Tophi are stone-like deposits of uric acid which are a late manifestation of chronic gout
* Classically of the olecranon, ear, achilles tendon

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18
Q

The gold standard for gout diagnosis is _

A

The gold standard for gout diagnosis is arthrocentesis/synovial fluid analysis
* Serum uric acid likely to be elevated
* Need synovial fluid analysis for definitive diagnosis

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19
Q

Classically, gout will present as [shape]-crystals and [+/-] birefrigence under polarized light

A

Classically, gout will present as needle-shaped crystals and (-) birefrigence under polarized light

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20
Q

Under parallel light, gout crystals appear [color] while under perpendicular light they appear [color]

A

Under parallel light, gout crystals appear yellow while under perpendicular light they appear blue

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21
Q

_ is a gout medication that binds tubulin in microtubules and inhibits neutrophil function

A

Colchicine is a gout medication that binds tubulin in microtubules and inhibits neutrophil function
* Does not alter urate levels

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22
Q

Acute management of gout includes [3 drugs]

A

Acute management of gout includes NSAIDs, colchicine, steroids

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23
Q

Allopurinol and febuxostat are classic gout medications that work by [MOA]

A

Allopurinol and febuxostat are classic gout medications that work by inhibiting xanthine oxidase
* Hypoxanthine –> Xanthine –> Uric acid (blocked by XO inhibitors)

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24
Q

_ is gout-like joint disease that involves crystal deposition in the tissues

A

Calcium pyrophosphate deposition disease is gout-like joint disease that involves crystal deposition in the tissues
* Involves the deposition of calcium pyrophosphate dihydrate crystals
* Also called pseudogout

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25
Calcium pyrophosphate deposition disease is often idiopathic but more common in older adults and may be associated with _
Calcium pyrophosphate deposition disease is often idiopathic but more common in older adults and may be associated with **hemochromatosis, hyperparathyroidism, joint trauma** * *Hypothyroidism can also be associated*
26
Pseudogout classically presents with [shape] crystals and [+/-] birefringence under polarized light
Pseudogout classically presents with **rhomboid-shaped crystals** and **(+)** birefringence under polarized light
27
Pseudogout will appear [color] under parallel light and [color] under perpendicular light
Pseudogout will appear **blue** under parallel light and **yellow** under perpendicular light * *This is opposite of gout*
28
X-ray of CPPD will show _ and serum uric acid will typically be _
X-ray of CPPD will show **chondrocalcinosis** and serum uric acid will typically be **normal**
29
Septic arthritis occurs secondary to _
Septic arthritis occurs secondary to **infection** (leads to inflammation of the joint) * *Can result from hematogenous infection or direct contamination*
30
Name some risk factors for septic arthritis:
Name some risk factors for septic arthritis: * Underyling joint disease * IVDU * Prosthetic implants * Immunosuppression * Diabetes * Advanced age
31
The most common organism responsible for septic arthritis is _ ; others include _
The most common organism responsible for septic arthritis is **staph aureus** ; others include **streptococcus, gonorrhea, pseudomonas aeruginosa**
32
Septic arthritis is typically [joint pattern] and most commonly affects the [joint]
Septic arthritis is typically **monoarticular** and most commonly affects the **knee**
33
Septic arthritis will present with [symptoms]
Septic arthritis will present with **decreased ROM, swelling, warmth, erythema, TTP, and fever due to infection**
34
Disseminated gonococcal infection involves a triad of _ , _ , and _
Disseminated gonococcal infection involves a triad of **polyarthralgias** , **tenosynovitis** , and **dermatitis** * *It will be a migratory/ asymmetric polyarthralgia* * If there is an overlying infection arthrocentesis is contraindicated
35
Septic arthritis is associated with a *purulent* synovial fluid and increased WBC > [number]
Septic arthritis is associated with a *purulent* synovial fluid and increased **WBC > 50,000** (neutrophil dominant) * *Also want to get blood cultures and gram stain* * X-ray may show soft tissue swelling or be unremarkable
36
Fibromyalgia is most common in [population]
Fibromyalgia is most common in **females, 20-50 years old**
37
Fibromyalgia requires the presence of _ for diagnosis
Fibromyalgia requires the presence of **3 months duration of pain in all quadrants of the body with profuse "tender points" on exam** for diagnosis
38
Fibromyalgia will have a _ ESR, no specific autoantibodies, and _ imaging
Fibromyalgia will have a **normal** ESR, no specific autoantibodies, and **normal** imaging
39
Treatment for fibromyalgia may include:
Treatment for fibromyalgia may include: * **Exercise** * **Duloxetine, amitriptyline** * **Gabapentin, pregabalin**
40
_ is heterotopic ossification of skeletal muscle that results from repeated or blunt msk trauma
**Myositis ossificans** is heterotopic ossification of skeletal muscle that results from repeated or blunt msk trauma * *It is a benign bony formation of soft tissue* * *May be seen in athletes* * *Often from overuse injuries*
41
Myositis ossificans will present as a [painful/painless] soft tissue mass
Myositis ossificans will present as a **painful** soft tissue mass * *Also local swelling, tenderness, decreased ROM*
42
Myositis ossificans is associated with increased ESR and increased [LFT]
Myositis ossificans is associated with increased ESR and increased **alkaline phosphatase** * *Alk phos is elevated due to the increased bone turnover*
43
Myositis ossificans is [prognosis]
Myositis ossificans is **often self-limiting** * *Over time the body can resorb the calcium* * *Treat with sx management (e.g. rest, activity modification, PT)*
44
Seronegative spondyloarthropathies include various forms of chronic inflammatory arthritis that are all _
Seronegative spondyloarthropathies include various forms of chronic inflammatory arthritis that are all **negative for RF** * PAIR: psoriatic arthritis, ankylosing spondylitis, IBD-associated, reactive arthritis
45
Seronegative spondyloarthritis is associated with [HLA marker]
Seronegative spondyloarthritis is associated with **HLA-B27**
46
OA or RA?
OA: * Joint space narrowing with osteophytes * Central erosion (OA) whereas RA tends to have marginal erosion of the joints * Involvement of the DIPs
47
Colchicine has a narrow therapeutic window; side effects include:
Colchicine has a narrow therapeutic window; side effects include: * **GI toxicity**: diarrhea even at low doses * **Marrow suppression** at high doses * Dose must be adjusted for renal insufficiency
48
Nodules at the elbow: think RA or _
Nodules at the elbow: think RA or **gout**
49
Xanthine oxidase inhibitors like _ or _ decrease the production of urate
Xanthine oxidase inhibitors like **allopurinol** or **febuxostat** decrease the production of urate
50
_ is a uricosuric agent that increases the excretion of urate but carries a risk of kidney stones
**Probenecid** is a uricosuric agent that increases the excretion of urate but carries a risk of kidney stones * *Only can be used in patients with normal kidney function*
51
There is a risk of _ when beginning urate lowering therapy like allopurinol
There is a risk of **precipitating acute attack** when beginning urate lowering therapy like allopurinol * *All patients should be on prophylactic therapy with NSAIDs, colchicine, or steroids*
52
Psoriatic arthritis involves the recruitment of [cells] which activate osteoclasts and lead to osteolysis
Psoriatic arthritis involves the recruitment of **T-cells** which activate osteoclasts and lead to osteolysis * **Increased IFN-a, IL-6, TNF-a** brings in T cells to the skin and joints
53
Psoriatic arthritis usually affects individuals around age _
Psoriatic arthritis usually affects individuals around **age 30-50** * *It will often present in the beginning as asymmetric oligoarthritis and then progress to symmetric polyarthritis in late stage*
54
Psoriatic arthritis symptoms include:
Psoriatic arthritis symptoms include: * **Skin psoriasis** * **Pitting nail beds** * **Enthesitis** (inflammation at attachment sites) * **Dactylitis** (sausage digits)
55
X-ray of psoriatic arthritis may show _ deformity of DIP joint
X-ray of psoriatic arthritis may show **pencil-in-cup** deformity of DIP joint
56
What do you expect to see on labs for psoriatic arthritis?
Elevated CRP, ESR, uric acid HLA-B27 positive RF negative
57
Bilateral low back pain that improves with activity but not rest (in 15-35 year olds) should give concern for _
Bilateral low back pain that improves with activity but not rest (in 15-35 year olds) should give concern for **ankylosing spondylitis** * *Commonly presents with decreased spine mobility and involvement of the sacroiliac joint*
58
Ankylosing spondylitis involves T cell and macrophage recruitment by [cytokines]
Ankylosing spondylitis involves T cell and macrophage recruitment by **TGF-b, TNF-a, IL-17, IL-23** * *Leads to joint erosion and bone spur formation*
59
In addition to low back pain and peripheral arthritis, ankylosing spondylitis causes [extra-articular manifestations]
In addition to low back pain and peripheral arthritis, ankylosing spondylitis causes **anterior uveitis, restrictive lung disease, aortitis/aortic regurg, enthesitis** * *The restrictive lung disease occurs because of costovertebral and costosternal ankylosis*
60
_ is a classic finding of ankylosing spondylitis on X-ray
**"Bamboo spine"** is a classic finding of ankylosing spondylitis on X-ray * *Due to vertebral fusion* * *Also may see erosion and sclerosis of SI joints on iliac side*
61
Psoriatic arthritis and ankylosing spondylitis are often treated with _ or _
Psoriatic arthritis and ankylosing spondylitis are often treated with **NSAIDs** or **TNF-alpha inhibitors**
62
Reactive arthritis is caused by an increased immune response following infection, involving the recruitment of [cells]
Reactive arthritis is caused by an increased immune response following infection, involving the recruitment of **T cells and macrophages** * *These mediate the damage to the joint synovium, conjunctiva, urethra, and cutaneous infiltration*
63
Reactive arthritis can be categorized as a [symmetry] migratory oligoarthritis
Reactive arthritis can be categorized as an **asymmetric migratory oligoarthritis** * Most commonly affects the lower extremities
64
The classic triad associated with reactive arthritis is _ , _ , and _
The classic triad associated with reactive arthritis is **conjunctivitis** , **urethritis**, and **arthritis** * *"Can't see, can't pee, can't climb a tree*
65
The cutaneous manifestation associated with reactive arthritis is called _
The cutaneous manifestation associated with reactive arthritis is called **keratoderma blenorrhagicum**
66
The classic infections that trigger reactive arthritis include:
The classic infections that trigger reactive arthritis include: * Campylobacter * Chlamydia * C. diff * E. coli * Shigella * Salmonella * Ureaplasma * Yersinia
67
Reactive arthritis has a high rate of recurrence, especially is the patient is positive for _
Reactive arthritis has a high rate of recurrence, especially is the patient is positive for **HLA-B27**
68
In antiphospholipid syndrome, platelet activity is _ and anticoagulant proteins are _
In antiphospholipid syndrome, platelet activity is **increased** and anticoagulant proteins are **decreased** * *This leads to a state of hypercoagulability and risk of thrombosis*
69
Primary antiphospholipid syndrome is idiopathic; secondary is most commonly caused by _
Primary antiphospholipid syndrome is idiopathic; secondary is most commonly caused by **SLE** * *Others include RA, HIV, bacterial infections, HIV*
70
Name (3) auto-antibodies associated with antiphospholipid syndrome
Name (3) auto-antibodies associated with antiphospholipid syndrome 1. **Lupus anticoagulant** 2. **Anti-cardiolipin** 3. **Anti-B2-glycoprotein** *Anti-cardiolipin can cause false negative syphilis*
71
APS will have the following findings: aPTT: Platelets: WBCs:
APS will have the following findings: aPTT: **prolonged** Platelets: **low** WBCs: **low** *Hemolytic anemia may be present*
72
In a patient suspected of APS who has a positive lupus anticoagulant, we expect the mixing study to [correct/ not correct]
In a patient suspected of APS who has a positive lupus anticoagulant, we expect the mixing study to **not correct** * aPTT will remain prolonged
73
The most common pathogen responsible for osteomyelitis is _
The most common pathogen responsible for osteomyelitis is **staph aureus** * *Others: E.coli, pseudomonas, proteus mirabilis*
74
Vertebral osteomyelitis caused by M. tuberculosis is called _
Vertebral osteomyelitis caused by M. tuberculosis is called **Pott disease**
75
What abx treatment is most appropriate for vertebral osteomyelitis?
Empiric coverage: **vancomycin** + **ceftriaxone or cefepime**
76
_ is the classic causative factor of infectious arthritis in the sternoclavicular joint
**IVDU** is the classic causative factor of infectious arthritis in the sternoclavicular joint
77
The most common source of infectious arthritis is _
The most common source of infectious arthritis is **hematogenous seeding** * Can also occur secondary to penetrating trauma, or adjacent spread from osteomyelitis
78
Hematogenous osteomyelitis is most likely to affect the [bone region] in kids
Hematogenous osteomyelitis is most likely to affect the **metaphysis** in kids * *Rarely spreads to joints* * Metaphyses in kids see a lot of blood flow (since growth plates are still open and growing) * Also metaphyseal vessels have sharp turns and turbulent flow which makes it an opportune location for bacteria to affect the bone
79
In *adults*, hematogenous osteomyelitis is likely to affect the vertebral _ and more likely to spread to the _ (compared to children)
In *adults*, hematogenous osteomyelitis is likely to affect the **vertebral bodies** and more likely to spread to the **joints** (compared to children)
80
Osteomyelitis mcc: [bug] Associated with implants: [bug] Sickle cell patient: [bug]
Osteomyelitis mcc: **staph aureus** Associated with implants: **staph epi** Sickle cell patient: **salmonella**
81
Vitamin D is a [type hormone] that gets synthesized in the [organ] and activated by the _ and _
Vitamin D is a **steroid hormone** that gets synthesized in the **skin** and activated by the **liver** and **kidneys**
82
(True/False) there are PTH receptors on osteoclasts
False; **PTH and vitamin D bind to osteoblasts** --> osteoblasts secrete RANKL --> activates the osteoclasts
83
84
85
In renal disease, we expect to see low Ca2+ for two reasons 1. ? 2. ?
In renal disease, we expect to see low Ca2+ for two reasons 1. **Kidneys aren't making enough 1-alpha-hydroxylase** 2. **Phosphate builds up and binds to all of the calcium** *Long term the phos-calcium can end up depositing in the tissues and causing osteosclerosis*
86
Osteogenesis imperfecta

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