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Integrated systems > Seronegative spondylitis & MSK > Flashcards

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
Q

Calcium pyrophosphate deposition disease is often idiopathic but more common in older adults and may be associated with _

A

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

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26
Q

Pseudogout classically presents with [shape] crystals and [+/-] birefringence under polarized light

A

Pseudogout classically presents with rhomboid-shaped crystals and (+) birefringence under polarized light

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27
Q

Pseudogout will appear [color] under parallel light and [color] under perpendicular light

A

Pseudogout will appear blue under parallel light and yellow under perpendicular light
* This is opposite of gout

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28
Q

X-ray of CPPD will show _ and serum uric acid will typically be _

A

X-ray of CPPD will show chondrocalcinosis and serum uric acid will typically be normal

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29
Q

Septic arthritis occurs secondary to _

A

Septic arthritis occurs secondary to infection (leads to inflammation of the joint)
* Can result from hematogenous infection or direct contamination

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30
Q

Name some risk factors for septic arthritis:

A

Name some risk factors for septic arthritis:
* Underyling joint disease
* IVDU
* Prosthetic implants
* Immunosuppression
* Diabetes
* Advanced age

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31
Q

The most common organism responsible for septic arthritis is _ ; others include _

A

The most common organism responsible for septic arthritis is staph aureus ; others include streptococcus, gonorrhea, pseudomonas aeruginosa

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32
Q

Septic arthritis is typically [joint pattern] and most commonly affects the [joint]

A

Septic arthritis is typically monoarticular and most commonly affects the knee

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33
Q

Septic arthritis will present with [symptoms]

A

Septic arthritis will present with decreased ROM, swelling, warmth, erythema, TTP, and fever due to infection

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34
Q

Disseminated gonococcal infection involves a triad of _ , _ , and _

A

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

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35
Q

Septic arthritis is associated with a purulent synovial fluid and increased WBC > [number]

A

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
Q

Fibromyalgia is most common in [population]

A

Fibromyalgia is most common in females, 20-50 years old

37
Q

Fibromyalgia requires the presence of _ for diagnosis

A

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
Q

Fibromyalgia will have a _ ESR, no specific autoantibodies, and _ imaging

A

Fibromyalgia will have a normal ESR, no specific autoantibodies, and normal imaging

39
Q

Treatment for fibromyalgia may include:

A

Treatment for fibromyalgia may include:
* Exercise
* Duloxetine, amitriptyline
* Gabapentin, pregabalin

40
Q

_ is heterotopic ossification of skeletal muscle that results from repeated or blunt msk trauma

A

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
Q

Myositis ossificans will present as a [painful/painless] soft tissue mass

A

Myositis ossificans will present as a painful soft tissue mass
* Also local swelling, tenderness, decreased ROM

42
Q

Myositis ossificans is associated with increased ESR and increased [LFT]

A

Myositis ossificans is associated with increased ESR and increased alkaline phosphatase
* Alk phos is elevated due to the increased bone turnover

43
Q

Myositis ossificans is [prognosis]

A

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
Q

Seronegative spondyloarthropathies include various forms of chronic inflammatory arthritis that are all _

A

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
Q

Seronegative spondyloarthritis is associated with [HLA marker]

A

Seronegative spondyloarthritis is associated with HLA-B27

46
Q

OA or RA?

A

OA:
* Joint space narrowing with osteophytes
* Central erosion (OA) whereas RA tends to have marginal erosion of the joints
* Involvement of the DIPs

47
Q

Colchicine has a narrow therapeutic window; side effects include:

A

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
Q

Nodules at the elbow: think RA or _

A

Nodules at the elbow: think RA or gout

49
Q

Xanthine oxidase inhibitors like _ or _ decrease the production of urate

A

Xanthine oxidase inhibitors like allopurinol or febuxostat decrease the production of urate

50
Q

_ is a uricosuric agent that increases the excretion of urate but carries a risk of kidney stones

A

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
Q

There is a risk of _ when beginning urate lowering therapy like allopurinol

A

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
Q

Psoriatic arthritis involves the recruitment of [cells] which activate osteoclasts and lead to osteolysis

A

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
Q

Psoriatic arthritis usually affects individuals around age _

A

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
Q

Psoriatic arthritis symptoms include:

A

Psoriatic arthritis symptoms include:
* Skin psoriasis
* Pitting nail beds
* Enthesitis (inflammation at attachment sites)
* Dactylitis (sausage digits)

55
Q

X-ray of psoriatic arthritis may show _ deformity of DIP joint

A

X-ray of psoriatic arthritis may show pencil-in-cup deformity of DIP joint

56
Q

What do you expect to see on labs for psoriatic arthritis?

A

Elevated CRP, ESR, uric acid
HLA-B27 positive
RF negative

57
Q

Bilateral low back pain that improves with activity but not rest (in 15-35 year olds) should give concern for _

A

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
Q

Ankylosing spondylitis involves T cell and macrophage recruitment by [cytokines]

A

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
Q

In addition to low back pain and peripheral arthritis, ankylosing spondylitis causes [extra-articular manifestations]

A

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
Q

_ is a classic finding of ankylosing spondylitis on X-ray

A

“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
Q

Psoriatic arthritis and ankylosing spondylitis are often treated with _ or _

A

Psoriatic arthritis and ankylosing spondylitis are often treated with NSAIDs or TNF-alpha inhibitors

62
Q

Reactive arthritis is caused by an increased immune response following infection, involving the recruitment of [cells]

A

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
Q

Reactive arthritis can be categorized as a [symmetry] migratory oligoarthritis

A

Reactive arthritis can be categorized as an asymmetric migratory oligoarthritis
* Most commonly affects the lower extremities

64
Q

The classic triad associated with reactive arthritis is _ , _ , and _

A

The classic triad associated with reactive arthritis is conjunctivitis , urethritis, and arthritis
* “Can’t see, can’t pee, can’t climb a tree

65
Q

The cutaneous manifestation associated with reactive arthritis is called _

A

The cutaneous manifestation associated with reactive arthritis is called keratoderma blenorrhagicum

66
Q

The classic infections that trigger reactive arthritis include:

A

The classic infections that trigger reactive arthritis include:
* Campylobacter
* Chlamydia
* C. diff
* E. coli
* Shigella
* Salmonella
* Ureaplasma
* Yersinia

67
Q

Reactive arthritis has a high rate of recurrence, especially is the patient is positive for _

A

Reactive arthritis has a high rate of recurrence, especially is the patient is positive for HLA-B27

68
Q

In antiphospholipid syndrome, platelet activity is _ and anticoagulant proteins are _

A

In antiphospholipid syndrome, platelet activity is increased and anticoagulant proteins are decreased
* This leads to a state of hypercoagulability and risk of thrombosis

69
Q

Primary antiphospholipid syndrome is idiopathic; secondary is most commonly caused by _

A

Primary antiphospholipid syndrome is idiopathic; secondary is most commonly caused by SLE
* Others include RA, HIV, bacterial infections, HIV

70
Q

Name (3) auto-antibodies associated with antiphospholipid syndrome

A

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
Q

APS will have the following findings:
aPTT:
Platelets:
WBCs:

A

APS will have the following findings:
aPTT: prolonged
Platelets: low
WBCs: low
Hemolytic anemia may be present

72
Q

In a patient suspected of APS who has a positive lupus anticoagulant, we expect the mixing study to [correct/ not correct]

A

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
Q

The most common pathogen responsible for osteomyelitis is _

A

The most common pathogen responsible for osteomyelitis is staph aureus
* Others: E.coli, pseudomonas, proteus mirabilis

74
Q

Vertebral osteomyelitis caused by M. tuberculosis is called _

A

Vertebral osteomyelitis caused by M. tuberculosis is called Pott disease

75
Q

What abx treatment is most appropriate for vertebral osteomyelitis?

A

Empiric coverage: vancomycin + ceftriaxone or cefepime

76
Q

_ is the classic causative factor of infectious arthritis in the sternoclavicular joint

A

IVDU is the classic causative factor of infectious arthritis in the sternoclavicular joint

77
Q

The most common source of infectious arthritis is _

A

The most common source of infectious arthritis is hematogenous seeding
* Can also occur secondary to penetrating trauma, or adjacent spread from osteomyelitis

78
Q

Hematogenous osteomyelitis is most likely to affect the [bone region] in kids

A

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
Q

In adults, hematogenous osteomyelitis is likely to affect the vertebral _ and more likely to spread to the _ (compared to children)

A

In adults, hematogenous osteomyelitis is likely to affect the vertebral bodies and more likely to spread to the joints (compared to children)

80
Q

Osteomyelitis mcc: [bug]
Associated with implants: [bug]
Sickle cell patient: [bug]

A

Osteomyelitis mcc: staph aureus
Associated with implants: staph epi
Sickle cell patient: salmonella

81
Q

Vitamin D is a [type hormone] that gets synthesized in the [organ] and activated by the _ and _

A

Vitamin D is a steroid hormone that gets synthesized in the skin and activated by the liver and kidneys

82
Q

(True/False) there are PTH receptors on osteoclasts

A

False; PTH and vitamin D bind to osteoblasts –> osteoblasts secrete RANKL –> activates the osteoclasts

83
Q
A
84
Q
A
85
Q

In renal disease, we expect to see low Ca2+ for two reasons
1. ?
2. ?

A

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
Q

Osteogenesis imperfecta

A

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