Week 4 Flashcards
A middle aged woman visits your clinic complaining of proximal muscle weakness, muscle and joint aches, shortness of breath and a cough. A muscle biopsy reveals inflammation around the muscle fibers and internalized nuclei. What is the most likely diagnosis?
Anti Jo-1 polymyositis Anti Jo-1 polymyositis is more common in females than males and often includes lung involvement (in the form of interstitial lung disease). Inflammation around relatively normal muscle fibers and internal nuclei are both signs of polymyositis.
Lecture: 246 Inflammatory Myopathies Objective: 1. Explain the pathologic differences between Polymyositis, Dermatomyositis and Inclusion Body Myositis. Also be aware of an emerging problem: necrotizing myopathy
What types of stimuli are transmitted via Aβ, Aδ and C fibers?
Aβ fiber = non-noxious mechanical stimuli Aδ fiber = noxious mechanical stimuli C fiber = noxious heat and chemical stimuli Lecture: 250 Acute vs Chronic Pain Objective: 1. Explain the basic underlying physiology of nociceptive pain and differentiate from chronic pain
Which of the following is not a part of the ascending pain pathway?
A.Thalamus
B.Gracile nucleus
C.Somatosensory cortex
D.Spinothalamic tract
B: Gracile nucleus is involved in the ascending pathway for non-noxious touch
Lecture: 250 Acute vs Chronic Pain
Objective: 1. Explain the basic underlying physiology of nociceptive pain and differentiate from chronic pain
A 20 year-old Chinese woman presents to your clinic complaining of pain in her legs and feet. She’s also been experiencing intermittent fevers and 10 pound weight loss in the month. While examining her you notice a +1 dorsalis pedis pulse and a systolic murmur on auscultation. CT reveals significant dilation of the aorta, along with wall thickening. What initial therapy should be administered?
High dose cortical steroids
The question requires that you identify the patient as a textbook example of Takayasus Arteritis which, while rare compared to giant cell arteritis, affects much younger patients (< 40 years of age), usually of Asian or Turkish decent. Affected patients are also overwhelmingly female (9:1). Imaging demonstrating aortic involvement is also implicates TA rather than GCA. High dose cortical steroids is usually the first step in treating TA.
Lecture: 249 Vasculitis
Objective: 3. Distinguish among different vasculitides based on their clinical and laboratory presentations
A 55 year-old man presents to your clinic complaining of sudden knee pain and leg swelling that occurred during his morning run. MRI reveals a mass of fluid in the medial popliteal fossa. What is the most likely diagnosis?
Ruptured baker’s (polpliteal) cyst
Lecture: 248 Limb Vasculature
Objective: Describe difference between deep venous thrombosis, ruptured Baker’s cyst, and other causes for calf pain
A mother brings her toddler to your clinic after he fell down a few stairs in their home. She states that she had to carry him because he refuses to walk and is clearly in pain. Xray reveals a fracture running through the metaphysis but terminating at the growth plate of the tibia. Using Salter-Harris classifications, what type of growth plate injury does the boy have?
Type II
Lecture: 251 Pediatric MSK
Objective: Describe the Salter-Harris classification system of pediatric fractures and the implications of fractures involving the growth plate
Injury to what structure causes muscle strain?
The myotendinous junction
Lecture: 252 Adult Sport and Overuse
Objective: 3. Explain the pertinent aspects of a muscle strain
By what 3 mechanisms does glucocorticoid resistance occur?
- Decreased expression of glucocorticoid receptor alpha
- Increased expression of glucocorticoid receptor beta
- Activation of MAPK which phosphorylates glucocorticoid receptor to prevent signaling
This can occur in cases of chronic glucocorticoid use such as patients with severe rheumatoid arthritis
Lecture: 243 Pharmacology: Glucocorticoids
Objective: Explain Modulation of Glucocorticoid Effect: Accentuation and Resistance
