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Pathology 2 - Block 3 - Part 1

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davidwurbel7's version from 2016-07-31 22:52

Joint Disease 1

Question Answer
Also known as synarthroses; lack a joint space, tightly connected to provide structural strengthSolid (nonsynovial) Joint
Have a joint space to allow for a wide range of motionCavitated (synovial) Joint
Articular surface of adjoining bones is made up of hyaline cartilage which is composed of this type of collagenType II Collagen
Composed of synoviocytes that lines the joint capsuleSynovial Membrane
This is secreted by synoviocytes. Pale yellow to clear, viscous. Rich in hyaluronic acid: acts as lubricant and provides nutrition for articular cartilageSynovial Fluid
The presence of Monosodium urate (MSU) crystals in the synovial fluid indicates thisGout
These crystals are needle shaped and negatively birefringentMonosodium Urate Crystals
The presence of Calcium pyrophosphate dehydrate (CPPD) crystals in the synovial fluid indicates thisPseudo-Gout
These crystal are rhomboid shaped and positively birefringentCalcium Pyrophosphate Dehydrate (CPPD) Crystals
The presence of infectious material in the synovial fluid indicates thisSeptic Arthritis
Pain in a joint without inflammationArthralgia
Pain in the joint with inflammationArthritis
Due to damage to ligament or joint capsule, morning stiffness and swellingAbnormal Mobility
Crackling sensation on moving the jointCrepitus
Joint diseases such as osteoarthritis and neuropathic jointGroup I - Non-inflammatory
Joint diseases such as rheumatoid arthritis, gout, pseudogout and Seronegative spondyloarthropathyGroup II - Inflammatory
Joint diseases such as infectious arthritis due to bacteria, fungi, and virusesGroup III - Septic
Joint diseases such as hemophilia, trauma and scurvyGroup IV - Hemorrhagic
Most common type of joint disease and joint disability in the USOsteoarthritis
Development of cracks both vertical and horizontal in the synovial membraneFibrillation
Non-inflammatory joint disease. A degenerative joint disease and is characterized by progressive erosion (degeneration, loss) of articular cartilage and associated reactive changes at the margin of the bone and in the subchondral boneOsteoarthritis
Primarily targets weight bearing joints - hips, knees, cervical and lumbosacral spine and distal interphalangeal joint (DIP) and proximal interphalangeal joint (PIP) of the handsOsteoarthritis
New bone formation at the margin of the jointOsteophyte
Bone has an ivory, shiny like appearance due to bone rubbing on boneEburnation
Bony enlargement of the distal interphalangeal jointsHeberden’s Nodes
Bony enlargement of the proximal interphalangeal jointsBouchard’s Nodes
Osteoarthritis as a result of aging phenomenon; seen in older individualsPrimary Osteoarthritis
Osteoarthritis develops as a result of a predisposing conditionSecondary Osteoarthritis
Fragmentation of cartilage and subchondral bone result in formation of loose bodiesJoint Mice
Clinical presents as joint stiffness in the morning that worsens during the day. Pain with passive motion of joint. Limitation of movement. CrepitusOsteoarthritis
Non-inflammatory joint disease. Secondary to a neurologic disease. Joint destruction is due to insensitivity to pain.Neuropathic Arthropathy
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Joint Disease 2

Question Answer
A female predominant, chronic, inflammatory, systemic, Autoimmune disease occurring between 30-50 years of age. May affect many tissues and organs but mainly - Affects the peripheral joints in a symmetric manner. Hallmark is proliferative synovitis leading to formation of pannus that causes destruction of articular cartilage & underlying bone, Ankylosis and joint deformity. Associated with HLA-DR4Rheumatoid Arthritis
Clinical features include arthritis with morning stiffness that improves with activity. Symmetric involvement of PIP and MCP joints of the fingers and other joints (wrists, elbows, knees). Swollen and warm joints. DIP is usually spared. Joint-space narrowing, loss of cartilage, and osteopenia are seen on X-ray. Fever, malaise, weight loss, and myalgiasRheumatoid Arthritis
A patient with RA can lead to this heart conditionRestrictive Cardiomyopathy
Restrictive Cardiomyopathy seen with patients with RA is due to thisAccumulation of Amyloid
Accumulation of amyloid in the spleen leads to thisSplenomegaly
A central zone of fibrinoid necrosis surrounded by epithelioid histiocytes; arise in skin (elbow) and visceral organs (lung)Rheumatoid Nodules
A Rheumatoid nodule in lung + PneumoconiosisCaplan Syndrome
Swelling of bursa behind the kneeBaker Cyst
Swelling behind the knee joint could possibly be thisPopliteal Artery Aneursym
Hyperextension of PIP and flexion of DIP jointsSwan neck deformity
Flexion of PIP and extension of DIP jointsBoutonnier deformity
IgM autoantibody against Fc portion of lgGRheumatoid Factor
Synovial fluid is turbid due to increased WBCs (Neutrophils), High protein content. No crystals and no organismsRheumatoid Arthritis
Complication of RA due to iron reserves not being available for hemoglobin formationAnemia of Chronic Disease
Antibodies to citrullinated fibrinogenCyclic Citrullinated Peptides Antibodies
First line therapy for RANSAIDs or Salicylates
Methotrexate, azathioprine and cyclophosphamide are examples of this class of drugsDMARDs
Clinical features include morning stiffness, arthritis in three or more joints, arthritis of typical hand joints, symmetric arthritis, rheumatoid nodules, serum rheumatoid factor, antibodies against cyclic citrullinated peptides (CCPs) and typical radiographic changesRA
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Joint Disease 3

Gout
Question Answer
Characterized by deposition of monosodium urate (MSU) crystals in tissues, especially the joints due to hyperuricemiaGout
Precipitation of this crystal leads to goutMonosodium Urate
The most common form; etiology of hyperuricemia is unknownPrimary Gout
The most common problem of primary gout is thisUnder-Excretion of Uric Acid
Leukemia and myeloproliferative disorders due to increased cell turnover, Tumor lysis syndrome, Lesch-Nyhan syndrome and Renal insufficiencySecondary Gout
X-linked deficiency of hypoxanthine-guanine phosphoribosyltransferase (HGPRT); presents with mental retardation and self mutilationLesch-Nyhan Syndrome
A large number of cancer cells die due to chemotherapy leading to secondary goutTumor Lysis Syndrome
Tumor lysis syndrome during chemotherapy can be prevented by adding this drug to the chemotherapyAllopurinol
An exquisitely painful arthritis of the great toePodagra
Consumption of meat or alcohol may precipitate this in persons with hyperuricemiaAcute Gout
A patient determined to be an over producer of uric acid should be given this drugAllopurinol
A patient determined to be an under excreter of uric acid should be given this drugProbenecid
A patient with gout can be given this drug that prevents the movement of neutrophils into the jointColchicine
Chunks of MSU crystals found in the joint or throughout the bodyTophi
Uric acid stones form in the kidney. passage of stone causes pain (renal colic)Gouty Nephropathy
In chronic gout, urate crystals may deposit in kidney tubulesUrate Nephropathy
Urate nephropathy can lead to thisRenal Failure
Treatment of acute goutNSAIDs and/or Colchicine
Management of gout after the acute phase for a patient that is an over producer of uric acidAllopurinol
Management of gout after the acute phase for a patient that is an under excreter of uric acidProbenecid
Treatment of chronic goutAllopurinol
Crystals are yellow against a red background when are aligned with the polarized lightNegatively Birefringent
Crystals are blue against a red background when are aligned with the polarized lightPositively Birefringent
Crystals that are needle like and negatively birefringentMonosodium Urate Crystal (MSU)
Crystals that are needle like or rhomboid and positively birefringentCalcium Pyrophosphate Dehydrate (CPPD)
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Question Answer
Phase in which there is hyperuricemia but no clinical problemAsymptomatic Hyperuricemia
Phase in which there is sudden onset, excruciating joint pain associated with localized erythema, and warmth. Constitutional symptoms are uncommon, except possibly mild feverAcute Gouty Arthritis
Phase in which is characterized by deposition of chunks of MSU crystals. Radiographs show characteristic juxtaarticular bone erosion caused by the crystal deposits and loss of the joint spaceChronic Tophaceous Gout
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Pseudogout
Question Answer
Typically first occurs in persons 50 years of age or older, becoming more common with increasing age. There is no gender or race predilectionPseudogout
Pseudogout also is known as thisChondrocalcinosis
Calcium pyrophosphate dihydrate crystal (CPPD) deposition in articular cartilage. Crystals produce linear deposits in articular cartilage. Most commonly in the kneePseudogout
Develop in genetically predisposed individuals when they come in contact with certain environmental factors. Characterized by absence of Rheumatoid factor (RF negative). High incidence in HLA-B27 positive individuals. Male dominant. Involve sacroiliac joint (sacroilitis) and vertebral column with or without peripheral arthritis. Similar clinical featuresSeronegative Spondyloarthropathies
The genetic type for Seronegative spondyloarthropathiesHLA-B27
The prototypical seronegative spondyloarthropathy is this conditionAnkylosing Spondylitis
A patient cannot bend forward due to fusion of the vertebra suggests this conditionAnkylosing Spondylitis
Begins at the sacroiliac joint. Bilateral sacroilitis causing back pain & morning stiffness is the first manifestation. Eventually targets the vertebral column resulting in the fusion of vertebrae “bamboo spine” causes forward curvatureAnkylosing Spondylitis
Calcification that has occurred between vertebral bodies at the edges of the diskBamboo Spine
A complication of Ankylosing Spondylitis that will cause blood gas abnormalitiesRestrictive Lung Disease
Most commonly occurs in men of 20-30 yrs age who are HLA B27 positive. Environmental triggers include Chlamydia trachomatis infection or GI infectionReiter's Syndrome
Infection with Yersinia, Shigella, Salmonella, Helicobacter, or Campylobacter can precipitate the development of this conditionReiter's Syndrome
This condition is characterized by Conjunctivitis, Urethritis, Arthritis with the additional findings of Achilles tendinitis and Mucocutaneous lesions (circinate balanitis)Reiter's Syndrome
The arthritis seen in Reiter's Syndrome is treated with thisIndomethacin
Inflammation at the insertion of Achilles tendonAchilles Tendinitis
Occurs in approximately 70% of patients with psoriasis. Arthritis usually affects small joints of the hands and feet. On x-ray, there is a “pencil in cup” appearance of the DIP joint. Characteristic skin lesions of psoriasis present. Nail changes include pitting nailsPsoriatic Arthritis
Psoriatic arthritis maybe confused with this similar conditionRheumatoid Arthritis
HLA B27 positive arthritis associated with Inflammatory bowel disease or gastroenteritis due to Shigella, Salmonella Campylobacter,& Yersinia speciesEnteropathic Arthritis
Are inflammatory types of arthritis secondary to microbial pathogens. Uncommon but can rapidly destroy a joint to produce permanent loss of motion. Usually monoarticularInfectious (Septic) Arthritis
Presents with warm, swollen and hot joint with limited range of motion; reluctance to bear weight, fever, chills, increased white count, and elevated ESRInfectious (Septic) Arthritis
Pathogenesis of Infectious (Septic) Arthritis is usually spread by thisHematogenous Spread
Infectious (Septic) Arthritis can be treated with thisCeftrixone
This condition predisposes a person to dissemination of gonococcemiaDeficiency of C5-C9
This disease is caused by the bacteria Borrelia burgdorferiLyme Disease
Lyme disease is transmitted by this tickIxodes
Characterized by a skin rash that develops at the site of tick bite. Red expansile lesion with concentric circlesEarly Lyme Disease
Characterized by Disabling arthritis (knees-usually develops days to weeks after the initial infection), Bilateral Bell’s palsy, Myocarditis and pericarditisLate Lyme Disease
Early Lyme Disease is treated with thisTetracycline
Late Lyme Disease is treated with thisCeftriaxone
Is a small (1-1.5cm) fluid filled cyst. Arises from joint capsule or tendon sheath. Location: small joints of wrist (pea sized nodule). Treatment is surgical removalGanglion Cyst
Herniation of synovium due to increased intra-articular fluid sometimes seen in the kneeSynovial Cyst
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Synovial Fluid Analysis
Question Answer
Synovial fluid analysis - Color: yellowish green. WBC count: between 100,000 – 200,000 / mm3. Neutrophils: >75% of total WBCs. Gram Stain: may identify the causative organism. Crystals: Negative. ESR: Elevated. C-RP: Elevated. Cyclic citrullinated peptides: NegativeInfectious (Septic) Arthritis
Synovial fluid analysis - Color: clear . WBC count: <200/ mm3. Neutrophils: . Gram Stain: None. Crystals: None. ESR: Normal. C-RP: Normal. Cyclic citrullinated peptides: NegativeOsteoarthritis
Synovial fluid analysis - Color: white/turbid . WBC count: 500-100,000/ mm3. Neutrophils: >75% of total WBCs . Gram Stain: None. Crystals: Negative. ESR: Elevated. C-RP: Elevated. Cyclic citrullinated peptides: ElevatedRheumatoid Arthritis
Synovial fluid analysis - Color: clear. WBC count: 500 - 100,000/ mm3. Neutrophils: >75% of total WBCs Gram Stain: None . Crystals: Needle shape, negative birefringent. ESR: Elevated. C-RP: Elevated. Cyclic citrullinated peptides: NormalGout
Synovial fluid analysis - Color: clear. WBC count: 500 - 100,000/ mm3. Neutrophils: >75% of total WBCs Gram Stain: None . Crystals: Rhomboid shape, positive birefringent. ESR: Elevated. C-RP: Elevated. Cyclic citrullinated peptides: NormalPseudogout
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