Term
| Morning stiffness lasting more than 30 minutes is suggestive of ____________ |
|
Definition
| inflammatory disease (specifically rhematoid arthritis) |
|
|
Term
| Morning stiffness lasting less than 30 minutes suggests __________ |
|
Definition
|
|
Term
| How do you know if joint paint is referred? |
|
Definition
| Referred pain cannot be reproduced by palpation or motion of the joint, ligaments, tendons, etc, of the area (Referred pain may also be associated with neuropathic features--numbness, paresthesias, burning and weakness) |
|
|
Term
| Joint paint due to _______ disorders typically cause more pain with active rather than passive motion |
|
Definition
| periarticular (that is, disorders in muscles, tendons, ligaments, bursa, etc. that are near the joint) |
|
|
Term
| Joint pain due to _________ disorders typically cause internal/deep pain that is exacerbated by active and passive motion |
|
Definition
| articular (that is, disorders within the joint itself) |
|
|
Term
| Joint pain affecting one joint is called _______, affecting 2-3 joints is called _______, and affecting 4+ joints is called ________ |
|
Definition
monoarticular
olligoarticular
polyarticular |
|
|
Term
| Risk factors for joint infection |
|
Definition
Recent sexual exposure (or STD’s), urethral/vaginal discharge, discomfort with voiding
Intravenous drug abuse
Diabetes mellitus
Joint surgery/replacement
Any underlying arthritis especially rheumatoid arthritis,
Use of immunosuppressive agents (e.g. steroids) |
|
|
Term
| Joint infections are most often due to disseminated ________ infection , but joint infections due to other bacteria are more destructive and dangerous. |
|
Definition
| gonococcal (caused by Neisseria gonorrheae) |
|
|
Term
| Joint paint with history of tick bites, antecedent rash, or travel to the Northeast United States could indicate ___________ |
|
Definition
|
|
Term
| Pain aggravated with activity, improved with rest, and localized to the involved joint is characteristic of __________ |
|
Definition
|
|
Term
| Does inflammatory arthritis improve with activity or rest? |
|
Definition
|
|
Term
| Does osteoarthritis improve with activity or rest? |
|
Definition
|
|
Term
| Sedimentation rate and C-reactive protein are non-specific indicators of what process? |
|
Definition
|
|
Term
| Joint pain is acute if it lasts |
|
Definition
|
|
Term
| Rheumatic fever & disseminated gonococcal infection have a(n) _________ temporal pattern of joint involvement |
|
Definition
|
|
Term
| Gout has a(n) _______ temporal pattern of joint involvement |
|
Definition
|
|
Term
| Rhematoid arthritis has a(n) __________ temporal pattern of joint involvement |
|
Definition
|
|
Term
| Joint pain that appears symmetrically in small joints suggests ___________ |
|
Definition
|
|
Term
| Joint paint that causes the patient to reduce active and passive motion suggests ________ |
|
Definition
| articular disorders (problem is IN joint) |
|
|
Term
| The most common joint pain syndrome with a non-inflammatory cause is ____________ |
|
Definition
|
|
Term
| Joint pain that is abrupt, often spontaneous, sharp, and radiating suggests ___________ |
|
Definition
|
|
Term
| Joint pain with fatigue, weight gain, hair loss, dry skin, cold intolerance, constipation, and depressed mood suggests __________ |
|
Definition
|
|
Term
| Disorder in which the cartilage between joints is worn away. |
|
Definition
|
|
Term
| The lateral part of forearm is the sensory territory of the ____________ nerve |
|
Definition
|
|
Term
| The lateral half of the palm, palm-side of thumb, index, middle, and half of the ring finger, and top half of the back side of those same fingers are the sensory territory of the ____________ nerve |
|
Definition
|
|
Term
| The palm-side & back-side of the pinkie & half of the ring finger, as well as the part of the palm proximal to those fingers is the sensory territory of the _________ nerve |
|
Definition
|
|
Term
| The ________ has a "arm badge" sensory territory |
|
Definition
| axillary (innervates a patch of skin at the top of the arm/side of the shoulder) |
|
|
Term
| The postero-lateral part of the arm, central posterior part of the forearm, and thumb-side of the back of the hand, and bottom half of the back of the thumb, pointer, index, and part of the middle finger are the sensory territory of the ________ nerve. |
|
Definition
|
|
Term
| The base of neck & across top of shoulders is the sensory territory of the __________ spinal nerve. |
|
Definition
|
|
Term
| The middle finger is the sensory territory of the __________ spinal nerve. |
|
Definition
|
|
Term
| The ring finger, pinkie finger, ulnar side of hand & wrist is the sensory territory of the __________ spinal nerve. |
|
Definition
|
|
Term
| The ulnar side of forearm to just above elbow is the sensory territory of the __________ spinal nerve. |
|
Definition
|
|
Term
| a problem with a nerve because of compression or injury near the root, such as in the intervertebral foramen |
|
Definition
|
|
Term
| a problem with a nerve because of compression or injury at the level of the plexus |
|
Definition
|
|
Term
| a problem with a nerve because of compression or injury at the level of the peripheral nerves |
|
Definition
|
|
Term
| The upper hips, groin, and upper inner thighs are the sensory territory of the __________ spinal nerve. |
|
Definition
|
|
Term
| The anterior and medial upper thighs, lateral hips, and lateral butt is the sensory territory of the __________ spinal nerve. |
|
Definition
|
|
Term
| The anterior knees (and a few inches above/below) and much of the medial & lateral thigh are the sensory territory of the __________ spinal nerve. |
|
Definition
|
|
Term
| The medial half of the anterior leg from a couple of inches below the knee to the ankle (but above the heel) is the sensory territory of the __________ spinal nerve. |
|
Definition
|
|
Term
| The lateral leg (anterior & posterior), and big toe half of the dorsal foot is the sensory territory of the __________ spinal nerve. |
|
Definition
L5
(remember: leg = "lower leg"; thigh = thigh) |
|
|
Term
| The heel, middle half of the lower 2/3 of the posterior leg, and lateral part of the foot is the sensory territory of the __________ spinal nerve. |
|
Definition
|
|
Term
leg : anatomist
________ : layperson |
|
Definition
|
|
Term
arm : anatomist
________ : layperson |
|
Definition
|
|
Term
| Most of the back of the thigh, back of the knee, and top 1/3 of the back of the leg is the sensory territory of the __________ spinal nerve. |
|
Definition
|
|
Term
| The anus is the sensory territory of the __________ & _________ spinal nerves. |
|
Definition
|
|
Term
| A roughly donut shaped area in the middle of the butt surrounding (but not including) the anus is the sensory territory of the __________ spinal nerve. |
|
Definition
|
|
Term
| the largest branch of the lumbar plexus, arises from the dorsal divisions of the ventral rami of the second, third, and fourth lumbar nerves. |
|
Definition
|
|
Term
| multipolar neuron which connects afferent neurons and efferent neurons in neural pathways. |
|
Definition
|
|
Term
| Interneuron cell bodies are always located in the |
|
Definition
| central neural system (CNS) |
|
|
Term
| a small membranous protrusion from a neuron's dendrite that typically receives input from a single synapse of an axon. |
|
Definition
|
|
Term
| where the soma becomes the axon |
|
Definition
|
|
Term
| the soma of a neuron is aka the _________ |
|
Definition
|
|
Term
|
Definition
|
|
Term
| The myelin sheath is an outgrowth of ______________ in the peripheral nervous system and ___________ in the central nervous system |
|
Definition
Schwann cells
oligodendrocytes |
|
|
Term
| most common type of neuron; have two or more dendrites and a single axon |
|
Definition
|
|
Term
| neurons that have one dendritic process that branches extensively at its distal tip, and one axon, with the cell body between them. Found in sensory structures such as retina, olfactory epithelium, vestibular & auditory systems |
|
Definition
|
|
Term
| A neuron in which a single axon extends from the cell body, then splits into one peripheral branch (dendritic process) that branches extensively at its distal tip, and one central branch (axon) that ends in the spinal cord. Found in sensory ganglia (dorsal root ganglia) of cranial & spinal nerves |
|
Definition
|
|
Term
| What is the normal resting membrane potential of a cell? |
|
Definition
-60 to -80 mV
(the inside of the cell is more negative than the outside) |
|
|
Term
| Is sodium or potassium more concentrated inside the cell? Outside? |
|
Definition
sodium--more concentrated outside
potassium--more concentrated inside |
|
|
Term
| A type of synapse that involves opening gap junctions in response to action potential. Overall function is to ensure synchronous activity of neurons having a common action. |
|
Definition
|
|
Term
| Collection of structurally and functionally related neuron bodies in the CNS |
|
Definition
|
|
Term
| Dense network of dendrites, axons and glial cell processes between neurons |
|
Definition
neuropil
(pronounced "neuro-pile") |
|
|
Term
| Layer of neurons within the CNS |
|
Definition
|
|
Term
| A collection of nerve fibers in the CNS |
|
Definition
|
|
Term
| A bundle of neuronal axons / fibers enclosed by a perineurium |
|
Definition
|
|
Term
| Bundle of sensory fibers in the brain stem |
|
Definition
|
|
Term
| Aggregation of nerve cell bodies in the PNS |
|
Definition
|
|
Term
| peripheral fascicle of axons enclosed by a perineurium |
|
Definition
|
|
Term
| Initial segment of a nerve leaving the CNS |
|
Definition
|
|
Term
| After they leave the spine, the dorsal and ventral roots join, and then split into the ________ and the ___________ |
|
Definition
dorsal ramus
ventral ramus |
|
|
Term
| Most important inhibitory neurotransmitter of the CNS |
|
Definition
| GABA (gamma aminobutyric acid) |
|
|
Term
| __________ is a neurotransmitter that is excitatory to skeletal muscles. May be excitatory or inhibitory elsewhere |
|
Definition
|
|
Term
| Does acetylcholine work in the CNS, PNS, skeletal neuromuscular junctions, or some combintation thereof? Is it excitatory, inhibitory, or both? |
|
Definition
works in all 3 (only neurotransmitter for skeletal neuromuscular junctions)
always excitatory for neuromuscular junctions; excitatory or inhibitory elsewhere |
|
|
Term
| Does norepinephrine work in the CNS, PNS, skeletal neuromuscular junctions, or some combintation thereof? Is it excitatory, inhibitory, or both? |
|
Definition
CNS & PNS
excitatory & inhibitory |
|
|
Term
| Does dopamine work in the CNS, PNS, skeletal neuromuscular junctions, or some combintation thereof? Is it excitatory, inhibitory, or both? |
|
Definition
CNS & PNS
usually excitatory, but sometimes inhibitory |
|
|
Term
| Does serotonin work in the CNS, PNS, skeletal neuromuscular junctions, or some combintation thereof? Is it excitatory, inhibitory, or both? |
|
Definition
CNS only
usually inhibitory |
|
|
Term
| Does GABA (gamma aminobutyric acid) work in the CNS, PNS, skeletal neuromuscular junctions, or some combintation thereof? Is it excitatory, inhibitory, or both? |
|
Definition
|
|
Term
| Does glycine work in the CNS, PNS, skeletal neuromuscular junctions, or some combintation thereof? Is it excitatory, inhibitory, or both? |
|
Definition
|
|
Term
| Does glutamate work in the CNS, PNS, skeletal neuromuscular junctions, or some combintation thereof? Is it excitatory, inhibitory, or both? |
|
Definition
|
|
Term
| Does aspartate work in the CNS, PNS, skeletal neuromuscular junctions, or some combintation thereof? Is it excitatory, inhibitory, or both? |
|
Definition
|
|
Term
| Does substance P work in the CNS, PNS, skeletal neuromuscular junctions, or some combintation thereof? Is it excitatory, inhibitory, or both? |
|
Definition
|
|
Term
| Does met-enkephalon (an endorphin) work in the CNS, PNS, skeletal neuromuscular junctions, or some combintation thereof? Is it excitatory, inhibitory, or both? |
|
Definition
CNS only
usually inhibitory |
|
|
Term
| Which is more likely to heal, and why: a wound that only affects articular cartilage, or a wound that affects bone as well. |
|
Definition
wounds that also affect underlying bone heal better
cartilage is avascular, so cartilage-only wounds don’t stimulate usual inflammatory wound-healing response (and stimulate only a slight reaction in the adjacent chondrocytes)
Wounds that also affect subchondral bone recruit cells from marrow of bone to attempt to fill defect with new tissue |
|
|
Term
| What happens when hyaline cartilage is damaged in infants? Children and young adults? Older adults? |
|
Definition
In infants hyaline cartilage may truly heal (be replaced with more hyaline cartilage very similar to the original tissue).
In children & young adults, damaged hyaline cartilage is repaired with fibrocartilage (if the subchondral bone is involved).
In middle aged and senior adults, little healing of any type takes place |
|
|
Term
| What is the best treatment for cartilage damage in an older adult (>65) and why? |
|
Definition
total joint replacement
the joint will probably outlive the patient
very unlikely to heal with other treatments |
|
|
Term
| What 2 treatments are better for treating cartilage damage that won't heal on its own people <60 years old, and why are they better than the alternatives? |
|
Definition
| OATS (OsteoArticular Transfer System) or microfracture are better options for this age group because total joint will have to have repaired or replaced they are more likely to be able to heal cartilage somewhat with other treatments |
|
|
Term
| What size of articular cartilage defects rarely heal? |
|
Definition
| defects greater than 2-4 mm |
|
|
Term
| Where do the cells in articular cartilage get their nutrients & where do they send their waste products? |
|
Definition
get nutrients from & send waste products to synovial fluid & underlying subchondral bone
(cartilage is avascular & has no lymphatic drainage) |
|
|
Term
| Over time, cartilage damage can lead to ___________ |
|
Definition
| osteoarthritis (damage to the bone at the articular joints) |
|
|
Term
| What is the process and result of microfracture as a treatment for cartilage damage? Who benefits most from this treatment? |
|
Definition
Microfracture recruits pluripotential stem cells from marrow by penetrating subchondral bone by shoving a small awl through the damaged cartilage into the marrow below.
Microfracture causes fibrocartillage (not articular cartilage) to grow in young people.
It works better in younger people (<60). Older people may not grow fibrocartilage. |
|
|
Term
| Continual passive motion helps heal _______ cartilage damage |
|
Definition
small (<3mm)
especially if used in combination with other techniques |
|
|
Term
| If you were giving someone growth factors to help heal cartilage damage, how would you dose it and why? |
|
Definition
give as a single injection
A single injection of growth factor stimulated a persistent increase in cartilage proteoglycan synthesis and content, but multiple injections induced
synovial hyperplasia (overgrowth of synovial membrane)
substantial synovitis (inflammation of synovial membrane) |
|
|
Term
| Is it a good idea to give corticosteroids to someone with cartilage damage? |
|
Definition
| No. Some studies find they help heal, but others find that they cause problems (impair normal cartilage; cause arthropathy) |
|
|
Term
| What is the main reason you would give someone with joint damage hyaluronic acid? Does it have other effects? |
|
Definition
Used as a “viscosupplement” (lubricant) for damaged joint
Probably has other actions, but not studied yet |
|
|
Term
| Should you give electrical stimulation to someone to help repair damaged cartilage? |
|
Definition
| No. Electrical stimulation helps to repair bone but shows little effect for helping heal damaged cartilage. |
|
|
Term
| Should you give laser treatment to someone to help repair damaged cartilage? |
|
Definition
| No. No positive effects shown (but little research done yet) |
|
|
Term
| What happens to scaffolds implanted in cartilage tissue? What is most recently being studied in scaffolds? |
|
Definition
Mostly, nothing happens (the hope is that cartilage will grow on the scaffold, but this mostly doesn't happen).
Recent research is being focused on scaffolds infused with growth hormones. |
|
|
Term
| What is the OATS procedure? |
|
Definition
| OATS (OsteoArticular Transfer System) is an autoograft transfer of a cartilage plug from an undamaged, non-weight-bearing site to a damaged, weight-bearing site. |
|
|
Term
| Is OATS allograft or autograft? |
|
Definition
autograft
OATS (OsteoArticular Transfer System) is an autoograft transfer of a cartilage plug from an undamaged, non-weight-bearing site to a damaged, weight-bearing site. |
|
|
Term
| What are the advantages of OATS procedure for treating cartilage? |
|
Definition
The OATS procedure is well established and had been well accepted by the orthopaedic surgeons.
o The techniques are well established.
o There is no possibility of a transplant rejection (even if it is slight) and there is no possibility of a disease transmission from the transplant.
o You do not have to purchase or wait on allograft tissues to be delivered for the operation. |
|
|
Term
| What are the disadvantages of OATS procedure for treating cartilage? |
|
Definition
There is a limited amount of cartilage available in the non-weight bearing region of the joint. If the surgeon needs more cartilage, a problem exists. The harvesting procedure can result in increased morbidity at the harvest site and increased risk of fracture.
There will be an increased operation time required to complete the operation as compared to the use of allograft cartilage. |
|
|
Term
| Describe the procedure transplantation of autogenous chondrocytes to promote cartilage healing |
|
Definition
Takes 2 procedures
Procedure 1: a small number of chondrocytes harvested from patient
Grown chondrocytes culture for 2-3 weeks
Procedure 2: chondrocytes implanted via open joint surgery
Usually use scaffolds or matrices to hold transplanted chondrocytes in place |
|
|
Term
| What are the advantages of transplantation of autogenous chondrocytes to promote cartilage healing |
|
Definition
Shows good results!
12 months later, cartilage appears mostly healed (although the edges were still visible)
5 years later, patients show good or excellent clinical results
Also, little or no chance that one's own chondrocytes will provoke immune response (cartilage is "immune privileged", but we don't know how much of an immune response it provokes. Obviously, as in rheumatoid arthritis, it is capable of producing SOME immune response). |
|
|
Term
| What are the advantages of transplantation of autogenous chondrocytes to promote cartilage healing |
|
Definition
Shows good results!
12 months later, cartilage appears mostly healed (although the edges were still visible)
5 years later, patients show good or excellent clinical results
Also, little or no chance that one's own chondrocytes will provoke immune response (cartilage is "immune privileged", but we don't know how much of an immune response it provokes. Obviously, as in rheumatoid arthritis, it is capable of producing SOME immune response). |
|
|
Term
| What are the disadvantages of transplantation of autogenous chondrocytes to promote cartilage healing |
|
Definition
takes 2 separate surgical procedures
double the pain
double the risk (every surgery carries risk)
double the expense (insurance may not pay) |
|
|
Term
| Explain how a tiny mal-alignment in the joint can cause big problems. |
|
Definition
A tiny mal-alignment of the joint can lead to unequal wear & wear out cartilage at the pressure points. After the pressure point is worn out, this exposes more cartilage to excessive wear & eventually large amounts of cartilage are worn out
If the mal-alignment is surgically fixed, the life expectancy of the joint can be increased |
|
|
Term
| Describe the Sanger Method of DNA sequencing |
|
Definition
Split DNA into single strands with heat
Add an appropriate primer
Divide DNA between 4 tubes, each of which contains
The 4 kinds of nucleotides (A, T, C, G)
1 kind of dideoxynucleotide (missing –OH); ddATP, ddCTP, ddGTP, or ddTTP
DNA polymerase
When the DNA polymerase adds the dideoxynucleotide the strand, it stops the building of the strand
Then use gel electrophoresis, putting each tube into a separate channel. The bigger the chain, the closer it will stay to the top
Read from bottom top (so, if the lowest line is in the "A" column, then the first base is "A") |
|
|
Term
| Which direction do you read the array in Sanger method DNA sequencing? |
|
Definition
|
|
Term
| What goes into each of the 4 tubes used in Sanger Method DNA sequencing? |
|
Definition
The 4 kinds of nucleotides (A, T, C, G)
1 kind of dideoxynucleotide (missing –OH); ddATP, ddCTP, ddGTP, or ddTTP
DNA polymerase |
|
|
Term
| enzymes that recognize specific nucleotide sequences (usually short palindromic sequences, such as GAATTC) & cut DNA into fragments at recognized sequences |
|
Definition
|
|
Term
| a restriction site in an engineered plasmid is a __________ site |
|
Definition
|
|
Term
| a sequence (usually palindromic) where restriction enzymes can cut the DNA & foreign DNA can be inserted |
|
Definition
|
|
Term
| What 3 things must a plasmid contain to make it an appropriate vector for introducing DNA into a cell? |
|
Definition
A cloning site (restriction site) to allow the vector to be cut & desired DNA to be inserted.
An antibiotic-resistance gene. Most cells won’t take up the vector. Only those that do will survive antibiotics.
An ori to allow replication in the host cell |
|
|
Term
| method of amplifying DNA using only chemicals & thermal cycling (no cells) |
|
Definition
| polymerase chain reaction (PCR) |
|
|
Term
| What does the mnemonic SNOW DROP mean for gel electrophoresis? |
|
Definition
Match up the letters of the first & 2nd words (skip the O):
Southern blot—DNA
Northern blot—mRNA
Western blot—Protein |
|
|
Term
| A southern blot is gel electrophoresis of ____ fragments and is best used for detecting: |
|
Definition
DNA
best used to detect
small deletions or insertions
large trinucleotide expansions
Ability to detect point mutations is limited unless the mutation destroys or creates a restriction site. |
|
|
Term
| A Northern blot is gel electrophoresis of ____ and is best used for detecting: |
|
Definition
mRNA
This technique may be useful
to identify mutations that affect the RNA length (splicing mutation)
or to determine that a mutation increases or decreases the expression of a gene. |
|
|
Term
| A Western blot is gel electrophoresis of ____ and is best used for detecting: |
|
Definition
| protein Can be useful for mutations that affect translation of protein without affecting DNA restriction sites, RNA length, or RNA expression |
|
|
Term
| What needs to be special about DNA polymerase used in Polymerase Chain Reactions (PCRs)? |
|
Definition
| needs to be heat-stabile (NOT heat-labile) to withstand thermal cycles |
|
|
Term
| What 3 kinds of things do you mix DNA with when doing Polymerase Chain Reaction (PCR)? |
|
Definition
heat-stable DNA polymerase
primers (short DNA sequences complimentary to target region)
nucleotides (DeoxyNucleotide TriPhosphate, dNTP) |
|
|
Term
| In PCR (polymerase chain reaction), how to you ensure that as much of the DNA is replicated as possible? |
|
Definition
the whole DNA strand isn’t replicated; just from the primer forward
if you want to replicate the whole strand, you want a primer that attaches as close to the 3’ end of the parent as possible
remember: strand builds in 5’-->3’ direction, moving along parent in 3’-->5’ direction |
|
|
Term
| What are 2 advantages & 1 limitation of Polymerase Chain Reaction (PCR)? |
|
Definition
Good:
Very fast!
Good for when only a little DNA is available (b/c DNA is not lost, unlike in cloning)
Limitation:
Only good for DNA fragments up to 10kb |
|
|
Term
| What size of DNA fragment can be replicated via Polymerase Chain Reaction (PCR)? |
|
Definition
| Only good for DNA fragments up to 10kb |
|
|
Term
| Describe how a microarray works in identifying certain sequences in DNA |
|
Definition
known probe sequences of DNA are attached to glass at known sites
DNA is isolated, fragmented, & tagged with fluorescent dye
Pour DNA-containing fluid onto a microarray of probes
DNA that matches probes sticks; DNA that doesn’t washes away
Look at brightness/color of glass slide at the known spot to know how much DNA of that sequence stuck
(may use >1 kind of fluorescent tag. If one kind of DNA is tagged red, & one is tagged green, then a mixture of the 2 is fluoresces yellow) |
|
|
Term
| a standard format for depicting a karyotype, in which chromosomes are shown in pairs, ordered by size (& by position of centromere for chromosomes of the same size) |
|
Definition
|
|
Term
| Do get a karyogram, you must arrest cells during __________ |
|
Definition
|
|
Term
| To be used to make a karyogram, cell must be capable of being __________ and of ___________ |
|
Definition
cultured
mitosis (it's OK if the cell is in G0, as long as a mitogen can force it back into mitosis) |
|
|
Term
| Why can't you use fixed or frozen cells to make a karyogram? |
|
Definition
| To be used to make a karyogram, cell must be capable of being cultured and of entering mitosis under the influence of a mitogen |
|
|
Term
| A chemical that induces mitosis in cells |
|
Definition
|
|
Term
| The most common kind of band staining of DNA. DNA rich in AT stains dark; DNA with little AT stains light |
|
Definition
|
|
Term
| Hybridization of a specific fluorescent probe with denatured mitotic or interphase chromosomes in a cell. |
|
Definition
| Fluorescence In Situ Hybridization (FISH) |
|
|
Term
| Can Fluorescence In Situ Hybridization (FISH) be used to detect very small changes in DNA? |
|
Definition
Yes.
FISH is hybridization of a specific fluorescent probe with denatured mitotic or interphase chromosomes in a cell. It can detect small changes if you know what specific changes you're looking for and provide matching probes. |
|
|
Term
| Someone comes in with a red, inflamed big toe so painful that they can't stand to let the sheet touch it. What illness do they most likely have? |
|
Definition
|
|
Term
|
Definition
| deposits of monosodium urate crystal in soft tissue in chronic gout |
|
|
Term
| Gout is caused by deposits of ________ _____________ crystals, while pseudogout is most often caused by deposits of ____________ _________ crystals |
|
Definition
monosodium urate
calcium pyrophosphate |
|
|
Term
| The end product of ____________ metabolism is uric acid |
|
Definition
|
|
Term
|
Definition
| too much uric acid in blood |
|
|
Term
| Explain the 2 main causes of hyperuricemia |
|
Definition
| Overproduction de novo biosynthesis of purines from nonpurine precursors (uric acid is the end-product of purine metabolism) high nucleic acid turnover salvage by phosphoribosyltransferase activities. dietary intake in excess of excretion rate (lots of foods rich in purine; diet alone is not enough to cause hyperuricemia; diet + under-excretion may cause hyperuricemia) abnormally rapid cellular breakdown due to cancer, chemo, or wasting disease Under-excretion impaired renal tubular transport due to drugs or kidney disease |
|
|
Term
| Other than the joints, where do monosodium urate crystals typically deposit in acute gout? |
|
Definition
| kidneys (as nephrolithiasis, kidney stones) |
|
|
Term
| In acute gout, ________ are attracted to monosodium urate crystals and produce ____________ |
|
Definition
neutrophils
pro-inflammatory cytokines (IL-1, TNF-α, PGE2 (ProstaGlandin E2)) |
|
|
Term
| How do you separate gout from pseudogout? |
|
Definition
Arthropathy—aspirate a little fluid form inflamed joint
Then examine the fluid for what kind of crystals are present
This is the ONLY way to distinguish gout from pseudogout. (Serum concentration of uric acid correlates poorly with onset & duration of acute attack) |
|
|
Term
| What 4 kinds of drugs do you give to people with an acute gout attack? |
|
Definition
drugs to treat inflammation:
NSAIDs
Prednisone
Colchicines
Anakinra
These drugs do not lower urate. Drugs that lower urate can make an acute attack worse. |
|
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Term
| Joint paint with an intense infiltration of neutrophils into joints is a hallmark of an acute attack of what? |
|
Definition
| crystal-induced arthropathy (gout & pseudo-gout) |
|
|
Term
| How do you treat an acute attack of gout & pseudo-gout differently? |
|
Definition
You don't. You give both kinds of patients drugs to treat inflammation:
NSAIDs
Prednisone
Colchicines
Anakinra |
|
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Term
| What does allopurinol do and what illness is it used to treat ? |
|
Definition
Allopurinol is a xanthine oxidase inhibitor. Xanthine oxidase catalyzes 2 steps of the metabolism of purine to uric acid.
Give patient allopurinol to lower uric acid production to treat chronic gout |
|
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Term
| What does Februxostat do and what illness is it used to treat ? |
|
Definition
Februxostat is a xanthine oxidase inhibitor. Xanthine oxidase catalyzes 2 steps of the metabolism of purine to uric acid.
Give patient Februxostat to lower uric acid production to treat chronic gout |
|
|
Term
| Name the 2 xanthine oxidase inhibitors that we learned. |
|
Definition
allopurinol
Februxostat
(used to treat chronic gout) |
|
|
Term
Which of the 2 xanthine oxidase inhibitors (used to treat chronic gout) is described below:
many patients discontinue use because of hypersensitivity reactions (rash, vasculitis) & GI troubles
Contraindicated in patients with renal insufficiency
Cheap (costs $14.70/day) |
|
Definition
|
|
Term
Which of the 2 xanthine oxidase inhibitors (used to treat chronic gout) is described below:
No hypersensitivity reaction
Higher rates of cardiovascular events
Can be used for patients with renal insufficiency
Expensive (Costs $161.40/day) |
|
Definition
|
|
Term
| Allopurinol & februxostat can induce flares of ________ |
|
Definition
gout
(as can all urate-lowering therapies) |
|
|
Term
| Most common joint affected by osteoarthritis |
|
Definition
|
|
Term
| osteoarthritis affects __________ (distal/proximal) finger joints more and causes fingers to deviate in the ___________ (radial/ulnar) direction |
|
Definition
|
|
Term
| The main treatment for osteoarthritis is ________ |
|
Definition
NSAIDs
(nothing works very well to treat underlying illness; just treat the pain) |
|
|
Term
| Methotrexate is a ___________ drug that is also used at much lower doses to treat _____________ (joint problem) |
|
Definition
chemotherapy
rheumatoid arthritis |
|
|
Term
| What are the 2 most important adverse effects of methotrexate (a chemotherapy drug that is also used to treat rheumatoid arthritis) |
|
Definition
causes myelosuppression—a condition in which bone marrow activity is decreased, resulting in fewer red blood cells, white blood cells, and platelets
can damage the epithelial lining of mouth and GI tract. |
|
|
Term
| Rheumatoid arthritis affects __________ (proximal/distal) joints of the fingers more and causes the fingers to deviate in the _________ (radial/ulnar) direction |
|
Definition
|
|
Term
Explain this mnemonic:
Osteo is Outside
Rheumatoid is wRist side |
|
Definition
Osteoarthritis affects proximal finger joints more than distal.
Rheumatoid arthritis affects distal joints more than proximal. |
|
|
Term
| Main component of ExtraCellular Matrix (ECM); provides structure/support |
|
Definition
|
|
Term
| Tropoelastin + microfibrils = |
|
Definition
|
|
Term
| Fibers that stretch & re-form without energy input (very important in lungs & blood vessels) |
|
Definition
|
|
Term
| The basal lamina is made of __________, which supports the extracellular matrix by binding its various parts to the basal lamina |
|
Definition
|
|
Term
| Heterotrimeric protein shaped like a cross |
|
Definition
|
|
Term
| Protein/carbohydrate mixture that provides resilience & flexibility to the extracellular matrix for compression & re-expansion |
|
Definition
| proteoglycans (Proteins + glycosaminoglycans (GAGs) |
|
|
Term
| A transmembrane protein consisting of an alpha and β subunit. Cellular receptors of the extracellular matrix that provide a link between ECM proteins and cytoskeleton |
|
Definition
|
|
Term
| Large multidomain proteins of fibronectin that link integrins to the extracellular matrix |
|
Definition
|
|
Term
| What's the difference between proteoglycans & glycoproteins |
|
Definition
| Proteoglycans are a subclass of glycoproteins in which the carbohydrate units are polysaccharides that contain amino sugars (glycosaminoglycans, GAGs). |
|
|
Term
| How do proteoglycans create a hydrated gel? |
|
Definition
| Negatively charged carboxylate and sulfate groups on the glycosaminoglycan (GAG) bind positively charged ions and form hydrogen bonds with trapped water molecules, thus creating a hydrated gel. |
|
|
Term
| How does systemic lupus erythematosus (SLE) affect joints? |
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Definition
| SLE induces body to produce antibodies directed against extracellular matrix proteins in cartilage. This leads to inflammation, which causes enzymatic degradation of proteoglycans thus reducing the cushioning function of articular cartilage |
|
|
Term
| How do the mucopolysaccharidoses affect joints? |
|
Definition
Part of the lysosomal storage disease family; unable to produce enzymes required to breakdown GAGs thus leading to an increased collection of GAGs
Over time, these glycosaminoglycans collect in the cells, blood and connective tissues. The result is permanent, progressive cellular damage which affects appearance, physical abilities, organ and system functioning, and, in most cases, mental development. |
|
|
Term
| What are the 3 primary components of hyaline cartilage |
|
Definition
75% water
15% collagen
10% proteoglycans (most important proteoglycans in hyaline cartilage are aggrecans) |
|
|
Term
| Describe how alterations in articular cartilage turnover can lead to osteoarthritis. |
|
Definition
| When bone surfaces become less well protected by cartilage, bone may be exposed and damaged. |
|
|
Term
| lack of response to self antigens |
|
Definition
|
|
Term
| tolerance to self-antigens acquired via negative selection when lymphocytes first encounter self antigens in central lymphoid organs (bone marrow & thymus) |
|
Definition
|
|
Term
| tolerance to self-antigens acquired when mature lymphocytes encounter self antigens outside of central lymphoid organs (bone marrow & thymus) |
|
Definition
|
|
Term
| What 2 things can happen to immature B cells that bind strongly to self antigens in bone marrow |
|
Definition
die by apoptosis
or undergo receptor editing (reactivate RAG genes, generate a new light chain, change specificity) |
|
|
Term
| What 2 things can happen to immature B cells that bind strongly to self antigens in bone marrow |
|
Definition
die by apoptosis
r undergo receptor editing (reactivate RAG genes, generate a new light chain, change specificity) |
|
|
Term
| Central tolerance for B cells occurs due to selection in: |
|
Definition
|
|
Term
| After T cells migrate from bone marrow to thymus, they become double-positive. What does that mean? |
|
Definition
| they begin to express CD4 (CD4+) and CD8 (CD8+) |
|
|
Term
| What 2 kinds of selection do new, double-positive T cells have to undergo in the thymus? |
|
Definition
Positive selection for self-reactivity—TCR must bind weakly to MHC-presented self-antigens or will undergo apoptosis
Negative selection for self-reactivity—TCR must not bind strongly to MHC-presented self-antigens or will undergo apoptosis |
|
|
Term
| What 2 things can happen to T cells that react strongly to MHC-presented self-antigen? |
|
Definition
they undergo apoptosis
develop into regulatory T cells (T regs) (some strongly auto-reactive T cells that recognize MCH II become TRegs) |
|
|
Term
| After T cells undergo the central tolerance process in the thymus, some of them lose one thing & some of them lose another thing. What do they lose, and what determines which thing they lose? |
|
Definition
TCRs that recognize MHC I (which displays peptides fomr inside the cell) lose CD4 and only express CD8
TCRs that recognize MHC II (which displays peptides picked up from outside the cell) lose CD8 and only express CD4 |
|
|
Term
| ________ is a transcription factor expressed in thymus that allows thymus to express a wide variety of self-antigens |
|
Definition
| AutoImmune REgulator (AIRE) |
|
|
Term
| How is that T cells see such a wide variety of self-antigens within the thymus, even though some antigens are peripherally-restricted (that is, typically only expressed in specific tissues) |
|
Definition
| AutoImmune REgulator (AIRE) is a transcription factor expressed in thymus that allows thymus to express a wide variety of self-antigens |
|
|
Term
| A mutation in AIRE can lead to what class of diseases? Which group of those diseases is particularly linked with AIRE mutations? |
|
Definition
auto-immune diseases
Autoimmune Polyendocrine Syndrome (APS1)
AutoImmune REgulator (AIRE) is a transcription factor expressed in thymus that allows thymus to express a wide variety of self-antigens |
|
|
Term
| a heterogeneous group of diseases characterized by autoimmune reaction against more than one endocrine system; linked with mutations in the AIRE transcription factor in the thymus |
|
Definition
| Autoimmune Polyendocrine Syndrome (APS1) |
|
|
Term
| A T cells that recognizes MHC ___ and _______________________________ could become a TReg |
|
Definition
II
is strongly auto-reactive |
|
|
Term
| TRegs respond to their antigen by producing __________________ such as ___________ and ___________ |
|
Definition
inhibitory cytokines
IL-10
TGF-beta
(TRegs are auto-reactive regulatory T cells) |
|
|
Term
| MHC I display ___________ while MCH II display ________ |
|
Definition
peptides form within the cell (such as self peptides or peptides form intracellular parasites)
peptides brought in form outside the cell |
|
|
Term
| Do TRegs express CD4 or CD8? |
|
Definition
| CD4 (they respond to MHC II) |
|
|
Term
| Mutations in transcription factor Foxp3, expressed on TRegs, can lead to the auto-immune disease |
|
Definition
| X-linked polyendocrinopathy and enteropathy (IPEX) |
|
|
Term
| What 2 cytokines do TRegs reequire for their development & maintenance |
|
Definition
IL-2
TGF-beta (they also produce TGF-beta, anti-inflammatory cytokine) |
|
|
Term
| A protein expressed on TRegs that binds to IL-2R alpha chain (expressed on other TRegs as well as other T cells) & convert IL-2R to high-affinity form |
|
Definition
|
|
Term
| T cell inactivation that occurs when T cells are insufficiently activated by Antigen Presenting Cells (APCs). T cells recognize MHC-presented peptides on resting APCs but don’t receive adequate co-stimulation/second signal (from costimulators like B7). Innactivated T cells are unresponsive to the antigen, but do not undergo apoptosis |
|
Definition
|
|
Term
| Protein expressed by CD4+ helper T cells. In the same family as CD28. Like CD28, this protein binds to B7 receptors. Unlike CD28, this protein transmits an inhibitory signal to the T cell |
|
Definition
| Cytotoxic T-Lymphocyte Antigen 4 (CTLA4) |
|
|
Term
| When _________ on a T cells binds with B7 on an Antigen Presenting Cell (APC), it transmits costimulator signal to T cell & stimulates to activate |
|
Definition
|
|
Term
| A T cell goes into anergy when it recognizes an MCH-presented peptide, but has too few interactions between its ______ and the APC's ___________ too many reaction between the T cell's ___________ and _________ on CD4+ helper T cells, or too many reactions between the T cell's ___________ and __________ |
|
Definition
A T cell goes into anergy when it recognizes an MCH-presented peptide, but has too few interactions between its B7 and the APC's CD28
too many reaction between the T cell's B7 and CTLA-4 on CD4+ helper T cells,
or too many reactions between the T cell's PD-1 and PD-L on Tregs
|
|
|
Term
| What 3 things do the 3 parts of the deltoid do? |
|
Definition
Anterior portion—flexes shoulder (swings arm forward)
Medial portion—abducts arm
Posterior portion—extends shoulder (swings arm backward) |
|
|
Term
| What originates on the bottom corner of the scapula and inserts near the top on the front of the humerus? |
|
Definition
|
|
Term
| What does the teres major do? |
|
Definition
Internally rotates arm (along with supraspinatus & teres minor)
Helps adduct arm
Helps latissimus dorsi to draw the previously-raised arm downward & backward
Helps stabilize the humeral head in the glenoid cavity |
|
|
Term
| What are the 4 muscles of the rotator cuff? |
|
Definition
Supraspinatus
Infraspinatus
Teres minor
Subscapularis |
|
|
Term
| What originates on the top part (above the spine) of the medial border of the posterior side of the scapula, goes over the top of the humerus, and inserts on the top of the front of the humerus? |
|
Definition
|
|
Term
| What does the supraspinatus do? |
|
Definition
abducts the arm (lifts out & up)
Main cause of arm abduction for first 10-15 degrees of its arc (after that, the supraspinatus helps the deltoid)
Then, the deltoid gradually takes over (supraspinatus still helps the deltoid) after 30o, it’s mostly deltoid |
|
|
Term
| The main cause of arm abduction for first 10-15 degrees of its arc is the _________. After 15 degrees, the _________ gradually takes over and by 30 degrees is mostly responsible for abduction. |
|
Definition
|
|
Term
| Originates on the bottom portion (below the scapular spine) of the medial portion of the posterior side of the scapula, goes over the top of the humerus, and inserts on the top of the front of the humerus? |
|
Definition
|
|
Term
| What does the infraspinatus muscle do? |
|
Definition
| externally rotates the arm (with teres minor) |
|
|
Term
| Originates in the middle of the lateral border of the scapula goes of the top-side of the humerus, and inserts on the antero-lateral part of the head of the humerus? |
|
Definition
|
|
Term
| What does the teres minor do? |
|
Definition
| helps the infraspinatus externally rotate the arm (it's not that critical) |
|
|
Term
| What originals on most of the anterior side of scapula, goes around the medial side of the head of the humerus, and inserts on the antero-medial part of the head of the humerus? |
|
Definition
|
|
Term
| What does the subscapularis do? |
|
Definition
| internally rotates the arm (with some help from the scapulohumeral muscle) |
|
|
Term
Explain the following mnemonic:
MHC put themselves before others |
|
Definition
MHC I displays self (actually, peptides from within the cell, so it could also be intracellular parasites)
MHC II displays others (peptides picked up from around the cell; on APCs) |
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