patho mod 10

In the liver, the inactive form of Vitamin D is converted to which of the following? (mark all that apply) 25-hydroxyvitamin D3 1,25-dihydroxyvitamin D3 24,25-dihydroxyvitamin D3

25-hydroxyvitamin D3

Which of following medication is used to treat an acute gout attack? (mark all that apply). Colchicine NSAIDS Allopurinol

Colchicine & NSAIDS

T/F - if False, change the statement to make it True Prolonged immobilization can lead to structural joint changes associated with OA.

True

A 68-year-old, white Caucasian female has a DEXA scan at the recommendation of her PCP. Her scan yielded a T-score of -0.9. Interpret the results of her DEXA scan. Develop a treatment plan giving a pharmacologic recommendation if applicable (be specific with name of supplement and/or class of drug), and a non-pharmacologic recommendation.

t-score is normal; but bc of risk grou she should supplement with Vit. D and regular weight bearing activities

A patient has a bilateral presentation of pain in the PIP joints of the hands. You believe this pain is due to arthritis but are unsure whether it is a result of RA or OA. What are 3 questions you could ask this patient to help you differentiate between RA and OA?

1. Do you experience stiffness in the morning? 2. If so, does it last less than or longer than 30 minutes? 3. Does prolonged movement aggravate or alleviate your symptoms?

Give 2 reasons that males are at a decreased risk for developing osteoporosis than females.

1. Males achieve 8-10% greater peak BMD than females do 2. they do not go through a midlife decline of sex hormone production.

What is the recommended calcium intake for premenopausal women? 2000 mg. daily 1500 mg. daily 1000 mg. daily

1000 mg. daily

Which of the following would a patient likely exhibit on an initial physical exam if you suspect they have OA? (mark all that apply) A typical gait pattern A capsular pattern Crepitus with movement Bilateral involvement

A capsular pattern & Crepitus with movement

A 72-year-old male is said to be in phase 3 of gout. He is obese and has a history of alcohol abuse. Develop a treatment plan including specific pharmacologic intervention and a non-pharmacologic recommendation to manage his disease.

A pharmacologic intervention would be the use of allopurinol. A non-pharmacologic intervention would be to reduce weight, switch to a diet with less rich proteins and more vegetables and completely stay away from the alcohol.

Each of the following are true of gout except: Tophi are a result of the accumulation of urate crystals Crystals are more likely to accumulate in the periphery A serum uric acid level greater than 6.8 mg/dL without symptoms leads to a diagnosis of gout Hyperuricemia may be a result of an overproduction of purines

A serum uric acid level greater than 6.8 mg/dL without symptoms leads to a diagnosis of gout

Articular cartilage receives its blood supply and nourishment from which of the following? Diffusion of blood from subchondral bone Direct blood supply of the perichondrium covering Answer Constant bathing of synovial fluid

Constant bathing of synovial fluid

Compare and contrast the blood supply of cortical bone and cancellous bone.

Cortical bone has a direct blood supply from anastomosis that circulates; Cancellous bone does not have a direct blood supply and revieves blood via diffusion from endosteal bone surface.

Cancellous bone receives its blood supply by what means? Arteries branching from the medullary cavity Arteries branching inward from the periosteal arteries Diffusion through the endosteal surface of the bone and the canaliculi

Diffusion through the endosteal surface of the bone and the canaliculi

T/F - if False, change the statement to make it True Volkmann canals run parallel to the long axis of the bone. These canals connect the vascular and nervous innervations of the periosteum and the medullary cavity.

False; positioned at a right angle

A 22-year-old competitive gymnast has experienced amenorrhea for the past 5 years. Her PCP is suspecting that she may have premature osteoporosis. Would you expect her RANKL levels to be high, normal, or low? Explain why her levels would be at this level.

Her RANKL levels would be higher than normal; amenorhea gives less estrogen. Low estrogen = lower OPG and higher RANKL

Which of the following is false regarding OA? It is characterized by the gradual deterioration of weight bearing joints Males over the age of 55 have the highest incidence of OA Age, gender, history of trauma, and weight all contribute to the risk of developing OA Males have a higher incidence of developing OA at younger ages

Males over the age of 55 have the highest incidence of OA

Which of the following is false regarding structural changes in OA? Articular cartilage will erode over time leaving the subchondral bone exposed Chondrocytes enlarge and reorganize Microfractures extend through the articular surface but not into the subchondral bone Small fragments of cartilage will break off and become free-floating in the joint cavity

Microfractures extend through the articular surface but not into the subchondral bone

Premature Osteoporosis is characterized by which of the following? (mark all that apply) Often a result of chronic corticosteroid use Premature birth An increase in intestinal calcium absorption

Often a result of chronic corticosteroid use Premature birth

Which of the following cells when stimulated by bone morphogenic proteins (BMPs) differentiate to contribute to normal bone growth? Osteocytes Osteoclasts Osteoblasts Osteoprogenitor cells

Osteoprogenitor cells

A 60-year-old, obese female works out of her home and rarely walks due to the sedentary nature of her job. Give 2 reasons why she is at increased risk for developing OA.

The patient is above the usual onset age of 55 and is likely to be menopausal at this age. In addition, she is obese and has a sedentary lifestyle which are risk factors of developing OA.

If someone loses their balance when walking on uneven terrain, explain how tendons and ligaments work to protect the joint and structures within it.

The tendons and ligaments of joints serve in proprioception (the awareness of ones' position in space or movement of the body). When these structures undergo stretch or torsional strain, these proprioceptive nerve fibers will cause a reflexive response to adjust the tension on the muscles (to maintain balance and not fall over) that support the joint protecting the capsule and other joint structures.

Which of the following are true regarding syndesmoses? (mark all that apply) They allow limited movement between them They allow no movement between them They allow a small degree of movement between them They are separated by a fibrous disc They are joined by dense connective tissue

They allow a small degree of movement between them; They are separated by a fibrous disc

A patient presents to the ER with severe pain in their right ankle. Blood tests reveal serum uric acid levels of 7.8 mg/dL. They are kept for observation and their 24-hr urine specimen reveals underexcretion of urate. Which phase of gout are they in? What is the goal of your treatment given the phase they are in?

This patient is in phase 2 of gout or acute gout arthritis. The goal of treatment is to manage symptoms and terminate the acute attack primarily through NSAIDS.

T/F - If False, change the statement to make it True The Dowager hump is a result of collapsed vertebrae.

True

T/F - if False, change the statement to make it True Hyperuricemia may be a result of an underproduction of purines.

false, overproduction of purines