Studied by 0 people
Bones regulate and store _______ & _______
Calcium & Phosphate
What composes the inorganic portion of bone matrix?
Hydroxyapatite
What acts as the "cement" in the organic component of bone matrix?
Hyaluronic acid (proteoglycans)
What bone cell:
AKA stem cells, precursors for future osteoblasts found in lining of bone
Osteoprogenitor cells
What bone cell:
Responsible for ossification, made up of type 1 collagen & hyaluronic acid
Osteoblasts
What bone cell:
Derived from mesenchymal osteoprogenitor cells forming an osseous matrix, in which it becomes enclosed as an osteocyte
Osteoblasts
What bone cell:
Found in lacunae, have cytoplasmic processes that extend into the canaliculi and make contact with each other via gap junctions
Osteocytes
What bone cell:
Bone absorption
Osteoclasts
What bone cell:
Large multi-nucleated cells with acidophilic cytoplasm that remove old bone from large "resorption pits"
Osteoclasts
What is collagen?
extracellular matrices that provide scaffolding of tissues and serve as a plethora of receptors and cell-matrix signal interactions
Two major types of extracellular matrices in connective tissue:
Interstitium, Basement membrane
Interstitium or Basement membrane:
Made of mesenchymal cells and forms stroma of organs
Interstitium
Interstitium or Basement membrane:
Thin and sheet-like, comprised of endothelial and epithelial cells, surround nerve and muscle cells
Basement membrane
Which collagen type is found in basement membranes?
IV
Which collagen type is found in skin, tendon, and bone?
I
Which collagen type is found in hyaline cartilage?
II
Which collagen type is found in blood vessels and parenchymal cells?
III
Which collagen type is found in smooth muscle?
V
What is another name for stroma?
Collagens
What is another name for scaffold?
Elastin
What is Elastin?
insoluble protein polymer comprised of tropoelastin, microfibrils, and fibrilin
What work as adhesion molecules?
Glycoproteins
What is the major structural glycoprotein?
Fibronectin
What functions as "multi-purpose glue" binding extracellular matrix components together?
Proteoglycans
What are the 4 classes of interstitium/extracellular macromolecules?
Collagens, Elastin, Glycoproteins, Proteoglycans
What is cartilage?
Non-vascular, rigid connective tissue matrix
What cell types make up cartilage?
Chondroblasts, Chondrocytes
What is perichondrium?
Outer layer surrounding cartilage
What are the 3 types of cartilage?
Hyaline, Elastin, Fibrin
What type of cartilage:
Articular cartilage that lines joints
Hyaline
What type of cartilage:
Mixture of cartilage and fibrous tissue that forms syndesmoses (ie pubic symphysis
Fibrin
What type of cartilage:
Has the ability to repair itself in response to injury
Fibrin
What type of cartilage:
Only found in ligamentum nuchae of the human C-spine & rib cage; common in other mammals
Elastin
What joints have no movement?
Fibrous (Synarthrodial)
What joints have minimal movement?
Cartilaginous (Amphiarthrodial)
What are freely moveable joints?
Synovial (Diarthrodial)
What type of joints have no cartilage lining, such as the cranium & distal tib-fib?
Fibrous (Synarthrodial)
What type of joints are ostochondral joints, pubic symphysis, and spine?
Cartilaginous (Amphiarthrodial)
What is the purposed of the synovial capsule?
surround and nourish joints
What is the purpose of bursa?
shock absorption; prevent sheering
What is Synovial fluid?
Lubricant/nutritional fluid in joint capsule
What is the primary purpose of synovial fluid?
Promote ROM, Reduce friction
What are the two types of synoviocytes?
Type A, Type B
Type A or Type B synoviocytes:
Phagocytose actively cell debris & waste in joint cavity; can be considered resident macrophages
Type A
Type A or Type B synoviocytes:
Involved in nutritional production of specialized matrix constituents including hyaluronan, collagens, and fibronectin
Type B
Which synovial fluid classification:
transparent, clear, high viscosity, <200 WBC, - cultures, <3.5 mL, <25% PMN
normal
Which synovial fluid classification:
transparent, yellow, high viscosity, 0-2,000 WBC, - cultures, <25% PMN, >3.5 mL
noninflammatory
Which synovial fluid classification:
translucent/opaque, yellow-clear, low viscosity, 2-100 k WBC, >50% PMN, - cultures, >3.5 mL
Inflammatory
Which synovial fluid classification:
opaque, yellow/green, variable viscosity, 15-100 k WBC, >75% PMN, + cultures, >3.5mL
Septic
Which synovial fluid classification:
bloody, red, variable viscosity, 200-2000 WBC, 50-75% PMN, - cultures, >3.5 mL
Hemorrhagic
What type of crystal is fine, needle-like, and negatively (yellow) birefringent?
Monosodium urate (gout)
What type of crystal is short, rhomboid, and positively (blue) birefringent?
Calcium pyrophosphate (pseudogout/CPPD)
What type of crystal is translucent and appears as stacked panes of glass?
Cholesterol (HLD)
What type of crystal is bipyrimidal (irregular) and positively birefringent?
Calcium oxalate (HPTH, myositis ossificans)
What type of crystal cannot be seen without EM or Alizarin red stain?
Hydroxyapatite (Milwakee shoulder)
What is classified as acute joint pain?
< 1 month
What is classified as chronic joint pain?
> 1 month
Monoarticular
1
Oligoarticular
4
Polyarticular
5+
Inflammatory or Noninflammatory:
Pain worse in AM
Inflammatory
Inflammatory or Noninflammatory:
Cold joints
Noninflammatory
Inflammatory or Noninflammatory:
Morning stiffness >1 hour
Inflammatory
Inflammatory or Noninflammatory:
No systemic signs
Noninflammatory
Articular or Periarticular:
Mostly joint or synovial region
Articular
Articular or Periarticular:
Mostly enthesis- tendon, ligament, muscle, nerve
Periarticular
Articular or Periarticular:
Diffuse, deep pain
Articular
Articular or Periarticular:
Point tenderness
Periarticular
Articular or Periarticular:
Pain on active & passive ROM
Articular
Articular or Periarticular:
Pain on active ROM
Periarticular
Muscle strength: trace (flicker) movement
1/5
Muscle strength: able to move with gravity
2/5
Muscle strength: able to move against gravity but not resistance
3/5
Muscle strength: able to oppose gravity and resistance
4/5
What are the 3 C's of joint fluid aspiration?
Cell count (w/ diff), Crystal analysis, Culture & sensitivities
What is the first step when evaluating pts?
*done prior to xray or labs
arthrocentesis
What should you always make sure to do prior to administering a therapeutic joint injection?
Drain joint fluid completely
When should you not do an arthrocentesis?
overlying cellulitis, wound, bacteremia
When should you not inject steroids into a joint?
suspected infxn or hemarthrosis
What are serologies?
blood tests
What are Immunoassays used for?
detect the interaction between an antibody and antigen in a controlled lab setting (in vitro)
What type of immunoassay is used for RF?
Hemagglutination
What type of immunoassay involves staining patterns of ANA antibodies?
Immunofluoresence
What type of immunoassay involves DNA testing?
Immunoblotting
What type of immunoassay observes for precipitins among antibody-antibody diffusion in agar wells (ie Ouchterlong analysis)?
Immunodiffusion
What type of immunoassay separates particles according to their electrical charge (IPEP, EPEP)?
Counter electrophoresis
What type of immunoassay is used for Lyme and HIV?
Enzyme Linked Immunoabsorbant (ELISA)
What are the 5 immunoglobulins?
MADGE: IgM, IgA, IgD, IgG, IgE
When determining levels of acute phase reactants (ESR, CRP), how do you account for gender and age?
Divide age by 2, and for women add 10 to final result
What diseases can cause elevated ACE levels?
Sarcoidosis, ILD, Leprosy
What disease can cause low ACE levels?
Scleroderma (endothelial injury)
What antibody is most specific for RA and should be drawn first?
Anti-CCP
Anti-CCP antibodies may develop ______ before joint symptoms appear
Years
What are Anti-neutrophilic cytoplasmic antibodes (ANCA)?
Group of antibodies that bind to enzymes present in the cytoplasm of neutrophils
P-ANCA is what antibody?
Anti-MPO antibody
C-ANCA is what antibody?
Anti-PR3 antibody
How are results of ANA reported?
Doubling titers & Patterns of immunofluoresence
ANA titers ≥_______ are positive in most labs
1:80
ANA titers ≥_______ correlate strongly with autoimmune disease
1:320
T/F: ANA does NOT correlate with disease activity
True
