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Path 26 Joints


solid joints, provide structural integrity and allow for minimal movement - Cranial sutures and bonds b/w roots of teeth and jawbones = ? - Symphyses = ? Synarthroses - Fibrous synarthroses - Synchondroses (Cartilaginous synarthroses)
Joints with joint space that allows for wide range of motion Synovial joints
Most common type of joint disease. progressive erosion of articular cartilage, dislodged pieces of cartilage/bone form loose bods (joint mice) in joint space, bone eburnation. knees and hands affected in women and hips in men. worse w use, morning stiff. Osteoarthritis - Heberden nodes at DIP joints in women
Chronic systemic inflamm affects many tissues/organs, principally attacks joints->inflamm synovitis->destroy articular cartilage and ankylosing joints. Women 40-70 y/o. Pannus bridge apposing bones, form fibrous ankylosis. nodules, HLA-DRB1, anti-CCP, TNF Rheumatoid Arthritis - symmetrical and small joints affected first - joints are swollen, warm, painful, morning stiff - Radial wrist deviation, Ulnar finger deviation, Swan Neck/Boutonniere finger deformities
Arthritis <16 y/o and persists for 6 wks. Oligoarthritis more common, systemic disease more freq (spiking fever, rash, hepatosplenomega, serositis), large joints affected, no nodules, ANA positive. Juvenile Idiopathic Arthritis (JIA) - Oligoarthritis=4 or less joints w/o psoriasis, HLA-B27, asymm, <6 y/o w iridocylitis - Rheumat factor-pos polyarth=teenage girls - Rheumat factor-neg polyarth= >5 joints - Enthesitis-related=male <6 y/o, HLA-B
Destroy articular cartilage and resulting bony ankylosis (sacroiliac and apophyseal joints). Squaring/Fusion of vertebral bods w bony outgrowths-> spinal immobility. HLA-B27. men 10-29 Ankylosing Spondyloarthritis (Marie-Strumpell)
triad of arthritis, nongonococcal urethritis or cervicitis, and conjunctivitis, d/t prior GI/GU infx. Ankles, knees, feet affected w sausage fingers/toes. men 20s and 30s. HLA-B27, inc risk w HIV. Reiter Syndrome
Arthritis d/t GI infx by Yersinia, Salmonella, Shigella, Campylobacter Enteritis-Associated Arthritis
Sudden painful, swollen joint w restricted ROM and fever, suppurative arthritis mostly d/t gonococcus (late teens, young adult), Staph (mainly), Strep, H. influ (<2 y/o), gram neg bacilli, Salmonella (Sickle cell). Most nongonococcals involve 1 knee only Bacterial Arthritis - Axial joint involvement w drug addicts
Arthritis caused by Borrelia burgdorferi, transmitted by Ixodes ticks. Large joints (knees, shoulders, elbows, ankles). Papillary synovitis w synoviocyte hyperplasia, fibrin deposit, CD4 T cell infiltrate, and onion-skin thickening of arterial walls. Lyme Arthritis
X-linked lack of HGPRT w hyperuricemia, neuro deficits w mental retardation, self mutilation, and gouty arthritis. Lesch-Nyhan syndrome
Precipitation of long, needle-like, NEGATIVELY BIREFRINGENT Monosodium Urate crystals into the joint space causing Tophi (urate crystals surrounded by inflamm rxn of macrophages, lymphocytes, giant cells). most first attacks occur in 1st MTP joint Gout - Risk factors for hyperuricemia: Age (gout rare b4 20-30) HGPRT and other familial links Heavy alcohol Obesity Drugs like Thiazides that reduce urate excretion Lead toxicity
Precipitation of blue-purple, geometric (rhomboid), WEAKLY BIREFRINGENT Calcium Pyrophosphate crystals first into articular matrix, menisci, and IV discs. Hereditary variant caused by mut ANKH gene. freq asymptomatic. Knees most commonly affected Pseudo-Gout
Small cyst almost always located near a joint capsule or tendon sheath (esp. wrist). firm, fluctuant, pea-sized translucent nodule. Ganglion - Synovial cyst: herniation of synovium through joint capsule or massive enlargement of bursa. In popliteal space w Rheumatoid arthritis = Baker cyst
Benign neoplasms that develop in synovial lining of joint, tendon sheaths, bursae. Chromo translocation t(1;2) (fuses CSF1 to promoter of collagen VI alpha-3 gene-> overexpress CSF1 [chemoattractant for macrophages]). Tenosynovial Giant-cell Tumor - Diffuse: Red-brown tangled mat of synovium w projections and nodules. pain, locking, swelling of knee - Localized: well circumscribed, resemble a small walnut
Most common soft-tissue tumor of adults. Benign Lipoma
Amplification of MDM2 oncogene inhibits p53-> lipoblasts that mimic fetal fat cells and contain round clear cytoplasmic vacuoles of lipid that scallop nuclei. t(12;16). 40-60s in the deep soft-tissue of prox extremities and retroperitoneum Liposarcoma
Most common reactive pseudosarcoma, often occurs in adults on the volar forearm. W plump, randomly oriented spindle cells surrounded by myxoid stroma Nodular Fasciitis
Can be palmar, plantar, or penile, nodular or poorly defined broad fasicles of fibroblasts and myofibroblasts surrounded by abundant dense collagen. Fibromatoses - Palmar: Dupuytren contracture, nodular thickening of palmar fascia w puckering and dimpling and flex contracture of 4th and 5th digits - Penile: Peyronie disease, curvature of shaft, constrict uretha
Large, infiltrative masses that freq recur after incomplete excision and are composed of banal well-differentiated fibroblasts that don't metastasize. teens to 30s. Mut APC or Beta-catenin. asso w Gardner synd (familial adenomatous polyposis). Deep-seated Fibromatosis
commonly in the deep soft tissue of the extremities. unencapsulated, infiltrative, soft, Fish-Flesh, spindled cell masses in Herringbone pattern to architectural disarray (pleomorphism, freq mitoses, necrosis). aggressive Fibrosarcoma
Most common soft-tissue sarcoma of kids/teens. most in head and neck or GU tract. tadpole or strap cells (rhabdomyoblasts: have abundant eosinophilic cytoplasm). Rhabdomyosarcoma - Embryonal type: most common, includes sarcoma botryoides. <10 y/o, nasal cavity, orbit, ear, prostate. cambium layer. - Alveolar type: teens, deep muscles of extremities. fibrous septae divide tumor into clusters that resemble alveo
Uterine these are the most common neoplasm of women. benign smooth muscle tumor. loss of func mut in Fumarate Hydratase. Blunt-ended, elongated nuclei w minimal atypia and few mitotic figs Leiomyoma
Malignant spindle cells w Cigar-shaped nuclei arranged in interweaving fascicles. in skin (small) and deep soft tissue of extremities and retroperitoneum (large). Leiomyosarcoma
Deep-seated mass noted for yrs, often in deep-soft tissue of LE around knee/thigh. Biphasic has dual lines of differentiation (epithel like and mesenchymal like). positive rxns w keratin and epithel memb antigen differentiates from other sarcomas. t(X;18) Synovial Sarcomas
Created by: Jakphooey