Mr. Yee, an 80-year-old man with diagnosis of Osteoarthritis Knee for 10 years. He currently complains of knee pain at a level of eight on a 0-10 pain scale. The nurse notices that his finger joints are very swollen. What is the most likely cause of the swelling in Mr. Yee's finger joints? a. A. Formation of urate crystals in the synovial tissue b. B. Inflammation of the synovial lining of the joint c. C. Swan neck deformity d. D. Excess synovial fluid between the bone and tissue

A 7-year-old girl complains of pain and swelling of the leftwrist and right knee off and on for the past 3 months. Shehas been previously healthy. The pain is worse in themorning and improves throughout the day. Physicalexamination is remarkable for swelling and effusion of theright knee, with decreased range of motion.Which of the following is the most probable diagnosis?a) Septic arthritisb) Polyarticular Juvenile Idiopathic Arthritisc) Systemic onset Juvenile Idiopathic Arthritisd) Systemic lupus erythematosuse) Pauciarticular Juvenile Idiopathic Arthritis

Lisa is an avid gardener who spends hours each day tending to her garden, which involves a lot of kneeling and leaning forward while working in her flower beds. Lately, she has been experiencing pain and swelling in her knees, particularly when she kneels or bends down. The discomfort has become persistent, affecting her gardening activities.What condition is Lisa most likely experiencing, given the described symptoms related to her gardening activities?Stress FractureTendinopathyBursitisOsteoarthritis

Maria, age 68, has difficulty managing simple everyday tasks because of the painful swelling of the joints in her hands. What condition is Maria likely to be diagnosed with?

Osteoarthritis (OA) is a disorder marked by the deterioration of articular (hyaline) cartilage, the connective tissue lining the ends of bones at most movable joints.  The progressive erosion of articular cartilage in OA is thought to be caused by an inflammatory response induced by years of biomechanical stress due to excessive compression and friction.  This response involves the release of proteolytic enzymes that break down cartilaginous proteins.  The progressive breakdown of articular cartilage ultimately results in complete exposure of the cortical portion of the underlying subchondral bone with narrowing of the joint space.  Repeated and abnormal joint stress can also cause the development of osteophytes (or small, bony growths) that form on the subchondral bone.  These degenerative processes cause pain and restrict joint movement.Stem cell therapy, in which injected or grafted stem cells are induced to differentiate into chondrocytes (cartilage cells), is a potential new treatment for OA.  To further understand chondrogenesis, researchers have been studying the molecules that regulate the expression and activity of the transcription factor Sox9, which has been shown to promote chondrocyte differentiation.  For example, researchers have found that binding of the growth factor TGF-β to its receptor results in Sox9 activation.MicroRNAs (miRNAs), which are known to alter gene expression by acting at the translational level, are also potential regulators of Sox9.  In particular, miRNA-145 is thought to regulate Sox9 expression by binding to the 3′-untranslated region (UTR) of the Sox9 mRNA transcript.  After chondrocyte differentiation was induced using TGF-β, researchers used western blotting to generate an expression profile of Sox9 and β-actin (a protein not regulated by miRNA-145) in mouse stem cells transfected with miRNA-145, anti-miRNA-145, or neither (Figure 1).Figure 1  Expression of Sox9 in the presence and absence of miRNA-145 or anti-miRNA-145 following induction of chondrocyte differentiationAdapted from Yang B, Guo H, Zhang Y, Chen L, Ying D, Dong S. MicroRNA-145 regulates chondrogenic differentiation of mesenchymal stem cells by targeting Sox9. PLoS ONE. 2011;6(7):e21679. Question 55OA commonly affects large, weight-bearing joints of the lower extremities such as the knee and hip.  Based on the passage, which of the following would most likely occur in a patient with OA involving the knees?A.Deterioration of the yellow bone marrow in affected bonesB.Deposition of excess bone on the epiphyses of affected long bonesC.Loss of hematopoietic function in the red marrow of affected bonesD.Degeneration of compact bone at the diaphysis of affected long bones

Osteoarthritis (OA) is a disorder marked by the deterioration of articular (hyaline) cartilage, the connective tissue lining the ends of bones at most movable joints.  The progressive erosion of articular cartilage in OA is thought to be caused by an inflammatory response induced by years of biomechanical stress due to excessive compression and friction.  This response involves the release of proteolytic enzymes that break down cartilaginous proteins.  The progressive breakdown of articular cartilage ultimately results in complete exposure of the cortical portion of the underlying subchondral bone with narrowing of the joint space.  Repeated and abnormal joint stress can also cause the development of osteophytes (or small, bony growths) that form on the subchondral bone.  These degenerative processes cause pain and restrict joint movement.Stem cell therapy, in which injected or grafted stem cells are induced to differentiate into chondrocytes (cartilage cells), is a potential new treatment for OA.  To further understand chondrogenesis, researchers have been studying the molecules that regulate the expression and activity of the transcription factor Sox9, which has been shown to promote chondrocyte differentiation.  For example, researchers have found that binding of the growth factor TGF-β to its receptor results in Sox9 activation.MicroRNAs (miRNAs), which are known to alter gene expression by acting at the translational level, are also potential regulators of Sox9.  In particular, miRNA-145 is thought to regulate Sox9 expression by binding to the 3′-untranslated region (UTR) of the Sox9 mRNA transcript.  After chondrocyte differentiation was induced using TGF-β, researchers used western blotting to generate an expression profile of Sox9 and β-actin (a protein not regulated by miRNA-145) in mouse stem cells transfected with miRNA-145, anti-miRNA-145, or neither (Figure 1).Figure 1  Expression of Sox9 in the presence and absence of miRNA-145 or anti-miRNA-145 following induction of chondrocyte differentiationAdapted from Yang B, Guo H, Zhang Y, Chen L, Ying D, Dong S. MicroRNA-145 regulates chondrogenic differentiation of mesenchymal stem cells by targeting Sox9. PLoS ONE. 2011;6(7):e21679. Question 58Which of the following statements is NOT true about hyaline cartilage?A.It lacks innervation.B.It gives rise to bone through endochondral ossification.C.It serves as an attachment that holds bones to muscle.D.It is avascular and receives nutrients from surrounding fluids.