arthritis

Question 1

what is a chronic, degenerative joint disease characterized by the breakdown of cartilage, leading to pain, stiffness, and reduced joint function. It is the most common form of arthritis, affecting weight-bearing joints like the knees, hips, spine, and hands.

Answer 1

osteoarthritis

Question 2

risk factors of OA

Answer 2

• Age: Most common in people over 50
• Obesity: Increases stress on weight-bearing joints
• Joint Injury or Overuse: Repetitive stress or trauma
• Genetics: Family history of OA
• Muscle Weakness: Poor joint support
• Inflammation & Metabolic Factors: Low-grade inflammation and metabolic disorders (e.g., diabetes)

Question 3

symptoms of OA

Answer 3

• Joint pain:
o Worse with motion (exercise)
o Better with rest
• Joint morning stiffness only less than 30 minutes (unlike inflammatory)

Question 4

what are joints affected in OA

Answer 4

o Weight bearing; knees, hips, vertebra
o Distal interphalangeal joints (most common involvement in the hand)
o First carpometacarpal of hands
o First metatarsophalangeal of feet

Question 5

on examination of OA

Answer 5

• Deformity and bony enlargement
• Limited ROM & crepitus. Joint effusion is rare.
• Muscle wasting of surrounding muscle groups
• Nodes:
oHeberden’s: distal IPs
oBouchard: proximal IPs (proximal; B before H)

Question 6

x ray features of OA

Answer 6

o Narrowing of joint space
o Osteophytes
o Subchondral sclerosis
o Cyst formation

Question 7

inflammatory arthritis characteristics

Answer 7

• Joint pain (better with movement, worse with rest)
• Morning Stiffness: (>30 mins, can last hours), increases after rest
• Blood: normochromic normocytic anemia, high ESR and CRP
• Predominant feature is synovial inflammation

Question 8

what is genetic component in RA

Answer 8

HLA-DR4

Question 9

in RA what joints affected

Answer 9

symmetrical polyarthritis

Question 10

what are seronegativs spondylarthritis

Answer 10

ankylosing spondylitis
psoritic arthritis
reactive arthritis
enterohepatic arthritis

Question 11

what is ankylosing spondykitis

Answer 11

Inflammatory disorder of the spine & sacroiliac joints, mainly in young adults
• 5 times more common & severe in men
morning stiffness in lower back & buttocks that
improves with exercise and is worse with rest

Question 12

what test is used in ankylosing spondylitis

Answer 12

abnormal Schober test (N>15cm)
loss of lumbar lordosis
increased thoracic kyphosis

Question 13

x ray shown in ankylosing spondylitisn

Answer 13

bamboo sign

Question 14

psoriatic arthritis

Answer 14

DIP arthritis: (Most typical)
-Dactylitis (sausage fingers)
-Nail pitting
- X-ray: pencil-in-cup deformity

Question 15

reactive arthritis

Answer 15

Sterile synovitis (persistent bacterial antigen in inflamed synovium)
• Occurs following:
o GI infection: shigella, salmonella, yersinia, campylobacter o STD: chlamydia, trachomatis, ureaplasma, urealyticum (nonspecific urethritis, cervicitis)

Question 16

what type of arthritis where cant see cant pee cant climb a tree

Answer 16

reactive arthritis
Reiter’s syndrome: conjunctivitis, urethritis, reactive arthritis
Circinate balanitis (superficial ulcers around penile meatus)

Question 17

septic arthritis

Answer 17

• MEDICAL EMERGENCY
• Usually monomicrobial. Most commonly by Staph. Aureus; may also be caused
by streptococci. May be caused by gram -ve organisms in elderly, IV drug users,
or immunocompromised patients.
• Most commonly arises via hematogenous seeding.
• May also develop from direct inoculation of bacteria into the joint.

Question 18

septic arthritis

Answer 18

• Usually present acutely with a single swollen and painful joint (monoarticular)
• Joint pain, swelling, erythema, warmth, and restricted movement
• Hot, painful, swollen, red joint, very limited ROM
• Fever, evidence of infection (older patients may be afebrile)

Question 19

what is osteomyelitis

Answer 19

Osteomyelitis is an infection of the bone caused by bacteria, fungi, or other microorganisms. It often results from an infection that spreads from nearby tissue or through the bloodstream.

Question 20

causative organism in osteomyelitis

Answer 20

• Staph aureus (most common)
• Hemophilus influenzae
• Salmonella (in sickle cell anemia)

Question 21

what is SLE

Answer 21

An autoimmune disorder characterized by exacerbations and remissions, leading to inflammation and tissue damage involving multiple organs systems

• Women account for 90% of cases, more frequently African American

Question 22

genetic in SLE

Answer 22

HLA-DR2, HLA-DR3, HLA-B8

Question 23

environmental cause of SLE

Answer 23

-Exposure to EBV
-UV light exposure
-Hormonal factors: estrogen

Question 24

prsentation of SLE

Answer 24

• Malar rash, joint pain, and fatigue are the most common initial findings
• Constitutional symptoms: Fatigue, malaise, fever, weight loss
• Multiple organ involvement –> many manifestations

Question 25

Diagnosis of SLE is based on the presence of at least 4 of 11 manifestations:

Answer 25

SKIN 1.! Malar rash: butterfly rash over the cheeks and bridge of nose 2.! Discoid rash: erythematous raised patches with keratotic scaling 3.! Photosensitivity 4.! Oral or nasopharyngeal ulcers JOINTS 5.! Arthritis (inflammatory and symmetrical but not erosive), arthralgia CHEST 6.! Serositis: pleuritis or pericarditis à chest pain +/- pericardial/pleural effusion RENAL 7.! Renal involvement: glomerulonephritis, proteinuria, hematuria, azotemia, ESRD NEUROLOGICAL 8.! Psychosis, seizures, stroke, headaches HEMATOLOGICAL 9.! Hemolytic anemia, leukopenia, lymphopenia thrombocytopenia (anemia of chronic disease is a more common presentation, but it is not part of the diagnostic criteria)

Question 26

investigations of SLE

Answer 26

• Positive ANA screening tests: very sensitive but not specific • Anti-dsDNA (60%) and Anti-Sm (30%) Ab: presence is diagnostic. specific.

Question 27

ANTIPHOSPHOLIPID SYNDROME

Answer 27

It’s a syndrome characterized by thrombosis &/or recurrent miscarriages & persistently + blood tests for antiphospholipid antibodies

Question 28

clinical features of antiphospholipid syndrome

Answer 28

Major features are the result of thrombosis: o In arteries: stroke, TIA, MI. o In veins: DVT, Budd-Chiari syndrome. o In the placenta: recurrent miscarriages. o Others: valvular heart disease, migraine, epilepsy, thrombocytopenia, renal impairment, & accelerated atheroma.

Question 29

Criteria for APS diagnosis: At least one of the following clinical criteria and at least one of the following laboratory criteria:

Answer 29

o Clinical criteria: -->Vascular thrombosis – One or more episodes of venous, arterial, or small vessel thrombosis in any tissue or organ --> Pregnancy morbidity o Lab criteria: -The presence of one or more of the following antiphospholipid antibodies (aPL) on two or more occasions at least 12 weeks apart: • IgG and/or IgM anticardiolipin antibodies • IgG and/or IgM anti-beta2-glycoprotein • Lupus anticoagulant

Question 30

When to investigate spontaneous abortion for APL?

Answer 30

• ≥ 2 1st trimester events • Single 2nd trimester event

Question 31

scleroderma

Answer 31

• A chronic connective tissue disorder in which cytokines stimulate fibroblasts- abnormally high amount of normal collagen deposition -widespread fibrosis • More common in young women • There are two types: Diffuse (20%) and limited (80%)

Question 32

diffuse sceloderma

Answer 32

• Rapidly progressive skin thickening (proximal to elbows/knees, including trunk) • Early organ involvement (lung fibrosis, renal crisis, heart disease) • Higher mortality risk compared to limited SSc Associated Antibodies: • Anti-Scl-70 (Anti-Topoisomerase I) → ↑ Risk of interstitial lung disease (ILD)

Question 33

limited sceloderma

Answer 33

• Skin involvement is “limited” to the distal extremities and face (NOT the trunk) • Slow progression, with internal organ involvement occurring later • Better prognosis compared to diffuse SSc • Strong association with pulmonary arterial hypertension (PAH) Associated Antibodies: • Anti-Centromere Antibodies (ACA) → Highly specific for limited SSc, associated with PAH

Question 34

what syndrome is associated with limited sceloderma

Answer 34

CREST: o Calcinosis of the digits o Raynaud phenomenon o Esophageal immobility o Sclerodactyly o Telangiectasias

Question 35

signs and symptoms of sceloderma

Answer 35

• Raynaud phenomenon: in almost all patients. due to vasospasm and thickeningof vessel walls. May lead to digital ischemia with ulceration and gangrene • Cutaneous fibrosis: Tightening of the face and extremities • Sclerodactyly: claw-like hand à contractures, disability, disfigurement. • Telangiectasia & abnormal pigmentation

Question 36

investigations of scleroderma

Answer 36

• Positive ANA in almost all patients: sensitive but not specific • Anticentromere Ab and anti-topoisomerase I (anti-scleroderma 70) Ab • Barium swallow and pulmonary function test are used to detect complications

Question 37

what is SJOGREN SYNDROME

Answer 37

a chronic autoimmune disorder characterized by lymphocytic infiltration and destruction of exocrine glands, leading to dry eyes (xerophthalmia) and dry mouth (xerostomia). It can occur as primary Sjogren’s or be secondary to other autoimmune diseases (e.g., rheumatoid arthritis, systemic lupus erythematosus).

Question 38

clinical clues in sjogern syndrome

Answer 38

• Clinical clues are difficulty eating a dry biscuit and absence of pooling of the saliva when the tongue is lifted • High risk of dental caries, and bilateral parotid gland enlargement

Question 39

serum antibodies in sjogern

Answer 39

Serum autoantibodies: o Antinuclear (in 80% of patients) o Anti-Ro (60–90%) o Rheumatoid factor in primary Sjögren’s syndrome.

Question 40

gout happens from defect in what

Answer 40

Defect in urate metabolism--> hyperuricemia and sodium urate deposition, due to: 1.! Overproduction of uric acid (breakdown of purines) 2.! Renal underexcretion: • Idiopathic primary gout is most common cause

Question 41

presentation of gout

Answer 41

Usually presents as acute gout attack (acute sodium urate synovitis): o Mostly middle-aged males (5x more common) & MTP of big toe o Sudden severe pain, swelling, tenderness o Fever is common, may give impression of cellulitis o Precipitated by; dietary/alcohol excess, dehydration, thiazide diuretic

Question 42

Synovial Fluid Analysis (Gold Standard) in gout and pseudogout

Answer 42

gout: Crystals= Needle-shaped, negatively birefringent Color under Polarized Light=Yellow when parallel, blue when perpendicular pseudogout: Rhomboid, positively birefringent blue when parallel

Question 43

first line tx of acute gout

Answer 43

-NSAIDs (Indomethacin, Naproxen)-->Reduce inflammation -Colchicine--> Inhibits neutrophil migration -Corticosteroids (Prednisone, Intra-articular Steroids)

Question 44

pseudo gout happens mostly in who

Answer 44

Mostly elderly women, usually in large joints (knee or wrist)

Question 45

what type of septic arthritis happens After asymptomatic genital/rectal local infection in Young adults present with Maculopapular pustules and Culture positive in blood, joint, and genital fluid

Answer 45

gonoccocal SA

Question 46

what type of septic Arthritis is Migratory polyarthritis deposits of circulatory immune complexes with meningococcal antigens and tx with penicillin

Answer 46

meningicoccal SA

Question 47

what type of SA happens in Hip, knee, spine present with symptoms of Febrile, night sweats, weight loss is Insidious onset, pain, swelling, dysfunction

Answer 47

tuberculous SA

Question 48

what are markers in disease activity innSLE during a flare up

Answer 48

Markers of disease activity (acute flare): o Drop in complement level C3 C4 o Rise in anti-dsDNA levels o Increased ESR/CRP is NOT a marker of disease activity. If higher inflammatory markers than baseline --> look for infection

Question 49

most common cause of death from scleroderma

Answer 49

Pulmonary fibrosis and/or pulmonary HTN.