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Robbins Pathology MSK (Chapters 24,25,26) > Clinical > Flashcards

Clinical Flashcards

1
Q

100% of modular RA will have which factor present

A

Rheumatoid factor

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2
Q

What are the hematologists findings to support SLE

A
  • Hemolytic anemia with reticulocytes is
  • Leukopenia
  • Lymphopenia on >1 occasion
  • Thrombocytopeina
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3
Q

What is the most common cause of arthritis

A

Osteoarthritis due to the increased pts with obesity and older age

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4
Q

When does osteoarthritis get better and worse

A

Better with rest, worse with activity

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5
Q

What is circulate balantitis

A

Lesions and crustation on the glans penis as a result of reactive arthritis

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6
Q

What is the allele that has an increased risk for RA

A

HLA-DB4

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7
Q

What is Parsonage Turner syndrome and what is the cause

A

Severe pain in the shoulder area followed wiring a few days of weaknes and atrophy in the shoulder girdle

*Most likely due to autoimmune causes since it follows infections, but will self resolve, but can be helped with steroids

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8
Q

ANA helps to support diagnosis of which condition

A

SLE

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9
Q

High arching foot with flexed toes usually are an indication for which conditions

A

Chronic Neuropathy

CMT1

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10
Q

Radiculopathy at the nerve root C7

A

Elbow extension weakness (triceps)

Wrist extent

Finger ext

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11
Q

ANTI CCP and RF positivity is indicative for which condition

A

99.5% specificity for RA

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12
Q

What are the presentations in those with psoriatic arthritis

A

30-50, equal sex ratio
-psoriasis (only 20-50% ahve B27)

-SI and axial

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13
Q

Which region of the body does the dermatome cover with regards to: L4

A

Medial calf

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14
Q

What is the location in the vertebra that tends to be affected by RA

A

Only C1/C2

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15
Q

Fabry’s disease is assocaited with which problems and which enzyme

A

Alpha galactosidease

-Polyneuropathioes and renal issues

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16
Q

High levels of Rheumatoid factor usually correlate which what

A

Increased levels correlate with an increased aggressiveness

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17
Q

What are the lab and test findings in multifocal motor neuropathy

A
  • GM1 antibody (50-80%)
  • EMG shows conduction block
  • Normal CSF
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18
Q

What is the term for 5 or more joints involved

A

Pauli

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19
Q

Which region of the body does the dermatome cover with regards to: T4

A

Nipple line

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20
Q

What are the clinical manifestations a pt with bulbar palsy will show

A

Dysarthria, dysphagia, dysphonia, chewing issues, drooling, respiratory difficulties

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21
Q

At 12 months of age, what should a child be able to do with regards to gross motor

A

Stands momentarily

*Should be able to say momma/dadda (specific)

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22
Q

Which test can SLE give a false positive

A

Syphilis

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23
Q

What is MUSK syndrome

A

Aka antibody negative myasthenia gravis

  • Oculopharyngeal weakness
  • Neck, shoulder, respiratory weakness
  • Indistinguishable from Ab positive MG
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24
Q

What is the term used for 3 or more joints involved

A

Oligo

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25
Q

What is CREST syndrome

A 
Calcium deposition in skin
Reynauds
Esophageal dysmotility 
Sclerodatcyly 
Telangiectasias
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26
Q

What is DISH and what is normally seen

A

Diffuses idiopathic Skeletal hyperosteosis

*Calcification along lateral aspect of four contiguous vertebral bodies, but the SI joint is fine

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27
Q

What form of CMT (hereditary motor sensory neuropathies) is most common

A

Type 1, which is demyelinating

*2 is less common, as is axonal degradation

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28
Q

What are the conditions that rheumatoid factor are present in

A
  • Sjogrens (95%)
  • Cyroglobulinemia (40-100%)
  • primary biliary cirrhosis (70%)
  • mixed connective tissue (60%)
  • Endocarditis (50%)
  • SLE (35%)
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29
Q

What are the nerve findings in the cause of GBS

A

Slow conduction velocity, focal conduction block with prolonged F waves

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30
Q

What is the damaged structure in the cause of Bronchial plexopathy caused by neoplastic

A

Medial cord

*Painful in the breast or lung

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31
Q

What is the genetic cause of DMD

A

Frameshift so no dystrophin

X linked recessive

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32
Q

What is the upside and downside of gadolinium

A

Upside: taken up by inflamed tissues so good to see in RA

Downside: toxic to the kidneys

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33
Q

What are the clinical signs of soon with CMT

A

Child who is clumsy, trouble walking or running

-slowing of nerve conductions

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34
Q

What are the important negatives seen in ALS

A 
Negatives:
-No eye involvement 
-Normal mental status 
-No extraocular muscle involvment 
-Bowl and bladder symptoms absent 
-Decubiti rare (aka bed sores) 
Fasciculations are rarely the presenting sx
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35
Q

What is the most common myopathy

A

DMD

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36
Q

What is the therm for 6 or more joints involved.

A

Poly

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37
Q

Large nerve fibers transmit which type of information and what would be the negative and positive signs if those nerves were affected

A

Vibration, joint position

Positive: tingling, pins and needles, numbness

Negative: loss of vibrations, Joint position, areflexia, ataxia, hypotonia

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38
Q

What nerves are affected in progressive bulbar palsy

A

Lower cranial nerves (CN 9, 10,)

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39
Q

At 9 months of age, what should a child be able to do with regards to gross motor

A

Pulls up
Cruises
Sits well without support

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40
Q

Radiculopathy at the nerve root C5

A

Shoulder abduction weakness (deltoid)

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41
Q

What condition is commonly associated with lambert Eaton myasthenia syndrome (LEMS)

A

Cancers (especially small cell lung cancer)

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42
Q

At 48 months of age, what should a child be able to do with regards to gross motor

A

Balance on one foot

Hop on one foot

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43
Q

What is the damaged structure in the cause of Bronchial plexopathy caused by radial injury

A

Upper trunk, lateral cord

*Painless

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44
Q

What is the clinal Presentation in someone with multifocal motor neuropathy

A

Adult males were there is neuropathy of one nerve, then slowing progressing from distal weakness

-No UMN signs, or sensory signs

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45
Q

What are the most common cervical radiculopathies involved

A

C5-C6 (C6 nerve compression)

C6-C7 (C7 nerve root compression)

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46
Q

What is a treatment to help a patient with DMD

A

Steroids if older than 5

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47
Q

What is the damaged structure in the cause of Bronchial plexopathy caused by ischemia

A

Usually diabetic causes in the lumbar area

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48
Q

What are keratoderma blennorrhagicum

A

Painless lesions on the feet as a result with reactive arthritis and reiter’s syndrome

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49
Q

Why is the EMG normal on a small nerve polyneuropathy

A

Because it is unmyelinated

50
Q

Which form of arthritis is seen with those diabetic patients

A
  • Charcot’s

- Cheiroarthropathy

51
Q

Radiculopathy at the nerve root C8

A

Finger abd

Finger flex

52
Q

At 6 months of age, what should a child be able to do with regards to gross motor

A

Sits momentarily

53
Q

Which region of the body does the dermatome cover with regards to: T10

A

Umbilicus

54
Q

What is chronic inflammatory demyelinating polyneuropathy (CIDP)

A

Basically similar to GBS, except is chronic and occurs over a longer time and is more persistent

55
Q

Which term is used for one joint involved

A

Arthritis

56
Q

Radiculopathy at the nerve root C6

A

Shoulder abduction weakness (deltoid)

Elbow flex (biceps)

57
Q

What muscle groups tend to be involved in spinal muscular atrophy

A

Upper extremity involvement

58
Q

What complication is seen in those with DMD

A

Cardiomyopathy

59
Q

What is commonly present in chronic inflammatory demyelinating polyneuropathy (CIDP)

A

15% have a monoclonal antibody (IgM or IgG)

60
Q

If someone had breast cancer that was causing weakness in the extremities, how would you be able to tell if it was from breast cancer or the radiation afterwards

A

Radiation causes painless weakness while neoplastic will be painful

61
Q

What are the classical clinical presentations of juvenile dermatomyositis

A
  • Proximal muscle weakness
  • Red or purplish heliotrope rash over the eyelids
  • thrombi or hemorrhage in the periungual capillary beds
  • Raised erythematous papules over the extensors Joints
62
Q

What is podagra

A

Inflammation of the big toe, seen in gout

63
Q

What is the best imaging for erosion on bones and inflammatory arthritis

A

CT

64
Q

Spinal muscular atrophy involves which set of motor neurons.

A

Only the lower motion neurons. Showing atrophy

65
Q

What is a classical sign of ALS

A

Mixed upper and lower motor neuron signs, usually in the same limb

Upper: Babinski sign, hyperreflexia, spasticity

Lower: Atrophy, fasciculations

66
Q

What is the Gowers maneuver.

A

When a child is laying down on their stomach. Then kind of walks their way up to standing

67
Q

How does lambert Eatoon myasthenic syndrome differ from MG with regards to increased situation

A

MG gets worse while LEMS gets better due to increased stimulation on the calcium channels to release the ACh into the synaptic cleft

68
Q

If the EMG is normal in trying to determine the form of CMT, which form is present

A

Type 2, because it is axonal loss, rather than type 1 that is demyelinating that slows nerve conduction

69
Q

At 24 months of age, what should a child be able to do with regards to gross motor

A

Walks up stairs

Kicks ball forward

70
Q

What is Feltys syndrome

A 
Splenomegaly
Neutropenia 
Fever
Anemia 
Thrombocytopenia
71
Q

What is the most common idiopathic inflammatory myopathy in children

A

Juvenile dermatomyositis

72
Q

What is the most common type of adult motor neuron diseases

A

ALS

73
Q

Seeing clubbing and arthritis in a patient is indicative of which condition until proven otherwise

A

Interstital lung disease

74
Q

Radiculopathy at the nerve root L5

A

Hamstring weakness

Foot forsiflexion, inversion, eversion

Sensory: lateral calf, dorsum of foot

75
Q

What is Miler fisher syndrome

A

In 5% of GBS patients, they proceed to:

  • Ophthalamoplkegia, ataxia, arreflexia
  • Facial weakness, dysarthria, dysphagia
76
Q

Small nerve fibers transmit which type of information and what would be the negative and positive signs if those nerves were affected

A

Pain and temp

Positive: Burning, jabbing pain

Negative: Loss of pain and temp

77
Q

What is the treatment for someone with RA

A

1) Start with an NSAID
2) Steroid (quick fix)
3) DMARDs

78
Q

Which region of the body does the dermatome cover with regards to: T1

A

Medial forarm

79
Q

Which region of the body does the dermatome cover with regards to: C7

A

Middle finger

80
Q

What is the inheritance of CMT 1

A

AD

81
Q

What are the clinical manifestations of childhood motor neuron diseases

A

Hypotonia, arreflexia, poor sucking, breathing difficulty, death in 6 to 12 months

82
Q

What is the gene that is mutated in myotonia congenita

A

Chloride channel CLCN1

83
Q

Which joints tend to be affected by osteoarthritis

A

Weight bearing joints such as the knees, hips, spine

84
Q

What are the key findings in the CSF in the case of GBS

A

Albumino-cytological dissociation

Aka increased protein with normal glucose and normal cell count

85
Q

To help determine which nerve or radicupathy might be present, which finger can you look at

A

Rink finger. If its the whole finger, then its the median and ulnar, if its just the lateral half of the finger, then its median only

86
Q

What is Lambert Eaton myasthenia syndrome (LEMS) due to

A

Autoimmune attach against voltage gated calcium channels on the presynaptic terminal

87
Q

Why fibers can not be tested on an EMG

A

Unmyelinated fibers

88
Q

Which region of the body does the dermatome cover with regards to: C8

A

Fourth/fifth finger

89
Q

What symptom may be present in the case of mitochondrial disorders

A

Mitochondrial encephalomyopathy with lactic acidosis and stroke like symptoms or MELAS

90
Q

In those patients with antibody negative MG, which antibody is present

A

MUSK (muscle specific tyrosine kinase) Abs

91
Q

What are some atrophic locations seen in ALS

A

Tongue, hands, arms

92
Q

Hypertrophied pronator teres can result in monneuropathy in which nerve

A

Median nerve

93
Q

Which region of the body does the dermatome cover with regards to: C6

A

Thumb/index

94
Q

What is Rieter’s syndrome

A

Can’t see (Conjunctivitis)
Can’t pee (urethritis)
Can’t climb tree (reactive arthritis)

95
Q

Which antibodies are present in Miler fisher syndrome

A

GQqb and GT1a antibodies

96
Q

Autonomic nerve fibers transmit which type of information and what would be the negative and positive signs if those nerves were affected

A

Negative: Hypotension, decreased sweat, impotence, urinary retention, constipation

97
Q

How will hip osteoarthritis manifest

A

As groin pain

98
Q

Rheumatoid factor is an autoantibodies of which class and to what

A

Most commonly IgM, usually to the Fc portion of IgG

99
Q

Administration of which drug can produce a disorder very similar to myasthenia gravis

A

D-penicillamine, and it was recipe when removed from treatment

100
Q

What are the depicting features of enteropathic arthritis

A
  • Associated with Crohns and UC
  • Axial involvement
  • IBD and arthritis will correlate with one another and flare up at the same time
  • Erythema nodosum

*B27

101
Q

Radiculopathy at the nerve root L4

A

Hip flexor weakness

Knee extension weakness

Sensory: medial calf

102
Q

What is the inheritance of myotonia congenita

A

AD

103
Q

At 36 months of age, what should a child be able to do with regards to gross motor

A

Tricycle

104
Q

What are the clinical manifestations of osteoarthritis

A

Crepeitus, Decreased ROM, effusion that is cold

105
Q

What are the most common lumbar nerve root compressions

A

L4-L5 (L5 nerve root compression)

L5-S1 (S1 nerve root compression)

106
Q

ACA is helpful in the diagnosis of which condition

A

Scleroderma

107
Q

What is the usual associations with reactive arthritis

A
  • Young male
  • Arthritis of LEs
  • Enthesitits (Achilles tendon/plantar fasciitis)
  • Dactylitis (sausage digit, finger or toe)
108
Q

What are the features of psoriatic arthritis that are Give always

A
  • Psiariatic lesions

- Pitting nails

109
Q

What is pyroderma gangrenosim and what condition is it associated with

A

Tender, reddish purple papule, leading to necrosis

*Seen with RA

110
Q

What is the damaged structure in the cause of Bronchial plexopathy caused by traumatic injury

A

Traction, laceration, missed

111
Q

Which HLA are associated with myasthenia gravis

A

HLA B8 and DR3

112
Q

Which region of the body does the dermatome cover with regards to: L5

A

Lateral calf

113
Q

Which form of arthritis can be seen in those patients with a thyroid issue

A

Carpal/tarsal tunnel syndrome

114
Q

Radiculopathy at the nerve root S1

A

Hamstring weakness

Foot plantarflexion

Sensory: postolateral calf, lateral foot

115
Q

Mitochondrial diseases leading to myopathies usually have what present

A

Abs to mitochondrial or nuclear DNA mutations

116
Q

Lateral sclerosis involves which set of motor neurons

A

Upper motor neurons giving you hyperreflexia and Babinski sign

117
Q

Which region of the body does the dermatome cover with regards to: L1

A

Inguinal

118
Q

What are the renal manifestations that would help conform SLE

A

Proteinuria > 500mg/day or 3+ cases

119
Q

At 70 months of age, what should a child be able to do with regards to gross motor

A

Skips

120
Q

What are the four domains of development

A
  • Gross motor
  • Fine motor
  • Language
  • Cognitive/social emotional

Robbins Pathology MSK (Chapters 24,25,26) (7 decks)

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