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internal medicine ishani > connective tissue ds > Flashcards

connective tissue ds Flashcards

1
Q

a pt comes with pain in both wrists , distal interphalygeal, metacarpophalyngeal jts wht r diffrential diagnosis

A 
rheumatoid arthritis 
SLE
viral arthritis 
       hepatitis B
       EBV
       Parvovirus B19

parvovirus b19 adult dont hve slapped cheek as in children usually adult who comes alot in contact with children like kindergarden teacher

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2
Q

how to differentiate rheumatoid arthritis and SLE

A

systemic symptoms present in SLE

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3
Q

a pt comes with involvement of knee from yrs

A 
monoarticular chronic         》 osteoarthritis 
no joint swelling and redness 
noninflammtory thus 
         ⬇️
osteoarthritis
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4
Q

pt comes with pain and swelling of knee from 2-3 days

A

monoarticular acute inflammatory
↙️ ↘️
septic arthritis gout

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5
Q

pt comes with migratory arthritis wht r diffrential

A

lyme ds
gonococcal arthritis
rheumatic fever

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6
Q

oligoarticular asymmetrical <5-6 joints involved wht r the diffrential

A

spondyloarthopathies

osteoarthritis

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7
Q

ANA VERY SPECIFIC FOR LUPUS ARE

A

ant DDNA

ANTI SMITH

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8
Q

anti histone ab is seen in

A

drug induced lupus

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9
Q

anti SSA (anti rho )

A

neonatal lupus

sjogren

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10
Q

anti ssb( anti LA )

A

sjogren

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11
Q

anti centromere is seen in

A

CREST

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12
Q

anticentromere antibodies are specific for

A

limited form of scleroderma

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13
Q

antibody specific for diffuse scleroderma

A

antitopoisomerase I ie antiscleroderma 70

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14
Q

clinical features of scleroderma

A

1.Raynauds syndrome
caused by vasospasm and thickening of vessel wall in digits
cold temperature and stress brings first blanching 》cyanosis》reactive hyperemia

2.cutaneous fibrosis
tightening of skin and face leads to sclerodactyly refers to claw hand
3.esophageal dismotility
4.lung, heart,renal involvement

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15
Q

difference bw diffuse and limited scleroderma

A

diffuse limited
skin involvement limited to distal extremities
widespread sparing of trunk

2.rapid onset delayed onset
3.significant organ involved organs involved late
4.no anticentromere anticentromere +
antitopoisomerase

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16
Q

diffrential diagnosis of raynauds phenomenon

A 
PRIMARY no cause 
SECONDARY 
scleroderma 
SLE
vasculitis 
certain medication bblocker, nictotine,bleomycin 
thromboangitis obliteratans
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17
Q

drugs causing lupus

A

quinidine
hydralazine
procainamide
isoniazid

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18
Q

pattern of joint involvement in reactive arthiritis

A

migratory arthritis

aymmertric inflammatory oligoarthritis

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19
Q

Reiter syndrome triad

A

arthritis
uveitis
urtheritis

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20
Q

organisms implicated in reiter syn

A 
salmonella
shigella
campylobacter 
chlamydia 
yersenia
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21
Q

types of seronegative spondyloarthopathies

A 
ankylosing spondylitis 
reiter syn 
psoriatic arthritis 
arthopathy with IBD
undifferentiated spondyloarthopathies
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22
Q

sausage shaped digits and nail pitting characteristic of

A

psoriatic arthritis

23
Q

pattern of joint involvement

A

asymmetric and polyarticular

24
Q

difference between joint involvement of psoriatic and reiter

A

psoriatic polyarticular

reiter oligoarticular

25
Q

felty syndrome

A

anemia
neuropenia
splenomegaly
Rheumatoid arthritis

26
Q

juvenile RA

A

begins before 18 yrs of age

extraarticular manifestations may predominate

27
Q

caplan syn

A

CWP + rheumatoid nodules

28
Q

deformity in rheumatoid arthritis

A

•hallux valgus deformity, commonly called a bunion, is when there is medial deviation of the first metatarsal and lateral deviation of the great toe (hallux)
•ulnar deviation of hand
•swan neck
•boutonniere deformity
•hammer toe
Ahammer toeorcontracted toeis adeformityof theproximalinterphalangeal jointof the second, third, or fourthtoecausing it to be permanently bent, resembling ahammer.Mallet toeis a similar condition affecting thedistalinterphalangeal joint.[1][2]

29
Q

wht is DISH

A

Diffuse idiopathic skeletal hyperostosis(DISH) is a condition

characterized by abnormal calcification/bone formation (“hyperostosis”) of the soft tissues surrounding the joints of the spine, and also the peripheral or appendicular skeleton.[1]In the spine, there is bone formation along theanterior longitudinal ligamentand sometimes theposterior longitudinal ligament, which may lead to partial or completefusionof adjacent spinal levels. The facet and sacroiliac joints tend to be uninvolved. The thoracic spine is the most common level involved.[2]In the peripheral skeleton, DISH manifests as a calcificenthesopathy, with pathologic bone formation atsites where ligaments and tendons attach to bone.

30
Q

other names if DISH

A

Forestier’s disease,
senile ankylosing spondylosis,
ankylosing hyperostosis

31
Q

diagnostic criteria of DISH

A

Diagnostic criteria
•flowing ossification along the anterolateral aspect ofat least 4 contiguous vertebraepreservation ofdisk heightin the involved vertebral segment;
• relative absence of significant degenerative changes (e.g. marginal sclerosis in vertebral bodies or vacuum phenomenon)
absenceof facet-joint ankylosis
•; absence of SI joint erosion, sclerosis or intraarticular osseous fusion

32
Q

wegener granulomatosis

A

upper and lower RESPIRATORY tract
renal involvement
vasculitis small vsel

cANCA +ve

33
Q

c ANCA is positive in

A

wegener granulomatosis

34
Q

temporal/ giant cell arteritis

A

temporal arteries most commonly effected
#symptoms
headache
intermittent jaw claudication
visual impairment can lead to blindness
tender temporal arteries
also associated with polymyalgia rheumatica ie proximal stiffness ( shoulder, hip)

mnemonic 60 age of patient
60 mg prednisone dose
60 ESR needed to diagnose

35
Q

treatment of temporal arteritis

A

clinical features of temporal arteritis
⬇️
do ESR and temporal artery biopsy
if ESR high immediately start 60 mg prednisone without waiting for temporal artery biopsy results

36
Q

large vsel vasculitis

A

temporal arteritis

takayasu arteritis

37
Q

medium vessel vasculitis

A 
chiurg strauss 
PAN 
wegner granulomatosis 
Kawasaki ds
microscopic polyangitis
38
Q

small vessel vasculitis

A

henoch scholein purpura
hypersensitivity vasculitis
behcet syndrome

39
Q

takayasu vasculitis

A

granulomatos vasculitis of arch of aorta
leading to its stenosis and narrowing

decreased or absent peripheral pulses
discrepencies of BP
ARTERIAL BRUITS

40
Q

churg strauss syndrome

A

prominent respiratory tract finding AASTHMA
EOSINOPHILIA
skin lesions palpable purpura , subcutaneous nodules
kidney
PANCA + VE

41
Q

PAN

A 
NO LUNG INVOLVEMENT 
effects nervous sys and GIT
associated with hepaitis B 
nerves involvement leads to mononeuritis mutiplex
git abdominal angina

PANCA + ve

42
Q

behcet syndrome

A

vasculitis causing

painful oral and genital ulcer
eye involvement
CNS involvement
arthritis (knee and ankle most common )

43
Q

buerger ds symptoms

A

thromboangitis obliteratans

occurs in young men smokers 
 segmental inflammation of arteries and veins 
may lead to gangrene and autoamputation 
symptoms 
     claudication 
     painful distal extremities 
     ulceration
   raynauds phenomenon
44
Q

causes of proximal myopathy

A 
eaton labert 
myasthenia
endocrinopathies 
      hyper /hypo thyroisidsm 
      adrenal insufficiency 
drug induced
      cyclosporine 
      statin 
inflammatory myopathy 
      polymyositis 
      dermatomyositis
45
Q

types of idiopathic inflammatory myopathies

A

polymyositis

dermatomyositis

46
Q

symptoms of polymyositis

A

Symmetrical proximal muscle weakness that develops subacutely over weeks or several months
•The earliest andmost.severely.affected muscle groups are the
neckflexors,
shoulder girdle, and
pelvic girdle muscles

47
Q

symptoms and signs of dermatomyositis

A

symptoms of polymyositis + skin involvement

Heliotrope rash (butterfly)—around eyes, bridge of nose, cheeks
b. Gottron papules—papular, erythematous, scaly lesions over the knuckles (MCP,PIP,DIP)
c. V sign—rash on the face, neck, and anterior chest
d. Shawl sign—rash on shoulders and upper back, elbows, and knee
s e.Periungual erythema with telangiectases
f. Subcutaneous calcifications in children—can be extremely painful
g. Associated with vasculitis of the GI tract, kidneys, lungs, and eyes (more common in children)

h. There is an increased incidence of malignancy in older adults (lung, breast, ovary, GI tract, and myeloproliferative disorders). Once dermatomyositis is diagnosed, make an effort to uncover an occult malignancy. Dermatomyositis associated with malignancy often remits once the tumor is removed

48
Q

diagnostic criteria of polymoyositis

A

If two of first four→possible polymyositis
If three of first four→probable polymyositis
If all four→definite polymyositis

  • Symmetric proximal muscle weakness
  • Elevation in serum creatine phosphokinase
  • EMG findings of amyopathy
  • Biopsy evidence of myositis
  • Characteristic rash of dermatomyositis
49
Q

odd ball of inflammatory myopathies

A

inclusion body myositis is the“odd ball of Inflammatory myopathies”for the following reasons

:Affects male patients more than female patients,
absence of autoantibodies,
distal muscle involvement, and relatively
low creatine kinase(CK);
prognosis is poor.

50
Q

lab finding of polymyositis

A

CK level is significantly elevated.
CK levels correspond to the degree of muscle necrosis, so one can monitor the disease severity
b. LDH, aldolase, AST, ALT elevated
c. ANA in over 50%
d. Antisynthetase antibodies (anti-Jo-1 antibodies)—abrupt onset of fever, cracked hands,Raynaud phenomenon,interstitial lung disease and fibrosis,arthritis; does not respond well to therapy
e. Antisignal recognition particle •Cardiac manifestations(common) •Worst prognosis of all subsets f. Anti-Mi-2 antibodies—better prognosis
2. EMG—abnormal in 90% of patients
3. Muscle biopsy
a. Shows inflammation and muscle fiber fibrosis in all three b. Dermatomyositis—perivascular and perimysial c.Polymyositis and inclusionbodymyositis—endomysial

51
Q

biopsy finding of polymyositis

A

Polymyositis and inclusion body myositis—endomysial

52
Q

muscle finding found in dermatomyositis

A

Dermatomyositis—perivascular and perimysial inflammation

53
Q

inclusion body myositis

A

Insidious onset of slowly progressive proximal and distal weakness,
Patients can also have loss of deep tendon reflexes(nerves are not involved in polymyositis and dermatomyositis)
Not associated with autoantibodies

internal medicine ishani (9 decks)

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