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MSK Exam 2 Spring 2015 > Crystal Disease - Told > Flashcards

Crystal Disease - Told Flashcards

1
Q

2 most common crystals

A

monosodium urate

calcium pyrophosphate dihydrate

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2
Q

episodic attack

A

think crystals

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3
Q

rare crystals

A

cholesterol
monoclonal proteins
calcium phosphate hydroxyapatite
calcium oxalate

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4
Q

caicific tendonitis

A

with calcium phosphate hydroxyapatite

does not react on polarized light**

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5
Q

oxalosis

A

kidney stops eliminating calcium oxalate from body
-get nephrolithiasis

get retinal sx as well

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6
Q

terminal tuft calcification

A

with psoriatic arthritis and oxylosis only**

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7
Q

multiple myeloma

A

monoclonal protein crystals in joints

S100A4 antibody**

MMP and apoptosis - matrix destruction of joint

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8
Q

YIPA

A

yellow in parallel - monosodium urate

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9
Q

BIPA

A

blue in parallel - calcium pyrophosphate

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10
Q

hyperuricemia/gout epidemiology

A

increased with age and body mass

middle age men

incidence of gout in females approaches that of males after menopause

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11
Q

risk with hyperuricemia

A

cardiovascular disease**

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12
Q

hot joint

A

with gout

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13
Q

decreased renal excretion

A

majority of hyperuricemia causes

impaired renal function
dehydration
acidosis
low dose salicylates
diuretic
pyrazinamide
cyclosporine
levodopa
ethambutol
nicotinic acid
hypothyroidism
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14
Q

podagra

A

first attack of gout

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15
Q

cytotoxic drugs

A

increase urate production - leads to hyperuricemia

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16
Q

best predictor of gout attack

A

sudden change in uric acid level

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17
Q

tophi

A

chronic urate overload

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18
Q

negative birefringement

A

monosodium urate crystals

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19
Q

clinical course of gout

A

1 - asymptomatic hyperuricemia
2 - intermittent arthritis
3 - chronic arthritis and acute exacerbations

20
Q

tophi

A

in gout

not just subQ
-can get into and destroy joint

21
Q

positive birefringement

A

BIPA
calcium pyrophosphate
pseudogout

22
Q

negative birefringement

A

YIPA
monosodium urate
gout

23
Q

indication for lowering of urate

A

tophi disease with erosions

uric acid nephrolithiasis

recurrent attack despite prophylaxis

24
Q

acute gout CI

A

allopurinol

but do not stop during attack if already taking**

25
Q

chondrocalcinosis

A

pseudogout

26
Q

calcium pyrophosphate deposition disease

A

CPPD - pseudogout

27
Q

associated with pseudogout

A 
hyperPTH
hypoT
hemochromatosis
wilsons disease
OA
28
Q

management of crystal disease

A

arhrocentesis - analyze crystals
NSAIDs
corticosteroids
colchicine - prophylaxis

29
Q

uric acid lowering agents

A

allopurinol
febuxostate
uricosuric agents

not during acute attacks

30
Q

acute tx of gout

A

indomethacin

31
Q

tx of asymptomatic hyperuricemia

A

no tx - check diuretic use and ASA use and niacin use

32
Q

colchicine

A

can be crap shoot

33
Q

purine free diet

A

only decrease uric acid by 1%mg

medication is best treatment**

34
Q

keratoconjunctivitis sicca

A

sjogrens disease

dry eyes and dry mouth

35
Q

primary sjogrens

A

women 40-60yo
exocrine gland dysfunction
RA and other auto-Abs common

36
Q

secondary sjogrens

A

with other autoimmune diseases

37
Q

diagnosis of sjogrens

A

4 of 6 criteria - sensitive 93% and specific 94%

1 - autoimmune exocrinopathy
2 - ocular sx
3 - oral sx
4 - ocular signs - schirmers or rose bengal
5 - characteristic histopath features
6 - salivary testing autoAbs - RF, SS-A, SS-B

38
Q

nucleolar anti Ro SSA

A

more specific than speckled**

39
Q

labs with sjogrens

A

anemia, leukopenia, eosinophilia

hypergammaglobulinemia

RA positive 70%

ANA positive 95%

40
Q

sialectasis

A

cystic dilation of duct

with sjogrens

41
Q

parotid gland enlargement

A

in sjogrens

42
Q

schirmers test

A

positive if cannot get tears

in sjogrens

wetting of 5mm/5min filter paper

43
Q

rose bengal staining

A

indicates inflammation and irritation of conjunctival layer of eyes

positive in sjogrens

44
Q

nonspecific interstitial pneumonia and xyerotrachea

A

low tracheobronchial secretions - in sjogrens

45
Q

tx of sjogrens

A

tx is symptoms

artifical tears - methyl cellulose
cyclosporine drops
oral hygiene and hydration
pilocarpine
cevimeline

careful watch for lymphoma**

MSK Exam 2 Spring 2015 (10 decks)

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