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Review / Wrong Answers > DIT review - MSK 2 > Flashcards

DIT review - MSK 2 Flashcards

1
Q

Why does meat consumption exacerbate gout?

A

excess DNA and RNA consumption

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2
Q

Why does alcohol consumption exacerbate gout?

A

alcohol competes with uric acid for renal excretion

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3
Q

What is the deficient enzyme in Lesch-Nyhan syndrome, and why does it cause gout?

A

Deficiency in HGPRT (hypoxanthine and guanine –> IMP/GMP) in the purine salvage pathway

Results in excess uric acid production and de novo purine synthesis

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4
Q

What is the MOA of colchicine

A
  • Colchicine – stabilizes tubulin to impair leukocyte chemotaxis
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5
Q

MOA of Probenecid

A
  • Probenecid – inhibits reabsorption of uric acid in PCT
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6
Q

MOA of Allopurinol

A
  • Allopurinol – inhibits xanthine oxidase, thus inhibiting uric acid synthesis
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7
Q

What are the seronegative spondyloarthropathies

A

PAIR:

Psoriatic arthritis, ankylosing spondyltitis, inflammatory bowel disease, reiter syndrome

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8
Q

What HLA is associated with seronegative spondyloarthropatheis

A

HLA-B27

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9
Q

What seronegative spondyloarthropathy is associated with “pencil-in-cup” x-ray?

A

Psoriatic arthritis

Deformity of the DIP

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10
Q

What are the 3 main clinical features of ankylosing spondylitis

A
  • (1) Fusion of vertebrae (ankyloses) = bamboo spine
  • (2) Uveitis
  • (3) Aortitis (weakened walls may lead to dilation and aortic regurgitation)
  • Think: Pandas:
    • They eat bamboo = bamboo spine
    • Raccoon eyes = uveitis
    • Clumsy climbing up trees causes branches to bend = aortitis
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11
Q

Most common pathogens involved in septic arthritis

A

Neisseria, Staph aureus, Strep

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12
Q

Which arthritis is associated with osteophyte (bone spurs)?

A

Osteoarthritis

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13
Q

What type of HSR is lupus?

A

Type III

Due to antibody-antigen complex deposition

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14
Q

Describe symptoms associated with lupus

A
  • RASH OR PAIN
    • R – Rash (malar or discoid)
    • A – Arthritis (non-erosive, 2 joints)
    • S – Serositis (e.g. pleuritic, pericarditis)
    • H – Hematologic disorders (hemolytic anemia, leukopenia, lymphopenia, thrombocytopenia)
    • O – Oral/nasopharyngeal ulcers (painless)
    • R – Renal disease
    • P – Photosensitivity
    • A – Antinuclear antibodies (+ANA)
    • I – Immunologic disorder (anti-dsDNA, anti-Smith, anti-histone, or anti-phospholipid/anti-cardiolipin)
    • N – Neurologic disorders (seizures, psychosis)
  • Other findings:
    • Fever, weight loss, fatigue
    • Raynaud phenomenon
    • Libman-Sacks endocarditis – vegetations on both sides of mitral valve
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15
Q

What renal diseases are associated with lupus

A

diffuse proliferative glomerulonephritis

membranous glomerulonephritis

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16
Q

What are common antibodies found in lupus

A

anti-nuclear (ANA), anti-dsDNA, anti-Smith, anti-histone, or anti-phospholipid/anti-cardiolipin

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17
Q

What antibody is present in drug-induced lupus?

A
  • Will have (+) anti-histone antibodies
18
Q

What are the drugs that cause drug-induced lupus?

A
  • SHIPP-E
    • S – sulfa drugs
    • H – Hydralazine
    • I – Isoniazid
    • P – Procainamide
    • P – Phenytoin
    • E – Etanercept
19
Q

What disorder is associated with anti-phospholipid antibodies?

A

Hypercoagulable state

20
Q

What is the antibody in diffuse and limited scleroderma

A

Diffuse = anti-Scl-70 aka anti-DNA topoisomerase

Limited = anti-centromere

21
Q

What are the features of CREST syndrome

A

· Calcinosis (calcium deposition) / anti-centromere antibody

· Raynoud

· Esophageal dysmotility

· Sclerodactyly (tightening of skin with loss of wrinkles)

· Telangiectasias

22
Q

What is the triad in Sjogren syndrome

A

§ Dry eyes (xerophthalmia)

· Dryness, conjunctivitis, sand in eyes

§ Dry mouth (xerostomia)

· Dysphagia, difficulty swallowing

§ Arthritis

23
Q

What are the antibodies associated with Sjogren?

A

§ Autoantibodies: Anti-SSA (Anti-Ro) and Anti-SSB (Anti-La)

24
Q

What is the difference in gene defect between Duchenne and Becker MD?

A

Duchenne = frameshift mutation leading to absent or truncated dystrophin gene

Becker = non-frameshift mutation with partially functional dystrophin gene

25
Clinical features and common cause of death in Duchenne?
* Weakness begins in pelvic girdle and progresses superiorly * Pseudohypertrophy of calf muscles due to fibrofatty replacement of muscle * Waddling gait * Gower sign * Onset before 5 y/o * Dilated cardiomyopathy is common cause of death
26
What are the clinical features of polymyalgia rheumatica
This is a problem of joints, not muscles (even though it has myalgia in name) * § Pain and stiffness in proximal joints (shoulders and hips) * § No muscle weakness * § Fever, malaise, weight loss
27
Describe lab values in polymyalgia rheumatica (ESR and CK)
§ Elevated ESR and CRP § Normal CK (this is not a muscle problem!)
28
What other disorder is associated with polymyalgia rheumatica?
o Associated with Giant cell (temporal) arteritis
29
What are the antibodies associated with polymyositis/dermatomyositis?
* (+) ANA * (+) anti-Jo-1 antibodies
30
How do you differentiate between polymyositis and polymyalgia rheumatica
Polymyositis = * Bilateral proximal muscle weakness (shoulders and pelvic girdle) * Vs. Polymyalgia rheumatica which is a disorder of proximal _joints_, not muscles * Elevated CK * vs. polymyalgia rheumatica which has normal CK
31
What are common derm findings in dermatomyositis
* Rash of upper eyelids (heliotrope rash) * Malar rash (butterfly rash) * Gottron papules – red papules on elbows, knuckles, and knees * “Shawl sign” * “Mechanic’s hands” – hands or feet rough and cracked
32
Differentiate between muscle inflammation in dermatomyositis and polymyositis
* Polymyositis * Endomysial inflammation with CD8+ T cells * Dermatomyositis * Perimysial (THINK: periphery b/c of muscle + skin involvement) inflammation with CD4+ T cells
33
What is fibromyalgia?
* Chronic, widespread musculoskeletal pain in 11/18 particular sites * Also associated with: * Stiffness, Paresthesias, Poor sleep, Fatigue, Cognitive disturbances (“fibro fog”)
34
Treatment of fibromyalgi
o Treatment = exercise, anti-depressants, anticonvulsants
35
What are the layers of the epidermis
* Stratum corneum lucidum, granulosum, spinosum, basale * THINK: Californians Like Girls in String Bikinis
36
What type of junction acts as a paracellular barrier, preventing things from passing between cells
Tight junctions
37
Protein components of tight junctions?
Claudins and occludins
38
What are the two type of junctions that act as cell anchors between adjacent cells, and what is their protein component?
Adherens (intermediate) junctions and desmosomes Connects actin skeleton of adjacent cells via _cadherins_
39
What junction allows signalling between adjacent cells, and what is the protein component?
Gap junctions Made up of connexons
40
What type of junction attaches cell to basement membrane, and what is the protein component?
Hemidesmosomes Integrins
41
What are the 4 main pathologic features of acne?
* (1) Hyperkeratosis – increased keratin * (2) Sebum overproduction * (3) Propionibacterium acnes proliferation * (4) Inflammation
42
What is the pathophysiology behind freckles?
* Increased number of _melanosomes_ (melanocytes NOT increased)

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