FA 2 Flashcards
1
Q
systemic scleroderma is divided into
A
- diffuse scleroderma (both skin and visceral organs)
2. limited scleroderma (only skin)
2
Q
diffuse scleroderma is associated with
A
anti-Scl 70 antibody (anti-DNA topoisomerase I antibody)
3
Q
Limited sclerodermia - clinical manifestation
A
- limited skin involvement (fingers and face)
- CREST: Calcinosis, Raynaud phenomenon, Esophangeal dysmotility, Sclerodactily, Talangiectasia
4
Q
Limited sclerodermia is associated with
A
anti-centromere antibodies
5
Q
myasthenia gravis - sex
A
MC seen in women
6
Q
Lambert-Eaton myasthenic syndrome - symptoms
A
- proximal muscle weakness
- autonomic symptoms (dry mouth, impotence)
improves with muscle use
7
Q
fibromyalgia - most commonly seenin
A
females 20-50
8
Q
fibromyalgia - clinical manifestation
A
(1) chronic, widespread musculoskeletal pain associated with (2)stiffness, (3) paresthesias, (4) poor sleep, (5) fatigue , 6. cognitive disturbance (“fibro fog”)
9
Q
fibromyalgia - treatment
A
- regular exercise
- antidepressants (TCAs, SNRIs)
- anticonvulsants
10
Q
polymyalgia rhematica - treatment
A
rapid response to low dose corticosteroids
11
Q
polymyalgia rhematica - labs
A
- increased ESR
- increased CRP
- normal CK
12
Q
polymyalgia rhematica - sex and age / associated with?
A
older women
- temporal (giant cell) arteritis
13
Q
polymyalgia rhematica clinical manifestation
A
- pain and stiffness in shoulders and hips
- fever
- malaise
- weight loss
(NO MUSCULAR WEAKNESS)
14
Q
polymyalgia rhematica - muscular weakness
A
NO MUSCULAR WEAKNESS
15
Q
polymyositis - clinical presentation / MC area
A
progressive SYMMETRIC proximal weakness
- shoulders
16
Q
polymyositis - treatment
A
steroid followed by long term immunosuppressant therapy (methotrexate)
17
Q
dermatomyositis - clinical presentation
A
- progressive symmetric proximal weakness (like polyomyositis)
- malar rash (similar to SLE)
- heliotrope rash
- Gottron papules
- shawl (or V-) and face rash
- mechanics hands
18
Q
mechanics hands
A
Cracking (and hyperkeratosis) of the finger pad skin, commonly involving the first, second, and third fingers
19
Q
dermatomyositis - treatment
A
steroid followed by long term immunosuppressant therapy (methotrexate) (same as polymyositis)
20
Q
dermatomyositis vs polymyositis - labs
A
SAME:
- increased CK
- ANA +
- anti-Jo-1 +
- anti-SRP +
- anti-Mi-2+
21
Q
polymyositis vs dermatomyositis regarding to cells
A
polymyositis –> CD8
dermatomyositis –> CD4
22
Q
sarcoidosis - CD4/CD8 ratio
A
elavated in BRONCHOALVEOLAR LAVAGE
23
Q
localized scleroderma - labs
A
antibodies against to DNA topoisomerase II
24
Q
Raynaud phenomenon - Reynuad disease vs syndrome
A
disease –> when 1ry (idiopathic), women under 30
syndrome –> 2ry to a disease process such as mixed connective tissue disease, SLE, CREST, male older 40 –> digital ulceration
25
Lupus nephritis - MC
nephritic - diffuse proliferative glomerulonephritis
nephrotic - membranous glomerulonephritis
MC and severe type is diffuse proliferative
26
Common causes of death in SLE
1. cardiovascular disease
2. Infection
3. Renal disease
27
SLE symptoms/findings/treatment etc
mnemonic: RASH OR PAIN
Rash, Arthritis, Soft tissues/Serositis, Hematologic disorders, Oral and nasopharyngeal ulcers, Renal disease/Raynaud phenomenon, Photosensitivity, Antinuclear antibodies, Immunologic disorfer (anti-dsDNA, anti-SM, antiphospholipids), Neurologic
28
SLE - heart
it can affect any layer of the heart (endo,myi,pericarditis)
29
SLE - treatment
1. NSAID 2. Steroids 3. immunosuppressants
| 4. hydroxychloroquine
30
SLE - lab findings
1. antinuclear antibodies (ANA)
2. anti-dsDNA antibodies
3. anti-Smith antibodies
4. decreased C3, C4, CH50
5. Anti-histone antibodies
31
SLE- sensitive, not specific test
SLE - specific, poor prognosis test
SLE - specific, not prognostic test
- ANA
- anti-dsDNA (renal disease)
- anti-Smith
32
SLE - sensitive for drug induced lupus
antihistone antibodies
33
clinical criteria of antiphospholipid syndrome
1. history of thrombosis (arterial or venous)
| 2. recurrent spontaneous abortion
34
antiphospholipid syndrome arterial or venous thrombosis includes
1. DVT
2. hepatic vein thrombosis
3. placental thrombosis
35
antiphospholipid syndrome - lab findings
1. lupus anticoagulants
2. anticardiolipin
3. anti-β2 glycoprotein antibodies
36
antiphospholipid syndrome - lupus anticoagulants and anticardiolipin antibodies can cause .... (lab)
false positive VDRL/RPR
| falsely elevated PTT
37
Mixed connective tissue disease - clinical presentation
Feature of SLE, systemic sclerosis, and/or polyomyositis
38
Mixed connective tissue disease - Labs
anti-U1 RNP antibodies (speckled ANA)
39
SLE - lab findings (and their characteristics)
1. antinuclear antibodies (ANA) - sensitive, Not specific
2. anti-dsDNA antibodies - Specific, poor prognosis (renal disease)
3. anti-Smith antibodies - Specific, not prognostic (directed against snRNPs)
4. decreased C3, C4, CH50 - due to immune complex formation
5. Anti-histone antibodies - sensitive for drug-induced lupus)
40
Acute gout drugs?
1. NSAID
2. Glucocorticoids (oral or intra-articular)
3. Colchicine
41
salicilates - gout
do not salicylates --> all but the highest doses depress uric acid clearance. Even high doses (5-6g/day) have only minor uricosuric activity
42
chronic gout drugs?
1. allopurinol
2. febuxostat
3. pegloticase
4. probenecid
43
Clinical use of aspirin (and doses)
```
Low dose, under 300 (inhibits platelet aggregation)
Intermediate dose (300-2400mg/day) --> antypyretic and analgesic
High dose (2400-4000mg/day) --> anti-inflammatory
```
44
Bisphosphonates - clinical use
1. osteoporosis
2. hypercalcemia
3. Paget disease of bone
4. metastatic bone disease
5. osteogenesis imperfecta
45
Teriparatide - clinical use (explain)
osteoporosis --> causes increased growth compared to antirepsorptive therapies (eg. biphosphanates)
(PTH ANALOGUE)
46
TNF-a inhibitors - drugs and mechanism of action
1. etanercept - fusion protein (receptor for TNF-A+IgG1 FC) produced by recombinant DNA
2. infliximab - anti-TNF-a monoclonal antibody
3. adalimumab - anti-TNF-a monoclonal antibody
4. certolizumab - anti-TNF-a monoclonal antibody
47
Sjogren syndrome - clinical findings
1. inflammatory joint pain
2. xerophthalmia and subsequent corneal damage --> Keratoconjunctivitis sicca
3. Xerostomia
4. Bilateral parotid enlargment
48
Sjogren syndrome - labs
1. antinuclear antibodies (anti-ribonucleoprotein antibodies) --> SS-A (anti-Ro), SS-B (anti-La)
2. ANA
49
joint findings of osteoarthritis
1. subchondral cysts
2. sclerosis
3. osteophytes (bone spurs)
4. eburnations of the subchondral bone
5. synovitis
6. Heberden nodes (DIP)
7. Bouchard nodes (PIP)
8. 1st carpometacarpal (CMC)
9. joint space narrowing
10. synovial fluid non inflammatory (less than 2000 WBC)
NO MCP
50
osteoarthritis of the hand - which joints
- DIP (Heberden nodes)
- PIP (Bouchard nodes)
- 1st carpometacarpal (CMC)
NO MCP
51
joint findings of Rheumatoid arthritis
1. pannus formation in joints (MCP, PIP) - NOT DIP or 1st CMC
2. subcutaneous rheumatoid nodules (fibrinoid necrosis) - soft tissue swelling
3. ulnar deviation of fingers
4. sublaxation
5. swan neck deformity (rare)
6. boutonniere deformity (rare)
7. rare DIP involvement
8. erosions
9. joint space narrowing
10. juxtaarticular osteopenia
11. Synovial fluid inflammatory (WBC more than 2000)
52
predisposing factor of Rheumatoid arthritis
1. female (80% vs males)
2. +Rheumatoid factor
3. Anti-cyclic citrullinated peptide antibody (more specific)
4. HLA-DR4
5. SILICA exposure
53
Heberden vs Bouchard nodes - area
Heberden: DIP
Bouchard: PIP
54
Rheumatoid arthritis vs osteoarthritis - according to joint involvement distribution
RA --> symmetrical
| Osteoarthritis --> asymmetrical
55
Rheumatoid arthritis - x-rays
joint-space narrowing loss of cartilage
| osteopenia
56
Rheumatoid arthritis vs osteoarthritis - increased synovial fluid / wbc?
RA --> increased fluid
| WBC --> less than 2000 in osteoarthritis, more in RA
57
causes of septic arthritis
1. Neisseria gonorrhoea (MCC)
2. S. aureus (2nd MCC)
3. Streptococcus
58
infectious arthritis - presentation (clinical and labs)
1. warm,red, painful joint with limited range of motion
fever
2. increased WBC and elevated ESR
3. Synovial fluid purulent (more than 50000 WBCs
59
Gonococcal arthritis is an STD that presents as a
STI either purulent arthritis (eg. knee) or triad of polyarthralgias, tenosynovitis (hand) ,dermatitis (pustules)
60
Serenegative spondyloarthropathies - types
1. Psoriatic arthritis
2. Ankylosing spondylitis
3. Inflammatory bowel disease
4. Reactive arthritis
61
Serenegative spondyloarthropathies - characteristics
1. rheumatoid factor (-)
2. HLA-B27 strong association
3. Subtypes share variable occurrence of inflammatory back pain (morning stiffness, improves with exercise), peripheral arthrites, enthesitis (inflamed insertion sites of tendons eg. Achilles), dactylitis (sausage fingers), uveitis
62
Psoriatic arthritis - clinical presentation
- joint pain and stiffness associated with skin psoriasis and nail lesions
- Asymmetric and patchy involvement
- Dactylitis (sausage fingers)
- sacroliti + spondilitis
- athriting mutilans (destructive and deforming)
63
Psoriatic arthritis - joints
axial and peripheral (DIP of hands and feet are MC)
64
Reactive arthritis (Reiter syndrome) - clinical presentation
```
Classic triad
1. Conjunctivitis and anterior uveitis
2. Urethritis
3. Arthritis
weeks after GI infection (Shigella, Salmonella, Yersinia, Campylobacter) or chlamydia infection
```
65
Ankylosing spondilitis causes (clinically) (and involves ...)
1. Symmetric involvement of spine and sacroiliac joints --> ankylosis (jonint fusion) and bamboo spine (vertebral fusion)
2. uveitis
3. aortic regurgitation
4. dactylitis
66
Gout - crystals?
monosodium urate crystals
67
monosodium urate crystals - characteristics
1. needle shaped
2. (-) birefringent under polarized light
3. blue under perpendicular light
4. yellow under paraller light
68
pseudogout present with
pain and effusion with acute infalmmation (pseudogout) and/or chronic degeneration (pseudo-osteoarthritis)
classically affects the knee
69
pseudogout is caused by
deposition of calcium pyrophosphate crystals within the joint space
70
x ray of pseudogout
chondrocalcinosis --> cartilage calcification
71
pseudogout - which joints
usually affects large joints (classically the knee)
72
diseases associated with pseudogout
Usually idiopathic
1. hemochromatosis
2. hyperparathyroidsm
3. Joint trauma
73
pseudogout - crystal characteristics
1. basophilic, rhomboid crystals
2. weakly birefringent under polarized light
3. blue under paraller light
74
pseudogout vs gout according crystals shape
pseudogout --> rhomboid
| gout --> needle shape
75
seronegative spondyloarthropathies are more common in
MALES
76
seronegative spondyloarthropathies - inflammatory bowel disease ?
Crohn disease and ulcerative colitis are often accompanied by spondyloarthritis
77
Felty syndrome
1. RA
2. neutropenia
3. splenomegaly
