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ICM Exam 2 Rheumatology (MC) > ICM - Rheum 5 > Flashcards

ICM - Rheum 5 Flashcards

1
Q

this inflammatory myopathy is due to problems with the humoral immune system

A

dermatomyositis

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2
Q

these inflammatory myopathies are due to cell-mediated response

A

polymyositis and inclusion-body

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3
Q

rash seen over knuckles/elbows in dermatomyositis

A

Gottron’s papules

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4
Q

this inflammatory myopathy is at increased risk for malignancies

A

dermatomyositis

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5
Q

inflammatory infiltrate seen in dermatomyositis biopsy

A

perivascular and perimysial

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6
Q

inflammatory infiltrate seen in polymyositis and inclusion-body myositis biopsy

A

endomysial

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7
Q

treatment for inflammatory myopathies

A

corticosteroids, immunosuppresion (methotrexate, cyclophosphamide)

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8
Q

muscle most affected in inflammatory myopathies (symmetrical proximal muscle weakness)

A

neck flexors, shoulder girdle, pelvic girdle

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9
Q

enzymes that are elevated in inflammatory myopathies

A

CPK, LDH, aldolase, AST, ALT

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10
Q

inflammation seen in inflammatory myopathies

A

lymphocytes

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11
Q

pathology: perivascular and perifascicular lymphocytic infiltrate, immune complex deposition in vessels, perifascicular atrophy and fibrosis

A

dermatomyositis

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12
Q

pathology: cellular infiltrate within fascicle, inflammatory cells invade individual muscle fibers

A

polymyositis

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13
Q

pathology: perivascular exudates rare, characteristic intracellular lined vacuoles; intracytoplasmic or intranuclear tubular or filamentous inclusions

A

inclusion body myositis

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14
Q

MCTD is overlap of these 3 conditions –> high ANA and anti-RNP

A

polymyositis, scleroderma, SLE

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15
Q

myositis specific Ab –> association with interstitial lung disease, Raynaud’s, arthritis, mechanics hands

A

anti-histidyl tRNA synthetase (anti-Jo1)

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16
Q

myositis specific Ab –> rapid onset of classical dermatomyositis

A

anti Mi2

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17
Q

pathognomic for dermatomyositis or scleroderma

A

nail fold capillary changes

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18
Q

5 diagnostic criteria for inflammatory myopathies

A

proximal muscle weakness, elevation serum muscle enzymes, EMG, biopsy, rash

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19
Q

possible pulmonary problems associated with inflammation myopathies

A

interstitial lung disease, infection

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20
Q

peak incidence (time) for inflammatory myopathy related malignancy

A

within 2 years

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21
Q

top 3 malignancies related to inflammatory myopathies

A

breast, lung, ovary

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22
Q

mainstay of therapy for inflammatory myopathies

A

corticosteroids

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23
Q

patient population affected mostly by scleroderma

A

female, 30-40 yo

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24
Q

DDX for Raynaud’s phenomenon

A

scleroderma, SLE, MCTD, vasculitis, medications

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25
Q

most common cause of death related to scleroderma

A

interstitial fibrosis/pulmonary HTN

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26
Q

CREST –> variant of limited scleroderma (symptoms)

A

calcinosis of digits, raynaud’s, esophageal dysmotility, sclerodatyly, telangiectases (digits and under nails)

27
Q

Ab found in most limited scleroderma patients

A

anticentromere

28
Q

markers for renal problems associated with scleroderma

A

proteinuria, HTN, azotemia, microangiopathic hemolytic anemia

29
Q

DDX for scleroderma

A

sclerederma, scleromyxedema, eosinophilic fasciitis, toxic syndroms

30
Q

specific test for the diffuse scleroderma form

A

antitopoisomerase I

31
Q

most common cause of death in Sjogrens

A

malignancy

32
Q

possible test used to diagnose Sjogrens…measures lacrimal gland output –> highly sensitive and specific

A

Schirmer test

33
Q

Rx treatments for Sjogrens –> to enhance oral and ocular secretions

A

pilocarpine or Cevimeline

34
Q

these NT are in lower levels in serum and CSF in fibromyalgia

A

serotonin and NE

35
Q

this NT is elevated in CSF in fibromyalgia patients

A

substance P

36
Q

type of oligarticular JRA –> female, 50% ANA+, uveitis, long term risk of developing polyarticular

A

I

37
Q

type of oligoarticular JRA –> male, 90% B27+, long term risk of ankylosing spondylitis

A

II

38
Q

hallmark for systemic JRA onset

A

spiking fever

39
Q

post-infectious arthritis that are on DDX for JRA

A

yersinia and rheumatic fever

40
Q

anemia common in JRA

A

normocytic hypochromic

41
Q

characteristic change of cervical spine in Xray of JRa –> complication in polyarticular JRA

A

atlantoaxial subluxation

42
Q

main treatments for JRA

A

NSAIDs, local corticosteroids, methotrexate (if don’t respond to NSAIDs)

43
Q

triad of Reiter’s syndrome

A

urethritis, conjunctivitis, arthritis

44
Q

primary site of inflammation in seronegative spondyloarthropathies

A

enthesis

45
Q

possible extra-articular manifesations of ankylosing spondylitis

A

prostitis, iritis and conjunctivitis, upper lobe fibrosis (lung), CV, cauda equina inflammation

46
Q

will see dacytlitis (sausage fingers) and “lovers heel” in this arthritis

A

reiter’s

47
Q

distribution of Reiter’s syndrome arthritis

A

pauciarticular, large joints, lower extremity

48
Q

characteristic skin lesions seen on soles, glans penis and toes in Reiter’s

A

keratoderma blenorrhagica

49
Q

these forms of arthritis can have accompanying “sausage fingers” (dactylitis)

A

Reiter’s and psoriatic

50
Q

deficiency in these enzymes can cause overproduction of uric acid

A

HGPRT, G6PD, F1P aldolase

51
Q

overactivity of this enzyme can cause overproduction of uric acid

A

PRPP

52
Q

primary reasonse for under excretion of urate

A

deficiency urate exporter, medullary cystic kidney disease (kids)

53
Q

drugs that promote hyperuricemia

A

diuretics, organic acids (salicylates, pyrazinamide), cyclosporine, ehtambutol

54
Q

treatment of choice in acute gouty arthritis

A

NSAIDs (indomethacin)

55
Q

alternative to NSAID treatment of acute gouty arthritis…but does have side effect of N/V, abdominal cramps, severe diarrhea

A

colchicine

56
Q

drugs for prophylaxis of gouty attack

A

uricosuric drugs or allopurinol

57
Q

what does allopurinol inhibit? (*used when uric acid is >800 mg/day*)

A

xanthine oxidase

58
Q

prophylaxis for gout if uric acid is undersecretion of urate (*drug works to increase excretion*)

A

uricosuric drugs

59
Q

will see this on Xray of pseudogout –> cartilage calcification

A

chondrocalcinosis

60
Q

only potent uricosuric agent in US (increases uric acid secretion)

A

probenecid

61
Q

these crystal deposition in articular cartilage is closely tied to OA –> can also cause chondrocalcinosis

A

basic calcium phosphate

62
Q

most common BCP crystal –> amorphous not visible with polarized light, chronic low grade inflammation and cartilage/bone damage

A

hydroxyapatite

63
Q

most commonly affected by hydroxyapatite (BCP) crystals –> can cause Milwaukee shoulder in elderly women

A

knee, shoulders, hips, fingers

64
Q

deposition disease associated with patients in end-stage renal disease who need hemodialysis and received ascorbic acid supplements

A

calcium oxalate deposition

ICM Exam 2 Rheumatology (MC) (5 decks)

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