Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Designated study period: daily cards > March 13 - Rheumatology > Flashcards

March 13 - Rheumatology Flashcards

1
Q

TNF-alpha inhibitors: MOA, use, ADRs

A

MOA: etanercept acts as TNF-alpha decoy receptor, infliximab works as monoclonal anti-TNF antibody

Use: moderate to severe rheumatoid arthritis, especially for those that have failed methotrexate

ADRs: impaired cell mediated immunity. Especially important for maintenance of granulomas - should screen for TB prior to starting therapy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Biosphosphanates: MOA

A

inhibit mature osteoclast-mediated bone resorption by binding to hydroxyapatite binding sites

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Treatment of acute gout

A

First line: NSAIDs

Second line: colchicine (inhibits MT polymerization, disrupting chemotaxis, phgocytosis, degranulation)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Contracture formation

A

Results from excess MPP activity. MPPs ecourage myofibroblast accumulation and scar tissue remodeling, leading to contracture

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Bones of wrist

A

From lateral to medial and proximal to distal:

  • scaphoid
  • lunate
  • triquetrum
  • pisiform
  • trapezium
  • trapezoid
  • capitate
  • hamate
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Osgood-Schlatter disease

A

Overuse injury of secondary ossification center of tibial tubercle. Seen in adolescent athletes following growth spurt. Presents with pain and swelling at tibial tubercle where the patellar ligament inserts.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Tibial nerve: course and what it innervates

A

Goes through popliteal fossa and into posterior compartment of leg

Motor innervation to posterior compartment muscles and intrinsic foot muscles. Responsible for inversion, plantarflexion, toe flexion.

Sensory innervation to sole of foot

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Superficial peroneal nerve and deep peroneal nerve: sensory innervation

A

Superficial: lateral legg, dorsal foot, medial foot
Deep: Skin between 1st and 2nd toes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Pharyngeal pouches 1-4

A

1 - middle ear and auditory tube
2 - palatine tonsil crypts
3 - thymus, inferior parathyroids
4 - superior parathyroids, ultimobranchial bodies

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

CREST syndrome: symptoms and autoantibody

A

Symptoms

  • calcinosis
  • raynaud’s
  • esophageal dysmotility
  • sclerodactyly
  • telangiectasias

Anti-centromere antibodies

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Succinylcholine: MOA and side effect

A

Depolarizing NMJ blocker. Attaches to nAChR but isn’t degraded by AChE resulting in continued stimulation and inactivation of sodium channels. Because nAChR is a non-selective cation channel, prolonged opening can lead to excess K+ release and hyperkalemia. This isn’t seen with non-depolarizing NMJ blockers which don’t open the channe.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Giant cell arteritis: symptoms, diagnosis, treatment, and histology, patient population

A

Symptoms: headache, jaw claudication, visual disturbances (ischemic optic neuropathy), polymyalgia rheumatica (achy pain in shoulders and hip girdles)

Diagnosis: temporal artery biopsy

Treatment: glucocorticoids

Histology: granulomatous inflammation of media with giant cells (same as Takayasu) in branches of carotid artery. segmental lesions.

Patient population: women over 50

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Takayasu arteritis: histology, population, presentation

A

Histology: granulomatous inflammation in aortic arch branches

Population: young Asian females

Presentation: pulseless disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Polyarteritis nodosa: population, pathology, arteries affected

A

Population: Young adults, associated with hep B (pos surface antigen)

Pathology: early lesions: transmural inflammation with fibrinoid necrosis; late lesions: massive fibrosis resulting in nodes

Arteries affect: all organs but lung is spared

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Kawasaki disease: population, presentation, arteries involved, treatment

A

Population: Kids less than 4

Presentation: Rash on palms and soles, conjunctivitis, fever, enlarged cervical nodes

Arteires: coronary a

Treatment: aspirin and IVIG to protect against thrombus in coronary artery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Buerger disease: presentation, population

A

Presentation: affects digits, associated with Raynaud phenomenon

Population: Smokers

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Wegener’s disease: pathology, presentation, diagnosis, treatment

A

Pathology: necrotizing granulomatous inflammation

Presentation: affects nasopharynx, lungs, kidney

Diagnosis: pos c-ANCA

Treatment: cyclophosphamide

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Microscopic polyangiitis: presentation

A

Affects lung and kidney but no nasopharyngeal involvement. No granulomas. Pos p-ANCA

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Churg-Strauss disease: presentation, pathology

A

Presentation: Affects lungs and heart. Associated with asthma. Peripheral eosinophilia. Positive p-ANCA

Pathology: granulomas

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

HSP: presentation, treatment

A

Presentation: palpable purpora in butt and legs of a kid due to IgA deposition, IgA nephropathy, occurs following UTI

Treatment: steroids if severe

21
Q

Muscles of rotator cuff: function and innervation

A

Supraspinatus: abduction, suprascapular n
Infraspinatus: external rotation, suprascapular n
Teres minor: adduction and ext rotation, axillary n
Subscapularis: adduction and int rotation, upper and lower subscapular n

22
Q

Joint disease and myeloproliferative disorders

A

Associated with acute gout– increased cell turnober results in increased urate production

23
Q

Radial head subluxation (nursemaid’s elbow)

A

Caused by pull on the arm while extended and pronated. Traction causes annular ligament to tear and slip over the head of the radius and get trapped. Seen in kids as the annular ligament is weak.

24
Q

Classic bone findings: rickets

A

Increase in unmineralized osteoid, widening between osteoid seams

25
Q

Classic bone findings: osteoporosis

A

Decrease in total bone mass, trabecular thinning

26
Q

Classic bone findings: hyperparathyroidism

A

Subperiosteal thinning

27
Q

Classic bone findings: paget’s disease

A

Mosaic lamellar bone

28
Q

Classic bone findings: osteopetrosis

A

Persistence of primary unmineralized lamellar bone in the medullary canals which is normally replaced by bone marrow

29
Q

Trendelenberg sign

A

Contralateral hip drop. Seen in superior gluteal nerve injury – damage can occur with injection into the superomedial quadrant of the buttock

30
Q

Pathophysiology of osteopetrosis

A

Inherited defect in bone resorption resulting in thick heavy bone. One cause is carbonic anhydrase 2 mutation: acidic environment needed to remove Ca++ from bone.

31
Q

Osteoclast: cell charactersitics, changes in Paget’s disease

A

Phagocytic lineage. Precursors fuse to form multinucleated mature cell. In Paget’s disease, can get very large containing over 100 nuclei as oppsed to 2-5.

32
Q

Osteoclast differentiation

A

Driven by M-CSF and RANK-L (receptor for activated nuclear factor kappa B). RANK-L produced by osteoblasts and marrow stroma and interacts with RANK.

Osteoprotegerin (OPG) is a RANK-L decoy receptor that inhibits the interaction between RNAK-L and RANK, decreasing the differentiation and survival of osteoclasts

33
Q

Reactive arthritis presentation

A

Arthritis, conjunctivitis, and urethritis following GI or GU infection

34
Q

Lymphatic drainage of leg

A

Medial tracts: follow long saphenous vein to superficial inguinal nodes, bypassing popliteal nodes

Lateral tracts: communicate with both popliteal and inguinal nodes

35
Q

Hematogenous osteomyelitits: population, pathophys

A

Population: young boys

Pathophysiology: Affects metaphysis of long bones which contains slow flowing vasculature conducive to bacterial growth. Bone marrow is seeded leading to inflammation and necrosis and spread of infection along hte periosteum

36
Q

Drugs that can increase risk of osteoporotic fracture (other than the obvious)

A
  1. CYP450 inducing anticonvulsants (increase vit D catabolism)
  2. PPIs: decreased Ca++ absorption (acidic environment needed for Ca++ absorption)
  3. Unfractionated heparin: decrease bone formation
  4. Thiazolinediones: decrease bone formation
37
Q

SERMs: tamoxifen vs raloxifene

A

Tamoxifen: used to treat breast cancer, agonist on endometrium

Raloxifene: used for postmenopasual osteoporosis, netural at endometrium

38
Q

Golgi tendon organ

A

Sensory receptor at junction of muscle and tendon. Innervated by 1b sensory axons. Connected in series with extrafusal fibers. Detects increase in tenstion that occurs when contract against resistance. Acts to provide negative feedback to muscle so that if exert too much force, there is sudden muscle relaxation to prevent MSK damage,

39
Q

Muscle spindle

A

Intrafusal muscle fibers organized in parallel with extrafusal fibers. Innervated by Ia and II sensory fibers. Sensitive to changes in muscle length, mediating stretch reflex by activating alpha motor neuron of same muscle in response to stretch

40
Q

Four types of sensory receptors in skin

A

Pacinian corpuscles: rapidly adapting, deep
Ruffini endings: slow adapting, deep
Meissner corpuscles: rapidly adapting, shallow
Merkel discs: slowly adapting, shallow

41
Q

Spinal involvement in RA and OA

A

RA: cervical spine
OA: lumbar spine

42
Q

Femoral nerve: course and neuropathy

A

Descends through the psoas, emerges laterally, and then goes under the inguinal ligament into the thigh.

Damage results in weak quads, decreased patellar reflex, sensory loss over anterior and medial thigh and medial leg

43
Q

Differentiating between polyarteritis nodosa and churg-strauss

A

Both cause transmural inflammation but polyarteritis nodosa affects mid sized vessels which churg strauss affects small vessels

44
Q

Valsalva maneuver

A

forcibly exhale against closed glottis. Recruits rectus abdominus, resulting in increased intraabdominal and intrathoracic pressure

45
Q

Azathioprine and allopurinol

A

Azathioprine is immunosuppressive agent used to prevent organ rejection and in autoimmune disorders. Purine analogue. Can be converted to active metabolites by HGPRT or inactive metabolites by xanthine oxidase. Allopurinol, which inhibits xanthine oxidase, blocks converstion to inactive metabolites therefore increasing conversion to active metabolites

46
Q

Parvovirus B19 infection in adult

A

Causes acute arthritis that mimics RA. Immune complex mediated.

47
Q

Hypercalcemia of sarcoidosis

A

Activated macropahges increase production of active vitamin D, increasing Ca++ absorption.

48
Q

Latissimus dorsi: function

A

Extension, adduction, and internal rotation of arm

Designated study period: daily cards (32 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions