Money makers 2 Flashcards
What is infliximab? When is it used?
Anti-TNF drug
Can be used for RA
Antihistone antibodies are seen with drug-induced lupus. What drugs cause this?
Hydralazine Procainamide Isoniazid Methyldopa Quinidine Chlorpromazine
A patient comes in with malar and discoid rashes, serositis (pleuritic, pneumonitis, pericarditis), oral ulcers, arthritis, photosensitivity, CNS symptoms, cardiac symptoms, and renal symptoms. What does this person have?
SLE
A patient has all of the symptoms of lupus, and because of some risky sexual behavior, STDs were checked. What might come back falsely positive?
Syphilis
What can all be used to treat SLE?
NSAIDs
Hydroxychloroquine
Corticosteroids
Sun avoidance
Who typically gets polymyositis/dermatomyositis? What can be seen?
Old black women
Proximal muscle weakness (legs first)
Red heliotropic rash on face, upper extremities, chest or back
Violet discoloration of eyelids
Scaly patches over hand joints
A patient has muscle pain/weakness and some rashes. What labs might be increased?
Cr Aldolase CK AST ALT LDH
A biopsy is taken for someone expected of either myositis or dermatomyositis. How can the two be told apart on biopsy?
Myo: inflammatory cells WITHIN the muscles
Dermatomyo: inflammatory cells SURROUNDING the muscles
When are anti-Jo-1 antibodies positive with myositis/dermatomyositis?
When there is also interstitial lung disease
An old lady has multiple sites of joint pain, headaches, and jaw pain. What could be going on? What should be done?
Temporal arteritis and polymyalgia rheumatica (often associated with temporal arteritis)
Start on corticosteroids (treats both…often resolves PMR w/in 1 day)…then get a temporal biopsy
Is the patient usually weak with polymyalgia rheumatica?
No…limited motion due to pain, not weakness
A 30yo white guy has hip and low back pain that is worse in the morning and following activity, but improves as the day goes on. The pain is also relieved by leaning forward (pain from kyphosis). What could be going on? what could be seen on x-ray? Treatment?
This could be ankylosing spondylitis (20-40yo white guys most common)
Bamboo spine (multiple vertebral fusions)
PT, NSAIDs…immunsuppression or surgery if necessary
A patient with a history of a scaly rash has asymmetric joint pain that is worse in the morning and most noticeable at that DIP and PIP joints. What is going on?
This is Psoriatic arthritis…different from RA in that it is asymmetric, includes DIP joint, and is RF and ANA negative
A patient has arthralgias, myalgias, hand swelling, Raynaud phenomenon, skin thickening, esophageal dysmotility, intestinal hypo motility, dyspnea, and heart issues. What could be going on? What lab could be positive? What is a syndrome that this is part of?
Scleroderma
Anti-scl-70 ANA
CREST syndrome (Calcinosis, Raynaud’s, Esophageal dysmotility, Sclerodactyly, and Telangiectasias
A patient comes in and seems to have aspects of SLE, scleroderma, and polymyositis…but doesn’t fit the criteria for any of them individually. What is likely going on? What usually isn’t seen with this diagnosis?
This is mixed connective tissue disease
Renal and neurological symptoms are usually absent
A patient comes in with dry eyes and dry mouth. On exam, the parotid gland is enlarged, there is purport on the legs, and peripheral neuropathy. What is likely going on? What else is likely going on? What is it called if nothing else is going on?
Sjogren syndrome
Often associated with RA, SLE, or PBC
If no secondary autoimmune association, it is called sick syndrome
What is the most common adult bone cancer?
Metastatic…breast, kidney, prostate, lung, thyroid, lymphoma
An adolescent boy comes in with pain in his right leg just above the knee. If it were a primary malignancy, what would it most likely be? What are risk factors?
Osteosarcoma is the most common primary malignant bone tumor
Paget disease of bone, p53 genetic mutations, familial retinoblastoma, radiation, and bone infarcts
An adolescent boy comes in with pain in his right leg just above the knee. What would be seen on x-ray that would make you think “osteosarcoma”? What should be ordered?
Sunburst pattern and Codman triangle (periosteal new one formation at the diaphysral end of the lesion)
MRI or PET to determine extent of lesion
Chest CT to look for metastases
A child (5-15yo) comes in with severe thigh pain after bumping into a table. The x-ray shows a femur fracture and an “onion-skin” bone lesion. What is the likely diagnosis?
Ewing sarcoma…highly malignant cartilage tumor occurring in diaphysis of long bones
A male patient who is less than 25yo comes in with a hard bump a little above/below a joint with muscle pain over the top of it. What is likely going on?
Osteochondroma…most common benign bone tumor in metaphysics of long bones
An x-ray shows a bony growth on a long bone that sits on top of cortical bone and is NOT continuous with the normal cancellous bone. What is the concern?
Malignant lesion
