MSK 4 Flashcards
What drugs may be given for rapid relief of ssx in Rheumatoid arthritis?
NSAIDs and glucocorticoids may be given for rapid, temporary relief since DMARDs, w/c are the foundation for RA management, take several weeks for a response to be elicited.
What diseases may be caused by Bartonella henselae infection?
Cat-scratch disease.
Bacillary angiomatosis.
Culture-negative endocarditis.
How does a patient w/ injury to the long thoracic nerve present?
The long thoracic nerve innervates the serratus anterior, w/c is responsible for arm abduction above the horizontal plane. Paralysis of serratus anterior will cause scapular winging and weak abduction above the horizontal.
A patient presents w/ urticaria after being given morphine. Through what mechanism does this occur?
This is IgE-INDEPENDENT mast cell degranulation, w/c may be triggered by medications like opioids, radiocontrast agents, and antibiotics like vancomycin. It activates protein kinase A and PI3 kinase to release mediators.
A patient is presenting w/ a tender, small red-blue lesion under he nail bed. What can this lesion be and what is its normal function?
This can be a glomus tumor (glomangioma), w/c consists of modified smooth muscle cells of a glomus body. The glomus body is a neurovascular organ of thermoregulatory fxns, as it shunts blood away from skin in cold temps and toward skin in hot environments.
What is the primary cause of morbidity in Acute Rheumatic Fever?
Severe pancarditis can lead to heart failure and death.
What is the pathogenesis of hematogenous osteomyelitis?
Bacterial seeding of the long bone metaphysis occurs due to its slower blood flow, causing cellulitis in bone marrow. Inflammation here can compromise blood flow and cause necrosis. The infection is forced into the cortex and periosteum. The necrotic bone then becomes a source of infection, w/ sinus tracts draining to the soft tissue or skin.
A patient w/ Atopic dermatitis is at risk of developing what other conditions?
Allergic rhinitis and Asthma (the allergic triad).
How does Atopic dermatitis (eczema) present?
Intense pruritus (hallmark for dx) and erythematous weeping or crusted papules and plaques in response to certain environmental antigens.
A patient at risk for breast cancer or has breast cancer also has osteoporosis. What drug should be given?
The SERM Raloxifene is an estrogen agonist of the bone but an antagonist on breast and uterus. Therefore, it prevents breast cancer and osteoporosis w/o increasing risk of endometrial cancer. Tamoxifen is not used for osteoporosis due to its risk for endometrial cancer.
The extensors of the wrist primarily attach where? What condition arises from overuse of these muscles?
The wrist extensors attach to the lateral epicondyle, and overuse (backhand strike) may cause lateral epicondylitis (Tennis elbow) due to inc. fibroblasts and neurovascularization.
*Medial epicondylitis (Golfer’s elbow) occurs the same way w/ wrist flexors.
For a patient taking Azathioprine, what other medication may be given to increase azathioprine’s activity?
Azathioprine may be inactivated by xanthine oxidase. To increase its active metabolite (6-MP), allopurinol may be given.
What is a classic predisposing procedure for cutaneous angiosarcoma?
Radical mastectomy w/ axillary lymph node dissection can result in chronic lymphedema, w/c is a risk factor for angiosarcoma.
In a patient w/ frequent gouty attacks, when should prophylactic therapy be initiated?
Prophylactic therapy (XO inhibitors) should be initiated during intercritical (b/w attacks) periods as acute changes in serum uric acid can worsen an acute attack.
What is the disease progression of Lyme disease?
> Early localized: flu-like, erythema chronicum migrans.
Early disseminated: facial palsy, AV block.
Late: asymmetric arthritis, encephalopathy.
*Tx: doxycyline, ceftriaxone.
