MSK/Derm IV Flashcards by Matt Stanton

osteoarthritis

mechanical damage of articular cartilage

subchondral cyst and bone spur

heberden node - DIP
bouchard node - PIP
no MCP involved

weight bearing joint
improved with rest

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tx osteoarthritis

acetaminophen
NSAID
intra-articular glucocorticoid

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rheumatoid arthritis

autoimmune destruction synovial joint - type III/IV HS

pannus - inflammatory graulation tissue
subQ rheumatic nodules - fibrinoid necrosis
ulnar devlation
swan neck and boutonniere deformity

PIP and MCP involvement

morning stiffnes >30 minute - improve with use

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anti-cyclic citrulliniated peptid Ab

specific for rheumatoid arthritis

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rheumatoid factor

anti IgG Ab

rheumatoid arthritis

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tx rheumatoid arthritis

NSAID
glucocorticoid
methotrexate
sulfasalazine
biologic - TNF-a

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HLA with rheumatoid arthritis

HLA DR4

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sjogren

autoimmune destruction exocrine gland

xerophthalmia - low tears
zerostomia - low saliva

SS-A and SS-G Abs

SS-A - anti Ro
SS-B - anti-La

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complication of sjogren

dental caries

MALT lymphoma - parotid enlargement

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gout

monosodium urate crystals

underexcretion uric acid (90%)
overproduction of uric acid (10%) - lesch nyhan, von gierke

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gout crystals

negative birefringement

yellow in parallel

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podagra

painful MTP joint big toe with gout

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tophus

gout crystal buildup

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acute tx gout

NSAID
colchicine
glucocorticoid

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chronic gout tx

allopurinol

febuxostat

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pseudogout

deposit calcium pyrophosphate

basophilic rhomboid crystals

positive birefringement
blue in parallel

tx pseudogout

NSAID - sudden attack

glucocorticoid, colchicine - prophylaxis

association with pseudogout

hemochromatosis
hyperPTH
osteoarthritis

infectious arthritis

staph aureus
streptococcus
neisseria onorrhea

gonococcal - migratory with asymmetric pattern

seronegative spondyloarthropathy

no rheumatoid factor
-no anti - IgG

HLA B27 association

often males

psoriatic arthritis

seronegative SA

joint pain with psoriasis

sausage fingers - pencil in cup

ankylosing spondylitis

seronegative SA

chronic inflammation spine and SI joint

ankylosis - stiff spine - fused joints

uveitis
aortic regurg

inflammatory bowel disease

crohn and UC

often accompanied ankylosing spondylitis and peripheral arthritis

reactive arthritis

reiter syndrome
seronegative SA

triad
-conjunctivitis
urethritis
arthritis

can’t see, can’t pee, can’t bend my knee

post GI - shigella, salmonella, yersinia, campylobacter, chlamydia

SLE

rash, joint pain, fever | female african descent

libman sack endocarditis

nonbacterial | wart like vegetation on both side valve

lupus nephritis

type III hypersensitivity nephritic - diffuse proliferative GN nephrotic - membranous GN

COD in SLE

cardiovasc infection renal disease

lab SLE

ANAa anti-dsDNA and anti-smith (specific) antihistone low complement smith - to snRNPs

tx SLE

NSAID steroid immunosuppressant hydroxychloroquine

antihistone Ab

sensitive for drug induced lupus

false positive VDRL

anticardiolipin Abs lupus anticoag also caus prolonged PTT

antiphospholipid syndrome

commonly with SLE ``` hx of thrombosis spontaneous abortion lupus anticoag Abs anticardiolipin Abs anti-B2 glycoprotein Abs ``` tx - anticoag

sarcoidosis

noncaseating granulomas elevated ACE elevated CD4/CD8 ration black females bilateral adenopathy hilar and mediastinal adenopathy with restrictive lung disease, erythema nodosum, lupus pernio, bells palsy, uveitis, hyperCa

hyper Ca with sarcoid

1-a hydroxylase mediated vit D activation in macrophages

tx of sarcoidosis

steroids

polymyalgia rheumatica

pain stiff shoulder and hip women >50yo temporal giant cell arteritis association elevated ESR, CRP, normal CK tx - rapid response to low dose corticosteroids

fibromyalgia

female 20-50yo chronic widespread MSK pain - stiff, paresthesia, poor sleep, fatigue tx - exercise, antidepressant, anticonvulsant