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First Aid > Musculo/Derm Last > Flashcards

Musculo/Derm Last Flashcards

1
Q

What are NSAIDs?

A

Nonsteroidal anti-inflammatory drugs.

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2
Q

What is intraarticular glucocorticoid injection used for?

A

It is used to reduce inflammation in joints.

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3
Q

What is colchicine?

A

A medication used to treat gout and pseudogout.

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4
Q

What is the prophylaxis for pseudogout?

A

Colchicine.

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5
Q

What are 3 conditions associated with Calcium Pyrophosphate Deposition Disease?

A
  1. Joint trauma
  2. Hyperparathyroidism
  3. Hemochromatosis
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6
Q

What causes arthritis in Hemochromatosis?

A
  1. Iron deposition in synovial tissue
  2. Calcium pyrophosphate deposition
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7
Q

What are 4 disorders classified as Seronegative Spondyloarthritis?

A
  1. Ankylosing spondylitis
  2. Psoriatic arthritis
  3. Inflammatory bowel diseases
  4. Reactive arthritis
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8
Q

What is the underlying mechanism of Seronegative Spondyloarthritis?

A

Autoimmune disorders mediated by T cells.

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9
Q

What are common features of all Seronegative Spondyloarthritis?

A
  • Asymmetric oligoarthritis, often lower extremity
  • Axial spine inflammation: Commonly SI joints
  • Dactylitis (sausage digits)
  • Enthesitis
  • HLA B27: 90% of ankylosing spondylitis cases, 50% of psoriatic arthritis cases
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10
Q

What occurs in Ankylosing Spondylitis?

A

New bone formation in spine → stiffness.

Most common in males 20-30 y/o.

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11
Q

What are characteristics of ‘Inflammatory’ back pain?

A
  1. Younger age
  2. Slow onset
  3. Improves with exercise
  4. Pain at night
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12
Q

What are 7 clinical features of Ankylosing Spondylitis?

A
  1. ‘Inflammatory’ back pain: Classically involves SI joint
  2. Bamboo spine: fused vertebrae
  3. Enthesitis: leads to heel pain
  4. Dactylitis
  5. Uveitis
  6. Aoritis: leads to aortic regurgitation
  7. Restrictive lung disease: decreased chest wall and spine mobility
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13
Q

What lab testing results are expected in Ankylosing Spondylitis?

A

↑ESR and ↑CRP.

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14
Q

What are 2 treatments for Ankylosing Spondylitis?

A
  1. NSAIDs
  2. Anti-TNF antibodies (infliximab)
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15
Q

What are clinical features of Psoriatic Arthritis?

A
  • Nail findings: Nail pitting, Onycholysis (90% of psoriatic arthritis cases)
  • Asymmetric polyarthritis that mimics RA (improves with use, morning stiffness)
  • DIP arthritis: ‘pencil in cup’ deformity
  • Sacroilitis
  • Dactylitis
  • Enthesitis (heel pain)
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16
Q

What is Onycholysis?

A

Separation of nail from nailbed.

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17
Q

What is a classic hand x-ray finding in Psoriatic Arthritis?

A

‘Pencil in cup’ deformity at DIP joint.

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18
Q

What conditions are frequently complicated by arthritis?

A

Crohn’s disease and Ulcerative colitis.

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19
Q

How does the Type 1 pattern of Inflammatory Bowel Disease arthritis present?

A

<5 joints, usually large joints. Symptoms often with flare of GI disease.

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20
Q

How does the Type 2 pattern of Inflammatory Bowel Disease arthritis present?

A

> 5 joints, usually small joints of the hands. Independent of GI disease.

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21
Q

What is Reactive Arthritis?

A

A form of spondyloarthritis, autoimmune process occurring days to weeks after an infection.

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22
Q

What are common triggering infections for Reactive Arthritis?

A

GI bacteria: Salmonella, Shigella, C.diff; Urogenital: Chlamydia trachomatis (often asymptomatic).

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23
Q

What are clinical features of Reactive Arthritis?

A
  1. Asymmetric oligoarthritis, commonly lower extremities
  2. Enthesitis
  3. Dactylitis
  4. Inflammatory low back pain
  5. Conjunctivitis
  6. Urethritis (dysuria)
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24
Q

What is Reiter syndrome?

A

A form of Reactive arthritis: Arthritis, urethritis, conjunctivitis following infection.

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25
Q

What is Polymyalgia Rheumatica?

A

An inflammatory disorder of unknown cause.

Clinical features include bilateral proximal muscle stiffness that is worse in the morning.

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26
Q

What are clinical features of Polymyalgia Rheumatica?

A
  1. Bilateral proximal muscle stiffness that is worse in the morning
  2. Does NOT cause muscle weakness
  3. Sometimes fever, fatigue
27
Q

What are Creatinine Kinase levels in Polymyalgia Rheumatica?

A

Normal.

28
Q

Polymyalgia Rheumatica commonly occurs with what condition?

A

Temporal arteritis.

29
Q

In what age group does Polymyalgia Rheumatica occur?

A

Older patients (>50 y/o).

30
Q

How is Polymyalgia Rheumatica diagnosed?

A

Clinically.

31
Q

What are 2 abnormal lab findings in Polymyalgia Rheumatica?

A

↑ CRP, ↑ESR.

32
Q

Polymyalgia Rheumatica responds well to what treatment?

A

Glucocorticoids.

33
Q

What is Fibromyalgia?

A

A chronic pain disorder with widespread musculoskeletal pain of unknown cause.

34
Q

Fibromyalgia is common in what demographic?

A

Women 20 to 55 years old.

35
Q

Fibromyalgia is associated with what condition?

A

Depression/anxiety.

36
Q

How to diagnose Fibromyalgia?

A

Diagnosed clinically with normal muscle biopsy and normal lab tests.

37
Q

What are clinical exam findings of Fibromyalgia?

A

Point tenderness in specific locations.

38
Q

What are 3 treatments for Fibromyalgia?

A
  1. Exercise
  2. Tricyclic antidepressants (amitriptyline)
  3. SSRIs
39
Q

What are Inflammatory Myopathies?

A

Autoimmune muscle disorders.

Major disorders include Polymyositis and Dermatomyositis.

40
Q

How to diagnose and treat Inflammatory Myopathies?

A

Diagnose: muscle biopsy; Treatment: Immunosuppression (prednisone initially then azathioprine or methotrexate).

41
Q

What should be suspected in a young woman with depression and diffuse muscle tenderness?

A

Fibromyalgia.

42
Q

What are clinical features of Inflammatory Myopathies?

A
  1. Myalgias
  2. Hallmark: slow onset proximal muscle weakness at first → distal weakness occurs later.
43
Q

What are 3 lab findings in Inflammatory Myopathies?

A
  1. Elevated Creatinine Kinase (CK)
  2. ANA
  3. Anti-jo1 antibodies: tRNA synthetase.
44
Q

What will muscle biopsy of Polymyositis show?

A

Endomysial inflammation, with predominately CD8+ T cells.

45
Q

What symptoms does Dermatomyositis present with?

A
  1. Slow onset proximal muscle weakness
  2. Skin changes: Heliotrope rash, Gottron papules, Malar rash, ‘Shawl and V signs’.
46
Q

What will muscle biopsy of Dermatomyositis show?

A

Perimysial inflammation, with predominately CD4+ T-cells.

47
Q

Inflammatory myopathies are associated with what condition?

A

Adenocarcinomas (cervix, lung, ovaries, etc.).

48
Q

How is Acetylcholine broken down?

A

By Acetylcholine esterase (AChE).

49
Q

What is the mechanism of Myasthenia Gravis?

A

Antibodies block nicotinic ACh receptors → ACh cannot bind → muscle weakness.

50
Q

How to diagnose Myasthenia Gravis?

A

Acetylcholine receptor antibodies.

51
Q

What are clinical features of Myasthenia Gravis?

A
  1. Muscle fatigability: Repeated nerve stimulation → ↓ ACh release → muscles weaken with use
  2. Diplopia and ptosis
  3. ‘Bulbar’ symptoms: Speech, chewing and swallowing problems.
52
Q

What are 2 treatments for Myasthenia Gravis?

A
  1. Acetylcholine esterase inhibitor: Neostigmine, Pyridostigmine, Edrophonium
  2. Immunosuppressants.
53
Q

What are 3 Acetylcholine esterase inhibitors?

A

Neostigmine, Pyridostigmine, Edrophonium.

54
Q

What are 2 reasons for Myasthenia gravis exacerbations?

A
  1. Insufficient dose AChE inhibitor
  2. Cholinergic crisis: Too much medication leads to muscle refractory to ACh.
55
Q

What test can be used to test the cause of Myasthenia gravis exacerbations?

A

Tensilon Test: administer Edrophonium.

Muscle function improves: ↑ dose AChE inhibitor; Muscle function fails to improve: ↓ dose.

56
Q

What complications can arise from the Tensilon test?

A

Diffusely increased ACh levels activate parasympathetic activity.

Symptoms include Bradycardia, Salivation, Abdominal cramping, Asthma.

57
Q

What condition do most Myasthenia Gravis patients have?

A

Abnormal thymus.

58
Q

Myasthenia Gravis often resolves with what procedure?

A

Thymectomy.

59
Q

What is a key test for Myasthenia Gravis?

A

Imaging of mediastinum (CT or MRI) to identify thymus abnormality.

60
Q

What is the mechanism of Lambert Eaton Myasthenic Syndrome?

A

Antibodies against pre-synaptic Ca channels → Prevent ACh release.

61
Q

Lambert Eaton Myasthenic Syndrome is associated with what condition?

A

Small cell lung cancer (paraneoplastic syndrome).

62
Q

What is the presentation of Lambert Eaton Myasthenic Syndrome?

A
  1. Slow onset symmetric proximal muscle weakness
  2. No muscle pain
  3. Autonomic dysfunction: dry mouth, erectile dysfunction, constipation.
63
Q

Does muscle use improve or worsen Myasthenia gravis and Lambert Eaton Myasthenic Syndrome?

A

Myasthenia gravis: worsen; Lambert Eaton Myasthenic Syndrome: improve.

64
Q

What does the Tensilon test in Lambert Eaton Myasthenic Syndrome show?

A

Mild ↑ in muscle function (much less effective than in MG).

First Aid (18 decks)

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