Musculo/Derm Last Flashcards
What are NSAIDs?
Nonsteroidal anti-inflammatory drugs.
What is intraarticular glucocorticoid injection used for?
It is used to reduce inflammation in joints.
What is colchicine?
A medication used to treat gout and pseudogout.
What is the prophylaxis for pseudogout?
Colchicine.
What are 3 conditions associated with Calcium Pyrophosphate Deposition Disease?
- Joint trauma
- Hyperparathyroidism
- Hemochromatosis
What causes arthritis in Hemochromatosis?
- Iron deposition in synovial tissue
- Calcium pyrophosphate deposition
What are 4 disorders classified as Seronegative Spondyloarthritis?
- Ankylosing spondylitis
- Psoriatic arthritis
- Inflammatory bowel diseases
- Reactive arthritis
What is the underlying mechanism of Seronegative Spondyloarthritis?
Autoimmune disorders mediated by T cells.
What are common features of all Seronegative Spondyloarthritis?
- 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
What occurs in Ankylosing Spondylitis?
New bone formation in spine → stiffness.
Most common in males 20-30 y/o.
What are characteristics of ‘Inflammatory’ back pain?
- Younger age
- Slow onset
- Improves with exercise
- Pain at night
What are 7 clinical features of Ankylosing Spondylitis?
- ‘Inflammatory’ back pain: Classically involves SI joint
- Bamboo spine: fused vertebrae
- Enthesitis: leads to heel pain
- Dactylitis
- Uveitis
- Aoritis: leads to aortic regurgitation
- Restrictive lung disease: decreased chest wall and spine mobility
What lab testing results are expected in Ankylosing Spondylitis?
↑ESR and ↑CRP.
What are 2 treatments for Ankylosing Spondylitis?
- NSAIDs
- Anti-TNF antibodies (infliximab)
What are clinical features of Psoriatic Arthritis?
- 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)
What is Onycholysis?
Separation of nail from nailbed.
What is a classic hand x-ray finding in Psoriatic Arthritis?
‘Pencil in cup’ deformity at DIP joint.
What conditions are frequently complicated by arthritis?
Crohn’s disease and Ulcerative colitis.
How does the Type 1 pattern of Inflammatory Bowel Disease arthritis present?
<5 joints, usually large joints. Symptoms often with flare of GI disease.
How does the Type 2 pattern of Inflammatory Bowel Disease arthritis present?
> 5 joints, usually small joints of the hands. Independent of GI disease.
What is Reactive Arthritis?
A form of spondyloarthritis, autoimmune process occurring days to weeks after an infection.
What are common triggering infections for Reactive Arthritis?
GI bacteria: Salmonella, Shigella, C.diff; Urogenital: Chlamydia trachomatis (often asymptomatic).
What are clinical features of Reactive Arthritis?
- Asymmetric oligoarthritis, commonly lower extremities
- Enthesitis
- Dactylitis
- Inflammatory low back pain
- Conjunctivitis
- Urethritis (dysuria)
What is Reiter syndrome?
A form of Reactive arthritis: Arthritis, urethritis, conjunctivitis following infection.
What is Polymyalgia Rheumatica?
An inflammatory disorder of unknown cause.
Clinical features include bilateral proximal muscle stiffness that is worse in the morning.
What are clinical features of Polymyalgia Rheumatica?
- Bilateral proximal muscle stiffness that is worse in the morning
- Does NOT cause muscle weakness
- Sometimes fever, fatigue
What are Creatinine Kinase levels in Polymyalgia Rheumatica?
Normal.
Polymyalgia Rheumatica commonly occurs with what condition?
Temporal arteritis.
In what age group does Polymyalgia Rheumatica occur?
Older patients (>50 y/o).
How is Polymyalgia Rheumatica diagnosed?
Clinically.
What are 2 abnormal lab findings in Polymyalgia Rheumatica?
↑ CRP, ↑ESR.
Polymyalgia Rheumatica responds well to what treatment?
Glucocorticoids.
What is Fibromyalgia?
A chronic pain disorder with widespread musculoskeletal pain of unknown cause.
Fibromyalgia is common in what demographic?
Women 20 to 55 years old.
Fibromyalgia is associated with what condition?
Depression/anxiety.
How to diagnose Fibromyalgia?
Diagnosed clinically with normal muscle biopsy and normal lab tests.
What are clinical exam findings of Fibromyalgia?
Point tenderness in specific locations.
What are 3 treatments for Fibromyalgia?
- Exercise
- Tricyclic antidepressants (amitriptyline)
- SSRIs
What are Inflammatory Myopathies?
Autoimmune muscle disorders.
Major disorders include Polymyositis and Dermatomyositis.
How to diagnose and treat Inflammatory Myopathies?
Diagnose: muscle biopsy; Treatment: Immunosuppression (prednisone initially then azathioprine or methotrexate).
What should be suspected in a young woman with depression and diffuse muscle tenderness?
Fibromyalgia.
What are clinical features of Inflammatory Myopathies?
- Myalgias
- Hallmark: slow onset proximal muscle weakness at first → distal weakness occurs later.
What are 3 lab findings in Inflammatory Myopathies?
- Elevated Creatinine Kinase (CK)
- ANA
- Anti-jo1 antibodies: tRNA synthetase.
What will muscle biopsy of Polymyositis show?
Endomysial inflammation, with predominately CD8+ T cells.
What symptoms does Dermatomyositis present with?
- Slow onset proximal muscle weakness
- Skin changes: Heliotrope rash, Gottron papules, Malar rash, ‘Shawl and V signs’.
What will muscle biopsy of Dermatomyositis show?
Perimysial inflammation, with predominately CD4+ T-cells.
Inflammatory myopathies are associated with what condition?
Adenocarcinomas (cervix, lung, ovaries, etc.).
How is Acetylcholine broken down?
By Acetylcholine esterase (AChE).
What is the mechanism of Myasthenia Gravis?
Antibodies block nicotinic ACh receptors → ACh cannot bind → muscle weakness.
How to diagnose Myasthenia Gravis?
Acetylcholine receptor antibodies.
What are clinical features of Myasthenia Gravis?
- Muscle fatigability: Repeated nerve stimulation → ↓ ACh release → muscles weaken with use
- Diplopia and ptosis
- ‘Bulbar’ symptoms: Speech, chewing and swallowing problems.
What are 2 treatments for Myasthenia Gravis?
- Acetylcholine esterase inhibitor: Neostigmine, Pyridostigmine, Edrophonium
- Immunosuppressants.
What are 3 Acetylcholine esterase inhibitors?
Neostigmine, Pyridostigmine, Edrophonium.
What are 2 reasons for Myasthenia gravis exacerbations?
- Insufficient dose AChE inhibitor
- Cholinergic crisis: Too much medication leads to muscle refractory to ACh.
What test can be used to test the cause of Myasthenia gravis exacerbations?
Tensilon Test: administer Edrophonium.
Muscle function improves: ↑ dose AChE inhibitor; Muscle function fails to improve: ↓ dose.
What complications can arise from the Tensilon test?
Diffusely increased ACh levels activate parasympathetic activity.
Symptoms include Bradycardia, Salivation, Abdominal cramping, Asthma.
What condition do most Myasthenia Gravis patients have?
Abnormal thymus.
Myasthenia Gravis often resolves with what procedure?
Thymectomy.
What is a key test for Myasthenia Gravis?
Imaging of mediastinum (CT or MRI) to identify thymus abnormality.
What is the mechanism of Lambert Eaton Myasthenic Syndrome?
Antibodies against pre-synaptic Ca channels → Prevent ACh release.
Lambert Eaton Myasthenic Syndrome is associated with what condition?
Small cell lung cancer (paraneoplastic syndrome).
What is the presentation of Lambert Eaton Myasthenic Syndrome?
- Slow onset symmetric proximal muscle weakness
- No muscle pain
- Autonomic dysfunction: dry mouth, erectile dysfunction, constipation.
Does muscle use improve or worsen Myasthenia gravis and Lambert Eaton Myasthenic Syndrome?
Myasthenia gravis: worsen; Lambert Eaton Myasthenic Syndrome: improve.
What does the Tensilon test in Lambert Eaton Myasthenic Syndrome show?
Mild ↑ in muscle function (much less effective than in MG).
