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Step 1 > Musculoskeletal 2 > Flashcards

Musculoskeletal 2 Flashcards

1
Q

List the 4 seronegative spondyloarthropathies.

A
  1. Psoriatic arthritis
  2. Ankylosing spondylitis
  3. IBD
  4. Reactive arthritis
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2
Q

Why are spondyloarthropathies described as seronegative?

A

Presentation - arthritis without rheumatoid factor

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3
Q

What are some general presenting symptoms of spondyloarthropathies?

A

Morning stiffness, improves with exercise, peripheral arthritis, enthesitis (inflamed tendon insertion sites), dactylitis (sausage fingers), uveitis

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4
Q

What specific presenting symptoms are seen in psoriatic arthritis?

A

Skin psoriasis and nail lesions - asymmetric and patchy

Dactylitis, pencil-in cup deformity of DIP on X-ray

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5
Q

What specific presenting symptoms are seen in ankylosing spondylitis?

A

Symmetric involvement of spine and sacroiliac joints -> ankylosis (especially bamboo spine)
Uveitis
Aortic regurgitation

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6
Q

Why can ankylosing spondylitis cause restrictive lung disease?

A

Limited chest wall expansion with costovertebral and costosternal ankylosis

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7
Q

What organisms are associated with reactive arthritis?

A

Shigella, Salmonella
Chlamydia, Campylobacter
Yersinia
SSCCY

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8
Q

What is the classic triad of reactive arthritis?

A

Conjunctivitis
Urethritis
Arthritis (asymmetric)
“Can’t see, can’t pee, can’t bend my knee”

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9
Q

What are the classic symptoms of SLE?

A

Rash (malar or discoid), arthritis (non-erosive), fever

Serositis, hematologic disoders, oral/nasopharyngeal ulcers, disease, photosensitivity, neurologic (seizures, psychosis, etc.)

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10
Q

What are significant complications of SLE?

A
  1. Libman-Sacks endocarditis

2. Lupus nephritis

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11
Q

What are two possible symptoms caused by antiphospholipid syndrome?

A

Thrombosis, spontaneous abortion

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12
Q

What is mixed connective tissue disease?

A

Features of SLE, systemic sclerosis, and/or polymyositis

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13
Q

What are the key microscopic morphologic features of sarcoidosis?

A

Non-caseating granulomas

Epithelioid granulomas containing microscopic Schaumann and asteroid bodies

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14
Q

What are the lab findings in sarcoidosis?

A

Elevated ACE, elevated CD4/CD8 ratio in bronchoalveolar lavage fluid
Hypercalcemia

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15
Q

What are the imaging findings in sarcoidosis?

A

Bilateral hilar adenopathy and coarse reticular opacities

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16
Q

Key features of polymyalgia rheumatica?

A

Pain and stiffness in shoulders and hips, often with fever, malaise, weight loss
NO MUSCLE WEAKNESS

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17
Q

Compare the CK findings in polymyalgia rheumatic, polymyositis, and dermatomyositis.

A

Normal in polymyalgia, increased in the myositises

18
Q

Compare the microscopic morphology of polymyositis and dermatomyositis.

A

P - endomysial inflammation with CD8+ T cells

D - perimysial inflammation and atrophy with CD4+ T cells

19
Q

Compare the presentations of polymyositis and dermatomyositis.

A

P - progressive symmetric proximal muscle weakness (esp. shoulders)

D - as above + malar rash, Gottron papules (erythematous plaques over joints/bony prominences of hands), heliotrope rash, shawl and face rash, mechanic’s hands

20
Q

Compare the cancers associated with MG and LEMS as paraneoplastic syndromes.

A

MG - thymoma

LEMS - small cell lung cancer

21
Q

Most common NMJ disorder?

A

MG

22
Q

Compare the autoantibodies seen in MG vs. LEMS.

A

MG - Ab against POST-synaptic ACh receptor

LEMS - Ab against PRE-synaptic calcium channels (decreases ACh release)

23
Q

Compare the symptoms of MG vs. LEMS.

A

MG - ptosis, diplopia, weakness that WORSENS WITH USE

LEMS - proximal muscle weakness that IMPROVES WITH USE, autonomic symptoms

24
Q

Compare the response of MG vs. LEMS to AChE inhibitors.

A

MG - improves (edrophonium/tensilon test)

LEMS - minimal effect

25
Q

What diseases may cause Raynaud syndrome?

A

Mixed connective tissue disease, SLE, CREST (limited form of systemic sclerosis)

26
Q

Describe the color change of Raynaud phenomenon.

A

White (ischemia) -> blue (hypoxia) -> red (reperfusion)

27
Q

Pathogenic triad of scleroderma (systemic sclerosis)?

A
  1. Autoimmunity
  2. Non-inflammatory vasculopathy
  3. Collagen deposition with fibrosis
28
Q

General presenting symptoms of scleroderma?

A

Sclerosis of skin (puffy, taut skin, no wrinkles, with fingertip pitting) + sclerosis of other systems

29
Q

Symptoms of limited scleroderma?

A

Skin involvement confined to fingers and face

CREST - calcinosis, raynaud, esophageal dysmotility, sclerodactyly, telangiectasias

30
Q

Most common cause of osteomyelitis? Other possible causes?

A

S. AUREUS

S. epidermidis
P. aeruginosa
Pasteurella
N. gonorroheae
Salmonella
M tuberculosis
Candida
31
Q

Osteomyelitis associated with sexual transmission?

A

N. gonorrheae

32
Q

Osteomyelitis associated with puncture wounds?

A

P. aeruginosa

33
Q

Osteomyelitis associated with sickle cell disease?

A

S. aureus and salmonella

34
Q

Osteomyelitis associated with prosthetic joint replacement?

A

S. aureus and S. epidermidis

35
Q

Osteomyelitis associated with vertebral involvement?

A

S. aureus and M. tuberculosis (Pott disease)

36
Q

Osteomyelitis associated with cat/dog bites?

A

Pasteurella

37
Q

Osteomyelitis associated with IV drug use?

A

S. aureus, P. aeruginosa, Candida

38
Q

N. gonorrheae more commonly causes which - osteomyelitis or septic arthritis?

A

Septic arthritis

39
Q

Most common cause of septic arthritis? Other causes?

A

S. AUREUS
Streptococcus
N. gonorrheae

40
Q

How does septic arthritis caused by N. gonorrheae present?

A

Often unilateral, presents as either a purulent arthritis or a triad of polyarthralgia , tenosynovitis, and dermatitis

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