Musculoskeletal and Rheumatology Flashcards
What are the mechanism and ADRs of methotrexate?
MOA: Folate antimetabolite
ADR: Hepatotoxicity, Stomatitis, Cytopenias
What are the mechanism and ADRs of Leflunomide?
MOA: Pyrimidine synthesis inhibitor
ADR: Hepatotoxicity, Cytopenias
What are the mechanism and ADRs of Hydroxychloroquine?
MOA: TNF & IL-1 suppressor
ADR: Retinopathy
What are the mechanism and ADRs of Sulfasalazine?
MOA: TNF & IL-1 suppressor
ADR: Hepatotoxicity, Stomatitis, Hemolytic anemia ([S]ulfasalazine [S]lices)
What are the class/mechanism and ADRs of adalimumab, certolizumab, etanercept, golimumab, infliximab?
TNF inhibitors
ADR: Infection, Demyelination, Congestive heart failure, Malignancy
Which stage of Lyme disease?
- Erythema migrans, fatigue, headache, myalgias, arthralgias
Early localized
days to 1 month
Which stage of Lyme disease?
- multiple erythema migrans, unilateral/bilateral CN palsy (eg, CN VII), meningitis, carditis (eg, AV block), migratory arthralgias
Early disseminated
weeks to months
Which stage of Lyme disease?
- arthritis, encephalitis, peripheral neuropathy
Late
months to years
- Asian or Middle Eastern descent
- Painful oral/genital ulcers is association with erythema nodosum-like lesions of the skin
- Ocular lesions (e.g. anterior uveitis, blindness)
Behçet Syndrome
Rheumatologic Condition:
- RA-like symptoms or hx of RA
- Splenomegaly
- Neutropenia/recurrent infections
Felty Syndrome (“Felt” my splenomegaly)
What is the difference between Systemic Sclerosis and CREST?
A spectrum of disease:
CREST = Calcinosis, Raynaud’s Esophageal Dysmotility, Sclerodactyly, Telangiectasia
When the above also involves the lungs, heart, and kidney it is scleroderma (a.k.a. systemic sclerosis)
What are the features of systemic sclerosis?
All of the features of CREST in addition to:
- Skin: Fibrosis of the hands, face, neck and extremities
- GI: GERD, diverticuli, diarrhea
- Renal: hypertensive crises
- Lung: fibrosis leading to restrictive lung disease and pulmonary hypertension
- Cardiac: myocardial fibrosis, pericarditis, and heart block, RVH
Pituitary irregularities
Parathyroid
Pancreatic islet cells
“Three P’s” = MEN1
Medullary thyroid carcinoma
Pheochromocytoma
Parathyroid
“Two P’s” = MEN 2A
Mucosal neuroma/Marfanoid habitus
Medullary thyroid carcinoma
Pheochromocytoma
“One P” = MEN 2B
Porphyria Cutanea Tarda
Blistering of sun-exposed skin in patients with a history of liver disease (e.g. Hepatitis C, alcoholism), estrogen use or iron overload (hemochromatosis)
Condition presenting with:
Fever
GI symptoms: severe abdominal pain, nausea, vomiting
Neurological abnormalities
Polyneuropathy: non-specific pain, weakness/fatigue, paresthesia, paresis
Seizures
Psychiatric abnormalities: hallucinations, disorientation, anxiety, insomnia
Autonomic dysfunction: tachycardia, hypertension
Red-purple urine
No skin involvement
Acute Intermittent Porphyria
Anti-CCP Ab is specific for?
RA
Anti-dsDNA and anti-Sm antibodies are specific for?
SLE
Anti-histone Ab is specific for?
Drug-induced lupus
think: histone like “hist”amine –> IgE response to drugs
Anti-Scl-70 Ab is specific for?
Systemic sclerosis
Anti-[c]entromere Ab is specific for?
Limited ([c]utaneous) systemic sclerosis ([C]REST)
Anti-Jo-1 Ab is specific for?
Polymyositis/Dermatomyositis
Patient presents with Raynaud phenomenon, hand/finger swelling, arrthritis/synovitis, inflammatory myopathy, pulmonary hypertension, malar or discoid rash, and mild CNS and/or renal disease.
Mixed Connective Tissue Disease = overlap of SLE, scleroderma and polymyositis
