Random Flashcards
Most common nail finding in PsA
Nail pitting
Most common PsA phenotypes
Oligoarthritis (>70%)
Polyarthritis (15%)
Most common sites of enthesitis (found in PsA)
Achilles tendon
Plantar fascia
Lateral epicondyles at elbows
Strongest genetic risk for PsA in patients with psoriasis vulgaris
HLA-B27
These tests are recommended to differentiate PsA from rheumatoid arthritis
Rheumatoid factor
Anti-CCP
(negative results will favor RA)
For PsA, how many months to maximize chances of minimal disease damage
6 months
This DMARD is preferred for peripheral spondylitis and improves psoriatic joint swelling. (NO SKIN improvement)
Reversible azoospermia may be seen
Sulfasalazine
This selective PDE4 inhibitor has moderate effects on PsA for skin, nails, joints, but may cause depression
Apremilast
These TNF inhibitors are effective for PsA with UVEITIS and IBD
Infliximab
Adalimumab
An inhibitor of common p40 subunit of IL12 and IL23, approved for Psoriasis and PsA, effective if with IBD and Crohn’s
Ustekinumab
But can cause eosinophilic pneumonia and cancer
This TNF-inhibitor can cause drug-induced SLE
Etanercept
Patient presents with urethral, ocular, and articular inflammation is seen in what disease
Reactive arthritis
(aka Reiter syndrome)
Patient presents with bloody diarrhea, dysuria with purulent discharge, conjunctivitis and photophobia, what is the diagnosis? Expected lab findings?
Reactive arthritis
Non-specific increased ESR, CRP, platelet count
Synovial fluid is sterile
Gram stain is negative
Can culture the urethra for Chlamydia
Criteria for diagnosing Reactive Arthritis
(in my own words)
- Arthritis should involve lower limb and should be asymmetric
- Should have history of bloody diarrhea or UTI at least 4 weeks prior
- No joint infection
This presents as erythematous vesicular-pustular keratotic lesions on the palms and soles coalescing into psoriatic-like plaques
Keratoderma blenorrhagicum
This presents as an erythematous papule or pustule with raised borders around the penile meatus, shaft, or glans.
If circumcised, becomes a hard, dry crust resembling a psoriatic plaque
Circinate balanitis
Etiology and pathogenesis of Rheumatic Fever
Pharyngitis caused by Grp A beta-hemolytic streptococcal infections triggers an abnormal inflammatory immune response. This cross-reacts with the myocardium, synovium, and basal ganglia chorea.
What is the common valve affected in rheumatic fever?
- Mitral Valve
- Aortic Valve
Patient presents with annular evanescent, erythematous patches along the torso, upper arms, legs
Think of erythema marginatium
Major Criteria for Acute Rheumatic Fever
- Carditis
- Chorea (jerky movements)
- Erythema marginatum
- Subcutaneous nodules
- Arthritis
This drug can cause ARF-like syndrome called erythema marginatum hemorrhagicum
Sorafenib
Treatment for Acute Rheumatic Fever
Penicillin VK
- 250mg BID for children
- 500mg BID for adults
Acute rheumatic fever occurs when?
2-3 weeks after a throat infection, more common in ages 5-15 years old
Patient with a history of URTI presents with nonpitting neck induration that appear waxy and smooth, with prominent follicular ostia giving a peau d’orange appearance.
Diagnosis and treatment options
Scleredema
Associated with diabetes
Treat the DM, UVA1 may be helpful
Major fibroblast products in scleredema-affected skin
Type 1 collagen and hyaluronate
Adult patient presents with generalized lichenoid eruption of minute papules on the extremities and trunk with bovine facies
Diagnosis and associated pathogenesis
Scleromyxedema
Monoclonal paraproteinemia of Immunoglobulin G-kappa
10/male presented with fever for the past 2 weeks, 39C twice a day - accompanied by evanescent, erythematous, salmon pink macular rash. Lymphadenopathy is present.
think Juvenile Idiopathic Arthritis
Macrophage Activation Syndrome (MAH)
potentially life-threatening complication of rheumatic disorders
febrile patient with known or suspected sJIA who has a ferritin value >684 ng/mL and also exhibits any 2 of the following:
- platelet count ≤181
- aspartate aminotransferase >48 units/L
- triglycerides >156 mg/dL
- fibrinogen ≤360 mg/dL
Macrophage Activation Syndrome (MAH)
- associated with thrombotic thrombocytopenic purpura
- hemorrhage
- irritability, seizure, coma
Two serious complications of Adult-Onset Still Disease
- reactive hemophagocytic syndrome
- thrombotic thrombocytopenic purpura
D-penicillamine therapy can cause what acquired perforating disorder?
Acquired elastosis perforans serpiginosa
Most common cardiac defect in Marfan Syndrome
Medial necrosis of the aorta
Most common cardiac defect in Marfan Syndrome
Medial necrosis of the aorta
Death in Marfan patient occurs due to?
Aortic dissection rupture and pericardial tamponade
A patient is noticeably tall, thin, and with striae on the upper chest, arms, thighs, and abdomen.
What is the gene defect and diagnosis?
FBN1 gene (fibrillin 1)
Marfan Syndrome
A tall and thin patient with ectopa lentis came in for consult for derma clearance. What ophthalmic procedure is contraindicated?
LASIK
(Marfan Syndrome patient, FBN1 gene)
A female patient came in with yellowish, flat-topped, discrete, confluent papules on the neck and flexural areas.
What eye findings are most common?
Eye findings: Angioid streaks, radial curvilinear extensions of gray, brown, red discolorations
Diagnosis: Pseudoxanthoma elasticum
A female patient with yellowish papules in a pebbly pattern on the flexural areas came in for biopsy.
What biopsy findings do you expect? Stains?
Histopath: Broken curls of basophilic elastic fibers - swollen, tortuous, and irregularly clumped
Stains:
Elastic fibers - Verhoeff von Gieson
Calcium - von Kossa
A 25/F with symmetric, tender, erythematous nodules on the anterior legs and ankles came in for consult. She has history of URTI one week prior.
What is your diagnosis and treatment?
Diagnosis: Erythema Nodosum
Treatment:
- treat underlying infection
- after which…
- give NSAIDs
- SSKI 2-10 drops 3x/day
- Colchicine
- Etanercept, Infliximab
A 35/F with symmetric, tender, erythematous nodules on the anterior legs and ankles came in for consult. You do not see any ulceration. Biopsy was done. What are the histopath findings?
Erythema Nodosum, wherein you will see septal panniculitis and the characteristic Miescher granuloma (histiocytes surrounding a central stellate cleft)
Histopath findings on a leg biopsy showed septal panniculitis with Meischer granuloma. What are the most common etiologic agents associated with the disease?
Erythema Nodosum
Causes - underlying infection
In Pedia - Strep throat infection
Recurrent - sarcoidosis, hormonal therapy, pregnancy, strep infection
A 35/F came in for consult with recurrent erythematous nodules with ulceration on the posterior calf.
What should you investigate for and histopath findings?
Case of Erythema Induratum
Investigate for MTB
Histopath will show lobular panniculitis and extensive necrosis of adipocytes in the center of adipose
Potential markers for extrapancreatic fat necrosis
Resistin and Leptin
Potential markers for extrapancreatic fat necrosis
Resistin and Leptin
These drugs can cause HAART-induced lipodystrophy in HIV patients
Nucleoside analogs - Zidovudine and Stavudine
They induce fat loss by inhibiting polymerase-y
An 8/F came in with hypopigmented skin. You noticed her hair was silvery. What is diagnostic for this and what is the diagnosis?
Check the hair for large clumps of pigment in the hair shaft.
Griscelli Syndrome
Patient presents with segmental vitiligo on the face, with poliosis, ipsilateral hearing loss, and visual changes.
Diagnosis?
Alezzandrini syndrome
Patient presents with segmental vitiligo on the face, with poliosis, ipsilateral hearing loss, and visual changes.
Diagnosis?
Alezzandrini syndrome
Patient presents with hearing loss, visual changed, meningitis, and flu-like symptoms. Depigmentation and poliosis presented after the systemic symptoms. Diagnosis?
Vogt-Koyanagi-Harada syndrome
Mucocutaneous pigmentation and intestinal hamartomas are the hallmarks of this condition
Peutz-Jeghers Syndrome (STK11)
commonly associated with GI malignancy
Most sensitive test for PCOS
Free Testosterone
The only FDA-approved OTC treatment for acne 12 yrs old and older
Adapalene 0.1% Gel
What does Verhoeff van gieson stain detects?
Elastic fibers
What does von kossa stain detects in PXE?
Calcium deposition in elastic fibers
Most frequent clinical pattern of AGA in men
Recession of frontal hairline in a triangular pattern
Most common type of AGA pattern in women
Diffuse thinning of centroparietal region with maintenance of frontal hairline
Adrenal adenomas secrete:
Testosterone
Adrenal carcinomas secrete:
Testosterone, DHEAS, and cortisol
The only drug approved for the removal of facial hair:
Topical eflornithine
- inhibits ornithine decarboxylase, which shortens the hair growth cycle
The only drug approved for the removal of facial hair:
Topical eflornithine
- inhibits ornithine decarboxylase, which shortens the hair growth cycle
Popping or snapping to augment sexual pleasure uses these inhalants:
Amyl nitrite or butyl nitrite
Popping or snapping to augment sexual pleasure uses these inhalants:
Amyl nitrite or butyl nitrite
Cold urticaria with deafness and amyloidosis may be associated with this syndrome
Muckle-Wells syndrome
causative agent: probably H. pylori
Prednisone dose sufficient to withhold live-virus vaccine (measles, oral polio, vaccine)
more than or equal to 2mg/kg/day or 20mg/day for children weighing more than 10kg, given more than 14 days
Recurrent crops of follicular papules and pustules that form an annular pattern on the face and arms in a Japanese patient
Ofuji Disease
Elderly male with pruritic red-to-brown confluent papules with a cobblestone appearance, sparing the abdominal folds
Papuloerythrodrrma of Ofuji
(+) deck-chair sign
(+) peripheral blood eos
