Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Musculoskeletal 1 > Rheumatological 2 > Flashcards

Rheumatological 2 Flashcards

1
Q

Infectious arthritis

- pathophys

A
  • bacterial or fungal infection of joint
  • Hematogenous seeding (MC), direct inoculation, contiguous spread from osteomyelitis, cellulitis, or septic bursitis
  • bacteria trigger inflammatory response of neutrophilic infiltration into joint space
  • can rapidly progress to joint damage
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Infectious arthritis

- dx

A
  • joint aspiration: gram stain, fungal stain, culture, acid fast stain (TB), crystal analysis
  • If suspect GC, gram stain and culture anus, urethra, cervix, and pharynx also
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Risk factors for infectious arthritis (10)

A
  • age
  • alcoholism
  • cutaneous lesions
  • dm
  • ESRD
  • hx steroid injections
  • IVDU
  • immunosuppresant
  • sickle cell
  • malignancy
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Infectious arthritis

- common bugs

A
  • staph aureus (MC)
  • strep pneumo
  • gonococcal (MC female)
  • non-gonococcal gram negs (MC in immunosuppressed)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Why is gonococcal infection in joint more common in females

A
  • males with GC have dysuria = treatment
  • females dont’ have obvious sx, infection travels from vagina to cervix to uterus to fallopian tubes without obv sx, longer time to get in blood
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What is presentation of GC infectious arthritis

A
  • acute arthritis
  • fever
  • skin lesions (vesiculopustular, hemorrhagic macules)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

5 MC fungus in infectious arthritis

A
  1. coccidiodes
  2. sporothrix
  3. cyptococcus
  4. blastomyces
  5. candida
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Viral infections associated with infectious arthritis

A
  1. HBV
  2. HCV
  3. Parvovirus B19 (Fifth disease)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What can both HBV and HCV cause in addition to infectious arthritis

A

polyarthritis in the prodromal phase of the hep virus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Describe presentation of Fifth disease infectious arthritis

A
  • aka erythema infectiosum
  • acute arthritis
  • usually young people
  • resembles acute RA without the antibodies
  • fever
  • slapped cheek erythematous rash
  • tx: supportive care
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Chikungunya

- describe pathogen

A
  • type of infectious arthritis
  • virus endemic to asia/africa
  • transmitted via mosquitos
  • in US from travelers
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Chikungunya

- sx

A
  • fever
  • myalgia
  • thrombocytopenia
  • leukopenia
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Chikungunya

- dx

A
  • travel hx

- IgM anti-chikungunya antibodies

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Idiopathic inflammatory myopathies (IIMs)

- describe

A
  • autoimmunity and inflammatory involvement of muscle fibers

- result in muscle weakness

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What are the three Idiopathic inflammatory myopathies (IIMs)

A
  1. Polymyositis (PM)
  2. Dermatomyositis (DM)
  3. Inclusion body myositis (IBM)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Idiopathic inflammatory myopathies (IIMs)

- pathophysiology of each subtype

A
  1. PM: CD8-positive T cell mediated immune disease = direct myocyte injury
  2. DM: immune complex dz with vascular inflammation, cutaneous findings
  3. IBM: mho-degenerative dz with vacuoles in muscle cells and related t-cell response
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Idiopathic inflammatory myopathies (IIMs)

  • common sx
  • antibodies
A
  • fatigue, wt. loss, fever

- Anti-jo-1 antibodies (acute onset)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What is antisynthetase syndrome?

A
  • Anti-jo-1 antibodies with m weakness, pain and 2+ of:
  • inflammatory myositis
  • interstitial lung dz
  • Raynaud
  • non-erosive inflammatory arthritis
  • mechanics hands
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Dermatomyositis cutaneous manifestations

A
  • Gottron sign/papules: symmetric erythematous violaceous macules, patches on extensor surface of hand
  • Heliotrope rash on sun exposed surfaces (upper eyelid)
  • shawl sign on back (sun)
  • v sign on chest (sun)
  • mechanics hands
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

How to diagnose idiopathic inflammatory myopathies

A
  • Hx and exam
  • muscle enzymes: Ck, aldolase, AST
  • electromyography
  • auto-antibodies (lots)
  • MRI: active muscle inflammation
  • Muscle bx
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

4 meds that can cause idiopathic inflammatory myopathies

A
  • cochicine
  • hydroxychloriquine
  • glucocorticoids
  • statins
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

idiopathic inflammatory myopathies

- management

A
  • high dose glucocoricoids initially, then taper to low dose
  • immunosuppressants
  • Rheumatology referral
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Systemic Vasculitis

- describe

A
  • inflammation of arteries, veins, capillaries
  • small, large, intermediate size vessels
  • r/o the many secondary causes
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Two types of large vessel vasculitis

A
  1. giant cell arteritis

2. takayasu arteritis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Giant cell arteritis

  • incidence
  • M vs. F
  • age
A
  • MC primary vasculitis
  • F > M
  • 70 av age of onset
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

Giant cell arteritis

- commonly affected

A
  • MC temporal
  • carotids
  • ciliary ophthalmic
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

Giant cell arteritis

- pathyophysiology

A
  • dendritic cells in vessel adventitia are activated & recruit T cells and monocytes to vessel wall
  • Macrophages coalesce and form giant cells
  • cells secrete metalloproteinases = disrupt vessel wall
  • Intimal proliferation = vessel closure, ischemia, dead tissue
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

Giant cell arteritis

- sx

A
  • scalp pain
  • HA
  • tenderness over temporal artery
  • jaw claudication
  • temp blindness
  • diplopia
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

Giant cell arterities

- dx tests

A
  • VERY high sed rate (>70)

- temporal artery bx

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

Giant cell arteritis

- tx

A
  • glucocorticoids

- high dose at first, then taper down

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

What co-morbidity is often found with giant cell arteritis

A
  • polymyalgia rheumatica
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

Takayasu arteritis

  • what vessels affected
  • who does it MC affect
A
  • aorta and its main branches

- young women

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

Takayasu arteritis

- presentation

A
  • s/s inflammatoin

- PE findings of vascular disease: decreased pulse, asymmetrical pulse, BP, bruits

34
Q

Takayasu arteritis

- dx

A
  • angiography: aneurysms and narrowing of affected arteries
35
Q

Takayasu arteritis

- tx

A
  • high dose steroids
36
Q

3 medium sized vasculitis

A
  • polyarteritis nodosa
  • primary angiitis of CNS
  • Kawasaki dz
37
Q

Polyarteritis nodosa

- incident

A
  • rare
  • m = f
  • 30% assoc. with past HBV infection
38
Q

polyarteritis nodosa

- presentation

A
  • aneurysm formation
  • ruptured aneurysms
  • organs: kidney, peripheral nerve, tests, ovaries, GI, coronaries
39
Q

How most likely to pick up polyarteritis nodosa?

A

ROS - will get unusual sx such as mononeuritis multiplex (numbness comes and goes)

40
Q

Polyarteritis nodosa

- tx

A
  • high dose glucocorticoids
  • DMARDS sometimes
  • GET HELP
41
Q

Primary angiitis of CNS

  • incidence
  • describe
A
  • VERY rare
  • vasculitis limited to CNS
  • necrotizing granulamatous vasculitis
42
Q

Primary angiitis of CNS

- presentation

A
  • CNS issues
  • stroke
  • visual field defects
  • seizures
43
Q

Primary angiitis of CNS

- Dx

A

brain biopsy (ahhh)

44
Q

Primary angiitis of CNS

- management

A
  • high dose steroids

- cyclophosphamide

45
Q

Kawasaki disease

- incidence

A
  • asian boys
46
Q

Kawasaki disease

- presentation

A
  • spiking fevers
  • conjunctivitis
  • mucusitis of lips and oral cavity
  • palmar/plantar erythema, induration, desquamation (like hand, foot, mouth dz)
47
Q

Kawasaki disease

- tx

A
  • IV immune globin

- ASA

48
Q

Small vessel vasculitis

  • what affected
  • two major categories
A
  • post-capillary venues, arterioles, capillaries
  • ANCA associated
  • immune complex-mediated (C3 & C4)
49
Q

What are the three ANCA associated vasculitis diseases

A
  • granulomatosis with polyangiitis (Wegener Granulomatosis)
  • Microscopic polyangitis
  • Eosiniphilic Granulomatosis (Churg-Strauss syndrome)
50
Q

what does ANCA stand for

A

anti-neutrophil cytoplasmic antibody

51
Q

ANCA associated vasculitis diseases

- pathophys

A
  • when ANCA attacks neutrophil, neutrophil degranulates
  • enzymes attack endothelium of small blood vessels
  • neutrophils disintegrate: can find remnants in vessel walls on bx
  • dz d/t closure of small vessels
52
Q

What do you order when suspect small cell vasculitis?

A
  • c-ANCA antibodies
  • p-ANCA antibodies
  • helps determine which disease
53
Q

Granulomatosis with polyangiitis

- presentation

A
  • upper resp. tract, nose, upper airway
  • lungs: SOB, hemoptysis
  • Kidney: glomerulonephritis
54
Q

Granulomatosis with polyangiitis

- Dx

A
  • ANCA antibodies

- lung/kidney tissue bx

55
Q

Granulomatosis with polyangiitis

- tx

A
  • steroids

- cyclophosphamide

56
Q

Microscopic polyangiitis

- presentation

A
  • very similar to granulomatosis with polyangiitis
57
Q

How differentiate microscopic polyangiitis from granulomatosis with polyangitis?

A

P-ANCA for microscopic

58
Q

Eosinophilic Granulomatosis

- presentation

A
  • allergic rhinitis
  • nasal polyps
  • asthma
  • lung dz
  • peripheral nerve dz (mono or multiple nerve numbness, permanent or come and go)
59
Q

Eosinophilic Granulomatosis

- lab findings

A
  • hypereosinophilia

- P-ANCA (but 40% negative…)

60
Q

Eosinophilic Granulomatosis

- tx

A
  • glucocorticoids
61
Q

Immune complex vasculitis

- basic pathophys

A
  • immune complex deposition in vessel walls

- fix complement and attract neutrophils

62
Q

Immune complex vasculitis

- what organs affected?

A
  • Any can be affected

- skin and joint MC

63
Q

Three immune complex vasculitis diseases

A
  1. Cryoglobulin vasculitis
  2. Leukocytoclastic vasculitis
  3. Henock-Schonlein Purpura
64
Q

Cryoglobulin vasculitis

- antibodies

A
  • antibodies precipitate in vitro at temp < body temp

- can precipitate in cooler areas of body

65
Q

Cyroglobulin vasculitis

- lab

A
  • cryoglobulins

- C3 and C4 low

66
Q

Leukocytoclastic vasculitis

- presentation

A
  • immune complex manifestation in skin

- palpable purpura

67
Q

Leukocytoclastic vasculitis

- dx

A
  • neutrophils in tissue bx
68
Q

Henock-Schonlein purpura

- describe

A
  • MC childhood vasculitis
  • rare in adults
  • tends to appear after URI
  • antigen unknown, antibody in IgA class
69
Q

Henock-Schonlein purpura

- presentation

A
  • abd pain
  • palpable purpura
  • vasculitis in abd and skin vessels
70
Q

Henock-Schonlein purpura

- tx

A
  • usually self limiting

- possibly steroids

71
Q

Scleroderma

  • aka
  • describe
A
  • aka systemic sclerosis
  • autoimmune dz
  • fibrosis = thickening and hardening of skin
  • internal organ involvement common
  • sig morbidity/mortality
72
Q

Scleroderma

- Pathophysiology

A
  • Excess deposition of structurally normal collagen
  • small artery endothelial damage/dysfunction
  • trigger unknown
73
Q

Scleroderma

- dx

A
  • mostly clinical dx
  • symmetric skin induration of hands, arms, face, torso
  • sclerodactyly (skin fibrosis of hands an fibers)
  • digital infarction
  • finger pitting
  • DOE
  • dysphagia
74
Q

Scleroderma

- lab findings

A
  • ANA in anti-centromere pattern

**KNOW THIS ONE

75
Q

Scleroderma

- treatment

A
  • immunosuppressant drugs IF active lung dz
76
Q

Behcet Syndrome

- describe

A
  • vasculitis that affects small to large arterial vessels

- can affect veins

77
Q

Behcet syndrome

  • presentation
  • lab
A
  • recurrent, painful oral ulcerations, vagina also

- HLA-B51

78
Q

Behcet Syndrome

- dx

A

Recurrent painful oral ulcers and 2+ of:

  • recurrent painful genital ulcerations
  • eye involvement
  • erythema nodosum
  • pathergy test (needle into skin = immediate inflammatory response)
79
Q

Sarcoidosis

- describe

A
  • multisystem dz characterized by noncaseating granuloma ** in tissues
80
Q

Sarcoidosis

  • MC affects what organ
  • what other sx?
A

Lungs

  • bilateral hilar adenopathy
  • erythema nodosum
81
Q

Sarcoidosis

- dx

A
  • bilateral hilar lymphadenitis
  • erythema nodosum
    if have both = dx
  • if don’t have both, bx showing noncaseating granulomas required for dx
82
Q

Sarcoidosis

- tx

A
  • symptomatic
  • NSAIDs, colchicine, low dose steroids
  • immunosuppressives
  • TNF alpha inhibitors

Musculoskeletal 1 (14 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions