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tsomkapQ > Rheumatology/MSK Clues 1-61, no derm ULTIMATE LIST > Flashcards

Rheumatology/MSK Clues 1-61, no derm ULTIMATE LIST Flashcards

1
Q

What is primary biliary cirrhosis?

A

Pruritis, xanthomas, anti-mitochondrial Ab; seen in females

Autoimmune rxn→ lymphocytic infiltrte +/- granulomas→ destruction of lobular vile ducts

Associated with other autoimmune conditions (hashimotos, rheumatoid, celiac, etc)

tx: ursodiol

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2
Q

What is primary sclerosing cholangitis?

A

P-ANCA Ab, bile duct inflammation, onion skinning, alternation beading of intra-extra hepatic bile ducts

associated with middle aged men, Ulcerative colitis, increased risk of cholangiocarcinoma and gallbladder cancer, MPO-ANCA/P-ANCA.

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3
Q

What is type I autoimmune hepatitis?

A

Anti-smooth mm. Ab; seen in young women

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4
Q

What is type II autoimmune hepatitis?

A

Anti-LKM Ab

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5
Q

What is bullous pemphigoid?

A

Anti-hemidesmosome Ab, subepithelial skin bullae

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6
Q

What is celiac sprue?

A

Anti-gliaden Ab (can’t eat wheat/ bread products = steatorrhea) assoc. w/ dermatitis herpetifomis

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7
Q

What Ab is assoc. w/ CREST Syndrome?

A

Anti-centromere Ab

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8
Q

What is dermatitis herpeteformis?

A

Vesicles on anterior thigh, Anti-BMZ Ab, Anti-endomysial Ab

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9
Q

What is dermatomyositis?

A

Anti-jo-1 Ab; Myositis with a rash; Assoc. w/ occult malignancy “dermato-jo”

  1. malar rash (distinguished from SLE by involving nasolabial folds)
  2. Gottron papules
  3. heliotrope (violaceous periorbital) rash
  4. darkening/thickening of finger tips
  5. perimysial inflammation + atrophy
  6. CD4+ T cells
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10
Q

What are symptoms of T1DM?

A

Polyuria, polydipsia, wt. loss, Anti-islet cell Ab, anti-GAD Ab, post-infection, DKA

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11
Q

What is drug Induced lupus(and causative drugs)?

A

Anti-histone-Ab; Drugs: Hydralazine Isoniazid Phenytoin Penicillamine Procainamide Ethosuximide

HiPPPE’s develop HISTONEs

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12
Q

What is gastritis type A?

A

Anti-parital cells, atrophic gastritis, adenocarcinoma

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13
Q

What is goodpasture’s?

A

Anti-GBM Ag, attacks the lungs and kidneys, can progress to RPGN and death

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14
Q

What is Graves’ disease?

A

Anti-TSHr Ab, hyperthyroid exopthalmos, pretibial myxedema

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15
Q

What is Hashimotos?

A

Anti-microsomal Ab/anti-TPO, hypothyroid

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16
Q

What is ITP (immune thrombocytopenic purpura)?

A

Anti-platelet Ab, anti-GP IIB/IIIA Ab

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17
Q

What is MCTD (mixed connective tissue disease)?

A

Anti-RNP Ab

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18
Q

What is mononucleosis?

A

Heterophile Ab positive; teenager w/ sore throat, lymphadenopathy, splenomegaly, “kissing disease”

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19
Q

What is MPGN type II?

A

Anti-C3 convertase Ab= C3 nephritic factor

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20
Q

What is paroxysmal hemolysis?

A

Donath landsteiner Ab; bleed when cold

Paroxysmal cold hemoglobinuria (PCH, also called Donath-Landsteiner hemolytic anemia or Donath-Landsteiner syndrome) is an uncommon type of autoimmune hemolytic anemia (AIHA) in which autoantibodies to red blood cells bind to the cells in cold temperatures and fix complement, which can cause intravascular hemolysis

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21
Q

What is pemphigus vulgaris?

A

Anti-desmosome Ab (skin sloughs off when touched) starts in oral mucosa

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22
Q

What is pernicious anemia?

A

Anti-IF Ab, via. B12 deficiency = megaloblastic anemia

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23
Q

What is polyarteritis nodosa?

A

P-ANCA Ab; attacks gut, kidneys and nervous system; assoc. w/ Hep. B infection. There is no pulmonary environment

PAN is a multisystem disease that may present with fever, sweats, weight loss, and severe muscle and joint aches/pains.

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24
Q

What is post-strep. GN?

A

ASO Ab, Nephritic w/ complement deposition; after 3 weeks post-infection

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25
Q

What is RA?

A

Rheumatoid factor present pain and swelling, worse in the morning, anti-citrullinated peptide protein Ab’s

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26
Q

What is scleroderma?

A

Anti-Scl70 Ab (anti-Topol), fibrosis, tight skin, masked faces

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27
Q

What is Sjogrens?

A

Anti-SSA Ab/Anti-Ro dry eyes, dry mouth, arthritis Sjogren’s is an ASS

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28
Q

What is SLE?

A

Anti-dsDNA; Anti-Smith, Anti-cardiolipin Ab. Malar rash, photosensitivity, oral ulcers, RF positive, VDRL positive but not infected, FTA-ABS to confirm

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29
Q

What is SLE Cerebritis?

A

Anti-neuronal Ab; Anti-ribosomal Ab

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30
Q

What is Vitiligo?

A

Anti-melanocyte Ab; white patches on skin

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31
Q

What is warm hemolysis?

A

Anti-Rh Ab; bleeds at body temperature

Rh factor (on Red Blood cells!!)

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32
Q

What is Wegner’s?

A

c-ANCA Ab; attacks ENT, Lungs, and kidney

Granulomatosis with polyangiitis

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33
Q

What is HSP?

A

IgA Disease - 2 or 3 days post-common cold or GI infection. Leads to Berger’s

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34
Q

What is Berger’s?

A

IgA disease, 2 weeks post vaccination; serum sickness

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35
Q

What is Alport’s?

A

IgA disease; 2 weeks after diarrhea, HSP and polio

  • bilateral sensorineural hearing loss
  • glomerular disease
  • ocular disease (lens dislocation)
  • x linked dominant
  • IgA attacks type IV collagen
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36
Q

Where is CK-MB found?

A

Heart

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37
Q

Where is CK-MM found?

A

Muscle

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38
Q

Where is CK-MB found?

A

Brain

39
Q

Why should you wait 30 mins after a meal before swimming?

A

All blood is shunted to GI for digestion, digestion depletes ATP stores; No ATP = no muscle movement

40
Q

How does neurogenic muscle disease present?

A

Distal weakness and fasciculations

41
Q

How does myopathy muscle disease present?

A

Proximal weakness and pain

42
Q

What is a light chain composed of?

A

Actin

43
Q

What is a heavy chain composed of?

A

Myosin

44
Q

What band of sarcomere does not change length?

A

The A band

45
Q

Where are T-tubules located?

A

Cardiac mm: at the z-line Skeletal mm: at the A-I junction

46
Q

What is duchenne’s muscular dystrophy?

A

Caused by a dystrophin frame shift; defective Dystrophin patient will have a Gower sign and calf pseudohypertrophy

47
Q

What is Becker Muscular Dystrophy?

A

Dystrophin Missense; milder form of DMD Symptoms present after 5yo

48
Q

What is seen with Myotonic Dystrophy?

A

Bird’s beak Face; can’t let go when shaking hands

49
Q

What is Myasthenic Syndrome/Lambert-Eaton?

A

Patients will tell you that they get stronger as the day goes by; stronger with EMG (electromyography) Assoc. w/ small cell CA

50
Q

What is Myasthenia Gravis?

A

Anti-ACh post-synaptic Ab; PT ~20-30yo, weaker as day goes on (dysarthria, ptosis, dysphagia) Periotic exacerbations get stronger w/ Edrophonium Weaker with EMG (electromyography); must rule out thymoma

51
Q

What is MS?

A

Production of Anti-myelin Ab MC in 20-40yo women, vision disturbances, spasticity (UMNs), decreased sensation, symptoms wax and wane - each MS attack gets worse

52
Q

What is Metachromatic Leukodystrophy?

A

Arylsulfatase A deficiency; a child who presents similar to MS

53
Q

What is ataxia telangiectasia?

A

IgA deficiency; PT has spider veins

54
Q

What do you see in Friedrick’s Ataxia?

A

Retinitis pigmentosa, scoliosis

55
Q

What is adrenal leukodystrophy?

A

Carnitine acyltransferase (CAT-1), defective adrenal failure (XR); long-chain FA stuck in cytoplasm

56
Q

What is Guillain-Barre?

A

Ab’s damage multiple peripheral nerves (acute inflammatory polyneuropathy); patients present with ascending paralysis 2 weeks post-UTI

57
Q

What is ALS?

A

Descending paralysis seen in middle aged men with fasciculations; no sensory problems

58
Q

What is Werdnig-Hoffman?

A

Fasciculations in newborn due to failure of anterior horns to develop

Werdnig Hoffman is the old name for Spinal Muscular Dystrophy, type 1 (SMA-1)

59
Q

What is polio?

A

Asymmetric fasciculations in kids; presents 2 weeks post- gastroenteritis

60
Q

What is choreoathetosis?

A

Dance-like movements; wringing of hands, quivering/unsteady voice

61
Q

What is Atonic Cerebral Palsy?

A

No mm. Tone - floppy

62
Q

Fatigue, malar rash, inflammatory and symmetric joint pain, photosensitivity

A

SLE (may also see discoid lesions, Reynaud’s, myalgias, pericarditis/endocarditis, pleuritis, hemolytic anemia, proteinuria/GN, impaired immune response, nausea/vomiting/dyspepsia, seizures/psychosis) Treatment: NSAIDS for mild symptoms, corticosteroids for exacerbations and severe manifestations, hydroxychloroquine (constitutional/cutaneous/articular), and cyclophosphamide (glomerulonephritis)

63
Q

SLE syndrome without CNS or kidney involvement

A

Drug-induced lupus Treatment: remove offending drug (hydrazine, procainamide, isoniazid, chlorpromazine, methyldopa, quinidine)

64
Q

Raynaud’s, sclerodactyly, dysphagia, pulmonary HTN

A

Diffuse scleroderma (can have renal malignant HTN, pulmonary HTN/interstitial fibrosis, or pericardial/myocardial involvement) Treatment: symptomatic, treat complications

65
Q

Raynaud’s, sclerodactyly, dysphagia, calcium deposits, telangiectases under nails

A

CREST (cutaneous limited–no renal/pulmonary/cardiac findings) Treatment: symptomatic

66
Q

Dry eyes/mouth, arthalgias, interstitial nephritis, vasculitis, positive Schirmer test

A

Sjogren’s (Dx: Schirmer test for lacrimal gland output, salivary gland biopsy) Treatment: pilocarpine/cevimeline (increase secretions), artificial tears, NSAIDS

67
Q

Pulmonary manifestations, esophageal dysfunction, polyarthritis, sclerodactyly, cutaneous findings, myopathy, Raynaud’s

A

Mixed connective tissue disease (SLE, RA, systemic sclerosis, polymyositis) Treatment: varies depending on which disease predominates

68
Q

Fatigue and symmetrical joint pain in PIP/MCP/wrist/knees, morning stiffness which improves throughout day, subcutaneous nodules over extensor surfaces

A

RA Treatment: NSAIDS/low dose corticosteroids and DMARDS (methotrexate with folate, leflunomide, or hydroxychloroquine)

69
Q

Anemia, neutropenia, splenomegaly, RA

A

Felty’s syndrome

70
Q

50 year old man with podagra and fever

A

Gouty arthritis (Dx: needle shaped negatively birefringent urate crystals in synovial fluid) Treatment: bed rest, indomethacin, colchicine, corticosteroids (oral or intra-articular injection) Prophylactic: allopurinol (xanthine oxidase inhibitor decreases uric acid synthesis), probenecid (uricosuric drugs increase renal excretion of uric acid)

71
Q

Acute onset of severe unilateral knee or wrist pain with erythema, swelling, and warmth

A

Pseudogout, also called calcium pyrophosphate deposition disease (Dx: weakly positively birefringent rod-shaped and rhomboidal crystals in synovial fluid) Treatment: treat underlying disease (hemochromatosis, hyperparathyroidism, hypothyroidism, Bartter’s syndrome) and manage symptoms with NSAIDS, colchicine, and intra-articular corticosteroid injections

72
Q

Subacute onset of weakness of neck flexors, shoulder girdle, and pelvic girdle muscles with myalgias and rash around eyes, bridge of nose, and cheeks Elevated CK, AST, ALT, and LDH

A

Dermatomyositis (can be associated with vasculitis) Types of rashes: heliotrope, Gottron’s papules (scaly lesions over knuckles), V sign (rash on face, neck, anterior chest), shawl sign (rash on shoulders, upper back, and elbows), periungual erythema with telangiectases Treatment: corticosteroids and immunosuppression (methotrexate, cyclophosphamide, chlorambucil)

73
Q

Weakness of shoulders and pelvic muscles, dysphagia, and myalgias

A

Polymyositis Treatment: corticosteroids and immunosuppression (methotrexate, cyclophosphamide, chlorambucil)

74
Q

Older man with progressive asymmetrical weakness of quadriceps, forearm flexors, tibialis anterior, and facial weakness with loss of deep tendon reflexes and dysphagia

A

Inclusion body myositis Treatment: poor response

75
Q

Weakness of shoulders and pelvic muscles, dysphagia, and myalgias

A

Polymyositis Treatment: corticosteroids and immunosuppression (methotrexate, cyclophosphamide, chlorambucil)

76
Q

Older man with progressive asymmetrical weakness of quadriceps, forearm flexors, tibialis anterior, and facial weakness with loss of deep tendon reflexes and dysphagia

A

Inclusion body myositis Treatment: poor response

77
Q

Older man with progressive asymmetrical weakness of quadriceps, forearm flexors, tibialis anterior, and facial weakness with loss of deep tendon reflexes and dysphagia

A

Inclusion body myositis Treatment: poor response

78
Q

Elderly patient with abrupt stiffness, especially in morning, in shoulder/hip after a period of inactivity. Pain with movement and muscle strength 5/5.

A

Polymyalgia rheumatica (10% develop temporal arteritis) Treatment: resolves within 1-2 years (self limited) but corticosteroids reduce inflammation until this happens

79
Q

Woman with anxiety/depression and aching pain in many joints exacerbated by weather changes and stress

A

Fibromyalgia Treatment: some effect with SSRIs and TCAs, otherwise cognitive/psych

80
Q

Man with low back pain/stiffness worse in morning, acute anterior uveitis, enthesitis

A

Ankylosing spondylitis Treatment: indomethacin, anti-TNF (etanercept, infliximab), PT

81
Q

Acute asymmetric arthritis and effusions of joints of lower extremities that progresses from one joint to another. History of recent GI infection

A

Reactive arthritis (preceded by salmonella, shigella, campylobacter, chlamydia, yersinia) Treatment: NSAIDS, if no response give sulfasalazine and immunosuppressive agent (azathioprine)

82
Q

Arthritis, uveitis, urethritis

A

Reiter’s syndrome Treatment: NSAIDS, if no response give sulfasalazine and immunosuppressive agent (azathioprine)

83
Q

Sausage digits, psoriasis, arthalgias of small joints

A

Psoriatic arthritis Treatment: NSAIDS, if no response methotrexate/leflunomide

84
Q

Severe headache with jaw claudication and visual impairment

A

Temporal arteritis (40% also have polymyalgia rheumatica) Treatment: high dose prednisone

85
Q

Constitutional symptoms, absent pulses in carotid/radial/ulnar arteries with tenderness and signs of ischemia

A

Takayasu’s arteritis (of aortic arch/branches) Treatment: steroids, anti-HTN, surgery/angioplasty

86
Q

Oral and genital ulcers, arthritis of knee/ankle, uveitis, intracranial HTN, fever

A

Behcet’s syndrome Eye findings: uveitis, optic neuritis, iritis, conjunctivitis CNS findings: intracranial HTN, meningoencephalitis Treatment: steroids

87
Q

Glomerulonephritis, sinusitis, and hemoptysis

A

Wegener’s granulomatosis Treatment: cyclophosphamide and corticosteroids can induce remission but most die within 1 year of diagnosis

88
Q

Painful palpable purpura, with fever, weight loss, and fatigue after infection

A

Hypersensitivity vasculitis (reaction to penicillin, sulfa drug, infection, or other stimulus) Treatment: steroids and removal of offending agent

89
Q

Oral and genital ulcers, arthritis of knee/ankle, uveitis, intracranial HTN, fever

A

Behcet’s syndrome Eye findings: uveitis, optic neuritis, iritis, conjunctivitis CNS findings: intracranial HTN, meningoencephalitis Treatment: steroids

90
Q

30 year old male smoker with leg pain on exertion, paresthesias, and ulcerations on digits

A

Buerger’s disease (thromboangiitis obliterans) Treatment: smoking cessation

91
Q

Painful palpable purpura, with fever, weight loss, and fatigue after infection

A

Hypersensitivity vasculitis (reaction to penicillin, sulfa drug, infection, or other stimulus) Treatment: steroids and removal of offending agent

92
Q

Glomerulonephritis, hemoptysis, and IgG anti-glomerular basement membrane antibody

A

Goodpasture’s syndrome

93
Q

1) progressive symmetric proximal m weakness, anti-Jo1+ (histidyl tRNA synthetate),+anti-Mi2, +ANCA,
2) progressive symmetric proximal m weakness, anti-Jo1+ (histidyl tRNA synthetate),+anti-Mi2, +ANCA + malar rash, gottron papules, heliotropic rash

A

1) polymyositis
2) dermatomyositis

94
Q

pain and stiffness in proximal muscles of shoulders and hips but does not cause muscle weakness

A

polymyalgia rheumatica

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