Seronegative Spondyloarthropathies - Darrow

Question 1

seronegative spondyloarthropathies

Answer 1

M > F
<40yo

spine and SI joints

HLA-B27 positive**

Question 2

non-vertebral sx of spondyloarthropathies

Answer 2

enthesopathy
sausage digits
pustular psoriasis
etc.

Question 3

HLA-B27

Answer 3

class I MHC - CD8 cells

often high in diseases
-but not absolutely necessary
10% of ankylosing spondylitis are HLA-B27 negative

Question 4

diagnosis of spondyloarthropathy

Answer 4

often needs sarcoilitis

-low back pain - worse in morning gets better over day

Question 5

Th17

Answer 5

tissue inflammation

Question 6

ankylosing spondylitis clinical**

Answer 6

bamboo spine - lateral**
SI inflammation
kyphosis
fatigue
ocular inflammation
reduced rib expansion
weight loss
AA subluxation
pulmonary fibrosis - upper lobe
aortic insufficiency

Question 7

associations with ankylosing spondylitis

Answer 7

upper lobe pulmonary fibrosis

aortic insufficiency

Question 8

schober test

Answer 8

for AS

when flex spine - should increase distance between points

Question 9

MRI of AS

Answer 9

edema at enthesitis sites

before you get sclerosis

Question 10

andersson lesion

Answer 10

simulate diskitis

-in AS

Question 11

syndesmophytes

Answer 11

bamboo spine of AS

Question 12

shiny corner sign

Answer 12

reactive sclerosis in AS

Question 13

anterior and thick syndesmophytes**

Answer 13

more in DISH - diffuse interosseous skeletal hyperostosis

AS - lateral - bamboo spine

Question 14

complications of AS

Answer 14

upper lobe pulmonary fibrosis

aortic regurgitation

Question 15

bilateral sarcoilitis

Answer 15

AS

Question 16

unilateral sarcoilitis, rash, sausage digits, pencil in cup

Answer 16

with psoriatic arthritis

Question 17

most common pattern in psoriatic arthritis

Answer 17

type 1 - oligoarthritis

Question 18

worst pattern in psoriatic arthritis

Answer 18

type 5 - opera glass
arthritis mutilans

gives pencil in cup

Question 19

young male, hell pain achilles insertion, pain knees, hips, low back

month ago - clear penile discharge

Answer 19

reactive arthritis

not usual - death

Question 20

Keratoderma blennorrhagicum

Answer 20

skin lesions - palms and soles

-in reactive arthritis

Question 21

infections in reactive arthritis

Answer 21

MUS3Y2C3 - GI and GU bugs

mycoplasma genitalium

ureaplasma urealtyicum - men

shigella flexneri
salmonella sp
streptococcus

yersinia enterocolitica
yersinia pseudotuberculosis

campylobacter jejuni
clostridium dificile
chlamydia trichomatis

Question 22

reiters syndrome

Answer 22

reactive arthritis

Question 23

lovers heel

Answer 23

reactive arthritis

Question 24

HLA-B27 positive, large joint arthritis, uveitis, urethritis, mouth ulcers, follows infection

Answer 24

reactive arthritis

Question 25

IBD with arthritis

Answer 25

sacroilitis - acts independently of IBD peripheral arthritis - corresponds to IBD often crohns

Question 26

hemophiliac

Answer 26

gets hemarthrosis diarrhea, b/l ankle and elbow synovitis, b/l heel pain, effusion of right knee

Question 27

hemarthrosis

Answer 27

persistant hemorrhage knees ankles and elbows boggy synovitis

Question 28

drug abuser arthritis

Answer 28

streptococcus agalactiae gram positive cocci group B lancefield antigen

Question 29

monoarthritis

Answer 29

septic - until proven otherwise

Question 30

more joints involved

Answer 30

less likely septic | -unless - RA, group B strep, endocarditis

Question 31

anti-TNF therapy

Answer 31

2x likely to get septic arthritis

Question 32

joint effusion septic arthritis

Answer 32

WBC >50,000 | gram stain and culture positive

Question 33

diagnosis of septic arthritis

Answer 33

check for AFB in anti-TNF therapy or HIV

Question 34

type III synovial fluid

Answer 34

purulent opaque low viscosity >100,000 WBC >75% polys in septic arthritis**

Question 35

string sign

Answer 35

for low viscosity of synovial fluid -type III septic arthritis

Question 36

majority of septic arthritis

Answer 36

gram positives | -staph, MRSA, group B strep, pneumococcus

Question 37

prosthetic joint infection

Answer 37

majority staph >24 months - seed from blood 3-24 months - coag negative staph from surgery

Question 38

migratory arthritis, meningitis, pancarditis, and skin pustules

Answer 38

gonococcal arthritis most common septic arthritis in young adults disseminated - fitz hugh curtis - liver perihepatitis**

Question 39

gonococcal arthritis

Answer 39

disseminated - arthritis/dermatitis syndrome also - C5-9 deficiency is risk fx**

Question 40

potts disease

Answer 40

TB septic arthritis to spine

Question 41

vague presentation of arthritis

Answer 41

viral

Question 42

severe joint pain and myalgias

Answer 42

HIV - no CD4 CD8 causes problems - sjogrens hilar nodes - CD4 - sarcoid disease

Question 43

diffuse infiltrative lymphocytosis syndrome

Answer 43

DILS CD8 cell infiltration of organs

Question 44

hilar lymphadenopathy in treated HIV patient, next test?

Answer 44

ACE

Question 45

erythema nodosum with arthritis

Answer 45

BUMPS ``` boecks sarcoid bechets disease UC/Crohns mycoses pills - BCP strep ```

Question 46

IRIS

Answer 46

immune reconstitution inflammatry syndrome -driven by CD4 lymphocytes RA, SLE, sarcoid, sjogrens

Question 47

lyme disease association

Answer 47

bells palsy | heart block

Question 48

diagnosis of lymes

Answer 48

confirmed with western blot