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MSK Exam 2 Spring 2015 > Seronegative Spondyloarthropathies - Darrow > Flashcards

Seronegative Spondyloarthropathies - Darrow Flashcards

1
Q

seronegative spondyloarthropathies

A

M > F
<40yo

spine and SI joints

HLA-B27 positive**

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2
Q

non-vertebral sx of spondyloarthropathies

A

enthesopathy
sausage digits
pustular psoriasis
etc.

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3
Q

HLA-B27

A

class I MHC - CD8 cells

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

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4
Q

diagnosis of spondyloarthropathy

A

often needs sarcoilitis

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

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5
Q

Th17

A

tissue inflammation

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6
Q

ankylosing spondylitis clinical**

A 
bamboo spine - lateral**
SI inflammation
kyphosis
fatigue
ocular inflammation
reduced rib expansion
weight loss
AA subluxation
pulmonary fibrosis - upper lobe
aortic insufficiency
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7
Q

associations with ankylosing spondylitis

A

upper lobe pulmonary fibrosis

aortic insufficiency

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8
Q

schober test

A

for AS

when flex spine - should increase distance between points

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9
Q

MRI of AS

A

edema at enthesitis sites

before you get sclerosis

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10
Q

andersson lesion

A

simulate diskitis

-in AS

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11
Q

syndesmophytes

A

bamboo spine of AS

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12
Q

shiny corner sign

A

reactive sclerosis in AS

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13
Q

anterior and thick syndesmophytes**

A

more in DISH - diffuse interosseous skeletal hyperostosis

AS - lateral - bamboo spine

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14
Q

complications of AS

A

upper lobe pulmonary fibrosis

aortic regurgitation

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15
Q

bilateral sarcoilitis

A

AS

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16
Q

unilateral sarcoilitis, rash, sausage digits, pencil in cup

A

with psoriatic arthritis

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17
Q

most common pattern in psoriatic arthritis

A

type 1 - oligoarthritis

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18
Q

worst pattern in psoriatic arthritis

A

type 5 - opera glass
arthritis mutilans

gives pencil in cup

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19
Q

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

month ago - clear penile discharge

A

reactive arthritis

not usual - death

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20
Q

Keratoderma blennorrhagicum

A

skin lesions - palms and soles

-in reactive arthritis

21
Q

infections in reactive arthritis

A

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

22
Q

reiters syndrome

A

reactive arthritis

23
Q

lovers heel

A

reactive arthritis

24
Q

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

A

reactive arthritis

25
Q

IBD with arthritis

A

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

often crohns

26
Q

hemophiliac

A

gets hemarthrosis

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

27
Q

hemarthrosis

A

persistant hemorrhage

knees ankles and elbows

boggy synovitis

28
Q

drug abuser arthritis

A

streptococcus agalactiae

gram positive cocci
group B lancefield antigen

29
Q

monoarthritis

A

septic - until proven otherwise

30
Q

more joints involved

A

less likely septic

-unless - RA, group B strep, endocarditis

31
Q

anti-TNF therapy

A

2x likely to get septic arthritis

32
Q

joint effusion septic arthritis

A

WBC >50,000

gram stain and culture positive

33
Q

diagnosis of septic arthritis

A

check for AFB in anti-TNF therapy or HIV

34
Q

type III synovial fluid

A

purulent

opaque
low viscosity
>100,000 WBC
>75% polys

in septic arthritis**

35
Q

string sign

A

for low viscosity of synovial fluid
-type III

septic arthritis

36
Q

majority of septic arthritis

A

gram positives

-staph, MRSA, group B strep, pneumococcus

37
Q

prosthetic joint infection

A

majority staph

> 24 months - seed from blood

3-24 months - coag negative staph from surgery

38
Q

migratory arthritis, meningitis, pancarditis, and skin pustules

A

gonococcal arthritis

most common septic arthritis in young adults

disseminated - fitz hugh curtis - liver perihepatitis**

39
Q

gonococcal arthritis

A

disseminated - arthritis/dermatitis syndrome

also - C5-9 deficiency is risk fx**

40
Q

potts disease

A

TB septic arthritis to spine

41
Q

vague presentation of arthritis

A

viral

42
Q

severe joint pain and myalgias

A

HIV - no CD4

CD8 causes problems - sjogrens

hilar nodes - CD4 - sarcoid disease

43
Q

diffuse infiltrative lymphocytosis syndrome

A

DILS

CD8 cell infiltration of organs

44
Q

hilar lymphadenopathy in treated HIV patient, next test?

A

ACE

45
Q

erythema nodosum with arthritis

A

BUMPS

boecks sarcoid
bechets disease
UC/Crohns
mycoses
pills - BCP
strep
46
Q

IRIS

A

immune reconstitution inflammatry syndrome
-driven by CD4 lymphocytes

RA, SLE, sarcoid, sjogrens

47
Q

lyme disease association

A

bells palsy

heart block

48
Q

diagnosis of lymes

A

confirmed with western blot

MSK Exam 2 Spring 2015 (10 decks)

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