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DIT topics > systemic MSK diseases > Flashcards

systemic MSK diseases Flashcards

1
Q

what causes:
african american female of reproductive to middle age with:
rash on face (worse in sun) + joint pain + nonspecific findings: fatigue, fever, weight loss, LAD, splenomegaly, Raynaud phenomenon (vasospasm of finger due to exposure to cold), edema

A

systemic lupus erythematosus

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2
Q

diagnostic criteria for systemic lupus erythematosus

A

4/11 (have at least four at any time during course of disease, don’t have to be at same time)
–skin disorders:
malar rash
discoid rash: raised erythematous base with scaling (face, scalp, ears), atrophic scar (SEAL)
photosensitivity
PAINLESS oral ulcers
–inflammatory disorders:
arthritis: non-destructive in at least 2 joints (vs OA - destructive)
serositis: pleuritis or pericarditis
+ ANA (very high, 1:160)
–organ system disorders:
renal: proteinuria, cellular casts, lupus nephritis
neuro: seizures, psychosis
heme: hemolytic anemia, leukopenia, lymphopenia, thrombocytopenia
immune: +antiphospholipid Ab, anti-dsDNA, anti-Smith (specific), false-positive VDRL

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3
Q

PAINLESS oral ulcers

A

SLE (a diagnostic criteria)

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4
Q

wart-like sterile vegetations on both sides of valve can be found in

A

SLE

called Libman-Sacks endocarditis (LSE in SLE)

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5
Q

“wire loops” thickening of capillary walls with deposits of immune complexes is found in

A

SLE
called lupus nephritis: type III hypersensitivity
“wire lupus” in lupus
can progress to renal failure → death

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6
Q

helpful for diagnosis of renal disease in lupus

A

anti-dsDNA antibodies - specific for renal disease in lupus

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7
Q

helpful for screening of lupus

A

ANA - antinuclear antibodies
sensitive but not specific: good screening test
Negative = no lupus
Positive = may have lupus

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8
Q

conditions that can have a + ANA

A 
Sjogren syndrome
Scleroderma
Polymyositis + dermatomyositis
RA
Juvenile Idiopathic Arthritis 
Mixed CT disease
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9
Q

helpful for screening of drug-induced lupus

A

Antihistone antibody - sensitive for drug-induced lupus

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10
Q

complication of + antiphospholipid = anticardiolipin antibody in lupus

A

antibodies cause hypercoguable disorders (prolong PTT, ↑ risk arteriovenous thromboembolism)

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11
Q

complication of ↓C3, C4 in lupus

A

↑risk of serious infections

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12
Q

treatment for lupus

A

NSAIDs
steroids
hydroxychlorquine
advanced (lupus nephritis): cyclophosphamide

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13
Q

female with excessive fibrosis + collagen deposition throughout body → interfere with tissue function
skin manifestations: shiny (no wrinkles) + tight skin, ulcers on fingers, can’t extend fingers/grip

A

scleroderma (systemic sclerosis)

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14
Q

type of scleroderma with:
widespread skin involvement
rapid progression
early visceral involvement

A

diffuse scleroderma

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15
Q

associated with anti-Scl-70 antibody = anti-DNA topoisomerase I antibody

A

diffuse scleroderma

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16
Q 
type of scleroderma with:
skin manifestations: fingers + face only
benign clinical course, progresses less rapidly
less visceral involvement
and CREST syndrome
Calcinosis (subepithelial calcium deposits)
Raynaud phenomenon
Esophageal dysmotility
Sclerodactyly (scarring of fingers)
Telangiectasia
A

limited scleroderma

17
Q

associated with anti-centromere antibody

A

limited scleroderma (Crest syndrome = antiCentromere antibody)

18
Q 
female, 40-60 yo with:
xerophthalmia: dry, conjunctivitis, sensation of sand in eyes
xerostomia
arthritis
bilateral parotid enlargement
labs:
antinuclear autoantibodies: SS-A (anti-Ro) and/or SS-B (anti-La)
\+ RF possible
A

Sjogren syndrome: autoimmune destruction of exocrine glands

19
Q

complication of sjogren syndrome

A

dental caries

↑ risk mucosa-associated lymphoid tissue (MALT lymphoma) - a B cell lymphoma - unilateral parotid enlargement

20
Q 
what are the following symptoms called
dry eyes
dry mouth
nasal dryness
vaginal dryness
chronic bronchitis
reflux esophagitis
A

sicca symptoms

21
Q

X-linked FRAMESHIFT mutation that cause deletion of dystrophin gene → no anchoring of muscle fibers → accelerated muscle breakdown →↑ CK + aldolase

A

Duchenne MD = Deleted Dystrophin

22
Q

X-linked POINT mutation that causes mutation in dystrophin gene

A

becker MD

23
Q
A

duchenne MD

24
Q

positive gower maneuver

A

duchenne MD

25
Q

teenager or young adult with proximal muscle weakness

A

becker MD (less severe than duchenne)

26
Q

50-70 yo female with JOINT pain + stiffness in shoulders + hips (proximal joints) + fever, weight loss, malaise
no muscular weakness or muscle pain
↑ESR
normal CK + aldolase

A

polymyalgia rheumatica (not a muscle problem)

27
Q

associated with temporal arteritis

A

polymyalgia rheumatica

28
Q

treatment of polymyalgia rheumatica

A

low dose corticosteroids

29
Q

proximal muscle weakness is due to a

A

muscle disease

30
Q

distal muscle weakness is due to a

A

neuro disease

31
Q

progressive symmetric proximal muscle weakness (shoulder, pelvic girdle) due to muscle inflammation
muscle bx = muscle inflammation
caused by CD8+ T cell injury to muscle
↑CK + aldolase
+ anti-Jo-1, aldolase (released from inflamed muscle)
↑risk of malignancy

A

polymyositis

32
Q

progressive symmetric proximal MUSCLE weakness (shoulder, pelvic girdle) due to muscle inflammation AND
malar rash
Gottron papules: red, scaly, knuckles, knee, elbows
heliotrope rash (periorbital)
“shawl and face” rash
“mechanics hands”: rough, cracked fingers + hands
“v sign” anterior chest
↑CK, anti-Jo-1, aldolase (released from inflamed muscle)
↑risk of malignancy

A

dermatomyositis

33
Q

chronic generalized pain (excess muscular tenderness at trigger points with pressure in 11 of 18 spots), fatigue, sleep disturbances, headache, cognitive difficulty, mood disturbances (some have depression, anxiety)

A

fibromyalgia

34
Q

treatment of fibromyalgia

A

fda: pregabalin (anticonvulsant - tx for neuropathic pain), milnacipran (SNRI)
traditional: amitryptiline (TCA), low dose NSAID/acetaminophen, fluoxetine (SNRI)

35
Q

most common cause of death in SLE

A

lupus nephritis

DIT topics (115 decks)

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