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Pance Re-Up > MSK Re-Up #2 > Flashcards

MSK Re-Up #2 Flashcards

1
Q

Eosinophilic Granulomatosis with Polyangiitis (EGPA - Churg-Strauss) is systemic small and medium sized granulomatous necrotizing vasculitis.

What is this a rare side effect of?

A

Montelukast and Zafirlukast

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2
Q

What triad of symptoms is associated with EGPA?

What labs (there is a specific lab)

A

Asthma + Eosinophilia + Chronic Rhinosinusitis

Eosinophilia + P-ANCA HALLMARK

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3
Q

What diagnostic is most accurate for EGPA?

Treatment?

A

Biopsy

Glucocorticoids (may add Cyclophosphamide if severe)

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4
Q

On the other hand, granulomatosis with polyangiitis is inflammation and necrosis of what three things?

What are symptoms?

A

-Nose, lungs, kidneys

-Triad: upper respiratory tract involvement + lower respiratory tract involvement + glomerulonephritis
–Nasal congestion, saddle nose deformity, otitis media, stridor, refractory sinusitis
–cough, dyspnea, wheezing, hemoptysis, pulmonary infiltrates
–rapidly progressive glomerulonephritis (crescent on biopsy), hematuria, RBC casts, proteinuria

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5
Q

Best initial test for GPA - Wegener’s

A

C-ANCA

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6
Q

Treatment for GPA - Wegener’s

A

Glucocorticoids PLUS Cyclophosphamide

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7
Q

Microscopic Polyangiits (MPA) is small and medium vessel vasculitis that is NOT associated with _________.

It’s symptoms include…

A

Nasopharyngeal symptoms, necrosis, or granulomatous inflammation (like in GPA)

Palpable purpura, cough, dyspnea, hemoptysis, acute rapidly progressive glomerulonephritis (crescentic)

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8
Q

Lab and treatment for MPA

A

-P-ANCA

Glucocorticoids PLUS Cyclophosphamide

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9
Q

Immunoglobulin A Vasculitis (Henoch-Schoenlein-Purpura) MC occurs in ________.

It often occurs after __________

What are the four cardinal symptoms (HSPA)

A

-MC occurs in children (3-15 years old)

After infection (URI, GABHS, Parvovirus B19)

Hematuria
Synovial (arthritis or arthralgia)
Palpable Purpura (on LE)
Abdominal Pain (may present with GI bleeding)

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10
Q

Usually a clinical diagnosis, Henoch-Schonlein Purpura has what lab studies?

What is seen on kidney biopsy?

A

-Normal PT, PTT, and platelets

-Mesangial IgA deposits

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11
Q

What is the treatment for HSPA?

A

-Supportive: NSAIDs, hydration, bed rest

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12
Q

Anti-GBM Antibody (Goodpasture’s) Disease is a Type II hypersensitivity reaction where IgG antibodies are against…..

Symptoms are limited to which systems? What are the symptoms?

A

Against Type IV collagen of alveoli and glomerular basement membrane of the kidney

Limited to lungs and kidneys
-Hemoptysis, dyspnea, dry cough, hematuria, oliguria

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13
Q

What is the best initial test for Goodpasture’s?

Next diagnostic (specific antibody)

What is seen on biopsy of the kidney?

A

UA: Increased BUN/Cr, hematuria, proteinuria, dysmorphic RBC’s, RBC casts
-Anti-glomerular basement membrane antibodies

-Linear IgG deposits. Crescentic glomerulonephritis

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14
Q

Treatment for Goodpasture’s

A

-Glucocorticoids + Cyclophosphamide + Plasmapheresis

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15
Q

Psoriatic Arthritis is inflammatory arthritis in patients with psoriasis. What are risk factors associated with this, along with other seronegative spondyloarthropathies?

A

Young males, < 40 years old, HLA-B27 positivity

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16
Q

Symptoms of psoriatic arthritis

What is seen on radiographs (it has a unique description)

A

-Arthritis (may involve the DIP joint)
-Dactylitis, Sacroilitis, Uveitis
-Psoriasis (thick silvery white scales and nail pitting)

Pencil in a cup deformities: thin end of one bone is being inserted into a thicker bone

17
Q

Treatment for Psoriatic Arthritis
-Mild
-Severe

A

Mild: NSAIDs
Severe: Methotrexate (> 5 joints, severe damage on XR, no response to NSAIDs)

18
Q

Ankylosing Spondylitis, another seronegative condition, with chronic inflammatory arthropathy of the axial skeleton. What are some symptoms of this condition?

A

-Back pain, stiffness, and decreased ROM worse in the morning with rest and decreases with exercise and activity
-Sacroilitis, large joint arthritis
-Dactylitis, uveitis
-AV cardiac blocks

19
Q

What labs would show for ALS?

A

-Increased ESR
-Negative RF and ANA

20
Q

What is seen on radiographs for ALS?

Most accurate diagnostic?

A

-Sacroilitis (narrowing of the SI joint)
-Bamboo spine: straightening of the spine, loss of normal lumbar curvature and squaring and fusion of the vertebrae.

MRI

21
Q

First-line treatment for ALS?

What if there is no response to the first option?

A

NSAIDs, exercise program, and PT

Anti-TNF drugs (Etanercept, Adalimumab, Infliximab)

22
Q

Reactive Arthritis, with is inflammatory arthritis in response to an infection or inflammation in another part of the body. Formerly known as Reiter Syndrome, this may be seen 1-4 weeks after _________ or ____________. It is also associated with ________ positivity.

A

Chlamydia Trachomatis

GI infection (Salmonella, Shigella, Yersinia)

HLA-B27 positivity

23
Q

Symptoms of Reactive Arthritis

A

-Arthritis + Ocular (Conjunctivitis, Uveitis) + Genital (Urethritis, Cervicitis, Balanitis)
–Can’t see, can’t pee, can’t climb a tree

-Keratoderma blennorrhagicum (hyperkeratotic lesions on palms and soles)

24
Q

What diagnostic should you do first and why for reactive arthritis?

A

Arthrocentesis: to rule out septic arthritis

25
Q

What is the first-line treatment for Reactive arthritis?

A

NSAIDs

26
Q

What is gout?

Who is it MC in?

What cause triggers of gout?

A

Uric acid deposition in soft tissues, joints, bones

MC in men (90%)

Purine-rich foods (alcohol, liver, seafood, yeasts).
Meds: Thiazides and Loop Diuretics, ACEi, Pyrazinamide, Ethambutol, Aspirin, ARBs

27
Q

What is the only ARB that decreases uric acid levels?

A

Losartan

28
Q

Symptoms of gout

A

-First MTP joint of the great toe MC (podagra)
-Severe joint pain, erythema, warmth, swelling, and tenderness, and fever

29
Q

What is the diagnostic of choice for gout?

What is seen on this?

A

-Athrocentesis: negatively birefringent, needle-shaped crystals

30
Q

What is also seen on radiographs for gout?

A

Mouse or rat bite lesions (punched out erosions with sclerotic and overhanging margins)

31
Q

Acute management (attacks) of gout

Chronic Management (Prophylaxis) of gout

A

-Acute Attacks: NSAIDs initially. Corticosteroids if refractory or if renal disease. Colchicine if unable to use NSAIDs or Corticosteroids.

-Chronic: Lifestyle (decrease alcohol, weight loss, high purine foods). Allopurinol first line. Colchicine.

32
Q

Calcium pyrophosphate dehydrate deposition disease AKA ________, involves what joints most commonly?

What is the initial diagnostic of choice and what is seen?

A

Pseudogout

Arthrocentesis: positively birefringent, rhomboid-shaped calcium pyrophosphate crystals

33
Q

What are symptoms of pseudo gout?

A

-Majority asymptomatic
-Acute CPP crystal arthritis: severe joint pain, erythema, warmth, swelling, tenderness (MUCH like gout)

34
Q

Treatment for pseudogout

A

-Corticosteroids IJ: if 1 or 2 joints
-NSAIDs if > 2 joints
Colchicine as prophylaxis if 3 or more attacks annually

35
Q

Juvenile Idiopathic (Rheumatoid) Arthritis is autoimmune arthritis in children <16 years for > 6 weeks. There are three types. Explain the following:
-Systemic (Still’s Disease)
-Oligoarticular
-Polyarticular

A

-Systemic: daily or diurnal high fever, daily arthritis. Salmon-colored pink migratory rash. NO iridocyclitis.

-Oligo: < 5 joints involved. Iridiocyclitis (anterior uveitis)

-Polyarticular: 5 or more small joints, morning stiffness (like adult RA), iridocyclitis.

36
Q

JRA is primarily a clinical diagnosis. What is the treatment?

A

NSAIDs first line
-Glucocorticoids second line
-PT
-Routine eye exam every 3 months if ANA positivity

Pance Re-Up (76 decks)

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