14.6.2013(connective Tissue,endocrinology) Flashcards
(109 cards)
0
Q
First line treatment for AS
A
NSAID(Indomethacin)
1
Q
HLAB8
A
Myasthenia gravis
Graves disease
2
Q
Joints involved in osteoarthritis
A
PIP
DIP
1st carpometacarpal jt
sparing of wrist and MCP
3
Q
Oral ulcers in reiter
A
Superficial
Transient
Painless
4
Q
Keratoderma blenorrhagica site
A
Palms and soles
5
Q
Reactive arthritis following urethritis
A
Chlamydia trachomatis
Ureaplasma urealyticum
Mycoplasma genitalium
6
Q
Enteric bacteria causing reactive arthritis
A
Salmonella Shigella Yersinia(enterocolitica,pseudotuberculosis) Campylobacter Clostridium difficle
7
Q
Shigella species causing reactive arthritis
A
S.flexneri
S.dysenteriae
S.sonnei
8
Q
Gout is common in
A
Men over 30yrs of age
9
Q
Which is more important in causing acute gout attack?
Raising or falling serum levels
A
Falling serum levels!
10
Q
Uric acid levels at time of gout attack
A
Maybe Normal or low
11
Q
Development of arthritis in gout
A
Correlates with level and duration of serum Uric acid elevation
12
Q
Sites of deposition of tophi
A
Joint cartilage Synovium Tendon Bursae Peri articular tissue Pinna Kidney Subcutaneous tissue
EXCEPT MUSCLES
13
Q
Commonest jt affected in gout
A
Metatarsophalangeal jt of big toe
14
Q
Appearance of tophi in x rays
A
Martel or G sign
Punched out cysts or deep erosions with overhanging bony edges
15
Q
Drugs that can precipitate gout
A
Aspirin
Diuretics
Allopurinol
16
Q
Hypouricemics(uricosurics)
A
Probenecid
Sulfinpyarazone
Benzbromarone
17
Q
Cause of hyperuricemia
A
Decreased excretion(90%) Increased production(<5%)
18
Q
Definitive diagnosis of gout
A
Joint aspiration and demonstration of negatively birefringent crystals
19
Q
Renal disease in gout
A
Urolithiasis
Acute Uric acid nephropathy(ARF due to collecting tubule deposition)
Chronic urate nephropathy(deposition in medullary interstitium)
20
Q
Most common manifestation of hyperuricemia
A
Asymptomatic
21
Q
Causes for secondary chondrocalcinosis
A
Previous joint destruction Hyperparathyroidism Hypothyroidism Hemochromatosis Hypomagnesimia Ochronosis Diabetes
22
Q
Hereditary chondrocalcinosis
A
ANKH mutation
Autosomal dominant
23
Q
Joint commonly affected in pseudogout
A
Knee
24
Goal level of Uric acid after Rx
<6mg/dl
25
Calcium pyrophosphate crystals
Rhomboidal
Small
Positively birefringent
26
Positive birefringence
Blue in color when aligned parallel to compensator
NBR crystals are yellow in color
27
Xanthine oxidase inhibitors
Allopurinol
| Febuxostat
28
Uricase enzymes
Rasburicase(used in TLS)
| Pegloticase
29
Fusion protein used in treatment of acute gout
Rilonacept
| Binds to IL-1 and neutralises it.
30
ARB with uricosuric effects
Losartan
31
Hypolipidemic drug which is uricosuric
Fenofibrate
32
Vit C effect on Uric acid levels
Decreases
| Uricosuric
33
Most common cause of Charcot joint
Diabetes
34
Charcoat joint causes
```
DM
tabes
Leprosy
Syringomyelia
Amyloidosis
Myelomeningocele
Peroneal muscular atrophy
Congenital insensitivity to pain
```
35
Muscles not affected in polymyositis
```
Facial
Ocular(except in rare case associated with myasthenia gravis)
```
36
Mutation in Marfan
Fibrillin
| Chr15q
37
Ocular changes in Marfan
Ectopia lentis
Elongation of globe(myopia)
Retinal detachment
38
Causes of Ectopia lentis
```
Marfan
Homocystinuria
Hyperlysinemia
Weil marchesani
Sulfite oxidase
```
39
Mutation in Wilson disease
ATP7B(Cu transport into lumen of ER of hepatocytes)
| Chr13
40
Type of hepatic involvement in wilson
Fulminant hepatitis
Acute hepatitis
Chronic active hepatitis
Cirrhosis
41
Number of Cu atoms in ceruloplasmin
8
42
Aceruloplasminemia
Leads to iron overload
43
Other name for ceruloplasmin
Ferroxidase
Converts Fe2+ to Fe3+
44
Mutation in menky kinky hair disease
ATP7A
| Intestinal absorption of Cu is reduced
45
Kidney changes in Wilson
Microscopic hematuria
Renal calculi
RTA
46
Diagnosis of Wilson
Serum ceruloplasmin less than 200mg/L+ KF ring
Or
Low ceruloplasmin+ Cu in liver biopsy greater than 250microg/g
47
Hemolysis
Liver cirrhosis
Likely diagnosis
Wilson
| Coombs negative Hemolytic Anemia
48
Effect of Wilson on reproductive functions in females
Primary or secondary amenorrhea
| Recurrent abortions
49
Urinary copper in Wilson disease
>100microg per 24 hours
50
Diagnosis of Wilson,which is superior?
| Serum ceruloplasmin or urinary Cu
Urinary Cu
Serum ceruloplasmin is normal in 10%
51
Gold standard for diagnosis of Wilson disease
Liver biopsy
52
Presence of KF ring
99% association with neurological and psychiatric symptoms
53
Role of zinc in Wilson disease
```
Presymptomatic
Pregnant
Pediatric
Maintanence therapy
Initial therapy in pts with hepatitis and without decompensation
```
54
False positive elevation of liver copper
Obstructive liver disease
55
Wilson disease with decompensated hepatitis
Trientine+zinc
56
Rx of initial neurologic manifestations in wilson
Tetrathiomolybdate
57
Difference between hemosiderosis and hemochromatosis
Hemochromatosis
Deposition of iron is both extracellular and intracellular
Irreversible
58
Earliest phenotypic marker of hereditary hemochromatosis
Elevation in transferrin saturation(more than 45%)
| Unsaturated iron binding capacity
59
First organ to be affected in hemochromatosis
Liver
60
Most common cause of death in treated hemochromatosis pts
HCC
61
Hyper pigmentation in hemochromatosis sites
```
Face
Neck
Extensor aspect of forearm,legs
Genitalia
Ears
```
62
Cause of hyper pigmentation in hemochromatosis
Increased melanin and iron in dermis
63
Joints affected in hemochromatosis
2nd and 3rd MCP joints
64
Cause of death in untreated hemochromatosis
Cardiac failure
65
Features that don't improve on treatment of hemochromatosis
Arthropathy
| Gonadal dysfunction
66
Rx of choice in hemochromatosis
Phlebotomy
67
Indications of chelating agents in hemochromatosis
Severe Anemia or Hypoproteinemia precluding phlebotomy
68
UIBC
Unbound iron binding capacity
| UBIC=TIBC-serum iron
69
HFE gene
Chromosome 6
70
Types of hereditary hemochromatosis
```
Type 1 HFE(C282Y)
Type 2A hemojuvelin
Type 2B hepcidin
Type 3 transferrin receptor 2
Type 4 ferroportin
```
71
Juvenile hemochromatosis
Type 2A and 2B
| Autosomal recessive
72
Autosomal dominant hemochromatosis
Type 3 and 4
73
Idiopathic Raynaud phenomenon
Raynaud disease
74
Most common cause of Raynaud phenomenon
Idiopathic Raynaud disease
75
Common cause of renal artery stenosis in middle aged and elderly
Atherosclerosis
76
Common cause of renal artery stenosis in young women
Fibromuscular dysplasia
77
Most common cause of renovascular HT in India
Takayasu
78
Causes of renal artery stenosis
```
Atherosclerosis
Fibromuscular dysplasia
Nonspecific aortoarteritis
Takayasu
APLAS
Transplant renal artery stenosis
Renal artery embolism
Dissecting aneurysm of aorta
Radiation arteritis
```
79
Best site of biopsy for amyloidosis
Rectal
| Gingival
80
Indications for IVIG
```
Primary Immunodeficiency states
Myasthenia gravis
GBS
CIDP
ITP
Post transfusion Purpura
Neonatal cytopenia
Kawasaki
Multiple sclerosis
Dermatomyositis
```
81
IVIG Rx in secondary immunodeficiency states
Pediatric HIV
| CLL
82
Diseases for which plasmapheresis is indicated
```
TTP
Posttransfusion Purpura
AIDP
CIDP
Myasthenia gravis
Good pasture
Refusum disease
```
83
Diagnosis of insulinoma
```
Low glucose (fasting)
High insulin(fasting)
Insulin/glucose ratio(greater than 0.3)
High C peptide
High proinsulin levels
Decreased plasma betahydroxy butyrate
```
84
Most common site of carcinoid
Bronchus,lungs,trachea
85
Most common site of midgut carcinoid
Illeum
86
Most common site of hindgut carcinoid
Rectum
87
Highest incidence of metastasis is seen with carcinoid arising from which site
1. Pancreas
| 2. jejunum and illeum
88
Incidence of carcinoid syndrome is highest with carcinoid arising from
Ovary and testis
89
Most common GIT site for carcinoid
Illeum
90
Carcinoid tumors are common in
Females
91
Most common cardiac valve involved in carcinoid
Ventricular surface of tricuspid valve
92
Hypercalcemia causes
| Weight gain or loss?
Loss
93
Genetic syndromes associated with weight gain
```
Prader willi
Laurence moon biedl
Ahistrom syndrome
Carpenter syndrome
Cohen syndrome
```
94
Tumors associated with weight gain
Insulinoma
| Craniopharyngioma
95
Cancers common in obese
Endometrial
Post menopausal breast cancer
Prostate
Colorectal
96
Hormones in obesity
Hyperinsulinemia
Low testosterone
Low GH(but normal IGF-1)
97
Endocrine work up of gynacomastia
```
Testosterone
Estradiol
hCG
LH
serum androstenedione and 24hr urinary 17 ketosteroids
```
Prolactin is not associated with gynacomastia
98
Most common site of extra adrenal pheochromocytoma
Organ of zuckerkandl
99
Passaro triangle
Junction of cystic and common hepatic duct
Neck of pancreas
Junction of 2nd and 3rd part of duodenum
100
Most common site of gastrinoma
Pancreas
101
Most common extra pancreatic site of gastrinoma
Duodenum
102
Cause of hypergonadotrophic hypogonadism
Myotonic dystrophy
| Cryptorchidism
103
Most common cause of hypergonadotrophic hypogonadism in males
Klinefelter syndrome
104
Endocrine causes of carpal tunnel syndrome
Acromegaly
Hypothyroidism
Diabetes Mellitus
Hyperparathyroidism
105
Endocrine causes of hirsutism
Acromegaly
Hyperprolactinemia
Cushing syndrome
106
Pregnancy related hirsutism
Due to hyperandrogenism
Thecoma of pregnancy
Hyperreactio luteinalis
107
Shigella species that commonly causes reiter
Shigella flexneri
108
Drugs causing hirsutism
```
Androgens
Androgen containing OCP
Minoxidil
Diazoxide
Phenytoin
Cyclosporine
```
