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MSK II - Exam 2 > Crystal Disease (Told) - MT > Flashcards

Crystal Disease (Told) - MT Flashcards

1
Q

There are 6 types of Crystals that Dr. Told mentioned can cause disease, what are they?

A
  • Monosodium urate (MSU)
  • Calcium pyrohosphate dihydrate (CPPD)
  • Basic Calcium PO4 (hydroxyapatite)
  • Calcium oxalate
  • Monoclonal proteins
  • Cholesterol crystals

…..Sadistic 6

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2
Q

What type of crystals can deposit in the retina and caue visual field defects and blindness?

A
  • Calcium oxylate crystals
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3
Q

Which is the most common rare crystal type to cause disease?

A

Calcium phosphate hydroxyapatite

followed by….

calcium oxylate

Cholesterol crystals

monoclonal proteins

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4
Q

Calcium PO4 (hydroxy apatite) deposition causes what?

Do most of these crystals react to polarized light?

A

calcific tendonitis

no

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5
Q

Calcium oxylate crystals can cause ______ in the spine and hands, and ______ in the kidneys.

A
  • terminal tuft calcification
  • nephrolythiasis (stones)
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6
Q

What kind of crystals can be seen in both joint effusions of rheumatoid arthirtis and chronic infection?

A

Cholesterol lipid crystals

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7
Q

In multiple myeloma, what is the classification of the antibody that is found in the plasma cell rich joint effusions that mediate bone destruction?

A

S100A4 antibodies

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8
Q
  • Describe what you would observe on a birefringent light test in a person with Gout vs. Pseudogout.
  • What type of crystals are found in these respective diseases?
A
  • Gout:

Monosodium urate crystals

negative birefringent test

(vertical in plane yellow needles, horizontal blue needles)

  • Pseudo-gout:

Calcium pyrophosphate crystals

positive birefringent test

(vertical in plane blue squares, horizontal yellow bodies)

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9
Q

Hyperuricemia and gout appears in about 2-3% of adult male population and incidence in females approach males after menopause. Describe weight and age of the people at risk for or who have this condition.

A
  • obese, increased risk with increased weight
  • middle aged males, also increased risk with increased age
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10
Q

With the presence of hyperuricemia, a physician should concurrently invsestigae for what other disease/pathology?

A
  • Cardiovascular disease

(hyperuricemia is a marker for atherogenesis)

especially in patients with other risk factors for Cardiovascular events

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11
Q

Describe the cause of inflammatioon in hyperuricemia.

A
  • urate crystals are coated with IgG antibodies,

***which attract neutrophils, other leukocytes, monocytes, fibroblasts, synoviocytes, renal cells.

All of these cells release cytokines, PGE2, oxygen radicals, and collagenase which cause inflammation

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12
Q

In the pathogenesis of hyperuricemia, what is the most common cause of hyperuricemia? Increased urate production or decreased renal excretion?

A

90% decreased renal excretion

10% increased urate production

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13
Q

an endocrine disorder that can decrease renal excretion and cause hyperuricemia is?

A

Hypothyroidism

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14
Q

What substance in a social hx can be abused and cause increased urate production?

A

ethanol, alcohol

*basically any disease, drug, or process that causes excess cell destruction can cause an increase in urate production and lead to hyperuricemia (10% of the time)

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15
Q

If a patient has a crystal disease, how will he/she most likely describe the timeframe of the pain?

A

intermittent, episodic attacks

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16
Q

A patient comes in complaining of new onset joint pain in his 1st right metatarsaphalangeal joint, which occurs for a few hours every week since a month ago. He has a history of HTN and hyperlipidemia, and is on a diuretic and statin drug. His birefringent test is negative.

  • What is your diagnosis?
  • What treatment is most appropriate at this time?
A
  • Acute Gouty arthritis
  • NSAIDs or Corticosteroid for acute pain relief, Allopurinol for long term prevention.

-

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17
Q

What would you see in a patient with chronic gouty arthritis? x2

  • what is the stage given to this type of gout?
A
  • Tophi
  • Polyarticular attacks
  • stage III

* acute attacks superimposed

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18
Q

What is a tophi?

A

deposits of monosodium urate crystals in muscle, cartilage, and bone that appear in stage III gout.

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19
Q

4 indications for urate lowering medication include?

A
  • tophaceous disease with erosions
  • uric acid nephrolithiasis
  • recurrent attacks depsite prophylaxis
  • Chemotherapy (acute cell lysis)
20
Q

A 80 y/o patient presents with inflammatory arthritis in her left knee, she also has chondrocalcinosis, and is being treated for hyperparathyroidism.

  • What is her diagnosis?
  • How would you diagnose?
A
  • calcium pyrophosphate depositin disease (CPPD)
  • birefringent test, which would be weakly positive for blue rhomboid crystals (pseudogout)
21
Q

in addition to hyperparathyroidism, what other medical cnoditions are associated with CPPD? x4

A
  • hypothyroidism
  • hemochromatosis
  • wilson’s disease
  • Osteoarthritis
22
Q

Management of acute crystal disease would include? x4

A
  • NSAIDs (indomethacin)
  • Corticosteroids
  • colchicine
  • IL-1 biologic inhibitor
23
Q

prophylactic tx of crystal diseases include what 3 categries of pharmaceuticals?

A
  • xantihine oxidae inhibitors like allopurinol and fabuxostat
  • Uricosurics (probenicid, losartan)
  • Uricases (procloticase)
24
Q

How would Dr. Told treat each of the respective patients?:

  • guy with asymptomatic hyperuricemia
  • gal presenting with acute attacks of gout
  • prophylaxis of dude with gout
A
  • no treatment but check diuretic use and ASA use and niacin use
  • NSAIDs (indomethacin the best), or Corticosteroids if renal function poor
  • Allopurinol or fabuxostat or probenecid over skethcy colchine
25
Q

In a gouty acute attack should, a patient stop taking allopurinol if they are already on it for prophylaxis?

A

no

26
Q

Strict purine free diet will decrease uric acid levels by about?

A

1 MG%

* medications are the best option

27
Q

Primary sjogren syndrome occurs predominately in women age ________. Presents with dry eyes, mouth, and __________. Has aspects of __________ gland dysfunction. RA and other autoantibodies common.

A
  • 40-60
  • respiratory tract
  • exocrine
28
Q

Secondary type sjogren syndrome is associated with a bunch of autoimmune diseases. x9

A

other rheumatic diseases

  • RA, SLE, PBC, scleroderma, polymyocitis, Hashimotos thyroiditis, polyarteritis, Interstitial pulmonary fibrosis
29
Q

What are the 6 preliminary criteria of classification of sjogren syndrome?

  • how many have to be present to have a sensitivity of 93.5% and a specificity of 94%?
A
  1. autoimmune exocrinopathy
  2. ocular sx
  3. oral sx
  4. ocular signs (schirmer’s/rose bengal)
  5. salivary gland involvement
  6. autoantibodies (RF, SS-A, SS-B)
    - 4/6
30
Q

What are the 3 types of auto antibodies found in 49% of patients with SLE and 75% of patients with Sjogren syndrome?

A
  • anti Ro60 SSA
  • anti Ro52 SSA
  • Anti LA SSB
31
Q

CBC of a person with sjogrens would show?

A

Anemia, leukopenia, eosinophelia

32
Q

A patient with Sjogren would be positive for RA _____% of the time, and positive for ANA ______% of the time.

A
  • RA 70%
  • ANA 95%
33
Q

leading 3 sx manifestation of sjogren syndrome are

A
  • Fatigue 80%
  • Articular involvement 50%
  • Tendomyalgia 40%
34
Q

What GI nd Urogenital sx can also present in Sjogrens?

A

GI - esophageal involvement, autoimmune hepatitis

GU - Bladder involvement

35
Q

in addition to dental caries, saliary duct stones, and infected stensons duct, _______ gland enlargement can present in sjogren syndrome.

A
  • Parotid
36
Q

sialogram of a submandibular gland would show ______ in a patient with sjogren syndrome.

A
  • sialectasis
37
Q

Lip gland histopathology would show what in a patient with sjogren syndrome?

A

Lymphocytic infiltration with glandular and ductal atrophy

38
Q

SICCA symptoms of sjogren syndromme include what 3 sx?

A
  • dry oral mucosa
  • dry vaginal mucosa
  • dry conjunctiva
39
Q

describe a Schirmer test in a patient with sjogren syndrome

A

wetting of filter paper strip takes longer and indicates reduced lacrimal secretions

40
Q

a positive Rose bengal staining test would indicate?

A

inflammation and irritation of conjunctival layer

41
Q

Low trachiobronchial secretions in sjogren syndrome lead to ____________.

A

nonspecific interstitial pneumonia (NSIP)

42
Q

Tx of sjogren syndrome focuses on?

A

symptomatic treatment

43
Q

treatment for sjogren syndrome can include? x4

A
  • artificial tears methyl cellulose
  • cyclosporin drops
  • pilocarpine
  • cevimeline
44
Q

What should be monitored in a patient with sjogren syndrome? x3

A
  • oral hygiene
  • hydration
  • careful watch for lymphoma
45
Q
A

MSK II - Exam 2 (7 decks)

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