Clinical Flashcards
(120 cards)
1
Q
100% of modular RA will have which factor present
A
Rheumatoid factor
2
Q
What are the hematologists findings to support SLE
A
- Hemolytic anemia with reticulocytes is
- Leukopenia
- Lymphopenia on >1 occasion
- Thrombocytopeina
3
Q
What is the most common cause of arthritis
A
Osteoarthritis due to the increased pts with obesity and older age
4
Q
When does osteoarthritis get better and worse
A
Better with rest, worse with activity
5
Q
What is circulate balantitis
A
Lesions and crustation on the glans penis as a result of reactive arthritis
6
Q
What is the allele that has an increased risk for RA
A
HLA-DB4
7
Q
What is Parsonage Turner syndrome and what is the cause
A
Severe pain in the shoulder area followed wiring a few days of weaknes and atrophy in the shoulder girdle
*Most likely due to autoimmune causes since it follows infections, but will self resolve, but can be helped with steroids
8
Q
ANA helps to support diagnosis of which condition
A
SLE
9
Q
High arching foot with flexed toes usually are an indication for which conditions
A
Chronic Neuropathy
CMT1
10
Q
Radiculopathy at the nerve root C7
A
Elbow extension weakness (triceps)
Wrist extent
Finger ext
11
Q
ANTI CCP and RF positivity is indicative for which condition
A
99.5% specificity for RA
12
Q
What are the presentations in those with psoriatic arthritis
A
30-50, equal sex ratio
-psoriasis (only 20-50% ahve B27)
-SI and axial
13
Q
Which region of the body does the dermatome cover with regards to: L4
A
Medial calf
14
Q
What is the location in the vertebra that tends to be affected by RA
A
Only C1/C2
15
Q
Fabry’s disease is assocaited with which problems and which enzyme
A
Alpha galactosidease
-Polyneuropathioes and renal issues
16
Q
High levels of Rheumatoid factor usually correlate which what
A
Increased levels correlate with an increased aggressiveness
17
Q
What are the lab and test findings in multifocal motor neuropathy
A
- GM1 antibody (50-80%)
- EMG shows conduction block
- Normal CSF
18
Q
What is the term for 5 or more joints involved
A
Pauli
19
Q
Which region of the body does the dermatome cover with regards to: T4
A
Nipple line
20
Q
What are the clinical manifestations a pt with bulbar palsy will show
A
Dysarthria, dysphagia, dysphonia, chewing issues, drooling, respiratory difficulties
21
Q
At 12 months of age, what should a child be able to do with regards to gross motor
A
Stands momentarily
*Should be able to say momma/dadda (specific)
22
Q
Which test can SLE give a false positive
A
Syphilis
23
Q
What is MUSK syndrome
A
Aka antibody negative myasthenia gravis
- Oculopharyngeal weakness
- Neck, shoulder, respiratory weakness
- Indistinguishable from Ab positive MG
24
Q
What is the term used for 3 or more joints involved
A
Oligo
25
What is CREST syndrome
```
Calcium deposition in skin
Reynauds
Esophageal dysmotility
Sclerodatcyly
Telangiectasias
```
26
What is DISH and what is normally seen
Diffuses idiopathic Skeletal hyperosteosis
*Calcification along lateral aspect of four contiguous vertebral bodies, but the SI joint is fine
27
What form of CMT (hereditary motor sensory neuropathies) is most common
Type 1, which is demyelinating
*2 is less common, as is axonal degradation
28
What are the conditions that rheumatoid factor are present in
- Sjogrens (95%)
- Cyroglobulinemia (40-100%)
- primary biliary cirrhosis (70%)
- mixed connective tissue (60%)
- Endocarditis (50%)
- SLE (35%)
29
What are the nerve findings in the cause of GBS
Slow conduction velocity, focal conduction block with prolonged F waves
30
What is the damaged structure in the cause of Bronchial plexopathy caused by neoplastic
Medial cord
*Painful in the breast or lung
31
What is the genetic cause of DMD
Frameshift so no dystrophin
X linked recessive
32
What is the upside and downside of gadolinium
Upside: taken up by inflamed tissues so good to see in RA
Downside: toxic to the kidneys
33
What are the clinical signs of soon with CMT
Child who is clumsy, trouble walking or running
| -slowing of nerve conductions
34
What are the important negatives seen in ALS
```
Negatives:
-No eye involvement
-Normal mental status
-No extraocular muscle involvment
-Bowl and bladder symptoms absent
-Decubiti rare (aka bed sores)
Fasciculations are rarely the presenting sx
```
35
What is the most common myopathy
DMD
36
What is the therm for 6 or more joints involved.
Poly
37
Large nerve fibers transmit which type of information and what would be the negative and positive signs if those nerves were affected
Vibration, joint position
Positive: tingling, pins and needles, numbness
Negative: loss of vibrations, Joint position, areflexia, ataxia, hypotonia
38
What nerves are affected in progressive bulbar palsy
Lower cranial nerves (CN 9, 10,)
39
At 9 months of age, what should a child be able to do with regards to gross motor
Pulls up
Cruises
Sits well without support
40
Radiculopathy at the nerve root C5
Shoulder abduction weakness (deltoid)
41
What condition is commonly associated with lambert Eaton myasthenia syndrome (LEMS)
Cancers (especially small cell lung cancer)
42
At 48 months of age, what should a child be able to do with regards to gross motor
Balance on one foot
| Hop on one foot
43
What is the damaged structure in the cause of Bronchial plexopathy caused by radial injury
Upper trunk, lateral cord
*Painless
44
What is the clinal Presentation in someone with multifocal motor neuropathy
Adult males were there is neuropathy of one nerve, then slowing progressing from distal weakness
-No UMN signs, or sensory signs
45
What are the most common cervical radiculopathies involved
C5-C6 (C6 nerve compression)
| C6-C7 (C7 nerve root compression)
46
What is a treatment to help a patient with DMD
Steroids if older than 5
47
What is the damaged structure in the cause of Bronchial plexopathy caused by ischemia
Usually diabetic causes in the lumbar area
48
What are keratoderma blennorrhagicum
Painless lesions on the feet as a result with reactive arthritis and reiter’s syndrome
49
Why is the EMG normal on a small nerve polyneuropathy
Because it is unmyelinated
50
Which form of arthritis is seen with those diabetic patients
- Charcot’s
| - Cheiroarthropathy
51
Radiculopathy at the nerve root C8
Finger abd
Finger flex
52
At 6 months of age, what should a child be able to do with regards to gross motor
Sits momentarily
53
Which region of the body does the dermatome cover with regards to: T10
Umbilicus
54
What is chronic inflammatory demyelinating polyneuropathy (CIDP)
Basically similar to GBS, except is chronic and occurs over a longer time and is more persistent
55
Which term is used for one joint involved
Arthritis
56
Radiculopathy at the nerve root C6
Shoulder abduction weakness (deltoid)
Elbow flex (biceps)
57
What muscle groups tend to be involved in spinal muscular atrophy
Upper extremity involvement
58
What complication is seen in those with DMD
Cardiomyopathy
59
What is commonly present in chronic inflammatory demyelinating polyneuropathy (CIDP)
15% have a monoclonal antibody (IgM or IgG)
60
If someone had breast cancer that was causing weakness in the extremities, how would you be able to tell if it was from breast cancer or the radiation afterwards
Radiation causes painless weakness while neoplastic will be painful
61
What are the classical clinical presentations of juvenile dermatomyositis
- Proximal muscle weakness
- Red or purplish heliotrope rash over the eyelids
- thrombi or hemorrhage in the periungual capillary beds
- Raised erythematous papules over the extensors Joints
62
What is podagra
Inflammation of the big toe, seen in gout
63
What is the best imaging for erosion on bones and inflammatory arthritis
CT
64
Spinal muscular atrophy involves which set of motor neurons.
Only the lower motion neurons. Showing atrophy
65
What is a classical sign of ALS
Mixed upper and lower motor neuron signs, usually in the same limb
Upper: Babinski sign, hyperreflexia, spasticity
Lower: Atrophy, fasciculations
66
What is the Gowers maneuver.
When a child is laying down on their stomach. Then kind of walks their way up to standing
67
How does lambert Eatoon myasthenic syndrome differ from MG with regards to increased situation
MG gets worse while LEMS gets better due to increased stimulation on the calcium channels to release the ACh into the synaptic cleft
68
If the EMG is normal in trying to determine the form of CMT, which form is present
Type 2, because it is axonal loss, rather than type 1 that is demyelinating that slows nerve conduction
69
At 24 months of age, what should a child be able to do with regards to gross motor
Walks up stairs
| Kicks ball forward
70
What is Feltys syndrome
```
Splenomegaly
Neutropenia
Fever
Anemia
Thrombocytopenia
```
71
What is the most common idiopathic inflammatory myopathy in children
Juvenile dermatomyositis
72
What is the most common type of adult motor neuron diseases
ALS
73
Seeing clubbing and arthritis in a patient is indicative of which condition until proven otherwise
Interstital lung disease
74
Radiculopathy at the nerve root L5
Hamstring weakness
Foot forsiflexion, inversion, eversion
Sensory: lateral calf, dorsum of foot
75
What is Miler fisher syndrome
In 5% of GBS patients, they proceed to:
- Ophthalamoplkegia, ataxia, arreflexia
- Facial weakness, dysarthria, dysphagia
76
Small nerve fibers transmit which type of information and what would be the negative and positive signs if those nerves were affected
Pain and temp
Positive: Burning, jabbing pain
Negative: Loss of pain and temp
77
What is the treatment for someone with RA
1) Start with an NSAID
2) Steroid (quick fix)
3) DMARDs
78
Which region of the body does the dermatome cover with regards to: T1
Medial forarm
79
Which region of the body does the dermatome cover with regards to: C7
Middle finger
80
What is the inheritance of CMT 1
AD
81
What are the clinical manifestations of childhood motor neuron diseases
Hypotonia, arreflexia, poor sucking, breathing difficulty, death in 6 to 12 months
82
What is the gene that is mutated in myotonia congenita
Chloride channel CLCN1
83
Which joints tend to be affected by osteoarthritis
Weight bearing joints such as the knees, hips, spine
84
What are the key findings in the CSF in the case of GBS
Albumino-cytological dissociation
Aka increased protein with normal glucose and normal cell count
85
To help determine which nerve or radicupathy might be present, which finger can you look at
Rink finger. If its the whole finger, then its the median and ulnar, if its just the lateral half of the finger, then its median only
86
What is Lambert Eaton myasthenia syndrome (LEMS) due to
Autoimmune attach against voltage gated calcium channels on the presynaptic terminal
87
Why fibers can not be tested on an EMG
Unmyelinated fibers
88
Which region of the body does the dermatome cover with regards to: C8
Fourth/fifth finger
89
What symptom may be present in the case of mitochondrial disorders
Mitochondrial encephalomyopathy with lactic acidosis and stroke like symptoms or MELAS
90
In those patients with antibody negative MG, which antibody is present
MUSK (muscle specific tyrosine kinase) Abs
91
What are some atrophic locations seen in ALS
Tongue, hands, arms
92
Hypertrophied pronator teres can result in monneuropathy in which nerve
Median nerve
93
Which region of the body does the dermatome cover with regards to: C6
Thumb/index
94
What is Rieter’s syndrome
Can’t see (Conjunctivitis)
Can’t pee (urethritis)
Can’t climb tree (reactive arthritis)
95
Which antibodies are present in Miler fisher syndrome
GQqb and GT1a antibodies
96
Autonomic nerve fibers transmit which type of information and what would be the negative and positive signs if those nerves were affected
Negative: Hypotension, decreased sweat, impotence, urinary retention, constipation
97
How will hip osteoarthritis manifest
As groin pain
98
Rheumatoid factor is an autoantibodies of which class and to what
Most commonly IgM, usually to the Fc portion of IgG
99
Administration of which drug can produce a disorder very similar to myasthenia gravis
D-penicillamine, and it was recipe when removed from treatment
100
What are the depicting features of enteropathic arthritis
- Associated with Crohns and UC
- Axial involvement
- IBD and arthritis will correlate with one another and flare up at the same time
- Erythema nodosum
*B27
101
Radiculopathy at the nerve root L4
Hip flexor weakness
Knee extension weakness
Sensory: medial calf
102
What is the inheritance of myotonia congenita
AD
103
At 36 months of age, what should a child be able to do with regards to gross motor
Tricycle
104
What are the clinical manifestations of osteoarthritis
Crepeitus, Decreased ROM, effusion that is cold
105
What are the most common lumbar nerve root compressions
L4-L5 (L5 nerve root compression)
| L5-S1 (S1 nerve root compression)
106
ACA is helpful in the diagnosis of which condition
Scleroderma
107
What is the usual associations with reactive arthritis
- Young male
- Arthritis of LEs
- Enthesitits (Achilles tendon/plantar fasciitis)
- Dactylitis (sausage digit, finger or toe)
108
What are the features of psoriatic arthritis that are Give always
- Psiariatic lesions
| - Pitting nails
109
What is pyroderma gangrenosim and what condition is it associated with
Tender, reddish purple papule, leading to necrosis
*Seen with RA
110
What is the damaged structure in the cause of Bronchial plexopathy caused by traumatic injury
Traction, laceration, missed
111
Which HLA are associated with myasthenia gravis
HLA B8 and DR3
112
Which region of the body does the dermatome cover with regards to: L5
Lateral calf
113
Which form of arthritis can be seen in those patients with a thyroid issue
Carpal/tarsal tunnel syndrome
114
Radiculopathy at the nerve root S1
Hamstring weakness
Foot plantarflexion
Sensory: postolateral calf, lateral foot
115
Mitochondrial diseases leading to myopathies usually have what present
Abs to mitochondrial or nuclear DNA mutations
116
Lateral sclerosis involves which set of motor neurons
Upper motor neurons giving you hyperreflexia and Babinski sign
117
Which region of the body does the dermatome cover with regards to: L1
Inguinal
118
What are the renal manifestations that would help conform SLE
Proteinuria > 500mg/day or 3+ cases
119
At 70 months of age, what should a child be able to do with regards to gross motor
Skips
120
What are the four domains of development
- Gross motor
- Fine motor
- Language
- Cognitive/social emotional
