connective tissue ds

Question 1

a pt comes with pain in both wrists , distal interphalygeal, metacarpophalyngeal jts wht r diffrential diagnosis

Answer 1

rheumatoid arthritis 
SLE
viral arthritis 
       hepatitis B
       EBV
       Parvovirus B19 

parvovirus b19 adult dont hve slapped cheek as in children usually adult who comes alot in contact with children like kindergarden teacher

Question 2

how to differentiate rheumatoid arthritis and SLE

Answer 2

systemic symptoms present in SLE

Question 3

a pt comes with involvement of knee from yrs

Answer 3

monoarticular chronic         》 osteoarthritis 
no joint swelling and redness 
noninflammtory thus 
         ⬇️
osteoarthritis

Question 4

pt comes with pain and swelling of knee from 2-3 days

Answer 4

monoarticular acute inflammatory
↙️ ↘️
septic arthritis gout

Question 5

pt comes with migratory arthritis wht r diffrential

Answer 5

lyme ds
gonococcal arthritis
rheumatic fever

Question 6

oligoarticular asymmetrical <5-6 joints involved wht r the diffrential

Answer 6

spondyloarthopathies

osteoarthritis

Question 7

ANA VERY SPECIFIC FOR LUPUS ARE

Answer 7

ant DDNA

ANTI SMITH

Question 8

anti histone ab is seen in

Answer 8

drug induced lupus

Question 9

anti SSA (anti rho )

Answer 9

neonatal lupus

sjogren

Question 10

anti ssb( anti LA )

Answer 10

sjogren

Question 11

anti centromere is seen in

Answer 11

CREST

Question 12

anticentromere antibodies are specific for

Answer 12

limited form of scleroderma

Question 13

antibody specific for diffuse scleroderma

Answer 13

antitopoisomerase I ie antiscleroderma 70

Question 14

clinical features of scleroderma

Answer 14

1.Raynauds syndrome
caused by vasospasm and thickening of vessel wall in digits
cold temperature and stress brings first blanching 》cyanosis》reactive hyperemia

2.cutaneous fibrosis
tightening of skin and face leads to sclerodactyly refers to claw hand
3.esophageal dismotility
4.lung, heart,renal involvement

Question 15

difference bw diffuse and limited scleroderma

Answer 15

diffuse limited
skin involvement limited to distal extremities
widespread sparing of trunk

2.rapid onset delayed onset
3.significant organ involved organs involved late
4.no anticentromere anticentromere +
antitopoisomerase

Question 16

diffrential diagnosis of raynauds phenomenon

Answer 16

PRIMARY no cause 
SECONDARY 
scleroderma 
SLE
vasculitis 
certain medication bblocker, nictotine,bleomycin 
thromboangitis obliteratans

Question 17

drugs causing lupus

Answer 17

quinidine
hydralazine
procainamide
isoniazid

Question 18

pattern of joint involvement in reactive arthiritis

Answer 18

migratory arthritis

aymmertric inflammatory oligoarthritis

Question 19

Reiter syndrome triad

Answer 19

arthritis
uveitis
urtheritis

Question 20

organisms implicated in reiter syn

Answer 20

salmonella
shigella
campylobacter 
chlamydia 
yersenia

Question 21

types of seronegative spondyloarthopathies

Answer 21

ankylosing spondylitis 
reiter syn 
psoriatic arthritis 
arthopathy with IBD
undifferentiated spondyloarthopathies

Question 22

sausage shaped digits and nail pitting characteristic of

Answer 22

psoriatic arthritis

Question 23

pattern of joint involvement

Answer 23

asymmetric and polyarticular

Question 24

difference between joint involvement of psoriatic and reiter

Answer 24

psoriatic polyarticular

reiter oligoarticular

Question 25

felty syndrome

Answer 25

anemia neuropenia splenomegaly Rheumatoid arthritis

Question 26

juvenile RA

Answer 26

begins before 18 yrs of age | extraarticular manifestations may predominate

Question 27

caplan syn

Answer 27

CWP + rheumatoid nodules

Question 28

deformity in rheumatoid arthritis

Answer 28

•hallux valgus deformity, commonly called a bunion, is when there is medial deviation of the first metatarsal and lateral deviation of the great toe (hallux) •ulnar deviation of hand •swan neck •boutonniere deformity •hammer toe A hammer toe or contracted toe is a deformity of the proximal interphalangeal joint of the second, third, or fourth toe causing it to be permanently bent, resembling a hammer. Mallet toe is a similar condition affecting the distal interphalangeal joint.[1][2]

Question 29

wht is DISH

Answer 29

Diffuse idiopathic skeletal hyperostosis (DISH) is a condition characterized by abnormal calcification/bone formation ("hyperostosis") of the soft tissues surrounding the joints of the spine, and also the peripheral or appendicular skeleton.[1] In the spine, there is bone formation along the anterior longitudinal ligament and sometimes the posterior longitudinal ligament, which may lead to partial or complete fusion of adjacent spinal levels. The facet and sacroiliac joints tend to be uninvolved. The thoracic spine is the most common level involved.[2]In the peripheral skeleton, DISH manifests as a calcific enthesopathy, with pathologic bone formation at sites where ligaments and tendons attach to bone.

Question 30

other names if DISH

Answer 30

Forestier's disease, senile ankylosing spondylosis, ankylosing hyperostosis

Question 31

diagnostic criteria of DISH

Answer 31

Diagnostic criteria •flowing ossification along the anterolateral aspect of at least 4 contiguous vertebraepreservation of disk height in the involved vertebral segment; • relative absence of significant degenerative changes (e.g. marginal sclerosis in vertebral bodies or vacuum phenomenon) absence of facet-joint ankylosis •; absence of SI joint erosion, sclerosis or intraarticular osseous fusion

Question 32

wegener granulomatosis

Answer 32

upper and lower RESPIRATORY tract renal involvement vasculitis small vsel cANCA +ve

Question 33

c ANCA is positive in

Answer 33

wegener granulomatosis

Question 34

temporal/ giant cell arteritis

Answer 34

temporal arteries most commonly effected #symptoms headache intermittent jaw claudication visual impairment can lead to blindness tender temporal arteries also associated with polymyalgia rheumatica ie proximal stiffness ( shoulder, hip) mnemonic 60 age of patient 60 mg prednisone dose 60 ESR needed to diagnose

Question 35

treatment of temporal arteritis

Answer 35

clinical features of temporal arteritis ⬇️ do ESR and temporal artery biopsy if ESR high immediately start 60 mg prednisone without waiting for temporal artery biopsy results

Question 36

large vsel vasculitis

Answer 36

temporal arteritis | takayasu arteritis

Question 37

medium vessel vasculitis

Answer 37

``` chiurg strauss PAN wegner granulomatosis Kawasaki ds microscopic polyangitis ```

Question 38

small vessel vasculitis

Answer 38

henoch scholein purpura hypersensitivity vasculitis behcet syndrome

Question 39

takayasu vasculitis

Answer 39

granulomatos vasculitis of arch of aorta leading to its stenosis and narrowing decreased or absent peripheral pulses discrepencies of BP ARTERIAL BRUITS

Question 40

churg strauss syndrome

Answer 40

prominent respiratory tract finding AASTHMA EOSINOPHILIA skin lesions palpable purpura , subcutaneous nodules kidney PANCA + VE

Question 41

PAN

Answer 41

``` NO LUNG INVOLVEMENT effects nervous sys and GIT associated with hepaitis B nerves involvement leads to mononeuritis mutiplex git abdominal angina ``` PANCA + ve

Question 42

behcet syndrome

Answer 42

vasculitis causing painful oral and genital ulcer eye involvement CNS involvement arthritis (knee and ankle most common )

Question 43

buerger ds symptoms

Answer 43

thromboangitis obliteratans ``` occurs in young men smokers segmental inflammation of arteries and veins may lead to gangrene and autoamputation symptoms claudication painful distal extremities ulceration raynauds phenomenon ```

Question 44

causes of proximal myopathy

Answer 44

``` eaton labert myasthenia endocrinopathies hyper /hypo thyroisidsm adrenal insufficiency drug induced cyclosporine statin inflammatory myopathy polymyositis dermatomyositis ```

Question 45

types of idiopathic inflammatory myopathies

Answer 45

polymyositis | dermatomyositis

Question 46

symptoms of polymyositis

Answer 46

Symmetrical proximal muscle weakness that develops subacutely over weeks or several months •The earliest andmost.severely.affected muscle groups are the neckflexors, shoulder girdle, and pelvic girdle muscles

Question 47

symptoms and signs of dermatomyositis

Answer 47

symptoms of polymyositis + skin involvement Heliotrope rash (butterfly)—around eyes, bridge of nose, cheeks b. Gottron papules—papular, erythematous, scaly lesions over the knuckles (MCP,PIP,DIP) c. V sign—rash on the face, neck, and anterior chest d. Shawl sign—rash on shoulders and upper back, elbows, and knee s e.Periungual erythema with telangiectases f. Subcutaneous calcifications in children—can be extremely painful g. Associated with vasculitis of the GI tract, kidneys, lungs, and eyes (more common in children) h. There is an increased incidence of malignancy in older adults (lung, breast, ovary, GI tract, and myeloproliferative disorders). Once dermatomyositis is diagnosed, make an effort to uncover an occult malignancy. Dermatomyositis associated with malignancy often remits once the tumor is removed

Question 48

diagnostic criteria of polymoyositis

Answer 48

If two of first four→possible polymyositis If three of first four→probable polymyositis If all four→definite polymyositis * Symmetric proximal muscle weakness * Elevation in serum creatine phosphokinase * EMG findings of amyopathy * Biopsy evidence of myositis * Characteristic rash of dermatomyositis

Question 49

odd ball of inflammatory myopathies

Answer 49

inclusion body myositis is the“odd ball of Inflammatory myopathies”for the following reasons :Affects male patients more than female patients, absence of autoantibodies, distal muscle involvement, and relatively low creatine kinase(CK); prognosis is poor.

Question 50

lab finding of polymyositis

Answer 50

CK level is significantly elevated. CK levels correspond to the degree of muscle necrosis, so one can monitor the disease severity b. LDH, aldolase, AST, ALT elevated c. ANA in over 50% d. Antisynthetase antibodies (anti-Jo-1 antibodies)—abrupt onset of fever, cracked hands,Raynaud phenomenon,interstitial lung disease and fibrosis,arthritis; does not respond well to therapy e. Antisignal recognition particle •Cardiac manifestations(common) •Worst prognosis of all subsets f. Anti-Mi-2 antibodies—better prognosis 2. EMG—abnormal in 90% of patients 3. Muscle biopsy a. Shows inflammation and muscle fiber fibrosis in all three b. Dermatomyositis—perivascular and perimysial c.Polymyositis and inclusionbodymyositis—endomysial

Question 51

biopsy finding of polymyositis

Answer 51

Polymyositis and inclusion body myositis—endomysial

Question 52

muscle finding found in dermatomyositis

Answer 52

Dermatomyositis—perivascular and perimysial inflammation

Question 53

inclusion body myositis

Answer 53

Insidious onset of slowly progressive proximal and distal weakness, Patients can also have loss of deep tendon reflexes(nerves are not involved in polymyositis and dermatomyositis) Not associated with autoantibodies