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Joint/muscle pathologies etc. Flashcards

1
Q

What collects in the joints in someone who has gout?

A

Monosodium urate crystals

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2
Q

Which is more common, the overproduction or uric acid or underexcretion?

A

Undersecretion of uric acid

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3
Q

Causes of undersecretion of uric acid

A

mostly idiopathic, but potentiated by renal failure

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4
Q

Causes of overproduction of uric acid

A

Lesch-Nyhan syndrome, PRPP excess, increased cell turnover

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5
Q

Findings under polarized light of joint fluid from someone with gout

A

Needle shaped crystals with - bifringence

-yellow under parallel light, blue under perpendicular light

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6
Q

Treatment of acute gout attack

A

NSAIDs, glucocorticoids, colchicine

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7
Q

Treatment of chronic gout attack

A

Xanthine oxidase inhibitors

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8
Q

What is calcium pyrophosphate deposition disease AKA

A

pseudogout

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9
Q

What deposits in the joints of someone with calcium pyrophosphate deposition disease?

A

calcium pyrophosphate

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10
Q

Most affected joint in calcium pyrophosphate deposition disease?

A

Knee

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11
Q

What will you see on xray of someone with calcium pyrophosphate deposition disease?

A

chondrocalcinosis

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12
Q

What do the crystals in calcium pyrophosphate deposition disease look like?

A

rhomboid and weakly + birefringent (blue when parallel to light)

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13
Q

acute treatment of calcium pyrophosphate deposition disease

A

NSAIDs, colchicine, glucocorticoids

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14
Q

Prophylaxis of calcium pyrophosphate deposition disease

A

colchicine

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15
Q

What is the presentation of systemic juvenile idiopathic arthritis?

A

Daily spikign fevers, salmon-pink macular rash, arthritis, leukocytosis, thrombocytosis, anemia,

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16
Q

Treatment of systemic juvenile idiopathic arthritis?

A

NSAIDs, steroids, methotrexate, TNF inhibitors

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17
Q

Sjogren syndrome pathophys

A

autoimmune disorder characterized by desctruction of exocrine glands by lymphocytes

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18
Q

Clinical findings in sjogrens syndrome

A

Inflammtory joint pain
Keratoconjunctivitis sicca (decreased tear production and corneal damage)
Xerostomia
Bilateral parotid enlargement

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19
Q

What will you find in the blood of someone with Sjogrens?

A

ANA antibodies, rheumatoid factor, and antiribonucleoprotein antibodies: SS-A, SS-B

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20
Q

In what condition other than Sjogrens may someone e have positive anti-SSA and anti-SSB antibodies?

A

SLE

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21
Q

Complications of sjogrens

A

dental caries

MALT (may present as parotid enlargement)

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22
Q

What confirms the diagnosis of sjogrens syndrome?

A

lymphocytic sialadenitis on labial salivary gland biopsy

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23
Q

What are the four types of seronegative spondyloarthritis?

A

Psoriatic arthritis
Ankylosing spondylitis
Inflammatory bowel disease
Reactive arthritis

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24
Q

What are seronegative spondyloarthritis’s?

A

arthritis without rheumatoid factor (no igG antibody)

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25
what HLA type are seronegative spondyloarthritis's associated with?
HLA-B27
26
What do the seronegative spondyloarthritis's have in common as presentation ?
inflammatory back pain that improves with exercise, peripheral arthritis, enthesitis and dactylitis, uveitis
27
What may you see on XRAY of someone with psoriatic arthritis?
Pencil in cup deformity
28
What is the presentation of someone with ankylosing spondylitis?
Arthritis with symmetric involvement of spine and SI joints which leads to joint fusion -also uveitis, aortic regurgitation and ankylosis
29
What may be seen on XRAY of someone with ankylosing spondylitis?
Bamboo spine
30
Complication of ankylosing spondylitis?
Restrictive lung disease
31
Explain the two different types of seronegative spondyloarthritis seen in IBD patients
Type I: <5 joints, large joints, worse w/ flares | Type II: >5 joints, small, independent
32
What is the triad seen in reactive arthritis?
conjunctivitis, urethritis, arthritis
33
What is SLE?
A relapsing and remitting autoimmune disease
34
Pathophys of lupus?
organ damage primarily due to type III hypersensitivity (partially type II) -associated with early complement protein deficiency leading to decreased clearance of immune complexes
35
How does lupus classically present?
rash, joint pain, fever, in female of reproductive age (especially african-american or Hispanic women)
36
What type of endocarditis is associated with SLE?
Libman-Sacks Endocarditis
37
What is libman-sacks endocarditis?
nonbacterial thrombi on mitral or aoric valve that may be present on either side of the valve
38
What is lupus nephritis?
glomerular deposition of DNA-anti-DNA immune complexes that leads to nephrotic or nephritic syndrome - most commonly diffuse proliferative
39
What is an anti-SSA + pregnant women at risk of?
the newborn developing neonatal lupus
40
Presentation of neonatal lupus?
congenital heart block, periorbital/diffuse rash, transaminitis, and cytopenias
41
What is a sensitive antibody for lupus?
ANA
42
What are some specific antibodies for lupus?
Sensitive - ANA | Specific - anti-dsDNA and anti-SM
43
What is mixed connective tissue disease?
Disease with features of SLE, systemic sclerosis, and or polymyositis
44
What antibody is associated with mixed connective tissue disease?
anti-U1 RNP antibodies
45
How does antiphospholipid syndrome present?
venous/arterial thrombosis and reccurrent fetal loss
46
What lab findings are present in antiphospholipid syndrome?
lupus anticoagulant, anticardiolipin, anti-B2 glycoprotein I antibodies
47
Treatment of antiphospholipid syndrome ?
systemic anticoagulation
48
antiphospholipid syndrome may occur secondarily to what?
SLE
49
Presentation of polymyalgia rheumatica?
Bilateral pain and stiffness in proximal muscles with fever, malaise and weight loss. NO muscle weakness.
50
What is polymyalgia rheumatica associated with?
giant cell arteritis
51
Findings in polymyalgia rheumatica?
increased ESR, Increased CRP, normal CK
52
Treatment for polymyalgia rheumatica?
corticosteroids (rapid response)
53
Fibramyolgia presentation
Chronic widespread musculoskeletal pain associated wiht tender points, stiffness, paresthesias, poor sleep, cognitive disturance. More common in women 20-50 years old.
54
Treatment of fibromyalgia
Regular exercise, antidepressants, neuropathic pain agents
55
Antibodies found in polymyositis/dermatomyositis?
+ANA, anti-Jo-1, anti-SRP, anti-Mi-2
56
polymyositis presentation
progressive symmetric proximal muscle weakness. | Usually involves shoulders.
57
pathophys of polymyositis
Endomysial inflammation with CD8+ T cells.
58
dermatomyositis presentation
Similar to polymyositis plus Gottron papules, photodistributed facial erythema, shawl and face rash., darkening and thickening of fingers tips.
59
dermatomyositis pathophys
perimysial inflammation and atrophy with CD4+ cells
60
pathophys of myasthenia gravis
autoantibodies to post-synaptic Ach receptors
61
presentation of myasthenia gravis
Ptosis, diplopia, weakness (may lead to dyspnea if respiratory muscles involved, or dysphagia if bublar muscle involvement). Worsen with muscle use.
62
What is myasthenia gravis associated wtih?
thymoma, thymic hyperplasia
63
Treatment of myasthenia gravis?
AchE inhibitors - pyridostigmine
64
Tensilon test use
Determines whether a patient presenting with worsening symptoms of myasthenia gravis has an insufficient dose or is having a cholinergic crisis.
65
Tensilon test findings
``` Administer edrophonium (a short acting AchE inhibitor). If symptoms improve, patient needs higher dose. If symptoms gett worse, patient needs lower dose. ```
66
Pathophys of lambert-eaton syndrome
autoantibodies to presynaptic Ca channels -- decreased Ach release
67
Presentation of lambert eaton syndrome
proximal muscle weakness, autonomic symptoms (dry mouth, impotence). Improves with muscle use.
68
what is lambert-eastion syndrome associated with?
small cell lung cancer
69
Treatment of Raynaud phenomonen ?
Ca channel blockers
70
Scleroderma pathophys
Autoimmunity activates fibroblasts --> collagen deposition
71
Diffuse scleroderma presentation
widespread skin involvment, rapid progression, early visceral involvment.
72
Antibodies seen in diffuse scleroderma?
anti-scl-70 | anti-RNA polymerase
73
someone with anti-RNA polyermase is at increased risk for what?
renal crisis
74
Limited scleroderma pathophys
skin involvement confined to fingers and face. Associated with CREST syndrome.
75
What is CREST syndrome?
Calcinosis cutis, anti-centromere antibody, raynaud phenomenon, esophageal dysmotility, sclerodactyly, telangiectasia.
76
Which antibody may be seen in limited scleroderma?
Anti-centromere antibody

Ortho ERIN (8 decks)

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