March 13 - Rheumatology Flashcards
(48 cards)
TNF-alpha inhibitors: MOA, use, ADRs
MOA: etanercept acts as TNF-alpha decoy receptor, infliximab works as monoclonal anti-TNF antibody
Use: moderate to severe rheumatoid arthritis, especially for those that have failed methotrexate
ADRs: impaired cell mediated immunity. Especially important for maintenance of granulomas - should screen for TB prior to starting therapy
Biosphosphanates: MOA
inhibit mature osteoclast-mediated bone resorption by binding to hydroxyapatite binding sites
Treatment of acute gout
First line: NSAIDs
Second line: colchicine (inhibits MT polymerization, disrupting chemotaxis, phgocytosis, degranulation)
Contracture formation
Results from excess MPP activity. MPPs ecourage myofibroblast accumulation and scar tissue remodeling, leading to contracture
Bones of wrist
From lateral to medial and proximal to distal:
- scaphoid
- lunate
- triquetrum
- pisiform
- trapezium
- trapezoid
- capitate
- hamate
Osgood-Schlatter disease
Overuse injury of secondary ossification center of tibial tubercle. Seen in adolescent athletes following growth spurt. Presents with pain and swelling at tibial tubercle where the patellar ligament inserts.
Tibial nerve: course and what it innervates
Goes through popliteal fossa and into posterior compartment of leg
Motor innervation to posterior compartment muscles and intrinsic foot muscles. Responsible for inversion, plantarflexion, toe flexion.
Sensory innervation to sole of foot
Superficial peroneal nerve and deep peroneal nerve: sensory innervation
Superficial: lateral legg, dorsal foot, medial foot
Deep: Skin between 1st and 2nd toes
Pharyngeal pouches 1-4
1 - middle ear and auditory tube
2 - palatine tonsil crypts
3 - thymus, inferior parathyroids
4 - superior parathyroids, ultimobranchial bodies
CREST syndrome: symptoms and autoantibody
Symptoms
- calcinosis
- raynaud’s
- esophageal dysmotility
- sclerodactyly
- telangiectasias
Anti-centromere antibodies
Succinylcholine: MOA and side effect
Depolarizing NMJ blocker. Attaches to nAChR but isn’t degraded by AChE resulting in continued stimulation and inactivation of sodium channels. Because nAChR is a non-selective cation channel, prolonged opening can lead to excess K+ release and hyperkalemia. This isn’t seen with non-depolarizing NMJ blockers which don’t open the channe.
Giant cell arteritis: symptoms, diagnosis, treatment, and histology, patient population
Symptoms: headache, jaw claudication, visual disturbances (ischemic optic neuropathy), polymyalgia rheumatica (achy pain in shoulders and hip girdles)
Diagnosis: temporal artery biopsy
Treatment: glucocorticoids
Histology: granulomatous inflammation of media with giant cells (same as Takayasu) in branches of carotid artery. segmental lesions.
Patient population: women over 50
Takayasu arteritis: histology, population, presentation
Histology: granulomatous inflammation in aortic arch branches
Population: young Asian females
Presentation: pulseless disease
Polyarteritis nodosa: population, pathology, arteries affected
Population: Young adults, associated with hep B (pos surface antigen)
Pathology: early lesions: transmural inflammation with fibrinoid necrosis; late lesions: massive fibrosis resulting in nodes
Arteries affect: all organs but lung is spared
Kawasaki disease: population, presentation, arteries involved, treatment
Population: Kids less than 4
Presentation: Rash on palms and soles, conjunctivitis, fever, enlarged cervical nodes
Arteires: coronary a
Treatment: aspirin and IVIG to protect against thrombus in coronary artery
Buerger disease: presentation, population
Presentation: affects digits, associated with Raynaud phenomenon
Population: Smokers
Wegener’s disease: pathology, presentation, diagnosis, treatment
Pathology: necrotizing granulomatous inflammation
Presentation: affects nasopharynx, lungs, kidney
Diagnosis: pos c-ANCA
Treatment: cyclophosphamide
Microscopic polyangiitis: presentation
Affects lung and kidney but no nasopharyngeal involvement. No granulomas. Pos p-ANCA
Churg-Strauss disease: presentation, pathology
Presentation: Affects lungs and heart. Associated with asthma. Peripheral eosinophilia. Positive p-ANCA
Pathology: granulomas
HSP: presentation, treatment
Presentation: palpable purpora in butt and legs of a kid due to IgA deposition, IgA nephropathy, occurs following UTI
Treatment: steroids if severe
Muscles of rotator cuff: function and innervation
Supraspinatus: abduction, suprascapular n
Infraspinatus: external rotation, suprascapular n
Teres minor: adduction and ext rotation, axillary n
Subscapularis: adduction and int rotation, upper and lower subscapular n
Joint disease and myeloproliferative disorders
Associated with acute gout– increased cell turnober results in increased urate production
Radial head subluxation (nursemaid’s elbow)
Caused by pull on the arm while extended and pronated. Traction causes annular ligament to tear and slip over the head of the radius and get trapped. Seen in kids as the annular ligament is weak.
Classic bone findings: rickets
Increase in unmineralized osteoid, widening between osteoid seams
