MSK path X

Question 1

What is enteritis assoc arthritis

Answer 1

GI infection causes it

yersinia salmonella shigella, campylobacter

Question 2

presentation enteritis assoc arthritis

Answer 2

knees and ankles
somtimes wrists fingers and toes
lasts for about a year then generally clears

Question 3

kid has new murmur and puffy face

recently had infeciton, not compliant to antibiotics

Answer 3

post strep glomerulonephritis

Question 4

What is Psoriatic arthritis

Answer 4

chronic inflammatory arthropathy assoc with psoriasis that affects peripheral and axial joints and entheses

Question 5

what are entheses

Answer 5

ligaments and tendons

Question 6

Sx psoriatic arthritis

Answer 6

30-50 years old
following onset of skin disease
peripheral joints of hands and feet
asymmetric distribution
"pencil in cup"

Question 7

pencil in cup

Answer 7

psoriatic arthritis

Question 8

what is atypical psoriatic lesion

Answer 8

not on elbow or knee at first presentation but on wrist

Question 9

what infections are asplenic patients at risk for

Answer 9

H influenza
pneumococcal
because these are encapsulated

Question 10

how do bacterial infections enter joints to cause infectious arthritis

Answer 10

hematogenous spread

Question 11

presentation infectious arthritis

Answer 11

sudden acute paingul and swollen joint with dec ROM

fever, leukocytosis and increase sed rate

Question 12

nongonococcal infecitous arthritis

Answer 12

single joint, usually knee

then hip shoulder elbow wrist and sternoclavicular joint

Question 13

axial joint involvement in infectious arthritis tells you what about patient

Answer 13

drug user

Question 14

Dx infectious arthritis

Answer 14

joint aspiration yielding purulent fluid

Question 15

lyme arthritis

Answer 15

caused by borrelia burgdorferi

Question 16

what stage do lymes unTx patients develop arthritis and in what joints

Answer 16

late stage

knees, shoulders elbows ankles

Question 17

how long does lymes arthritis last

Answer 17

one or 2 joints for few weeks- months then moves to new sites

Question 18

Dx of lymes arthritis

Answer 18

anti-Borrelia Ab

Question 19

Tx lymes arthritis

Answer 19

antibiotics

Question 20

early stage lymes presentation

Answer 20

erythema multiforme

targetoids

Question 21

what is crystal induced arthritis

Answer 21

acute and chronic joint disorders like gout and pseudogout

Question 22

what is psuedogout composed of

Answer 22

Ca pyrophosphate dehydrate

Question 23

what is gout made of

Answer 23

monoNa urate from broken down DNA

Question 24

majority gout

Answer 24

idiopathic

Question 25

secondary gout causes

Answer 25

increased nucleic acid turnover from leukemia chronic renal disease congenital

Question 26

what can cause primary gout

Answer 26

idiopathic and known enzyme defects like HGPRT

Question 27

what is hyperuricemia

Answer 27

plasma urate >6.8

Question 28

what can lead to hyperuricemia

Answer 28

increased production or decreased excretion

Question 29

inflammation in gout triggered by

Answer 29

precipitation of monoNa urate crystals into joints | recruits lymphocytes

Question 30

when does gout appear

Answer 30

after 20-30 years of hyperuricemia

Question 31

genetic predisposition to gout

Answer 31

male beause X linked abnormalities of HGPRT

Question 32

what polymorphisms can lead to gout

Answer 32

URAT1 and GLUT9

Question 33

what lifestyle factors contribute to gout

Answer 33

alcohol obesity drugs (thiazides) lead toxicity

Question 34

what are the distinctive morphologic features of gout

Answer 34

acute arthritis chronic tophaceous arthritis tophi in various states gouty nephropathy

Question 35

acute arthritis in gout

Answer 35

dense neutrophilic infiltrate | need shaped crystals

Question 36

chronic trophaceous arthritis in gout

Answer 36

repetitive precipitation of urate crystals during acute attacks hyperplastic synovium with fibrosis and thickening by inflammatory cells and forms pannus that destroys cartilage

Question 37

what will gout look like grossly

Answer 37

white and chalky

Question 38

ASx hyperuricemia in males and females

Answer 38

males around puberty | females postmenopause

Question 39

locations for acture arthritic attacks from gout

Answer 39

insteps, ankles, heels, knees, wrists, fingers, elbows

Question 40

how long till get chronic trophaceous gout

Answer 40

12 years after initial attack | see juxtaarticular bone erosion from osteoclastic bone resorption and loss of joint space

Question 41

progression of chornic trophaceous gout can lead to

Answer 41

crippling disease

Question 42

pseudogout presentation

Answer 42

50+ years old | some swelling and redness, not as much

Question 43

crystal morph in pseudogout

Answer 43

oval blue purple aggregates rhomboid crystals inflammation

Question 44

how long does pseudogout last

Answer 44

several days to weeks

Question 45

where does pseudogout appear

Answer 45

monoarticular or poly | knees, wrists elbow, shoulders, ankles

Question 46

Tx for pseudogout

Answer 46

supportive

Question 47

if yellow crystals are parallel to axis then what

Answer 47

gout

Question 48

if yellow not parallel to axis then what

Answer 48

pseudogout

Question 49

what immune response is in RA

Answer 49

humoral and cellular