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Musculoskeletal system > rheumatoid diseases (except RA and gout) > Flashcards

rheumatoid diseases (except RA and gout) Flashcards

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1
Q

systemic juvenile idiopathic osteoarthritis: what is this?

A

systemic arthritis in <16 y/o

presents with
1) arthritis (+2 joints)
2) salmon pink macular rash
3) daily spiking fevers

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2
Q

systemic juvenile idiopathic osteoarthritis: in who?

A

children <16 y/o

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3
Q

systemic juvenile idiopathic osteoarthritis: presentation?

A

arthritis commonly in +2 joints
daily spiking fevers
salmon pink macular rash

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4
Q

arthritis in +2 joints, pink macular rash, fever in 12 y/o. what is this suggestive of?

A

systemic juvenile idiopathic arthritis

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5
Q

what is systemic juvenile idiopathic arthritis associated with?

A

anterior uveitis

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6
Q

systemic juvenile idiopathic arthritis: lab?

A

leukocytosis, thrombocytosis, anemia
elevated ESR and CRP

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7
Q

systemic juvenile idiopathic arthritis: ESR and CRP?

A

elevated

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8
Q

systemic juvenile idiopathic arthritis: treatment?

A

NSAIDs
steroids
methotrexate
TNF inhibitors

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9
Q

Sjogren: what is this?

A

auto-immune disorder characterized by destruction of exocrine glands by lymphocytic infiltrates

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10
Q

Sjogren: what gets destructed?

A

exocrine glands, especially lacrimal and salivary

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11
Q

which glands gets most commonly destructed in Sjogren?

A

lacrimal and salivary

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12
Q

which cell type infiltrate glands in Sjogren?

A

lymphocytes

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13
Q

Sjogren: who gets mostly affected?

A

females 40-60 y/o

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14
Q

Sjogren: symptoms?

A
  • inflammatory joint pain
  • dry, sandy feeling eyes (keratoconjunctivitis sicca)
  • dry mouth (xerostomia)
  • bilateral parotid enlargement
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15
Q

what causes the dry eyes (keratoconjunctivitis sicca) in Sjogren?

A

decreased tear production and subsequent corneal damage

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16
Q

Other word for dry eyes in Sjogren?

A

keratoconjunctivitis sicca

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17
Q

Other word for dry mouth in Sjogren?

A

Xerostomia

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18
Q

joint pain with dry eyes/mouth and enlarged parotides. what can it be?

A

sjogren

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19
Q

sjogren: what is the cause of xerostomia?

A

decreased saliva production -> mucosal damage

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20
Q

what can you see on a tongue in sjogren?

A

fissuring

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21
Q

sjogren: which antibodies?

A

ANA +
RF + (can be positive without RA)
SS-A and SS-B

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22
Q

what are antiribonucleoprotein antibodies?

A

SS-A and SS-B

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23
Q

what kind of antibodies are SS-A and SS-B?

A

antiribonucleoprotein

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24
Q

in which diseases may SS-A and SS-B be seen?

A

sjogren and SLE

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25
is sjogren common as a primary disorder?
yes
26
what can sjogren be secondary to?
RA, SLE, SS (systemic sclerosis)
27
sjogren: complications?
dental caries MALT lymphoma risk of giving birth of baby with neonatal lupus
28
MALT lymphoma: complication of what?
sjogren
29
dental caries: complication of what?
sjogren
30
sjogren: risk of having baby with what kind of disorder?
neonatal lupus
31
sjogren: how to confirm diagnosis?
labial salivary gland biopsy (focal lymphocytic sialadenitis)
32
what do you see on the labial salivary gland biopsy in sjogren?
focial lymphocytic sialadenitis
33
other word for inflammation of a salivary gland?
sialadenitis
34
septic arthritis: common causes? (pathogens)
s. aureus streptococcus neisseria gonorrea
35
septic arthritis: mostly bilateral or unilateral?
unilateral
36
septic arthritis: presentation?
swollen, red, painful joint synovial fluid purulent
37
septic arthritis: synovial fluid?
purulent (WBC >50,000/mm3)
38
septic arthritis: treatment?
antibiotics, aspiration (needle), drainage (cut) to prevent irreversible joint damage
39
what do you do in septic arthritis to prevent irreversible joint damage?
drainage (+/- debridement)
40
difference joint drainage and aspiration?
aspiration: needle to let fluids out drainage: cut it open en let fluids come out
41
disseminated gonococcal infection: how does it get transmitted? how does it present?
STI that presents as either a 1) purulent arthritis (e.g. knee) 2) or triad from polyarthralgia, tenosynovitis (hand), dermatitis (pustules)
42
what is the triad of disseminated gonoccal infection? (presents as this triad or as a purulent arthritis)
polyarthralgia tenosynovitis (e.g. hand) dermatitis (pustules)
43
Pain at multiple joints, pustules and a tenosynovitis of the hand. What is this suggestive of?
disseminated gonococcal infection
44
what are the types of seronegative spondyloarthritis?
psoriatic arthritis ankylosing spondylitis IBD reactive arthritis (PAIR)
45
psoriatic arthritis ankylosing spondylitis IBD reactive arthritis what are these?
seronegative spondyloarthritis
46
what characterizes seronegative spondyloarthritis?
no RF association with HLA-B27 shared symptoms: - inflammatory back pain - peripheral arthritis, - enthesitis - dactylitis - uveitis
47
HLA-B27 associated with what?
seronegative spondyloarthritis (bechterew, IBD, reactive, psoriatic arthritis)
48
- inflammatory back pain - peripheral arthritis, - enthesitis - dactylitis - uveitis shared symptoms of what?
seronegative spondylarthritis
49
which type of arthritis are NEGATIVE for RF?
seronegative spondyloarthritis (bechterew, reactive, psoriatic arthritis, IBD)
50
what is dactylitis?
swelling of fingers, 'sausage' fingers
51
what is enthesis?
inflamed insertion sites of tendons, e.g. Achilles
52
characteristics of back pain in seronegative spondylarthritis?
worse in morning, better with movement
53
Psoriatric arthitis: arthritis in combination with what?
skin psorias and nail lesions
54
psoriatric arthritis: involvement of joints symmetric or asymmetric?
asymmetric
55
psoriatric arthritis: xray?
dactylitis and pencil-in-a-cup deformity
56
pencil-in-a-cup deformity of DIP on xray. suggestive of what?
psoriatric arthritis
57
how often is psoriatric arthritis seen in psoriatric patients?
fewer than 1/3
58
ankylosing spondylitis: other name?
Bechterew
59
Bechterew: other name?
ankylosing spondylitis
60
ankylosing spondylitis: involvement of which joints?
spine and sacroiliac joints
61
ankylosing spondylitis: symmetric or asymmetric?
symmetric
62
complications ankylosing spondylitis?
joint fusion (ankylosis), uveitis, aortic regurgitation restrictive lung disease
63
symmetric inflammation of sacroiliac joints. what kan it be?
ankylosing spondylitis (Bechterew)
64
ankylosing spondylitis: what happens to he spine?
vertebral fusion -> bamboo spine
65
ankylosing spondylitis: what can happen if costovertebral and costosternal ankylosis occurs?
restrictive lung disease
66
what can lead to restrictive lung disease in ankylosing spondylitis?
ankylosis of costovertebral and costosternal joints
67
how to assess disease severity of restrictive lung disease in ankylosing spondylitis?
degree of chest expansion
68
ankylosing spondylitis: more common in who?
males (20-40 y/o)
69
ankylosing spondylitis: age of onset?
20-40
70
which GI diseases are associated with seronegative spondylarthritis?
crohn and ulcerative colitis (IBD)
71
reactive arthritis: triad?
conjunctivitis urethritis arthritis (can't see, can't pee, can't bend my knee)
72
can't see, can't pee, can't bend my knee what is this?
reactive arthritis (conjunctivitis, urethritis, arthritis)
73
reactive arthritis is what kind of arthritis?
seronegative spondyloarthritis (RF negative, HLA-B27 associated)
74
psoriatic arthritis is what kind of arthritis?
seronegative spondyloarthritis (RF negative, HLA-B27 associated)
75
bechterew is what kind of arthritis?
seronegative spondyloarthritis (RF negative, HLA-B27 associated)
76
mnemonic reactive arthritis symptoms?
can't see, can't pee, can't bend my knee
77
menmonic reactive arthritis bacteria?
She Caught Every Student Cheating Yesterday (and overREACted) Shigella Campylobacter E.coli Salmonella Chlamydia Yersinia
78
which pathogens cause reactive arthritis?
Shigella Campylobacter E.coli Salmonella Chlamydia Yersinia (she caught every student cheating yesterday and overreacted)
79
SLE: abbreviation for what?
systemic lupus erythematosus
80
SLE: what is it?
relapsing-remitting auto-immune disease classic presentation: rash, joint pain, fever in female of reproductive age
81
SLE: which type of hypersensitivity reactions are involved?
type III: immune complex (=> most common) type II: IgE, IgM
82
How fast is a type III hypersensivity reaction?
1-3 weeks
83
How fast is a type II hypersensitivity reaction?
hours to days
84
what is a type III hypersensitivity reaction?
immune complex 1-3 wks
85
what is a type II hypersensitivity reaction?
IgG, IgM hours-days
86
which type of hypersensitivity reaction causes most organ damage in SLE?
type III immune complex 1-3 weeks
87
SLE is associated with a deficiency of what kind of proteins?
complement (e.g. C1q, C4, C2) -> reduced clearance of immune complexes
88
SLE is associated with a reduced clearance of what?
immune complexes (due to complement deficiency)
89
what is an immune complex?
combination of an antibody with its antigen (can be multiple) must be cleared, if not ->auto immune
90
rash, joint pain, fever in female of reproductive age suggestive of?
SLE
90
classic presentation of SLE?
fever, rash and joint pain in female of reproductive age
91
increased prevalence of SLE in which populations in the US?
black, hispanic, asian, caribbean
92
heart condition associated with SLE?
LSE (Libman Sacks Endocarditis) sterile thrombotic vegetations
93
what is endocarditis?
inflammation of the inner lining of the heart's chambers and valves
94
which important complications can be caused by SLE?
LSE and lupus nephritis
95
what is lupus nephritis?
glomerular deposition of DNA-anti-DNA immune complexes
96
which immune complexes are deposited in lupus nephritis?
DNA-anti-DNA
97
what is glomerular deposition of DNA-anti-DNA immune complexes?
lupus nephritis
98
symptoms of lupus nephritis?
hematuria and proteinuria
99
causes of death in SLE?
renal, infection and cardiovascular (accelerated CAD)
100
what is the most common cause of death in SLE?
renal disease
101
mnemonic causes of death in SLE?
patients die with Redness In their Cheeks renal - infection - cardiovascular
102
SLE with anti-SSA: increased risk of giving birth to baby with what?
neonatal lupus
103
symptoms neonatal lupus?
neonatal heart block periorbital/diffuse rash transaminitis cytopenia (present at birth)
104
what kind of antibody in a person with SLE gives increased risk of neonatal lupus?
anti-SSA
105
mnemonic SLE symptoms?
RASH OR PAIN Rash Arthritis Serositis Hematological (cytopenia) Oral/nasopharyngeal ulcers Renal disease Photosensitivity ANA Immunological Neurological symptoms
106
is arthritis in SLE erosive?
no
107
what kind of serositis in SLE?
pleuritis, pericarditis
108
what kind of hematological symptoms in SLE?
cytopenias
109
what kind of rash in SLE?
malar or discoid
110
what kind of ulcers in SLE?
oral and nasopharyngeal ulcers, painless
111
what is ANA short for?
antinuclear antibodies
112
neurological symptoms in SLE?
seizures, psychosis
113
antibodies in SLE?
anti-nuclear antibody anti-dsDNA anti-Smith antiphospholipid ANA, anti-dsDNA, anti-Sm, antiphospholipid
114
which antibody is specific for SLE?
anti-Smith (anti-Sm)
115
is positive ANA always associated with an auto-immune disease?
no
116
mixed connective tissue disease: which antibody?
speckled ANA (=anti-U1 RNP)
117
mixed connective tissue disease: features of which diseases?
SLE, SS, polymyositis
118
antiphospholipid syndrome: if secondary, to what?
SLE
119
can antiphospholipid syndrom be a primary disease?
yes
120
antiphospholipid syndrome: diagnosis based on what?
clinical criteria: 1) history of thrombosis (arterial or venous) OR 2) spontaneous abortion with lab findings of antiphospholipid antibodies
121
which are the antiphospholipid proteins?
lupus anticoagulant anti B2 glycoprotein I anticardiolipin
122
anticardiolipin is what kind of protein?
antiphospholipid
123
anti b2 glycoprotein is what kind of protein?
antiphospholipid
124
lupus anticoagulant is what kind of protein?
antiphospholipid
125
antiphospholipid syndrom: treatment?
systemic anticoagulation
126
history of thrombosis and lupus anticoagulant positive suggestive of?
antiphospholipd syndrome
127
history of spontaneous abortion and anticardiolipin positive suggestive of?
antiphospholipid synrome
128
what test can anticardiolipin influence?
syphilis test (VDRL/RPR) -> false positive
129
which test can lupus anticoagulant influence?
can cause prolonged PTT not correct by addition of normal platelet free plasma
130
polymyalgia rheumatica: symptoms?
pain and stiffness in proximal muscles (shoulders, hip) often with systemic symptoms (fever, malaise, weight loss)
131
does polymyalgia rheumatica cause muscle weakness?
no
132
what is polymyalgia rheumatica associated with?
giant cell (temporal) arteritis
133
polymyalgia rheumatica: most common in who?
females >50 y/o
134
woman 55 y/o, stiff and painful shoulders and hips. no weakness what is this suggestive of?
PMR
135
polymyalgia rheumatica: lab values?
elevated ESR and CRP normal CK
136
polymyalgia rheumatica: creatinine kinase elevated?
no
137
polymyalgia rheumatica: treatment?
low dose glucocorticosteroids
138
polymyalgia rheumatica: how fast is the response to low dose corticosteroids?
fast
139
fibromyalgia: most common in who?
females 20-50 y/o
140
fibromyalgia: symptoms?
chronic, widespread musculoskeletal pain associated with 'tender points, stiffness, paresthesias, poor sleep, fatigue, cognitive disturbances 'fibro fog'
141
which rheumatic disease is associated with 'tender points'?
fibromyalgia
142
45 y/o woman with diffuse chronic pain in joints with tender points, poor sleep and fatigue suggestive of?
fibromyalgie
143
fibromyalgie: how are the inflammatory markers (ESR, CRP)?
normal
144
Fibromyalgia: treatment?
exercise, antidepressants (TCA), neuropathic pain agents (gabapentin)
145
what is gabapentin?
neuropathic pain agent used in fibromyalgia
146
what is a neuropathic pain agent used in fibromyalgia?
gabapentin
147
Polymyositis/dermatomyositis: nonspecific antibodies/lab values
ANA + elevated CK
148
polymyositis/dermatomyositis: specific antibodies
anti-Jo-1 (histidyl-tRNA synthetase) anti-SRP (signal recognition particle) anti-Mi-2 (helicase)
149
anti-Jo-1: antibody against?
histidyl-tRNA synthetase
150
anti-SRP: antibody against?
signal recognition particle
151
anti-Mi-2: antibody against?
helicase
152
anti-Jo-1: specific for which diseases?
polymyositis/dermatomyositis
153
anti-SRP: specific for what?
polymyositis/dermatomyositis
154
anti-Mi-2: specific for what?
polymyositis/dermatomyositis
155
Polymyositis: symptoms?
progressive symmetric proximal muscle weakness
156
polymyositis: symmetric or asymmetric?
symmetric
157
polymyositis: which muscles most often?
proximal muscles, most often shoulders
158
polymyositis: underlying pathology?
endomysial inflammation with CD8+ cells endomysium: surrounds each individual muscle fiber/cell
159
what is the endomysium?
the sheath surrounding each individual muscle fiber
160
polymyositis: weakness?
yes
161
person with progressive symmetrical weakness in shoulders no skin involvement suggestive of?
polymyositis
162
dermatomyositis: symptoms?
similar to polymyositis (progressive symmetric proximal muscle weakness) with skin involvement: - Gottron papules - facial erythema - shawl and face rash - mechanic's hands
163
dermatomyositis: dermatological symptoms?
- Gottron papules - facial erythema (eyelids) - face and shawl rash - mechanic's hands
164
what are gottron papules?
red, dry/flaky, bumps overlying the knuckles of the fingers pathognomic for dermatomyositis
165
how does the facial erythema in dermatomyositis commonly look?
heliotrope (violet) edema of the eyelids face and shawl edema
166
what color is heliotrope edema?
violet heliotrope edema of the eyelids often seen in dermatomyositis
167
what are 'mechanic's hands'?
thickening, cracked, irregular, 'dirty' skin of fingers due to hyperkeratosis often seen in dermatomyositis
168
dermatomyositis: pathology?
perimysial inflammation and atrophy with CD4+ cell involvement perimysium: sheet of connective tissue surrounding a bundle of muscle fibers
169
what cells are involved in polymyositis?
CD8+
170
what cells are involved in dermatomyositis?
CD4+
171
which sheet in a muscle is involved in polymyositis?
endomysium (surrounds individual muscle cell)
172
which sheet in a muscle is involved in dermatomyositis?
perimysium (surrounds bundle of muscle cells)
173
dermatomyositis gives increased risk of what other disease?
occult malignancy (can't find the primary tumor)
173
person with progressive, symmetric weakness of the shoulders and red bumps on joints of the fingers suggestive of?
dermatomyositis
174
myositis ossificans: what is this?
heterotopic ossification in skeletal muscle (e.g. quadriceps)
175
heterotopic: meaning?
in the wrong place
176
heterotopic ossification: what is this?
extraskeletal bone in muscle and soft tissue
177
myositis ossificans: associated with what?
blunt muscle trauma
178
myositis ossificans: presentation?
painful soft tissue mass
179
myositis ossificans: imaging?
eggshell calcification
180
myositis ossificans: histology?
metaplastic bone surrounding area of fibroplastic proliferation
181
myositis ossificans: benign or malignant?
benign
182
what may myositis ossificans be mistaken for?
osteosarcoma (myositis ossificans is benign)
183
person develops hard, painful mass in quadriceps after blunt trauma imaging: eggshell calcification near femur what benign condition can this be?
myositis ossificans
184
RA: most commonly affected joints?
hands, wrists, and knees
185
osteoarthritis: most commonly affected joints?
hands, hips, and knees

Musculoskeletal system (17 decks)

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