Term
| what is juvenile idiopathic arthritis? |
|
Definition
| umbrella diagnosis for heterogeneous group of chronic arhtridities in kids <16, requires persistent objective arthrits for at least 6 weeks |
|
|
Term
| what are some objective signs of arthritis? |
|
Definition
| joint swelling, joint pain, loss of motion, joint warmth, joint erythema |
|
|
Term
| interleukin causing inflammation in JIA |
|
Definition
|
|
Term
| what contistutes polyarthritic JIA? What are the subtypes? |
|
Definition
| arthritis in 5+ joints, RF + and - |
|
|
Term
| characteristic of oligoarthritis JIA |
|
Definition
| arthr in 4 or less joints |
|
|
Term
|
Definition
| inflammation of where tendons or ligaments insert into bone |
|
|
Term
| 2 forms of oligoarthritis JIA and what distinguishes? |
|
Definition
persistent: affecting 4 or fewer joints throughout dz
extended: initially affect 4 or less joints in first 6 months, but go on to affect more |
|
|
Term
| what characterizes JIA systemic arthritis? |
|
Definition
arthritis with or preceded by daily fever for 3+days, with one or more of:
evanescent erythematous rash
lymphadenopathy
hepatomegaly/splenomegaly
serosis
must exclude infection or cancer |
|
|
Term
| what characterizes JIA psoriatic arthritis? |
|
Definition
arthritis and psoriasis, or arthritis with two of:
dactylitis
nail pitting or onycholysis
psoriasis in 1st deg relative |
|
|
Term
| what are the characteristics of enthesitis-related arthritis JIA? |
|
Definition
arthritis and enthesitis or enthesitis with 2 of:
SI joint pain or inflammatory lumbo sacral pain
HLA B27
onset after age 6 in males
acute anterior uveitis
Hx of HLA B27 assoc dz in 1st deg rel |
|
|
Term
| characteristics of undifferentiated arthritis JIA |
|
Definition
| fullfills more than 2 or none of other criteria |
|
|
Term
| of the types of JIA, which has the worse prognosis for clinical remission without meds? |
|
Definition
|
|
Term
| Of the types of JIA, which has the worst mortality? |
|
Definition
|
|
Term
| which JIA pts are at greatest risk for uveitis? |
|
Definition
oligoarticular JIA
females < 7yrs
ANA+ |
|
|
Term
| what are some JIA associated uveitis complications? |
|
Definition
| cataracts, glaucoma, band keratopathy, posterior synechiae, vision loss |
|
|
Term
|
Definition
| iris adheres to cornea or lens, due to scars in the eye that cause the pupil to be irregular, hold down the iris and keep it from dilating normally) |
|
|
Term
| systemic JIA is driven primarily by what two interleukins? |
|
Definition
|
|
Term
| child presenting with fever, adenopathy, rash, arthralgia, develop arthritis later |
|
Definition
|
|
Term
| 3 yowf, fever, rash, anemia, pernicious polyarthritis. Lymphadenopathy, hepatosplenomegaly, mphage activation syndrome, perimyocarditis |
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
| fully human, long acting IgG1 anti IL1beta |
|
|
Term
| polyarticular forms of JIA are all driven by what? |
|
Definition
|
|
Term
| what are two treatments for systemic JIA? |
|
Definition
|
|
Term
| treatments for polyarticular JIA |
|
Definition
| hydroxychloroquine, D-penicillamine, Auranofin, methotrexate, etanercept |
|
|
Term
| why doesn't methotrexate cause negative side effects in JIA pts like it does in cancer pts? |
|
Definition
|
|
Term
| 4yowf monoarticular involvement of left knee, onset insidious 1yr prior to MD intervention, progressive bone overgrowth, marked contracture formation, +ANA, significant limb length discrepency |
|
Definition
|
|
Term
|
Definition
| focused on involved joints and may be very localized with steroid injections or milder systemic therapy with NSAIDs |
|
|
Term
| which JIA group is at highest risk for uveitis? |
|
Definition
|
|
Term
| initial tx for oligoarticular subtype of JIA; what is effectiveness? |
|
Definition
| steroid injections; 82% full remission >6mos |
|
|
Term
| complications of steroid injections in JIA |
|
Definition
local fat atrophy
local skin depigmentation
post injection flare
systemic steroid effect
Ca deposits in needle tract |
|
|
Term
| you need to be worried about using steroids in which type of patients? |
|
Definition
| diabetic (can cause metabolic syndrome) |
|
|
Term
| what are the biologics used for polyarticular JIA? |
|
Definition
| etanercept, infliximab, abatacept, adalimumab |
|
|
Term
| biologics for systemic JIA |
|
Definition
| cyclosporine, anakinra, tocilizumab, canakinumab |
|
|
Term
| naproxin is what type of drug? |
|
Definition
|
|
Term
| most common inflammatory arthritis affecting the elderly |
|
Definition
|
|
Term
|
Definition
| group of diseases characterized by hyperuricemia and uric acid crystal formation |
|
|
Term
|
Definition
gouty arthritis
tophaceous gout
uric acid nephrolithiasis
gouty nephropathy |
|
|
Term
| patient has elevated uric acid; does he have gout? |
|
Definition
|
|
Term
| gout in women almost exclusively occurs in what population? |
|
Definition
|
|
Term
| what is the earliest stage of gout? |
|
Definition
| asymptomatic hyperuricemia |
|
|
Term
| do you treat asymptomatic hyperuricemia? |
|
Definition
| no, rarely progresses into gout |
|
|
Term
|
Definition
|
|
Term
|
Definition
| abrupt onset of severe joint inflammation, subsides completely in 3-10 days |
|
|
Term
| 75% of initial presentations of acute gouty arthritis affect what joint? |
|
Definition
|
|
Term
| when gout involves the big toe it is called what? |
|
Definition
|
|
Term
| what joints does gout not usually involve early on? |
|
Definition
| large axial joints and spine |
|
|
Term
|
Definition
|
|
Term
| when do you treat a pt with gout? |
|
Definition
|
|
Term
|
Definition
| monosodium urate being dumped into knee during intercritical period |
|
|
Term
| intercritical period of gout |
|
Definition
| patients have another attack after acute gouty arthritis (usually <2yrs) |
|
|
Term
| gout develops into what stage after intercritical gout? |
|
Definition
|
|
Term
|
Definition
short intercritical periods, often polyarticular attacks, may involve atypical sites such as spine or axial jnts
can occur as early as 3 yrs or 42 yrs after first attack |
|
|
Term
| diseases that can present with symmetrical small joint arthritis |
|
Definition
| gout, lupus, psoriatic arthritis, RA, parvovirus |
|
|
Term
| effectiveness of treating tophi surgically? |
|
Definition
| not very effective, can lead to infection |
|
|
Term
| do you need to treat tophi? |
|
Definition
| yes, tophi can form in heart valves creating CV problems |
|
|
Term
| does arthritis always procede tophi or renal lithiasis? |
|
Definition
|
|
Term
| what are heberden's nodes? what do they indicate? |
|
Definition
| swelling of DIPs; osteoarthritis |
|
|
Term
| what is the only test for gout? |
|
Definition
| joint aspirate, check under microscope for negative birefringent crystals |
|
|
Term
| what are some reversible causes of hyperuricemia? |
|
Definition
| obesity, hyperlipidemia, hypertension, atherosclerotic coronary artery disease, diabetes, EtOHism, diuretics. Also, fam hx of gout; renal insufficiency, nephrosclerosis, avascular necrosis of bone |
|
|
Term
|
Definition
|
|
Term
| 2 basic pathologies of gout |
|
Definition
| underexcretion or overproduction |
|
|
Term
| what can cause overproduction of urea? |
|
Definition
| EtOH, def of HGPRT or G6PD, superactive PRPP synthetase, myeloproliferative disorders, psoriasis, hemolytic anemias |
|
|
Term
| what alcoholic drink has an exceptional amount of purines? |
|
Definition
|
|
Term
| uricase breaks uric acid into what? |
|
Definition
|
|
Term
| enzyme that turns hypoxanthine into uric acid |
|
Definition
|
|
Term
|
Definition
| takes hypoxanthene and guanine back to inosinic acid and guanylic acid, respectively |
|
|
Term
| enzyme that catalyzes final conversion to uric acid |
|
Definition
|
|
Term
| what can cause underexcretion of uric acid? |
|
Definition
| dehydration, starvation, ketosis, renal abnormality, drugs (diuretics, low dose aspirin) toxins (ethanol, lead) hypothyroidism |
|
|
Term
| what factors influence the development of crystal formation from simple hyperuricemia? |
|
Definition
| joint damage, cool temps, plasma proteins, other solutes |
|
|
Term
| once crystals develop in hyperuricemic patient, what factors lead to inflammation? |
|
Definition
| protein coating crystals, flux in urate concentrations, trauma |
|
|
Term
| 3 common treatments for gout |
|
Definition
| colchicine, NSAIDs, corticosteroids |
|
|
Term
| when to use colchicine and how much? |
|
Definition
| use for acute attacks or prophylaxis, treat with 0.6mg |
|
|
Term
| what is the problem with giving colchicine for gout? |
|
Definition
| 80% of pts experience D+, abd pain, n+ and V+ before improvement. has narrowest benefit to tox ration of any of the gout drugs |
|
|
Term
| colchicine must be used cautiously in what pts? |
|
Definition
|
|
Term
| colchicine is contraindicated in what pts? |
|
Definition
|
|
Term
| most common drug to treat acute gout |
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
| when to use urate lowering therapy in gout? |
|
Definition
| recurrent gout attacks, arthropathy, tophi, radiographic changes of gout (joint degradation), >800mg of uric acid in a 24hr urine, nephrolithiasis, freq attacks |
|
|
Term
| what is the goal for urate lowering therapy? |
|
Definition
<6.0 mg/dL mean urate
no recurrences or fewer acute flares
less crystals in joints
reduction in tophus size
no recurrence of tophaceous deposits |
|
|
Term
| what is drug of choice for lowering urate in gout? |
|
Definition
|
|
Term
|
Definition
| increases secretion and inhibits resorption and post secretory resorption in kidney tubule |
|
|
Term
| class of drugs that increase excretion of uric acid |
|
Definition
|
|
Term
| side effects of probenecid |
|
Definition
| rashes, GI complaints, nephrotic syndrome |
|
|
Term
|
Definition
| triad of proteinurea, hypoalbuminemia, edema; indicative of kidney damage |
|
|
Term
| probenecid is contraindicated in what pts? |
|
Definition
|
|
Term
| probenecid is ineffective in what pts? |
|
Definition
| renal insufficiency or taking salicylates |
|
|
Term
| what gout drug targets xanthine oxidase? |
|
Definition
|
|
Term
|
Definition
| inhibit xanthine oxidase, build up of hypoxanthine and xanthine which are more soluble and can be excreted |
|
|
Term
| a patient with gout has kidney stones; what drug do you put him on? |
|
Definition
|
|
Term
| when antihyperuricemic agent is required, under what conditions would you use allopurinol? |
|
Definition
urate overproduction primary or secondary
acute uric acid nephropathy, tumor lysis syndrome
nephrolithiasis of any type
renal impairment |
|
|
Term
|
Definition
| a group of metabolic conditions that can occur after treatment for cancer caused by the breakdown of dying cells. These include hyperkalemia, hyperphosphatemia, hyperuricemia and hyperuricosuria, hypocalcemia, and consequent acute uric acid nephropathy and acute renal failure. |
|
|
Term
| typical dose of allopurinol |
|
Definition
|
|
Term
| side effects of allopurinol |
|
Definition
rash and fever (most common)
potentiates bone marrow suppression
increase anticoagulation effects of warfarin
fulminant hepatitis
interstitial nephritis, toxic epidermal necrolysis
allopurinol hypersensitivity rxn which MAY BE FATAL |
|
|
Term
| allopurinol hypersensitivity syndrome consists of |
|
Definition
| erythematous rash, fecer, hepatitis, eosinophilia, acute renal failure |
|
|
Term
| mortality in allopurinol hypersensitivity syndrome |
|
Definition
|
|
Term
| risk of death when taking allopurinol |
|
Definition
|
|
Term
|
Definition
| emerging xanthine oxidase inhibitor |
|
|
Term
| when would you use febuxostat over allopurinol? |
|
Definition
| pts with renal insufficiency |
|
|
Term
| difference in febuxostat and allopurinol AEs |
|
Definition
| febuxostat hasn't been shown to cause hypersensitivity rxn and is not hampered by renal insufficiency; no serious AEs reported in Febuxostat |
|
|
Term
| what is losartan and what is its effect on urate concentration? |
|
Definition
| it is an angiotensi II antagonist, used to treat Hi BP, also has mild uricosuric effect |
|
|
Term
| what is finofibrate used for? what is its effect on urate level? |
|
Definition
| used to lower cholesterol, also mild uricosuric agent |
|
|
Term
| two drugs that are mild uricosuric agents |
|
Definition
|
|
Term
| diet that helps to lower uric acid; who first proposed this? |
|
Definition
| low meat and seafood, high dairy products; John Locke |
|
|
Term
| drug used for pts with refractory or treatment failure gout in whom standard uric lowering therapy didn't work |
|
Definition
| peloticase (pegylated uricase) |
|
|
Term
|
Definition
| polyethylene glycol modified mammalian uricase: converts uric acid to allantoin |
|
|
Term
| drug approved for lowering urate in tumor lysis syndrome |
|
Definition
|
|
Term
| when must colchicine be administered to be effective in gout? |
|
Definition
|
|
Term
| before determining urate lowering therapy, what must you determine about the nature of the pt's gout? |
|
Definition
| underexcreter or overexcreter |
|
|
Term
| what are two basic types of joints? |
|
Definition
|
|
Term
| what are nonsynovial joints? |
|
Definition
mainly for structure (eg skull)
minimal movment
aka solid joints or synarthroses
fibrous tissue can bridge btw skeletal elements
eg cranial sutures or tooth to jaw |
|
|
Term
| what are examples of nonsynovial joints? |
|
Definition
| sternum, skull, pelvis, jaw/tooth |
|
|
Term
| what are synovial joints? |
|
Definition
joints that permit wide ROM
aka cavitated joints
lubricated by synovial fluid
bound by synovial membrane
|
|
|
Term
| what two things to chondrocytes in joints secrete to prevent the joint from wearing out? |
|
Definition
| proteases and protease inhibitors; continual turnover of cartilage (like bone) |
|
|
Term
| type B cells in synovial lining have what fxn |
|
Definition
|
|
Term
| type A cells in synovial lining have what fxn? |
|
Definition
|
|
Term
| key lubricant of synovial joints; by which cell is it made? |
|
Definition
| hyaluronic acid; made by B cells |
|
|
Term
| part of the joint capsule that contains blood vessels and is made from elastic fibers |
|
Definition
|
|
Term
| type of cartilage that forms articular surfaces |
|
Definition
|
|
Term
| hyaline cartilage is composed of what type of cartilage? |
|
Definition
|
|
Term
| synovium is lined by what cells? |
|
Definition
|
|
Term
| what is the normal consistancy of synovial fluid? |
|
Definition
|
|
Term
| test to assess synovial fluid viscosity |
|
Definition
| mucin clot test (add fluid to dilute acetic acid) |
|
|
Term
|
Definition
| a normal hyaluronic acid-protein complex; synovial fluid is normally very rich in |
|
|
Term
| how does inflammatory arthritis affect viscosity of synovial fluid? |
|
Definition
| viscosity is decreased; "rice bodies" on mucin clot test (no proper clot) |
|
|
Term
| another name for degenerative joint disease |
|
Definition
|
|
Term
| most common form of arthritis |
|
Definition
|
|
Term
| osteoarthritis primarily affects what pop? |
|
Definition
|
|
Term
deep pain, increasing with use during day
morning stiffness (<30min)
usually one or few joints involved
can be asymmetric joint involvement
crepitus
decreased ROM
spinal nerve root compression
|
|
Definition
|
|
Term
| xray changes in osteoarthritis |
|
Definition
| joint space narrowing, often asymmetric |
|
|
Term
| what is primary osteoarthritis? |
|
Definition
| idiopathic, happens with aging, symptoms starting in 50s |
|
|
Term
|
Definition
| due to trauma, obesity, limb deformity, may occur at younger age |
|
|
Term
| joints that osteoarthritis tends to involve |
|
Definition
| knee, hip, spine, hand DIP and PIP, base of thumb, 1st TMT |
|
|
Term
| early pathology of osteoarthritis |
|
Definition
chondrocyte damage (due to aging, biomech stress, genetic, biochemic factors)
chondrocyte proliferation
release of inflammatory mediators, proteases
cartilage proteoglycan and collagen degraded
cartilage matrix weakened |
|
|
Term
| what is cartilage fibrilation? what pathology is it consistant with? |
|
Definition
| superficial clefting, softening of cartilage; part of osteoarthritis pathology |
|
|
Term
| fibrillation in osteoarthritis can lead to what additional pathology? |
|
Definition
| loose bodies/ "joint mice" which are broken off pieces of cartilage in the joint space |
|
|
Term
| what can happen after enough joint fibrillation? |
|
Definition
| subchondral bone exposure and eburnation (smooth bone surfaces, bone grinding on bone) |
|
|
Term
|
Definition
| smooth bone surfaces in joint, bone grinding on bone |
|
|
Term
| after joint bones are exposed to eburnation, what can develop in osteoarthritis? |
|
Definition
| subchondral syst formation from fluid entry into small fractures |
|
|
Term
| subchondral cyst formation is pathology for what joint disease? |
|
Definition
|
|
Term
| after subchondral cysts develop, what is an additional complication of osteoarthritis? |
|
Definition
| osteophytes arise at margins of articular surfaces |
|
|
Term
| osteophytes developing at DIP joint are called |
|
Definition
|
|
Term
| osteophytes developing at PIP joint are called |
|
Definition
|
|
Term
|
Definition
| layman's term for any of various conditions characterized by inflammation or pain in muscles, joints, or fibrous tissue |
|
|
Term
|
Definition
| of or relating to characteristsics of, or affected with rheumatism (eg rhematic pain, a rheumatic joint, rheumatic fever, rheumatic heart disease, systemic rheumatic diseases) |
|
|
Term
| typical onset for RA, who does it affect more? |
|
Definition
| 3rd and 4th decades, girls>boys |
|
|
Term
| malaise, fatigue, musculoskeletal pain, hand joints symmetric swelling (metacarpophalangeals, PIPs) |
|
Definition
|
|
Term
| joints RA tends to affect |
|
Definition
| feet, wrists, ankles elbows, knees |
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
| skin manifestations of RA |
|
Definition
| subcutaneous rheumatoid nodules |
|
|
Term
|
Definition
| inflammation of tendon sheath |
|
|
Term
|
Definition
| RA nodules can develop there |
|
|
Term
| how can RA affect arteries? |
|
Definition
|
|
Term
| diagnostic criteria for RA |
|
Definition
4 of these:
1.morning stiffness (at least 1hr)
2. arthritis of three or more joints
3. arthritis of hand joints (at least 1 swollen joint)
4. Symmetrical arthritis
5. Rheumatoid nodules
6. serum RF
7. radiographic erosion |
|
|
Term
| what disease is caused by antibody to Fc portion of IgG? |
|
Definition
|
|
Term
| what is ACPA? what disease is it a marker for? |
|
Definition
Anti-cyclic citrullinated peptide IgG antibody
highly specific marker for RA |
|
|
Term
| what serum marker for RA involves an argine to citrulline post translational change? |
|
Definition
|
|
Term
| what HLA is implicated in ACPA? |
|
Definition
|
|
Term
| HLA DRB1 allele is implicated in what disease/abnormality? |
|
Definition
|
|
Term
| inflammatory mediators involved in RA |
|
Definition
|
|
Term
| pathologic change to synovial lining in RA |
|
Definition
| develop fronds (undulating surface) |
|
|
Term
|
Definition
vacular proliferation
hemosiderin, fibrin deposition
neutrophil infiltrate in synovial surface and fluid |
|
|
Term
|
Definition
activation of osteoclasts in bone
allows synovium to penetrate bone
contributes to juxta-articular erosion
contributes to osteoporosis
contributes to subchondral cysts |
|
|
Term
| swan-neck deformity in hands is from what disease? |
|
Definition
|
|
Term
| mass of inflamed abnormal synovium that drapes over and causes degradation of cartilage surface |
|
Definition
|
|
Term
| potential complication of pannus formation in RA |
|
Definition
| bridge 2 surfaces causing ankyulosis |
|
|
Term
| late stage deformities in RA |
|
Definition
ulnar deviation
juxta-articular bone loss
contractures |
|
|
Term
| which is oligoarthritis more common in, JIA or RA? |
|
Definition
|
|
Term
| seronegative spondyloarthropathies |
|
Definition
develop in genetically predisposed individuals
associateed with HLA B27
abscence of autoantibodies
triggered by T cell response, often initiated by infection |
|
|
Term
| ankylosing spondylitis is associated with what genetic abnormality? |
|
Definition
|
|
Term
| ankylosing spondylitis is aka what other names? |
|
Definition
rheumatoid spondylitis
Mari Strumpell disease |
|
|
Term
|
Definition
arthritis, urethritis, conjunctivitis
HLA B27, men in 20s 30s
autommune rxn post infection
symmetric ankles knees, feet |
|
|
Term
|
Definition
affects psoriatic population
30-50
DIP, axial joints, entheses |
|
|
Term
| arthritis can be associated with what chronic GI disease? |
|
Definition
IBD
most pts HLA B27+
pathology similar to RA
in UC, colectomy relieves arthritis |
|
|
Term
| joint pain, sudden swelling, fever is likely what? |
|
Definition
|
|
Term
| most common organisms to cause infectious arthritis |
|
Definition
| gonococcus, staph, strep, H. influenza, E. coli, pseudomonas, salmonella |
|
|
Term
| predisposing factors to infectious arthritis |
|
Definition
| chronic arthritis (RA, gout), salmonella, hemophilia, AIDs, IV drug use |
|
|
Term
| infection that causes granulomatous inflammation, central caseous necrosis, palisading histiocytes |
|
Definition
|
|
Term
|
Definition
| extrapulmonary manifestations of TB, typically in thoracic and lumbar vertebrae |
|
|
Term
| accumulation of calcium phosphate crystals in joints |
|
Definition
|
|
Term
| weakly positive birefringent crystals |
|
Definition
|
|
Term
|
Definition
| small cyst, can be at joint capsule, arises from degradation of connective tissue |
|
|
Term
|
Definition
| from herniation of synovium through joint capsule (or enlargement of bursa), eg baker cyst of knee |
|
|
Term
| tenosynovial giant cell tumor |
|
Definition
| benign tumor, treated by surgical excision |
|
|
Term
|
Definition
| malignant, 30% 10yr survival |
|
|
Term
| when, during the course of RA, does most damage/disability occur? |
|
Definition
| during first few years after disease onset |
|
|
Term
A 49-year-old third-grade schoolteacher presents with a history of onset of marked stiffness. About 8 months ago she began to notice marked morning stiffness and visible swelling in her wrists and the proximal interphalangeal joints of both hand.
Laboratory studies:
Hemoglobin10.5 g/dl
Hematocrit35%
Leukocyte count6800/uL
Differential normal
Erythrocyte sedimentation rate30 mm/h
Repeat ESR (2mos ago)45 mm/h
Urinalysis normal
Latex fixation testnegative
Serum antinuclear antibody testnegative
|
|
Definition
|
|
Term
| what causes premature death in RA pts? |
|
Definition
| coronary artery disease complications |
|
|
Term
| acute onset of insidious pain, stiffness, symmetrical swelling of small joints in middle age woman |
|
Definition
|
|
Term
| rheumatic disorders that can have positive RF serum |
|
Definition
RA
Sjogren's syndrome
mixed CT disease
Mixed cryoglobinemia
systemic lupus erythematosus
polymyositis/dermomyositis |
|
|
Term
| non rheumatic disorders that can have positive RF |
|
Definition
infection
inflammatory or fibrosing pulmonary disorders (sarcoidosis)
malignancy
primary biliary cirrhosis |
|
|
Term
| what are risk factors for progressive RA? |
|
Definition
RF +
RA nodules
young female
slow onset with symmetrical upper extr
systemic dz
thrombocytosis
circulating immune complexes
radiographic detection of erosions
HLA DR4, Dw4, Dw14
persistantly elevated acute phase reactant
loss of fxn |
|
|
Term
|
Definition
no fatigue
morning stiffness <15min
no joint pain
no joint tenderness or pain on motion
no soft tissue swelling in joints or tendon sheath
ESR <30 in women (20 in men) |
|
|
Term
|
Definition
|
|
Term
|
Definition
| block cyclooxygenase, can't make prostaglandins |
|
|
Term
|
Definition
dyspepsia
GIbleeding
renal insufficiency
confusion/depression
rash
HA
retarded clotting time
NSAID sensitivity |
|
|
Term
| limitation of NSAIDs in RA |
|
Definition
| do not prevent joint damage |
|
|
Term
| what pts are at most risk for AEs from NSAIDs? |
|
Definition
|
|
Term
| advantage of COX2 inhibitors in arthritis pts |
|
Definition
| decrease incidence of gastroduodenal ulcers |
|
|
Term
| are COX2 inhibitors disease modifying drugs? |
|
Definition
|
|
Term
| most effective disease modifying agent in RA |
|
Definition
|
|
Term
| potential AEs from methotrexate for RA |
|
Definition
rheumatoid nodules
mucositis
GI intolerance
bone marrow suppression
pulmonary interstitial inflammation
liver disease |
|
|
Term
| how long does it take for methotrexate to work in RA pts? |
|
Definition
|
|
Term
| until methotrexate starts working, what drug should you use in the meantime for RA? |
|
Definition
|
|
Term
| time it takes for glucocorticoids to work in RA pts? |
|
Definition
|
|
Term
| glucocorticoid toxicities |
|
Definition
HTN
hyperglycemia
osteoporosis
cataracts
weight gain |
|
|
Term
| MOA of leflunomide (Arava) |
|
Definition
| pyrimidine synthesis inhibitor, anti-proliferative and anti-inflammatory activity; blocks T cell clonal expansion |
|
|
Term
| what is major AE of leflunomide? |
|
Definition
| terribly teratogenic, must stop 2yrs prior to pregancy |
|
|
Term
| 2 forms of TNF antagonists in RA biologics |
|
Definition
MABs which inhibit TNF/TNFR interactions by sequestering TNF from cells
soluble TNF receptor: competes with endogenous TNF receptors to block TNF signaling |
|
|
Term
|
Definition
|
|
Term
| inflixamab (remicade) MOA |
|
Definition
| MAB that inhibits TNF-TNFR interactions by sequestering TNF from cells |
|
|
Term
| MABs that inhibit TNF alpha |
|
Definition
infliximab (Remicade)
Adalimumab (humira)
Certolizumab
Golimumab |
|
|
Term
|
Definition
|
|
Term
|
Definition
| b cell depleting monoclonal CD20 antibody (B cells involved in RA) |
|
|
Term
|
Definition
| selective co-stimulation modulator (modulates T cell activity in RA) |
|
|
Term
| definition of acute arthritis |
|
Definition
sudden onset of inflammation of the joint causing:
severe joint pain
swelling
warmth
redness
decreased ROM |
|
|
Term
|
Definition
| inflammation in 1 joint, occasionally polyarticular diseases can present with monoarticular onset |
|
|
Term
| DDx for acute monoarthritis |
|
Definition
septic joint
crystal deposition
inflammatory
hemoarthrosis |
|
|
Term
| most useful diagnostic study in initial evaluation of monoarthritis |
|
Definition
|
|
Term
| what can synovial fluid analysis help determine? |
|
Definition
infection
crystal-induced arthritis
hemarthrosis
inflammatory vs noninflammatory arthritis |
|
|
Term
| in gonococcal infections, what precedes monoarticular infection? |
|
Definition
| 5-7 days fever and skin lesions |
|
|
Term
| disseminated gonococcal skin findings |
|
Definition
|
|
Term
|
Definition
| vasopressive disorder causing discoloration of fingers and toes. can be idiopathic or from SLE |
|
|
Term
| migratory patterns in polyarthritis; what can cause this? |
|
Definition
| Rheumatic fever, gonococcal (disseminated gonococcemia), early phase of Lyme disease |
|
|
Term
| what can cause addititive pattern of polyarthritis? |
|
Definition
|
|
Term
| what can cause intermitttent pattern of polyarthritis? |
|
Definition
|
|
Term
| what can cause symmetric polyarthritis? |
|
Definition
| RA, viral, SLE, one subtype of psoriatic |
|
|
Term
| what can cause asymmetric, oligo and polyarthritis? |
|
Definition
| reactive arthritis, one type or psoriatic, enteropathic arthritis |
|
|
Term
| what form of arthritis tends to involve DIP joints? |
|
Definition
|
|
Term
| prognosis of viral arthritis? |
|
Definition
|
|
Term
| children with "slapped cheek" appearance; adults with flu-like illness, joints more involved in adults. acute onset symmetric polyarthralgia or polyarthritis with stiffness. Persists a few weeks to months |
|
Definition
|
|
Term
aka German measles, present in young women exposed to school-age children with infection. arthritis in 1/3 of natural infections, also following vaccination.
morbilliform rash, constitutional symptoms. symmetric inflammatory arthritis (small and large joints) |
|
Definition
|
|
Term
| rash between phylangeal joints |
|
Definition
|
|
Term
| hair follicles are rooted in which layer of the skin? |
|
Definition
|
|
Term
| benign epidermal neoplasms |
|
Definition
seborrheic keratosis
verruca
skin tag |
|
|
Term
| grey, black, or brown skin morphology with warty surface, but can be smooth. Have a "stuck on" appearance" |
|
Definition
|
|
Term
| histopathology of skin biopsy shows hyperkeratosis, papillomatosis, epidermal hyperplasia, even bottom with no filtration |
|
Definition
|
|
Term
| histopathology of skin biopsy reveals smooth border with no hyperkeratosis, no papillomatosis. Epidermal hyperplasia present with horn cysts |
|
Definition
|
|
Term
| horn cysts are composed of what and are indicative of what pathology? |
|
Definition
| laminated rings of keratin due to epidermis proliferation to produce hyperplasia. indicative of seborrheic keratosis |
|
|
Term
| verruca is another name for |
|
Definition
|
|
Term
|
Definition
|
|
Term
| skin biopsy with hyperkeratosis, papillomatosis, epidermal hyperplasia, and koilocytes |
|
Definition
|
|
Term
| fibroepithelial polyps or acrochordons are other names for what? |
|
Definition
|
|
Term
| skin tags are associated with what comorbidities |
|
Definition
|
|
Term
| risk of skin tags developing malignancy |
|
Definition
|
|
Term
|
Definition
also known as solar keratosis
induced by UV
light skinned at risk
chronically sun exposed
this is only premalignant epidermal neoplasm |
|
|
Term
| on the dorsal surface of the hand of an older farmer you see rough scaly red macules or patches. what do you suspect? |
|
Definition
| actinic (solar) keratosis |
|
|
Term
| red scaly patch on the lower lip |
|
Definition
| actinic cheilitis (actinic keratosis on the lip) |
|
|
Term
| histology of , skin biopsy shows crowded, atypical basal cells with large, hyperchromatic cells |
|
Definition
|
|
Term
|
Definition
| nuclei are present in the stratum corneum (in contrast to normal keratinization in which nuclei are lost, indicates rapid proliferation); actinic keratosis |
|
|
Term
| malignant epidermal neoplasms |
|
Definition
squamous cell carcinoma in situ
invasive squamous cell carcinoma
basal cell carcinoma |
|
|
Term
| skin carcinoma usually induced by UV light, rarely by HPV; red and scaly patch or thin placque |
|
Definition
| squamous cell carcinoma in situ |
|
|
Term
| another name for squamous cell carcinoma in situ |
|
Definition
|
|
Term
| histopath of skin biopsy reveals very blue epiderm with high N:C ratio of keratinocytes. no polarity to epidermis; rarely invades |
|
Definition
|
|
Term
|
Definition
exophytic and endophytic, forms dome like scaly nodule
lobules of atypical epidermal cells pushing into dermis |
|
|
Term
| atypical epithelial cells with horn pearls that proliferate downward |
|
Definition
|
|
Term
| most common type of skin cancer |
|
Definition
|
|
Term
| scaly red patch of skin but nothing clears it up |
|
Definition
|
|
Term
| budding of basal cells with high N:C ration and peripheral palisading |
|
Definition
|
|
Term
| pearly telangiectatic papule that often ulcerates, continues to grow if untreated but rarely metastasizes |
|
Definition
|
|
Term
| buds of expanding basal papules that infiltrate into the dermis. islands of basal cells retract leaving empty clefts as artifacts |
|
Definition
|
|
Term
| smaller islands and strands of basaloid cells that move past dermis. |
|
Definition
| infiltrative BCC, needst to be cut away |
|
|
Term
| difference in treatment btw nodular and infiltrating basal cell carcinoma |
|
Definition
| nodular can just be scraped off, infiltrating needs to be cut out |
|
|
Term
| hyperkeratosis reflects what clinical finding? |
|
Definition
|
|
Term
| is a melanocytic nevus benign or malignant? |
|
Definition
|
|
Term
| brown/black flat small macules with smooth border |
|
Definition
|
|
Term
| hist shows proliferation of single and nested melanocytes at the junction |
|
Definition
|
|
Term
| histo shows multiple nests of melanocytes at the tips of epidermal rete, increased melanin taken up by mphages |
|
Definition
|
|
Term
| smooth brown papule of elevated skin; histo shows nests in epidermis and dermis |
|
Definition
|
|
Term
| color of nevus is gone but nevus is still elevated. can be confudes with BCC or skin tag |
|
Definition
|
|
Term
| hist shows nests of melanocytes confined to dermis, melanocytes less pigmented with descent ito dermis |
|
Definition
|
|
Term
| risk factors for melanoma |
|
Definition
total # of benign nevi
presence and number of abnormal (dysplastic nevi)
history of sunburns
family history of melanoma
personal hx of melanoma
fair skin blue eyes
tanning bed use |
|
|
Term
| larger, asymmetric macule with irregular borders |
|
Definition
|
|
Term
| most common type of melanoma in US |
|
Definition
| Lentigo melanoma (melanoma in situ), common in chronically photo-exposed skin of elderly |
|
|
Term
| which cheek is more likely to get skin cancer on typical american? |
|
Definition
|
|
Term
| histo: abnormal melanocytes limited to epidermis but through all layers of epi (not just junctional); melanocytes surrounded by vacuolated cytoplasm, hyperchromatic, variable sizes, all levels of epidermis, single and focally grouped |
|
Definition
|
|
Term
| sheets of atypical melanocytes in dermis |
|
Definition
|
|
Term
| what is dermatitis and what are the types of etiologies? |
|
Definition
inflammation of epidermis and papillary dermis;
immune, toxic, idiopathic |
|
|
Term
|
Definition
|
|
Term
|
Definition
| perivascular lymphatic infiltrate |
|
|
Term
| skin histology that shows spongiosis and exocytosis |
|
Definition
|
|
Term
| skin histo shows less spongiosis; parakeratosis, epidermal hyperplasia, lymphocytes |
|
Definition
|
|
Term
| skin histo: no spongiosis, parakeratosis, marked epidermal hyperplasia, thick papillary dermis, lymph infiltrate |
|
Definition
|
|
Term
| allergic contact dermatitis is what type of hypersensitivity rxn? |
|
Definition
|
|
Term
| erythema, vesicles of variable size, arranged linearly |
|
Definition
|
|
Term
| atopic dermatitis can be associated with a deficiency of what protein? |
|
Definition
|
|
Term
|
Definition
| dz of neonates or adults, occurs in distribution of greatest sebum production (head, upper trunk), stimulated by androgens (basically this is acne) |
|
|
Term
| interleukins involved in psoriasis |
|
Definition
|
|
Term
skin histo: diffuse parakeratosis, regular epidermal hyperplasia of the rete, epidermis btw the rete is thinned, loss of granular layer, papillary dermis is edematous, capillaries are dilated/tortuous
loss of granular layer, + neutrophils |
|
Definition
|
|
Term
A 34-y.o. male archaeologist presents with high fever, malaise, intense headache, severe myalgia and painful swelling in the axillary region. He recently returned from a trip to NM and AZ. He has an insect bite on his right upper arm. His lymph nodes are enlarged and tender. Numerous organisms are seen in the suppurative lymph tissue.
|
|
Definition
|
|
Term
| giemsa stain reveals bacteria with "safety pin" bipolar appearance |
|
Definition
|
|
Term
| y. pestis is part of what bacteria family? |
|
Definition
|
|
Term
|
Definition
|
|
Term
| what factor determines y. pestis virulence factor expression? |
|
Definition
|
|
Term
| 1st plasmid for y. pestis |
|
Definition
| plasminogen activator protease (interferes with host defense; coagulase activity) |
|
|
Term
| 2nd plasmid for y. pestis |
|
Definition
| F1 capsule antigen and murine toxin (anti-phag) |
|
|
Term
| 3rd plasmid for y. pestis |
|
Definition
| genes for adherence, regulation, etc |
|
|
Term
| most genes for y. pestis are expressed at what temp? what is the temp of its vecor? |
|
Definition
| optimal at 37d C. Flea is 25dC |
|
|
Term
| sylvatic plague is endemic in what species? |
|
Definition
|
|
Term
| contraction of plague from prairie dogs is what kind of plague? |
|
Definition
|
|
Term
|
Definition
| enlarged, tender, infected lymph node |
|
|
Term
| which kinds of plague are transmissible from humans to humans? |
|
Definition
|
|
Term
| 2 ways someone can get pneumonic form of plague |
|
Definition
hematogenous spread to lungs
or from aerosolization from other infected individual |
|
|
Term
| which kind of y. pestis infection develops dark skin patches late in its course? |
|
Definition
|
|
Term
| what is the best way to eliminate urban plague? |
|
Definition
| effective control of rats |
|
|
Term
| how is franciscella tularensis transmitted? |
|
Definition
| by ticks or by direct contact with infected animal |
|
|
Term
| minimum infectious dose of Franciscella tularensis |
|
Definition
|
|
Term
| most common manifestation of franciscella tularensis |
|
Definition
| ulceroglandular: local lesion and spread to draining lymph nodes |
|
|
Term
| franciscella tularensis: gram and shape? |
|
Definition
|
|
Term
| most common vector borne dz in US |
|
Definition
|
|
Term
|
Definition
| Ixodes scapularis, I. pacificus |
|
|
Term
| vectors for rocky mnt spotted fever |
|
Definition
| dermacentor variabilis, D. andersonii (dog tick and wood tick) |
|
|
Term
| bulls eye rash indicates what agent and what stage of infection? |
|
Definition
|
|
Term
| incubation period for lyme dz |
|
Definition
|
|
Term
| results of blood tests in patients with bull's eye rash |
|
Definition
|
|
Term
| tx for borrelia burgdorferi |
|
Definition
|
|
Term
| how to confirm dx of lyme dz |
|
Definition
|
|
Term
11 y.o. girl
Good health until developed fever of several days duration
No localizing symptoms except for large annular rash
Hx:Summer vacation in CT
Rode horses and walked in woods
|
|
Definition
|
|
Term
| infective agent for spotted fever and typhus group |
|
Definition
|
|
Term
| vectors for spotted fever |
|
Definition
|
|
Term
| presentation of rickettsia |
|
Definition
|
|
Term
| infective agent for Q fever |
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
| pneumonitis, rash is rare |
|
|
Term
| dz caused by ehrlichia/anaplasma |
|
Definition
|
|
Term
| presentation of ehrlichiosis |
|
Definition
| HA, fever, rash in 20-35% |
|
|
Term
| what is characteristic of Rickettsia, coxiella, and ehrlichia/anaplasma? |
|
Definition
| obligate intracellular (can't culture) |
|
|
Term
| of rickettsia, ehrlichia, coxiella, which evades the host by escaping from the phagosome? |
|
Definition
|
|
Term
| of rickettsia, ehrlichia, coxiella, which evades the host by inhibition of phagosome-lysosome fusion? |
|
Definition
|
|
Term
| of rickettsia, ehrlichia, coxiella, which evades the host by surviving inside the fused phagosome-lysosome? |
|
Definition
|
|
Term
| in RMSF, what is the vector, what is the reservoir? |
|
Definition
| tick is both (dog tick in east, wood tick in west) |
|
|
Term
Spots begin as flat (macular) red (erythematous) patches that may bleed into the skin, causing purplish spots (purpura). Rash starts most often on the ankles and wrists, and then moves from the extremities to the trunk. As the rash progresses, it becomes bumpier.
what is this dz? |
|
Definition
|
|
Term
|
Definition
|
|
Term
A 24 y.o. male, brought to ER after auto accident.
Compound fracture of left tibia and fibula.
Surgery within 6 hours of accident. Wound debrided, leg immobilized, therapy begun.
Four days post surgery, low grade fever, tachycardic, painful left leg, sense of impending doom.
Open cast.
Entire lower leg swollen, reddish brown, and exuding foul smelling discharge.
Palpable crepitations.
Unstable, dropping blood pressure.
Gram stain of aspirate demonstrated gram-positive rods.
Start IV penicillin; perform above knee amputation; patient recovers. |
|
Definition
|
|
Term
| c. perfringens gram, shape, characteristics? |
|
Definition
| gram +, spore forming, anaerobic rod |
|
|
Term
| most significant virulence of C. perfringens |
|
Definition
| alpha toxin/phospholipase C |
|
|
Term
| what does phospholipase C do? what bacteria produces it? |
|
Definition
| attacks cell membranes, C. perfringens |
|
|
Term
| C. perfringens is etiologic agent of what disease morphologies? |
|
Definition
| anaerobic cellulitis and gas gangrene |
|
|
Term
| what are some other organisms that can be present in C perf infections? |
|
Definition
| C. histolyticum, C. novyi, C. septicum |
|
|
Term
| infected wound becomes bronze, then purplish red; tense and tender with overlying bullae. crepitus is present along with severe pain at site of infection. sepsis signs develop quickly. Radiographs reveal subcu gas. What is the organism and what the treatment? |
|
Definition
| C. perf; aggressive surgical debridement, antibiotics, consider hyperbaric o2 therapy |
|
|
Term
|
Definition
|
|
Term
A 35-year-old farmer presents for evaluation of a growth on his arm. He also has a low grade fever. He has cows, horses, goats, sheep and chickens on his South African farm. On examination, you find the lesion with black eschar.
He has tender, enlarged axillary lymph nodes.
A gram stain of biopsy from eschar shows gram-positive bacilli.
What is your diagnosis?
|
|
Definition
|
|
Term
| bacillus anthracis, gram and shape and metabolism |
|
Definition
| gram +, spore forming rod, aerobic metabolism |
|
|
Term
| virulence factors for B. anthracis |
|
Definition
D glutamic acid (antiphagocytic, weakly antigenic; not polysaccharide but protein)
PA= protective antigen, binds to receptors on cell surface
LF= lethal factor (metalloprotease)
EF = edema factor (adenyl cyclase) |
|
|
Term
| how do PA, LF, and EF function in B. anthracis to produce disease? |
|
Definition
| PA acts as B subunit and binds host cell membrane, LF or EF is endocytosed and causes disease |
|
|
Term
| transmission routes of b. anthracis |
|
Definition
cutaneous, inhalation, visceral
growth in soil and in mammals; transmission is via contaminated soil, water, animal carcasses, and hides |
|
|
Term
| most serious form of b anthracis |
|
Definition
|
|
Term
| how to prevent contracting b. anthracis? |
|
Definition
| vaccinate to control disease in livestock, use Sterne strain (live attenuated) |
|
|
Term
| human vaccine for b. anthracis |
|
Definition
| a cellular culture supernatants containing PA |
|
|
Term
| drug to treat b. anthracis |
|
Definition
| ciprofloxacin or doxycycline |
|
|
