1A: Dt 8-3

Front 1

Seronegative spondyloartrhopathies:
What is it?
Examples?

Back 1

Arthritis without rheumatoid factor (anti-IgG antibody)

Strong association with HLA-B27

PAIR:
Psoriatic arthritis
Ankylosing spondylitis
Inflammatory bowel dz
Reactive arthritis (Reiter's; can't see, can't pee, can't climb a tree)

Front 2

Ankylosing spondylitis:
Pathophys
Diagnostics
Presentation

Back 2

Chronic inflammatory dz of spine, sacroiliac joints-->ankylosis (stiff spine due to fusion of joints), uveitis, aortic regurgitation

Stiffness that is relieved with activity

x-ray: bamboo spine

Front 3

Reiter's Arthritis:
Presentation

Back 3

Conjunctivitis, anterior uveitis
Urethritis
Arthritis

ASSOCIATED WITH POST-GI or chlamydia infections

Front 4

Back 4

Lupus GN--wire-loop thickening occurs as result of immune complex deposition

Front 5

Lupus:
Lab tests
Complement levels

Back 5

Antinuclear antibodies (not specific), but good for ruling out

Anti-dsDNA--very specific, poor prognosis

Anti-Smith--very specific, not prognostic

Antihistone--drug-induced lupus

Dec'd C3/C4

Front 6

Sarcoidosis:
Pathophys
Presentation

Back 6

Immune-mediated widespread NONCASEATING GRANULOMAS, elevated ACE

B/L hilar LAD
Gammaglobulinemia
Rheumatoid arthritis
ACE increase
Interstitial fibrosis
Noncaseating granulomas
(GRAIN)

Hypercalcemia too!

Front 7

Polymyalgia Rheumatica:
Presentation
Risks
Labs

Back 7

Pain and stiffness in shoulders, hips
Fever, malaise

Associated with temporal arteritis!

Elevated ESR, NORMAL CK (no muscle dz)

Front 8

Dermatomyositis vs Polymyositis:
Presentation
Labs

Back 8

Polymyositis--symmetric proximal weakness caused by CD8+ cell injury to myofibers. Most often involves shoulders. Perifascicular inflammn is diagnostic.

Dermatomyositis--similar to polymyositis, but also involves malar rash, heliotrope rash, inc'd risk of malignancy!

Labs are the same: elevated CK, positive ANA, anti-Jo-1

Front 9

Lambert-Eaton syndrome:
Pathophys
Associations

Back 9

Autoab's to presynaptic Ca2+ channels-->dec'd ACh release-->proximal muscle weakness

Syx improve with muscle use; no eversal of syx w/AChE-i (opposite of myasthenia gravis)

Assocd w/small cell lung ca.

Front 10

Scleroderma:
Pathophys
Presentation
Diffuse vs CREST

Back 10

Excessive fibrosis and collagen deposition throughout body

Commonly sclerosis of skin, manifesting as puffy, and taut skin w/absence of wrinkles. Also in renal, pulm, cv, and GI systems.

Diffuse: widespread involvement of skin, rapid progression, Anti-Scl-70 Ab

CREST:
Calcinosis
Raynaud's
Esophageal dysmotility
Sclerodactyly
Telangiectasia

Limited skin vinvolvement, often confined to skin on fingers and face. Anti-Centromere antibody (C for CREST)

Front 11

Back 11

Tight skin-->scleroderma

Front 12

Back 12

b/l hilar LAD-->sarcoidosis

Front 13

A patient has difficulty swallowing, distal cyanosis in cold temperatures, and anti-centromere antibodies.

What else would you expect to see in this patient?

Back 13

Calcinosis
Sclerodactly
Telangiectasias

Front 14

A patient presents with photosensitivity, arthritis, renal disease, and recurrent oral ulcers is taking primaquine and NSAIDs.

What type of check-up should she receive twice a year?

Back 14

Lupus! Must check for renal dz-->proteinuria, serum Cr level, Anti-dsDNA

Front 15

A 30 year-old woman presents with low grade fever, a rash across her nose that gets worse when she is out in the sun, and widespread edema.

What blood test would you order to confirm your clinical suspicion?

Back 15

ANA to screen

Front 16

A 75 year-old man presents with acute knee pain and swelling. An x-ray reveals absence of erosion of the joint space and calcium deposits in the menisci.

What is the diagnosis and what would you find on aspiration of the joint?

Back 16

Pseudogout-->calcium pyrophosphate crystals

Front 17

What drugs cause a lupus-like syndrome?

Back 17

SHIPP
Sulfasalazine
Hydralazine
Isoniazid
Procainamide
Phenytoin

Front 18

Dermatologic term:
Flat discoloration <1 cm, >1cm

Back 18

<1 cm = macule
>1 cm = patch

Front 19

Dermatologic term:
Elevated skin lesion <1cm, >1cm

Back 19

<1cm = papule
>1cm = plaque

Front 20

What is a keloid?

Back 20

Irregular, raised lesion resulting from scar tissue hypertrophy (follows trauma to skin, esp. in African-Americans)

Front 21

Allergic contact dermatitis:
Hypersens type

Back 21

IV

Front 22

Psoriasis:
Hypersens type
Presentation

Back 22

Type IV rxn

Papules and plaques with silvery scales, bleed when scraed off.

Associated with nail pitting and psoriatic arthritis.

Front 23

Seborrheic keratosis:
Presentation

Back 23

Flat, greasy, pigmented squamous epithelial proliferation w/keratin-filled cysts (horn cysts). Looks "pasted on".

Occur on head, trunk, extremities. Common benign neoplasm of older persons.

Front 24

Acne:
Pathophys
Treatment

Back 24

Hyperkeratosis--tx w/ Retinoic Acid (vitamin A analog), isotretinoin

Sebum overproduction--tx w/isotretinoin, sprinolactone, OCPs

Propionibacterium acnes proliferation--Tx: Erythromycin, Tetracycline, topical clindamycin, benzoyl peroxide

Inflammation--Tx with injected steroids (acute only!)

Front 25

Impetigo:
Pathophys
Presentation

Back 25

Superficial skin infection with Staph aureus OR Strep pyogenes

HONEY COLORED CRUST
HIGHLY CONTAGIOUS

Front 26

Pemphigus vulgaris:
Pathophys
Presentation

Back 26

IgG Abs x Desmosomes (Desmoglein)--connect cell to cells

Acantholysis; separatin of epidermis upon stroking of skin

Front 27

Bullous pemphigoid:
Pathophys
Presentation

Back 27

IgG ab's x Hemidesmosomes (Epidermal BM; 'bullow' the epidermis)

Presents with tense bullae (vesicles)

Front 28

Erythema Multiforme:
Pathophys

Back 28

Associated with infections (Mycoplasma, HSD), drugs (sulfa, beta-lactams, phenytoin)

Front 29

Stevens-Johnson Syndrome:
Pathophys
Presentation

Back 29

Fever, bulla formation and necrosis, sloughing of skin, high mortality rate

Assocd w/adverse drug rxn:
-Seizure drugs
-Sulfa
-PCNs
-Allopurinol

Note: becomes toxic epidermal necrolysis when 30% of more of skin sloughs off

Front 30

Lichen Planus:
Presentation

Back 30

Pruritic, purple, polygonal papules

Assocd w/Hep C

Front 31

Squamous cell carcinoma of skin:
Presentation
Histologic features

Back 31

Sun-exposed lesion (red, ulcerative)
Rarely mets
Keratin pearls

Front 32

Basal cell carcinoma:
Presentation

Back 32

Locally invasive, never mets

Rolled edges with central ulceration in sun-exposed areas

Front 33

Melanoma:
Presentation
Predictor of metastasis
Tumor marker

Back 33

Dark with irregular borders in sun-exposed areas

Depth

Tumor marker: S100

Front 34

Why can't acetaminophen be used as an anti-inflammatory drug?

Back 34

Inactivated peripherally so has no anti-inflamm ability

Only antipyretic and analgesic

Front 35

Back 35

Erythema multiforme (drug-induced)

Front 36

Back 36

Keratin pearl-->Squamous CC

Front 37

Back 37

Basal cell carcinoma (rounded; non-ulcerative)

Front 38

Back 38

Squamous cell carcinoma--ulcerative

Front 39

Back 39

Melanoma

Front 40

Which skin disorder:
Pruritic, purple, polygonal papules

Back 40

Lichen planus

Front 41

Which skin disorder:
Life threatening rash with bulla

Back 41

Steven-Johnson
Pemphigus

Front 42

Which skin disorder:
Pruritis associated with asthma

Back 42

Atopic dermatitis

Front 43

Which skin disorder:
Pruritic vesicles associated with Celiac Disease

Back 43

Dermatitis herpetiformis

Front 44

Which skin disorder:
Allergy to nickel

Back 44

Type IV Hypersens; contact dermatitis

Front 45

Which skin disorder:
Antibodies against epidermal basement membrane

Back 45

Bullous pemphigoid

Front 46

Which skin disorder:
Antibodies against epidermal cell surface

Back 46

Pemphigus vulgaris

Front 47

Which skin disorder:
Parakeratotic scaling

Back 47

Psoriasis

Front 48

Which skin disorder:
Keratin-filled cysts

Back 48

Psoritic(?) Keratosis

Front 49

Which skin disorder:
Pruritic, purple, polygonal papules

Back 49

Lichen planus

Front 50

Which skin disorder:
Life threatening rash with bulla

Back 50

Steven-Johnson
Pemphigus

Front 51

Which skin disorder:
Pruritis associated with asthma

Back 51

Atopic dermatitis

Front 52

Which skin disorder:
Pruritic vesicles associated with Celiac Disease

Back 52

Dermatitis herpetiformis

Front 53

Which skin disorder:
Allergy to nickel

Back 53

Type IV Hypersens; contact dermatitis

Front 54

Which skin disorder:
Antibodies against epidermal basement membrane

Back 54

Bullous pemphigoid

Front 55

Which skin disorder:
Antibodies against epidermal cell surface

Back 55

Pemphigus vulgaris

Front 56

Which skin disorder:
Parakeratotic scaling

Back 56

Psoriasis

Front 57

Which skin disorder:
Keratin-filled cysts

Back 57

Psoritic(?) Keratosis

Front 58

Which skin disorder:
Sand paper, predisposition to squamous cell carcinoma

Back 58

Actinic keratosis

Front 59

Which skin disorder:
Skin rash and proximal muscle weakness

Back 59

Dermatomyositis

Front 60

Which skin disorder:
Honey crusting lesions near the nose and lips

Back 60

Impetigo

Front 61

Which skin disorder:
Hyperkeratosis, koilocytosis

Back 61

Veruchi (HPV)

Front 62

Which skin disorder:
Histology showing palisading nuclei

Back 62

Basal cell carcinoma

Front 63

Which anticancer drug:
Fragments DNA, toxicity = Pulmonary Fibrosis

Back 63

Bleomycin

Front 64

Which anticancer drug:
Blocks purine synthesis, metabolized by xanthine oxidase

Back 64

6-Mercaptopurine

Front 65

Which anticancer drug:
Folic acid analog that inhibits dihydrofolate reductase

Back 65

MTX

Front 66

Which anticancer drug:
Prevents tubulin disassembly

Back 66

Taxols

Front 67

Which anticancer drug:
DNA alkylating agents used in brain cancer

Back 67

Nitrosylureas (nitro on a mustang--mustines!)

Front 68

Which anticancer drug:
SERM-blocks estrogen binding to ER+ cells

Back 68

Tamoxifen, raloxifen

Front 69

What are the manifestations of CREST scleroderma?

Back 69

Calcinosis
Raynaud's
Esophageal dysmotility
Sclerodactyly
Telangiectasia

Front 70

What are the manifestations of sarcoidosis?

Back 70

GRUELING
Granulomas
RA
Uveitis
Erythema nodosum
LAD--hilar, b/l
Idiopathic
Not TB
Gammaglobulinemia

ACE is inc'd, as is vitamin D

Front 71

What are the classic symptoms of Sjögren's syndrome?

Back 71

Dry eyes, mouth, arthritis

Front 72

Which pathology:
Signet ring cells in ovary

Back 72

Krukenberg tumor (stomach mets to ovary)

Front 73

Which pathology:
Smudge cell

Back 73

CLL

Front 74

Which pathology:
Spike and dome of glomerulus on EM

Back 74

Membranous GN

Front 75

Which pathology:
Tram track of glomerulus on light microscopy

Back 75

Membranoprolif GN

Front 76

Which pathology:
Strawberry tongue

Back 76

Scarlet fever
Kawasaki Dz

Front 77

Which pathology:
Most common location of tophi

Back 77

External ear

Front 78

Which pathology:
Signet rings in RBCs

Back 78

Trophozoites--seen in malaria

Front 79

What drugs can be used in the treatment of gout?

Back 79

Acute: NSAIDs, colchicine, steroids

Chronic: Colchicine, NSAID, allopurinol, probenecid

Front 80

What is the mechanism of treating acetaminophen overdose?

Back 80

N-acetylcysteine to regenerate glutathione

Front 81

What are the risk factors for osteoporosis?

What measures can be taken to prevent osteoporosis?

Back 81

RIsk factors:
Age, smoking, steroids, heparin, white, thin, not exercising, poor Ca2+, low T, low E2

Prevention: weight bearing exercise, calcium and vit D intake, not smoking, addressing hypogonadism

Front 82

What drugs are known for causing drug-induced lupus?

Back 82

Sulfonamides
Hyrdralazine
Isoniazid
Phenytoin
Procainamide

Front 83

Silver-staining spherical aggregation of tau proteins in neurons

Back 83

Pick bodies (similar to AD)

Front 84

Soap bubble in femur or tibia on x-ray

Back 84

Giant cel tumor of bone--generally benign

Front 85

Spikes on basement membrane, dome-like endothelial deposits

Back 85

Membranous GN (may progress to nephrotic syndrome)

Front 86

Stacks of RBCs

Back 86

Rouleaux formation (high ESR, multiple myeloma)

Front 87

Stippled vaginal epithelial cells

Back 87

Clue cells--Gardnerella vaginalis

Front 88

Rectangular, crystal-like, cytoplasmic inclusions in Leydig cells

Back 88

Reinke crystals (lydig cell tumor)

Front 89

Renal epithelial casts in urine

Back 89

Acute toxic/viral nephrosis

Front 90

Rhomboid crystals, positively birefringent

Back 90

Pseudogout (calcium pyrophophate dihydrate)

Front 91

Rib notching

Back 91

Coarcation of the aorta

Front 92

Sheets of medium-sized lymphoid cells (starry sky appearance on histology)

Back 92

Burkitt's lymphoma (t(8;14)

Front 93

Tennis racket shaped cytoplasmic organelles in Langerhans cells

Back 93

Birbeck granules

Front 94

Thrombi made of white/red layers

Back 94

Lines of Zahn (arterial thrombus, layers of PLTs/RBCs)

Front 95

Thumb sign on lateral x-ray

Back 95

Epiglottitis (H. flu)

Front 96

THyroid-like appearance of kidney

Back 96

Chronic bacterial pyelonephritis

Front 97

Tram track appearance of kidney

Back 97

Chronic bacterial pyelonephritis

Front 98

Triglyceride accumulation in liver cell vacuoles

Back 98

Fatty liver disease

Front 99

WBCs that look smudged

Back 99

CLL (almost always B cell; affects the elderly)

Front 100

Wire loop glomerular appearance on light microscopy

Back 100

Lupus nephropathy

Front 101

Yellow CSF

Back 101

Xanthochromia--subarachnoid hemorrhage