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19 Cards in this Set

  • Front
  • Back
Signs of Dermatomyositis
- Gottron's papules
- mechanic's hands
- shawl sign
- heliotrope rash
- Periungual Telangiectasias
What is "shawl sign"
Poikilodermatous macules in a shawl distribution, over the shoulders, arms and upper back.
What is Poikilodermatous?
Poikilodermatous is pigmentary and atrophic changes in the skin giving it a mottles appearance
Fibromyalgia - how many trigger points
18
Fibromyalgia - how many trigger points needed for diagnosis
11
Fibromyalgia - how is it like polymyalgia rheumatica?
Both are forms of soft tissue rheumatism or diffuse pain syndrome
Fibromyalgia - why is it considered an affective disorder?
Most patients have a history of anxiety, panic disorder, depression and/or disordered, non-refreshing sleep
Fibromyalgia - what are its clinical features?
- widespread pain, esp. in muscles and tendons of axial areas --> neck, trapezius, lower back, upper buttocks
- pain exacerbated by stress
- chronic fatigue
- morning stiffness
- associated sx: tension h/a, IBS, sicca syndrome, urinary freq/urg, sensation of swollen hands
Fibromyalgia - what is its epidemiology?
- more women
- middle age onset
- across races, ethnic groups
Fibromyalgia - what is its pathophysiology?
- unknown
- maybe CNS mechanism rather than aberration of muscle & tendon
Fibromyalgia - what are precipitating events?
- infectious illness
- physical or emotional stress
Fibromyalgia - what neurotransmitter is increased in CSF?
- Substance P, a neurotransmitter specific for pain transmission in the dorsal horn of the spinal column
Fibromyalgia - where is decreased blood flow found?
- thalamus: deep-brain relay station for all sensory input (pain and other), except olfaction.

- caudate nucleus
- accompanying lower pain thresholds
Fibromyalgia - what stage sleep is interrupted?
- stage 3-4 interrupted by alpha wave intrusion, leading to non-refreshing sleep and chronic fatigue
Fibromyalgia - how do you diagnosis it?
- Clinically. No diag labs
- Widespread pain > 3 mos
- 11 of 18 trigger points
- xrays & blood work to r/o hypothyroidism, SLE, osteo/RA
Fibromyalgia - what is treatment?
- no steroids
- stretch, low stress aerobics
- muscle relaxant, Flexeril
- TCA's, e.g., Elavil
- SSRI's, e.g., Prozac
- low dose TCA + SSRI
Gout - what kind of disease is it?
- what causes it?
- Metabolic
- hyperuricemia (too much uric acid in the blood) which has musculoskeletal consequences
Gout - where does uric acid come from
- breakdown of purines: adenosine and guanosine
Gout - what is the sodium salt of uric acid and what is its max solubility?
- Monosodium urate
- 6.5 mg/dl of plasma