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163 Cards in this Set
- Front
- Back
- 3rd side (hint)
Achondroplasia does not affect which type of bone formation?
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Membranous ossification is not affected (skull, facial bones, and axial skeleton are normal). Head and trunk are normal in size, but limbs are much shorter than normal.
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What's the classic presentation of osteoarthritis?
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Pain in weight bearing joints after use (eg. at the end of the day), improving with rest. No systemic symptomes. Common in older patients.
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name 7 mechanical features of osteoarthritis:
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-wear and tear of joins leads to destruction of articular cartilage
-subchondral bone formation -sclerosis -ostephytes -eburnation - bone looks shiny because it's lost cartilage -Heberden's nodes (DIP) -Bouchard's nodes (PIP) |
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What's the classic presentation of Rheumatoid Arthritis?
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-morning stiffness improving with use
-symmetric joint involvement -systemic symptomes (fever, fatigue, pleuritis, pericarditis) |
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Lab test for Rheumatoid Arthritis:
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80% of RA patients have positive Rheumatoid Factor (anti-IgG antibody)
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Etiology and Pathologies of Rheumatoid Arthritis
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-Autoimmune-inflammatory disorder affecting synovial joints with pannus formation in joints (MCP, PIP)
-subcutaneous rheumatoid nodules -ulnar deviation -subluxation. |
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Which arthritis is worse in the morning? which at night?
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Rheumatoid arthritis is worse in the morning, osteoarthritis is worse after a long days use.
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Which arthritis gets better with use?
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Rheumatoid arthritis- morning stiffness improves with use.
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what are the 4 systemic symptoms of rheumatoid arthritis?
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fever
fatigue pleuritis pericarditis |
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what are the systemic symptoms of osteoarthritis?
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there are no systemic symptomes of osteoarthritis
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Definition of osteoporosis
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reduction of bone mass in spite of normal bone mineralization
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Type 1 vs Type 2 osteoporosis
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Type 1:
-Postmenopausal -increased bone resorption due to decreased estrogen levels -estrogen replacement is controversial as prophylaxis due to side-effects Type 2: (Senile Osteoperosis) -affects men and women older than 70 |
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What racial groups does osteoperosis affect?
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whites > blacks > asians
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3 Common fractures in osteoporosis
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-Vertebral crush fractures--acute back pain, loss of height, kyphosis
-Distal radius (Colles') factures -vertebral wedge fractures |
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Treatement for osteoperosis
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Bisphosphonates or pulsatile PTH for severe cases
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Osteopetrosis is also known as
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marble bone disease
(is also known as) |
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Osteopetrosis is caused by
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Abnormal function of osteoclasts → Failure of normal bone resorption → thickened, dense bones
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blood values in osteopetrosis
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Serum Calcium, Phosphate and Alkaline Phosphatase are ALL NORMAL.
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In osteomalacia/rickets, vitamin D deficiency leads to...
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Vitamin D deficiency → ↓Calcium → ↑PTH secretion, ?serum phosphate
Defective mineralization of osteoid → soft bones |
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Osteitis Fibrosa Cystica is caused by
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Hyperparathyroidism
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Osteitis Fibrosa Cystica is characterized by
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"brown tumors" (cystic spaces lined by osteoclasts, filled with fibrous stroma and sometimes blood)
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what are brown tumors?
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cystic spaces lined by osteoclasts, filled with fibrous stroma and sometimes blood - found in Osteitis Fibrosa Cystica
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blood values in Osteitis Fibrosa Cystica
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High serum calcium
Low serum phosphorus High alkaline phosphatase |
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Paget's disease is also known as
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osteitis deformans
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Paget's disease (osteitis deformans) is caused by
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abnormal bone architecture caused by an ↑ in both osteoblastic and osteoclastic activity
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blood values in paget's disease (osteitis deformans)
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serum calcium, phosphorus and PTH levels are normal
Serum Alkaline Phosphatase is Elevated! |
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what is Polyostotic Fibrous Dysplasia?
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Bone is replaced by fibroblasts, collagen, and irregular bony trabeculae. Affects many bones.
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What is Albright's Syndrome?
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a form of polyostotic fibrous dyplasia in which there are multiple unilateral bone lesions associated with endocrine abnormalities (precocious puberty) and unilateral pigmented skin lesions
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How does Polymyalgia Rheumatic present?
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Pain and siffness in shoulders and hips, often with fever, malaise, and weight loss.
Does not cause muscle weakness Occurs in patients >50 y.o. *Associated with temporal (giant cell) arteritis |
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what blood values would you see in Polymyalgia Rheumatica?
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↑ ESR
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How do you treat Polymyalgia Rheumatica?
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with Predisone
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Polymyositis - what is it and what's it caused by?
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Progressive proximal muscle weakness caused by CD8+ T-cell-induced injury to myofibers.
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How do you diagnose Polymyositis?
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muscle biopsy with evidence of inflammation is diagnostic
Labs show: ↑CK ↑aldolase positive ANA anti-Jo-1 |
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what is dermatomyositis?
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similar to polymyositis but also involves skin rash and ↑ risk for malignancy
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How do you diagnose dermatomyositis?
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Labs show:
↑CK ↑aldolase positive ANA anti-Jo-1 |
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6 characteristics of Mixed Connective Tissue Disease
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Raynaud's phenomenon
Arthralgias Myalgias Fatigue Esophageal Hypomotility Antibodies to U1RNP |
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Classic triad of Sjogren's syndrome
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Xerophthalmia - dry eyes, conjunctivitis
Xerostomia - dry mouth, dysphagia Arthritis (also see parotid enlargment) |
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Autoantibody production in Sjogren's syndrome
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Autoantibodies to:
ribonucleoprotein antigens SS-A (Ro) SS-B (La) |
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Associated diseases with Sjogren's syndrome
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Sjogrens patients have ↑ risk of B-cell lymphoma.
Sjogren's is also associated with rheumatoid arthritis and Sicca syndrome (a type of sjogren's?) |
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what is Sicca syndrome? (5 symptomes)
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another name for Sjogren's syndrome?
-Dry eyes, -dry mouth -nasal and vaginal dryness -chronic bronchitis -reflux esophagitis |
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Sjogren's affects which demographic predominantly?
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Females, 40-60 y.o.
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Systemic Lupus Erythematosus affects which demographic predominantly?
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90% are female between 14 - 45 y.o. Mostly black females.
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Mnemonic for Lupus and associated symptoms
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I'M DAMN SHARP
Immunoglobulins (anti-dsDNA, anti-Sm, antiphospholipid) Malar rash Discoid rash Antinuclear antibody Mucositis (oropharyngeal ulcers) Neurologic disorders Serositis (pleuritis, pericarditis) Hematologic disorders Arthritis Renal disorders Photosensativity |
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7 symptoms for Lupus (not found in IM DAMN SHARP)
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fever
fatigue weight loss nobacterial verrucous endocarditis hilar adenopathy Raynaud's phenomenon |
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Renal characteristics of Lupus
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WIRE LOOP lesions in kidney with immune complex deposition (with nephrotic syndrome)
Death from renal failure and infections |
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_______ are found in drug-induced lupus
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Antihistone antibodies
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Lupus can cause false positives on which test? why?
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syphilis tests (RPR/VDRL) due to antiphospholipid antibodies
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Lab tests for lupus detect which antibodies?
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Antinuclear antibodies (ANA) - sensitive, but not specific for SLE
Antbodies to double-stranded DNA (anti-dsDNA) - very specifice, poor prognosis Anti-Smith antibodies (anti-Sm) - very specific, but not prognostic Antihistone antibodies - drug-induced lupus |
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Which antibodies indicate a poor prognosis in lupus?
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Anti-dsDNA
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what is Celiac sprue caused by?
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Autoimmune-mediated intolerance of gliadin (wheat) leading to steatorrhea
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what type of diarrhea is found in Celiac sprue
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steatorrhea
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Celia sprue is associated with which race?
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people of northern european descent
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3 Findings in Celia sprue
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blunting of villi
lymphocytes in the lamina propria abnormal D-xylose test |
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what part of the GI tract does celia sprue affect?
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tends to affect the Jejunum
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what other 2 diseases is celiac sprue associated with?
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dermatitis herpetiformis
and 10-15% lead to malignancy (most often T-cell lymphoma) |
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what crystals precipitate in the joints in gout?
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monosodium urate crystals
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what is gout?
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precipitation of monosodium urate crystals into the joints due to hyperuricemia
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5 etiologies of gout
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Lesch-Nyhan syndrome
PRPP excess Decreased excretion of uric acid glucose-6-phosphatase deficiency Thiazide Diuretics |
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What class of drugs can lead to gout? why?
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Thiazide diuretics, which competitively inhibit the secretion of uric acid
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is the joint distribution in gout symmetric or asymmetric?
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asymmetric
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2 classic manifestations of gout
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Painful MTP joint in the big toe (Podagra)
Tophus formation (often on external ear or Achilles tendon) |
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Describe gout crystals
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needle shaped and negatively birefringent
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demographic of gout
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more common in men
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when do acute attacks of gout usually occur?
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after alcohol consumption or a large meal
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4 treatments of gout
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Allopurinol
Probenecid colchicine NSAIDs |
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describe the crystals found in pseudogout
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calcium pyrophosphate crystals found in pseudogout are:
basophilic rhomboid weakly positively birefringent |
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what crystals are found in pseudogout
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calcium pyrophosphate crystals
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what joints are affected in pseudogout
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large joints (especially the knee)
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demographics of pseudogout
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>50 y.o.
both sexes affected equally |
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treatment for pseudogout
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no treatment
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2 major Findings in Goodpasture's Syndrome
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pulmonary hemorrhages -> hemoptysis
renal lesions -> hematuria, anemia, crescentic glomerulonephritis |
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demographics of Goodpasture's syndrome
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most common in men 20-40
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immonofluorescence pattern seen in Goodpasture's
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anti-glomerular basement membrane antibodies produce linear staining on immunofluorescence
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Goodpastures is a Type # hypersensitivity?
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Type 2
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Sarcoidosis is characterized by
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immune mediated, widespread noncaseating granulomas and elevated serum ACE levels.
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Mnemonic for Sarcoidosis
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GRAIN
Gammaglobulinemia Rheumatoid arthritis ACE increase Interstitial fibrosis Noncaseating granulomas |
GRAIN
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Associated with:
restrictive lung disease bilateral hilar lymphadenopathy erythema nodosum Bell's palsy Epithelial granulomas containing microscopic Schaumann and asteroid bodies uveoparotitis hypercalcemia (due to elevated conversion of vitamin D to its active form in epitheliod macrophages) |
Sarcoidosis
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why do you see hypercalcemia in Sarcoidosis
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b/c of elevated conversion of vitamin D to its active form in epitheliod macrophages
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Epithelial granulomas containing ____________ are found in Sarcoidosis
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epithelial granulomas containing microscopic Schaumann and asteroid bodies
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name 2 seronegative spondyloarthopathies
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Ankylosing spondylitis
Reiter's syndrome |
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Arthritis without rheumatoid factor (no anti-IgG antobody)
Strong association with HLA-B27 (gene that codes for HLA MHC I) -describes what group of diseases |
seronegative spondyloarthopathies
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what does HLA-B27 code for?
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gene that codes for HLA MHC I
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HLA-B27 is associated with which 4 diseases?
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Psoriasis
Ankylosing Sponylitis Inflammatory bowel disease Reiter's syndrome mnemonic: PAIR |
PAIR
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demographics of seronegative spondyloarthopathies
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most often in males
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Describe Ankylosing spondylitis
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Chronic inflammatory disease of spine and sacroiliac joints → ankylosis (stiff spine), uveitis, and aoritic regurgitation
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Classic triad of Reiter's syndrome
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Urethritis
Conjunctivitis and anterior uveitis Arthritis Can't see, can't pee, can't climb a tree |
Can't see, can't pee, can't climb a tree
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Reiter's syndrome often occurs post-____ infections?
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post-GI or chlamydia infections
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another name for Scleroderma?
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Progressive systemic sclerosis - PSS
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2 major categories of Scleroderma
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Diffuse scleroderma
CREST syndrome |
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Scleroderma is characterized by?
which organs are affected? |
Excessive fibrosis and collagen deposition throughout the body.
Commonly sclerosis of skin but also of cardiovascular and GI systems and kidney |
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demographics of scleroderma
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75% female
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which antibodies are Diffuse scleroderma and CREST syndrome associated with?
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Diffuse scleroderma - anti-Scl-70 antibody
CREST syndrome - anticentromere antibody |
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describe Diffuse scleroderma
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widespread skin involvement,
rapid progression, early visceral involvement. Associated with anti-Scl-70 antibody |
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describe CREST syndrome
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Calcinosis
Raynaud's phenomenon Esophageal dysmotility Sclerodactyly Telangiectasia Limited skin involvement, often confined to fingers and face More benign clinical course associated with anti-centromere antibody |
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mutation in Achondroplasia
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FGF receptor 3
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pannus formation
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Rheumatoid Arthritis
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ulnar deviation,
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Rheumatoid Arthritis
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fever, fatigue, pleuritis, pericarditis
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systemic symptomes of Rheumatoid Arthritis
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Boutonnière deformity, Swan-neck deformity, Z-thumb deformity
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Rheumatoid Arthritis
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↑ bone resorption due to ↓estrogen levels.
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Type 1 (postmenopausal) osteoporosis
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Senile osteoporosis––
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Type 2 osteoporosis. >70 y.o.
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tx for osteoporosis
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Bisphosphonates or pulsatile PTH for severe cases.
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Failure of normal bone resorption → thickened, dense bones.
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Osteopetrosis (marble bone disease)
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Failure of normal bone resorption → thickened, dense bones. Bone defect is due to abnormal function of osteoclasts. Serum calcium, phosphate, and alkaline phosphatase are normal.
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Bone defect is due to abnormal function of osteoclasts.
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Osteopetrosis (marble bone disease)
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Failure of normal bone resorption → thickened, dense bones. Bone defect is due to abnormal function of osteoclasts. Serum calcium, phosphate, and alkaline phosphatase are normal.
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Serum calcium, phosphate, and alkaline phosphatase are normal.
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Osteopetrosis (marble bone disease)
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Failure of normal bone resorption → thickened, dense bones. Bone defect is due to abnormal function of osteoclasts. Serum calcium, phosphate, and alkaline phosphatase are normal.
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Defective mineralization of osteoid → soft bones.
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Osteomalacia/rickets
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Defective mineralization of osteoid → soft bones. Vitamin D deficiency in adults →
↓ calcium levels →↑ secretion of PTH, ↑ in serum phosphate. Reversible when vitamin D is replaced. Vitamin D deficiency in childhood causes rickets. |
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Vitamin D deficiency in adults →
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↓ calcium levels →↑ secretion of PTH
Osteomalacia/rickets |
Defective mineralization of osteoid → soft bones. Vitamin D deficiency in adults →
↓ calcium levels →↑ secretion of PTH, ↑ in serum phosphate. Reversible when vitamin D is replaced. Vitamin D deficiency in childhood causes rickets. |
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Caused by hyperparathyroidism.
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Osteitis Fibrosa Cystica
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Caused by hyperparathyroidism. Characterized by “brown tumors” (cystic spaces lined by osteoclasts, filled with fibrous stroma and sometimes blood). High serum calcium, low serum phosphorus, and high alkaline phosphatase.
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Characterized by “brown tumors” (cystic spaces lined by osteoclasts, filled with fibrous stroma and sometimes blood).
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Osteitis Fibrosa Cystica
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Caused by hyperparathyroidism. Characterized by “brown tumors” (cystic spaces lined by osteoclasts, filled with fibrous stroma and sometimes blood). High serum calcium, low serum phosphorus, and high alkaline phosphatase
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High serum calcium, low serum phosphorus, and high alkaline phosphatase
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Osteitis Fibrosa Cystica
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Caused by hyperparathyroidism. Characterized by “brown tumors” (cystic spaces lined by osteoclasts, filled with fibrous stroma and sometimes blood). High serum calcium, low serum phosphorus, and high alkaline phosphatase
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Abnormal bone architecture caused by ↑ in both osteoblastic and osteoclastic activity.
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Paget’s disease (osteitis deformans)
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Abnormal bone architecture caused by ↑ in both osteoblastic and osteoclastic activity. Serum calcium, phosphorus, and PTH levels are normal. Serum alkaline phosphatase is elevated.
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osteitis deformans -- aka?
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Paget’s disease
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Abnormal bone architecture caused by ↑ in both osteoblastic and osteoclastic activity. Serum calcium, phosphorus, and PTH levels are normal. Serum alkaline phosphatase is elevated.
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Serum alkaline phosphatase is elevated.
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Paget’s disease (osteitis deformans)
Osteitis Fibrosa Cystica |
Abnormal bone architecture caused by ↑ in both osteoblastic and osteoclastic activity. Serum calcium, phosphorus, and PTH levels are normal. Serum alkaline phosphatase is elevated.
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Bone is replaced by fibroblasts, collagen, and irregular bony trabeculae.
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Polyostotic fibrous Dysplasia
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Bone is replaced by fibroblasts, collagen, and irregular bony trabeculae. Affects many bones. Albright’s syndrome is a form of polyostotic fibrous dysplasia in which there
are multiple unilateral bone lesions associated with endocrine abnormalities (precocious puberty) and unilateral pigmented skin lesions. |
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unilateral pigmented skin lesions.
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Albright’s syndrome
Albright’s syndrome is a form of polyostotic fibrous dysplasia in which there are multiple unilateral bone lesions associated with endocrine abnormalities (precocious puberty) and unilateral pigmented skin lesions. |
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Pain and stiffness in shoulders and hips, often with fever, malaise, and weight loss.
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Polymyalgia Rheumatica
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Pain and stiffness in shoulders and hips, often with fever, malaise, and weight loss. Does not cause muscular weakness. ↑ ESR. Occurs in patients > 50 years of age; associated with temporal (giant cell) arteritis. Treated with prednisone.
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Does Polymyalgia Rheumatica cause muscle weakness?
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NO
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Pain and stiffness in shoulders and hips, often with fever, malaise, and weight loss. Does not cause muscular weakness. ↑ ESR. Occurs in patients > 50 years of age; associated with temporal (giant cell) arteritis. Treated with prednisone.
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↑ ESR. Occurs in patients > 50 years of age
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Polymyalgia Rheumatica
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Pain and stiffness in shoulders and hips, often with fever, malaise, and weight loss. Does not cause muscular weakness. ↑ ESR. Occurs in patients > 50 years of age; associated with temporal (giant cell) arteritis. Treated with prednisone.
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associated with temporal (giant cell) arteritis
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Polymyalgia Rheumatica
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Pain and stiffness in shoulders and hips, often with fever, malaise, and weight loss. Does not cause muscular weakness. ↑ ESR. Occurs in patients > 50 years of age; associated with temporal (giant cell) arteritis. Treated with prednisone.
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How do you treat Polymyalgia Rheumatica?
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prednisone
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Pain and stiffness in shoulders and hips, often with fever, malaise, and weight loss. Does not cause muscular weakness. ↑ ESR. Occurs in patients > 50 years of age; associated with temporal (giant cell) arteritis. Treated with prednisone.
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Does Polymyositis cause muscle weakness?
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Yes - progressive proximal muscle weakness caused by CD8+ T-cell-induced injury to myofibers. Muscle biopsy with evidence of inflammation is diagnostic.
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Polymyositis— progressive proximal muscle weakness caused by CD8+ T-cell-induced injury to myofibers. Muscle biopsy with evidence of inflammation is diagnostic.
Dermatomyositis—similar to polymyositis but also involves skin rash and ↑ risk of malignancy. Labs for polymyositis/dermatomyositis show ↑ CK, ↑ aldolase, and positive ANA, anti-Jo-1. |
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Muscle biopsy with evidence of inflammation is diagnostic.
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Polymyositis/dermatomyositis
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Polymyositis— progressive proximal muscle weakness caused by CD8+ T-cell-induced injury to myofibers. Muscle biopsy with evidence of inflammation is diagnostic.
Dermatomyositis—similar to polymyositis but also involves skin rash and ↑ risk of malignancy. Labs for polymyositis/dermatomyositis show ↑ CK, ↑ aldolase, and positive ANA, anti-Jo-1. |
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involves skin rash and ↑ risk of malignancy.
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dermatomyositis
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Polymyositis— progressive proximal muscle weakness caused by CD8+ T-cell-induced injury to myofibers. Muscle biopsy with evidence of inflammation is diagnostic.
Dermatomyositis—similar to polymyositis but also involves skin rash and ↑ risk of malignancy. Labs for polymyositis/dermatomyositis show ↑ CK, ↑ aldolase, and positive ANA, anti-Jo-1. |
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↑ CK, ↑ aldolase, and positive ANA, anti-Jo-1.
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Labs for polymyositis/dermatomyositis
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Polymyositis— progressive proximal muscle weakness caused by CD8+ T-cell-induced injury to myofibers. Muscle biopsy with evidence of inflammation is diagnostic.
Dermatomyositis—similar to polymyositis but also involves skin rash and ↑ risk of malignancy. Labs for polymyositis/dermatomyositis show ↑ CK, ↑ aldolase, and positive ANA, anti-Jo-1. |
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Raynaud’s phenomenon, arthralgias, myalgias, fatigue, and esophageal hypomotility.
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Mixed connective Tissue Disease
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Raynaud’s phenomenon, arthralgias, myalgias, fatigue, and esophageal hypomotility. Antibodies to U1RNP.
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Antibodies to U1RNP.
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Mixed connective Tissue Disease
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Raynaud’s phenomenon, arthralgias, myalgias, fatigue, and esophageal hypomotility. Antibodies to U1RNP.
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Raynaud's phenomenon AND Esophageal dysmotility/hypomotility are seen in which 2 diseases?
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Mixed connective Tissue Disease
CREST Scleroderma |
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Raynaud's phenomenon is seen in whic 4 diseases?
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Mixed connective Tissue Disease
CREST Scleroderma Systemic Lupus Erythematosus Buerger's disease (vasculitis) |
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Parotid enlargement,
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Sjögren’s syndrome
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Classic triad––xerophthalmia (dry eyes, conjunctivitis), xerostomia (dry mouth, dysphagia), arthritis. Parotid enlargement, ↑ risk of B-cell lymphoma. Autoantibodies to ribonucleoprotein antigens, SS-A (Ro), SS-B (La). Predominantly affects females between 40 and 60 years of age.
Associated with rheumatoid arthritis |
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↑ risk of B-cell lymphoma
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Sjögren’s syndrome
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Classic triad––xerophthalmia (dry eyes, conjunctivitis), xerostomia (dry mouth, dysphagia), arthritis. Parotid enlargement, ↑ risk of B-cell lymphoma. Autoantibodies to ribonucleoprotein antigens, SS-A (Ro), SS-B (La). Predominantly affects females between 40 and 60 years of age.
Associated with rheumatoid arthritis |
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2 diseases associated with rheumatoid arthritis
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Sjögren’s syndrome,
Sarcoidosis |
Classic triad––xerophthalmia (dry eyes, conjunctivitis), xerostomia (dry mouth, dysphagia), arthritis. Parotid enlargement, ↑ risk of B-cell lymphoma. Autoantibodies to ribonucleoprotein antigens, SS-A (Ro), SS-B (La). Predominantly affects females between 40 and 60 years of age.
Associated with rheumatoid arthritis |
|
-xerophthalmia (dry eyes, conjunctivitis)
-xerostomia (dry mouth, dysphagia) -arthritis Parotid enlargement, |
Sjögren’s syndrome
|
Classic triad––xerophthalmia (dry eyes, conjunctivitis), xerostomia (dry mouth, dysphagia), arthritis. Parotid enlargement, ↑ risk of B-cell lymphoma. Autoantibodies to ribonucleoprotein antigens, SS-A (Ro), SS-B (La). Predominantly affects females between 40 and 60 years of age.
Associated with rheumatoid arthritis |
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dry eyes, dry mouth, nasal and vaginal dryness, chronic bronchitis, reflux esophagitis.
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Sicca syndrome
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Symptoms include fever, fatigue, weight loss, nonbacterial verrucous endocarditis, hilar adenopathy, and Raynaud’s phenomenon.
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Lupus
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90% are female and between ages 14 and 45. (Especially black females)
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Lupus
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lymphocytes in the lamina propria, abnormal D-xylose test, blunting of villi,
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Celiac sprue
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Autoimmune-mediated intolerance of gliadin (wheat) leading to steatorrhea. Associated
with people of northern European descent. Findings include blunting of villi, lymphocytes in the lamina propria, and abnormal D-xylose test. Tends to affect jejunum. Associated with dermatitis herpetiformis. 10–15% lead to malignancy (most often T-cell lymphoma). |
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10–15% lead to malignancy (most often T-cell lymphoma)
|
Celiac sprue
|
Autoimmune-mediated intolerance of gliadin (wheat) leading to steatorrhea. Associated
with people of northern European descent. Findings include blunting of villi, lymphocytes in the lamina propria, and abnormal D-xylose test. Tends to affect jejunum. Associated with dermatitis herpetiformis. 10–15% lead to malignancy (most often T-cell lymphoma). |
|
Associated with dermatitis herpetiformis
|
Celiac sprue
|
Autoimmune-mediated intolerance of gliadin (wheat) leading to steatorrhea. Associated
with people of northern European descent. Findings include blunting of villi, lymphocytes in the lamina propria, and abnormal D-xylose test. Tends to affect jejunum. Associated with dermatitis herpetiformis. 10–15% lead to malignancy (most often T-cell lymphoma). |
|
Autoimmune-mediated intolerance of gliadin (wheat) leading to steatorrhea.
|
Celiac sprue
|
Autoimmune-mediated intolerance of gliadin (wheat) leading to steatorrhea. Associated
with people of northern European descent. Findings include blunting of villi, lymphocytes in the lamina propria, and abnormal D-xylose test. Tends to affect jejunum. Associated with dermatitis herpetiformis. 10–15% lead to malignancy (most often T-cell lymphoma). |
|
monosodium urate crystals
|
Gout
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Precipitation of monosodium urate crystals into joints due to hyperuricemia, which can be
caused by Lesch-Nyhan syndrome, PRPP excess, ↓ excretion of uric acid, or glucose-6- phosphatase deficiency. Also associated with the use of thiazide diuretics, which competitively inhibit the secretion of uric acid. Asymmetric joint distribution. Classic manifestation is painful MTP joint in the big toe (podagra). Tophus formation (often on external ear or Achilles tendon). Crystals are needle shaped and negatively birefringent. More common in men. Acute attack tends to occur after alcohol consumption or a large meal (see Color Image 54). Treatment includes allopurinol, probenecid, colchicine, and NSAIDs. |
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Gout can be caused by
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hyperuricemia <-- Lesch-Nyhan syndrome, PRPP excess, ↓ excretion of uric acid, or glucose-6-phosphatase deficiency.
Also associated with the use of thiazide diuretics, which competitively inhibit the secretion of uric acid. |
Precipitation of monosodium urate crystals into joints due to hyperuricemia, which can be
caused by Lesch-Nyhan syndrome, PRPP excess, ↓ excretion of uric acid, or glucose-6- phosphatase deficiency. Also associated with the use of thiazide diuretics, which competitively inhibit the secretion of uric acid. Asymmetric joint distribution. Classic manifestation is painful MTP joint in the big toe (podagra). Tophus formation (often on external ear or Achilles tendon). Crystals are needle shaped and negatively birefringent. More common in men. Acute attack tends to occur after alcohol consumption or a large meal (see Color Image 54). Treatment includes allopurinol, probenecid, colchicine, and NSAIDs. |
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Crystals are needle shaped and negatively
birefringent. |
Gout
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Precipitation of monosodium urate crystals into joints due to hyperuricemia, which can be
caused by Lesch-Nyhan syndrome, PRPP excess, ↓ excretion of uric acid, or glucose-6- phosphatase deficiency. Also associated with the use of thiazide diuretics, which competitively inhibit the secretion of uric acid. Asymmetric joint distribution. Classic manifestation is painful MTP joint in the big toe (podagra). Tophus formation (often on external ear or Achilles tendon). Crystals are needle shaped and negatively birefringent. More common in men. Acute attack tends to occur after alcohol consumption or a large meal (see Color Image 54). Treatment includes allopurinol, probenecid, colchicine, and NSAIDs. |
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Tophus formation often occurs in
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external ear or achillis tendon
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Precipitation of monosodium urate crystals into joints due to hyperuricemia, which can be
caused by Lesch-Nyhan syndrome, PRPP excess, ↓ excretion of uric acid, or glucose-6- phosphatase deficiency. Also associated with the use of thiazide diuretics, which competitively inhibit the secretion of uric acid. Asymmetric joint distribution. Classic manifestation is painful MTP joint in the big toe (podagra). Tophus formation (often on external ear or Achilles tendon). Crystals are needle shaped and negatively birefringent. More common in men. Acute attack tends to occur after alcohol consumption or a large meal (see Color Image 54). Treatment includes allopurinol, probenecid, colchicine, and NSAIDs. |
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Acute Gout attack tends to occur after
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alcohol or large meal
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Precipitation of monosodium urate crystals into joints due to hyperuricemia, which can be
caused by Lesch-Nyhan syndrome, PRPP excess, ↓ excretion of uric acid, or glucose-6- phosphatase deficiency. Also associated with the use of thiazide diuretics, which competitively inhibit the secretion of uric acid. Asymmetric joint distribution. Classic manifestation is painful MTP joint in the big toe (podagra). Tophus formation (often on external ear or Achilles tendon). Crystals are needle shaped and negatively birefringent. More common in men. Acute attack tends to occur after alcohol consumption or a large meal (see Color Image 54). Treatment includes allopurinol, probenecid, colchicine, and NSAIDs. |
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calcium pyrophosphate crystals
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Pseudogout
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Caused by deposition of calcium pyrophosphate crystals within the joint space. Forms
basophilic, rhomboid crystals that are weakly positively birefringent (as opposed to the negatively birefringent, needle-shaped crystals in gout). Usually affects large joints (classically the knee). > 50 years old; both sexes affected equally. No treatment. |
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basophilic, rhomboid crystals that are weakly positively birefringent
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Pseudogout
calcium pyrophosphate crystals |
Caused by deposition of calcium pyrophosphate crystals within the joint space. Forms
basophilic, rhomboid crystals that are weakly positively birefringent (as opposed to the negatively birefringent, needle-shaped crystals in gout). Usually affects large joints (classically the knee). > 50 years old; both sexes affected equally. No treatment. |
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Usually affects large joints (classically the knee)
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Pseudogout
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Caused by deposition of calcium pyrophosphate crystals within the joint space. Forms
basophilic, rhomboid crystals that are weakly positively birefringent (as opposed to the negatively birefringent, needle-shaped crystals in gout). Usually affects large joints (classically the knee). > 50 years old; both sexes affected equally. No treatment. |
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pulmonary hemorrhages → hemoptysis;
renal lesions → hematuria, anemia, crescentic glomerularnephritis |
Goodpasture’s
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Goodpasture’s is most common in
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men 20-40 y.o.
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Anti–glomerular basement membrane antibodies produce linear staining on immunofluorescence.
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Goodpasture’s
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Characterized by immune-mediated, widespread noncaseating granulomas and elevated serum ACE levels. Common in black females.
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Sarcoidosis
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GRAIN in Sarcoidosis stands for?
BHUSHAN & LE is on hint |
Gammaglobulinemia
Rheumatoid arthritis ACE increase Interstitial fibrosis Noncaseating granulomas |
-Bell’s palsy
-hilar lymphadenopathy -uveoparotitis, -Schaumann bodies (in epithelial granulomas) -hypercalcemia (due to elevated conversion of vitamin D to its active form in epithelioid macrophages) -asteroid bodies (in epithelial granulomas) -noncaseating granulomas -restrictive Lung disease, -erythema nodosum (inflammation of fat under skin. Tender, red nodules usually on shins) |
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BHUSHAN & LE in Sarcoidosis stand for?
GRAIN is on hint |
-Bell’s palsy
-hilar lymphadenopathy -uveoparotitis, -Schaumann bodies (in epithelial granulomas) -hypercalcemia (due to elevated conversion of vitamin D to its active form in epithelioid macrophages) -asteroid bodies (in epithelial granulomas) -noncaseating granulomas -restrictive Lung disease, -erythema nodosum (inflammation of fat under skin. Tender, red nodules usually on shins) |
Gammaglobulinemia
Rheumatoid arthritis ACE increase Interstitial fibrosis Noncaseating granulomas |
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Arthritis without rheumatoid factor (no anti-IgG antibody).
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Seronegative Spondyloarthropathies
-Ankylosing Spondylitis -Reiters |
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ankylosis (stiff spine) uveitis
aortic regurgitation |
Ankylosing spondylitis
Chronic inflammatory disease of spine and sacroiliac joints → ankylosis (stiff spine), uveitis, and aortic regurgitation. |
Chronic inflammatory disease of spine and sacroiliac joints → ankylosis (stiff spine), uveitis, and aortic
regurgitation. |
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Urethritis
Conjunctivitis and anterior uveitis Arthritis |
Reiter’s syndrome
Post-GI or chlamydia infections. |
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Excessive fibrosis and collagen deposition throughout the body. 75% female.
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Scleroderma (Progressive Systemic Sclerosis - PSS)
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CREST syndrome
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Calcinosis, Raynaud’s phenomenon, Esophageal dysmotility, Sclerodactyly, and Telangiectasia. Limited skin involvement, often confined to fingers and face. More benign clinical course. Associated with anticentromere antibody
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Limited skin involvement, often confined to fingers and face
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CREST syndrome
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Calcinosis, Raynaud’s phenomenon, Esophageal dysmotility, Sclerodactyly, and Telangiectasia. Limited skin involvement, often confined to fingers and face. More benign clinical course. Associated with anticentromere antibody
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anticentromere antibody
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CREST syndrome
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Calcinosis, Raynaud’s phenomenon, Esophageal dysmotility, Sclerodactyly, and Telangiectasia. Limited skin involvement, often confined to fingers and face. More benign clinical course. Associated with anticentromere antibody
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anti-Scl-70 antibody
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Diffuse scleroderma
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Diffuse scleroderma––widespread skin involvement, rapid progression, early visceral involvement. Associated with anti-Scl-70 antibody.
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widespread skin involvement, rapid progression, early visceral involvement.
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Diffuse scleroderma
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Diffuse scleroderma––widespread skin involvement, rapid progression, early visceral involvement. Associated with anti-Scl-70 antibody.
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Scleroderma is commonly sclerosis of the skin but also of the
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cardiovascular and GI systems and kidney.
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