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28 Cards in this Set
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DDx for polyarticular arthritis
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Inflammatory: Lupus, RA, PA
NonInflammatory: OA |
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Define: papule
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primary skin lesion
raised/palpable small |
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Define: scale
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secondary skin lesion
Abnormal accumulation or shedding of flakes of skin |
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What are the pros of biological therapy?
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Slows progression of disease and therefore preserves function longer
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What are impacts of costs of biological treatments?
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Patient: Expensive. 20 000$/yr
Health care system: can save money because decrease in morbidity |
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Define: oncholysis
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Loosening of exposed part of nail bed
Associated with: internal disease, trauma, infxn, nail fungi, allergies/side effect of drugs |
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Define: oil drop sign
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Nail finding of psoriasis and PA.
Transleucent Discoloration of nail bed (associated with thickening of nail at tip, ridge and pitting) |
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Define: Auspitz sign
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Pinpoint bleeding following removal of psoriatic scale
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Define: papulosquamous
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Papules + scales
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DDx of papulosquamous disease (name 3)
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Psoriasis
Lupus Syphilis Lichen planus Pityriasis rosacea Dermatitis |
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Define Koebner phenomenOn. What does it suggest?
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Lesions that occur following trauma (ex scratch)
Suggests Psoriasis |
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Patient presents with dandruff and scratches on skin where he has exfoliated in the shower. How would you describe the lesions to a dermatogist?
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Koebner phenomenon: lesions occurring after trauma
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Define: guttate psoriasis
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Symmetrical trunk involvement
Often follows URT induction (strep throat) |
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Which type of psoriasis can be a medical emergency?
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Pustular psoriasis
Can develop acutely, involve all skin surfaces, leading to fluid loss + electrolyte imbalance Treat: like burn victm |
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Patient presents to your clinic with psoriais. What would you expect to find on clinical exam?
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Distribution: extensor surfaces and scalp, fingernails
Extensor surfaces: well-defined plaques that aren't too itchy, may see Koebner phenomenon Scalp: thick and silvery Nails: oil drop sign |
Distribution and what you'd see
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What is the treatment for psorisis?
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All use topical emollients +
1. mild/moderate plaque or guttate - topical corticosteroids, vti D analogues, topical retinoids, phototherapy 2. Severe plaque or guttate - oral retinoids, methotrexate, biologics 3. Pustular - retinoids PUVA |
Break it down into mild-moderate, severe and pustular
Localized --> systemic --> biologics |
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Why might you use salicyclic acid to treat psoriasis?
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To remove plaques
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Px comes in with recent onset of joint pain in low back. No recent injury. Family hx of psorisis. What do you suspect? What is your initial investigation?
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PA
Investigations to confirm: CRP (+\- ESR) |
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DDx of seronegative spondyliartritis
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Ankylylosing spondylis
Enteropathic - IBD Reactive arthritis - Reiters PA Juvenile onset Undifferentiated |
Theres 6 of them but ones a catch-all
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What is the distribution of seronegatie arthritis?
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Axial. Asymmetric.
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Unlike RA distribution
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Antibody associated with PA?
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HLA-B27
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Px presents with joint pain in lumbar spine. No recent trauma. Worse in morning. Also complains of eye problems. Lab work confirms suspicion of seronegatie arthritis. What's the likely dx?
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Reactive arthritis = Reiters
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What happens to ESR? Why?
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Increases. RBCs fall faster because more cytokines attached
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Define: dactylitis
Which of the seronegatie arthritises is is associated with? |
Dactylitis- sausage finger. Swelling of entire digit causing limited mobility
Associated with PA |
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What is the clinical term for pain at site of tendon attachment?
What seronegatie arthritis is it associated with? |
Entheseal pain
PA |
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Entheseal pain: where might ou look for it clinically?
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Heel
Elbow Lateral hip |
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Extra articular features of PA?
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Hx of Scalp/nail problems, aortic insufficiency, apical lung fibrosis, ophthalmic can lead to conjuntivits, cauda equine syndrome (retain urine, bowel incontinence)
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Treatments for PA
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NSAIDs + PPI
Intraarticular steroid injections - bridge DMARDs/biologics |
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