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68 Cards in this Set
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- Back
- 3rd side (hint)
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Heberden's nodes
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DIP
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Osteoarthritis shows the following in the joints
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subchondral cysts, sclerosis, osteophytes, eburnation, Heberden/Bouchards
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Legg-Calves-Perthes
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aseptic necrosis of the femoral ossification center seen in children
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Pannus
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mass of synovium w/ inflammatory cells, granulation tissue, fibroblasts that cause erosion
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HLA associated w/ RA
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DR4
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RA pathogenesis
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RF (IgM) reacts w/ IgG and deposits in synovial tissue leading to T-cell mediated damage to bone
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RA labs
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increased ESR, CRP, polyclonal gammopathy
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Hydroxychloroquine S/E
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retinal damage
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Sicca syndrome
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Sjogren's without arthritis and with bronchitis and esophagitis
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Dx of Sjogren
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lip salivary gland biopsy showing destruction and focal collection of lymphocytes
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Sjogren effect on fetus heart
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may lead to congenital 3rd degree block because anti-RNP (ribonucleoproteins) antibodies destroy the AV node
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Leflunomide MOA and use
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MOA: inhibits pyrimidine synthesis
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Use: RA
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Felty's syndrome
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RA + splenomegaly + leukopenia
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Caplan's syndrome
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RA + intrapulmonary rheumatoid nodules + pneumoconiosis
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Tophi form where?
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External ear, olecranon bursa, achilles tendon
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Things that exacerbate gout by decreasing excretion
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alcohol, large meals, lead (via interstitial nephritis)
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Tophi are made of...
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granulomas w/ giant cells and negatively birefringent urate crystals
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Gout is most commonly due to underexcretion or overproduction? Etiologies?
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underexcretion
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Etiologies: protein rich diet, Lesch-Nyhan, PRPP excess (because more purines are made), thiazides, von Gierke's, tumor lysis
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Pseudogout
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deposition of calcium pyrophosphate crystals that are rhomboid and weakly positively birefringent. Affects large joints
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Septic arthritis in elderly? Sexual active?
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Elderly: E. coli
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Sexually active: gonorrhea
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Chronic infectious arthritis
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TB, Lyme disease
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Ankylosing spondylitis tx
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TNF-alpha inhibitors
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Fusion of spine, uveitis, aortic regurgitation, difficulty breathing due to mechanical issues
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Reactive arthritis Sx other than the obvious
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Oral ulcers, keratoderma blenorrhagica, circinate balantis
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Psoriatic arthritis
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dactylitis (sausage), pencil-in-cup
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Type of hypersensitivity in SLE
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All symptoms are due to Type III except for blood disorders, which are type II (IgG hemolytic anemia)
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Schaumann and asteroid bodies
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sarcoidosis
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Polymyalgia rheumatica Sx and labs
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pain and stiffness in shoulders and hips w/ fever, weight loss. > 50 yo w/ temporal cell arteritis
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Labs: increased ESR, normal CK, increased CRP
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Dermatomyositis Sx and histology
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Sx: polymyositis + heliotrope rash + malar rash + Gottron's + increased risk of malignancy
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Histology: perifascicular inflammation w/ antibody mediated inflammatory infiltrate
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Polymyositis histology
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endomysial inflammation w/ CD8+ cell mediated infiltrate
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Polymyositis/Dermatomyositis labs
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INCREASED CK, positive anti-Jo-1
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MC COD in Mixed Connective Tissue Disease
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pulmonary HTN
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Mixed connective tissue disease Sx
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Raynaud's, Fatigue, Arthralgias, Myalgias, Esophageal hypomotility (Raynaud's FAME)
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MCTD antibodies
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anti-U1RNP
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MC COD in scleroderma
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respiratory failure
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CREST
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Calcinosis, raynauds, esophageal dysmotility, sclerodactyly, telangiectasia
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Hyperkeratosis
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increased thickness of stratum corneum
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Parkeratosis
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hyperkeratosis w/ retention of nuclei in stratum corneum
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Acanthosis
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epidermal hyperplasia (increase spinosum)
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What kind of esophageal cancer is seen in scleroderma
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adenocarcinoma
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Malabsorption in scleroderma
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due to intestinal fibrosis which decreases the villous surface area
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Koilocytes
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epithelial cells infected w/ HPV w/ vacuolated cells and perinculear halo
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spongiosis
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allergic contact dermatitis (eczematous dermatitis)
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Munro microabscesses
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seen in psoriasis where there is neutrophilic infiltrate of the epidermis
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Auspitz sign
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bleeding spots when scales are scraped off in psoriasis
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Keratin filled "horn" cysts
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seborrheic keratosis
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Sudden appearances of multiple seborrheic keratoses indicates...
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underlying malignancy, usually GI or lymphoid
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Melasma
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hyperpigmentation due to pregnancy of OCP use
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Pathophys of SSSS
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exotoxin destroys keratinocyte desmoglein in stratum granulosum only
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Risk of malignancy in Hairy Leukoplakia
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none
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Bullous vs. pemphigus
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Bullous: hemidesmosomes, subepidermal bullae, linear IF, eosinophils, spares mucosa, not painful, negative Nikolsky
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Pemphigus: desmoglein, intraepidermal, fishnet IF, involves mucosa, painful, Nikolsky sign
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Infections associated w/ erythema multiforme
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Mycoplasma, HSV
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Erythema multiforme w/ classic target lesions indicates...
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HSV etiology
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Lichen planus Sx and association
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Sx: pruritic, purple, polygonal papules w/ sawtooth lymphocytic infiltration at dermal-epidermal junction
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Associated w/ Hep C
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Cutaneous horns
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actinic keratosis
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as opposed to keratin-filled horn cysts of seborrheic keratosis
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Erythema nodosum seen in...
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coccidioidomycosis, histo, TB, leprosy, strep infections, sarcoidosis, Crohns
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Keratoacanthoma
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variant of actinic keratosis that grows rapidly and regresses spontaneously.
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has central keratin plug
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Skin cancer with palisading nuclei
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BCC
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HMB-45
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Human melanoma black-45: used as a marker for melanomas
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Marjolin ulcer
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SCC that arises from on-healing ulcer, burn wound, osteomyelitis
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omega-3-fatty acid
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alpha-linolenic acid
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NSAIDs that aren't obvious
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naproxen, ketorolac, diclofenac, piroxicam
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Cilostazol Use and MOA
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Use: used to treat peripheral artery disease and claudication
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MOA: inhibits platelet aggregation and induces vasodilation
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MOA of acetaminophen
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reversibly acts on COX, endocanabinoids, and inhibits Na+ channels
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Bisphosphonate MOA and S/E
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pyrophosphate analog that inhibits osteoclastic activity, reducing formation and resorption of hydroxyapatite
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S/E: corrosive esophagitis
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What do salicylates do in gout
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all but the highest doses of salicylates depress uric acid clearance, so it's not recommended to give aspirin
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Etanercept
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recombinant analog of TNF receptor
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Infliximab
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anti-TNF antibody
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Adalimumab
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TNF-receptor antagonist
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