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100

Name the 4 pathologies associated with HLA B-27

Psoriatic arthritis, reactive arthritis, entero-arthritis, ankylosing spondylitis

100

What are these lab findings showing? 

  • UA would show Ig light chains (Bence Jones proteinuria) with negative urine dipstick

  • Serum: Sharp M-spike in the γ (gamma) region → monoclonal IgG or IgA, Normocytic anemia (low reticulocyte count), rouleaux formation oof RBCs on peripheral smear, Hypercalcemia, 

Multiple myeloma

100

Why would a young patient present with their arm internally rotated, hand flexed, adducted

Bonus: what muscles are affected in this condition?

Erb's Palsy

Birds eat Erb’s; Biceps brachii, Infraspinatus, wRist extensors, Deltoid, Supraspinatus

100

What pathology is associated with IgG antibodies against desmoglein 3?

Phemigus Vulgaris

200

Name this pathology! 

Erosions, juxta-articular osteopenia, soft tissue swelling, subchondral cysts, joint space narrowing (symmetric). Deformities: cervical subluxation, ulnar finger deviation, swan neck F , boutonniere G. Involves MCP, PIP, wrist; not DIP or 1st CMC. 

Rheumatoid Arthritis

200

What are the 2 genetic mutations associated with osteosarcoma? 

P53 and RB1

200

What are the 2 stages of aspirin toxicity?

  • Stage 1: respiratory alkalosis

  • Stage 2: metabolic acidosis (partially compensated respiratory alkalosis)

  • Salicylate toxicity can present with hyperthermia, altered mental status, and seizures (due to neuroglycopenia).  Tachypnea, tinnitus, and acid-base abnormalities are also common.

200

What are the lab associations with lupus?

  • Screen: ANA (sensitive, but not specific).

  • Specific: anti-dsDNA (activity/nephritis), anti-Sm.

  • Antiphospholipid: anticardiolipin, lupus anticoagulant (↑PTT, arterial/venous clots, false-positive VDRL/RPR).

Low C3/C4, cytopenias; anti-histone = drug-induced lupus (I don’t like his tone when he’s on drugs) 

300

Name the most logical organism that caused septic arthritis in (pick 3): 

  • Most common

  • Sexually active young

  • Elderly/DM/urinary source

  • IVDU

  • Kids:

  • Most common: S. aureus

  • Sexually active young: N. gonorrhoeae.

  • Elderly/DM/urinary source: Gram-negatives (E. coli) + S. aureus.

  • IVDU: Pseudomonas, MRSA.

  • Kids: S. aureus, Strep; neonates add GBS.

300

Name this pathology!

  • Pleomorphic osteoid-producing cells (malignant osteoblasts). Presents as painful enlarging mass or pathologic fractures. Codman triangle (from elevation of periosteum) or sunburst pattern on x-ray, cloud-like osteoid; metaphysis

Osteosarcoma

300

Describe endochondral ossification

 (Cartilage First; long bones, vertebrae, pelvis): Mesenchymal cells → chondroblasts → hyaline cartilage → blood vessel invasion (at diaphysis bring OB and OC) → osteoblasts (replace cartilage)

300

Name the common causes of avascular necrosis of the femoral head

  • Causes include glucoCorticoids, chronic Alcohol overuse, Sickle cell disease, Trauma, SLE, “the Bends” (caisson/decompression disease), LEggCalvé-Perthes disease (idiopathic), Gaucher disease, Slipped capital femoral epiphysis— CASTS Bend LEGS.

400

Name this pathology!

Systemic arthritis seen in < 16 years of age. Usually presents with daily spiking fevers, salmon-pink macular rash, arthritis (commonly 2+ joints). Associated with anterior uveitis. Frequently presents with leukocytosis, thrombocytosis, anemia, ^ ESR, ^ CRP.

Juvenile idiopathic arthritis

400

What are the ESR levels in fibromyalgia? 

(Low, Normal, Elevated)

Normal!

 Fibromyalgia is diagnosed clinically using the 2016 ACR criteria: chronic (>3 months), widespread pain (WPI ≥7 + SSS ≥5) with no other cause identified.

400

Causes of osteoporosis

Most commonly due to increased bone resorption (inc osteoclast number and activity) related to decreased estrogen/testosterone levels, old age, and cigarette smoking

400

Name this pathology!

Acanthosis with parakeratotic scaling (nuclei still in stratum corneum), Munro microabscesses. Increased stratum spinosum, decreased stratum granulosum. Auspitz sign

Psoriasis

500

Name this pathology!

congenital heart block, periorbital/diffuse rash, hepatitis (transaminitis), and cytopenias at birth

Neonatal lupus

500

What pathology presents with insidious onset of hip pain that may cause child to limp. More common in males (4:1 ratio). Initial x-ray often normal

Legg Calve Perthes

500

MOA of Alendronate

Induces osteoclast apoptosis; binds hydroxyapetitie in bone inhibiting osteoclast activity

500

Name this pathology!

Characterized by fever, bullae formation and necrosis, sloughing of skin at dermal-epidermal junction (⊕ Nikolsky), high mortality rate. Typically mucous membranes are involved

Stevens Johnson Syndrome