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STEP 2CK Review > 8 Rheum > Flashcards

8 Rheum Flashcards

1
Q

Arthrocentesis for joint pain:
what are 4 possibilities?
appearance, WBC, polys

A
  1. Normal: clear, WBC <2, Polys <25%
  2. non inflamm: clear, <2, >25%
  3. inflamm: yellow/white, 2-50, >50%
  4. septic: cloudy, >50, >75%.

normal
OA
everything else (look for crystals)
septic joint

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2
Q

Antibodies to memorize

ANA
Anti-histone
Anti dsDNA
Anti Smooth muscle
Mitochondrial Ab
anti-centromere
topoisomerase
Anti Ro+La
Anti CCP
Anti RF
Anti Jo
A

ANA–Lupus, sensitive
Anti-histone–drug induced lupus
Anti dsDNA–lupus, specific+renal involvement
Anti Smooth muscle–Autoimmune hepatitis
Mitochondrial Ab–PBC
anti-centromere–CREST/Scleroderma (C for CREST and Centromere)
topoisomerase Ab (aka Anti Scl-70)–Scleroderma, systemic
Anti Ro+La–Sjogrens
Anti CCP–RA
Anti RF–RA
Anti Jo–Polymyositis

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3
Q

What ab?

Lupus, sensitive
drug induced lupus
lupus, specific+renal involvement
Autoimmune hepatitis
PBC
CREST/Scleroderma
Scleroderma, systemic
Sjogrens
RA
RA
Polymyositis
A

ANA–Lupus, sensitive
Anti-histone–drug induced lupus
Anti dsDNA–lupus, specific+renal involvement
Anti Smooth muscle–Autoimmune hepatitis
Mitochondrial Ab–PBC
anti-centromere–CREST/Scleroderma (C for Centromere and CREST)
topoisomerase Ab (aka Anti Scl-70)–Scleroderma, systemic
Anti Ro+La–Sjogrens
Anti CCP–RA
Anti RF–RA
Anti Jo–Polymyositis

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4
Q

Lupus criteria

what other 2 things not on criteria to remember:

A

4 of 11: SOAP BRAIN MD

Serositis
Oral ulcers
Arthritis
Photosensitivity

Blood--hemolytic anemia, antiphospholipid, etc
Renal
ANA+
Immune labs (anti histone, anti dsDNA)
Neuro

Malar Rash
Discoid Rash

  • libman-sacks endocarditis
  • alopecia
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5
Q

Lupus miscarriages: what trimester?

A

2nd trimester losses

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6
Q

Diagnostic tests of SLE:

  • screen, confirm, track
  • renal involvement screen, confirm
  • flare
A

1st: ANA to screen
confirm: Anti-dsDNA (most spec), anti-Smith, anti-histone (drug)

Track: ESR, CRP

Renal involvement:
Screen: UA
confirm: Kidney bx

Flare: complement levels (low C3, C4)

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7
Q

SLE, drug induced

  • which drugs
  • how present differently than regular SLE
A

SHIPP

sulfa
hydralazine
INH
procainamide
phenytoin

-spares CNS and Renal sxs. (reminds of FAT RN) Usu skin and joint presentation

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8
Q

SLE treatment approach, what to know

A

Know 3 tx in SLE:

  1. arthalgias, serositis: NSAIDs, then Hydroxychloroquine, MTX 2nd line.
  2. Flares: Steroids
  3. Nephritis, cerebritis, severe flare: Cyclophosphamide, MMF 2nd line
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9
Q

RA + splenomegaly, think what

A

think neutropenia. This is Felty’s syndrome

RA, Splenomegaly, Neutropenia

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10
Q

Pt going for surgery. Pt has RA, think what and why

A

Get cervical film. Spine involvement C1,C2.

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11
Q

Morning stiffness + spine, think what

A

C1,C2 then RA

lower back, then Ank Spond.

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12
Q

RA: what joints

A

MCP and PIP.

If DIP, then NOT RA! never affects DIPS

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13
Q

RA tests

A

Rh factor: sens

Anti-CCP: spec

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14
Q

RA dx criteria

A

“Nobody Should Have Rhematoid Symptoms 3X”

Nodes
Symmetric
Hand
RF or CCP
Stiffness, AM
3+ joints, spares DIPs
X-ray findings of erosions

However, IRL can have RA with Rh-, CCP-; or no RA with Rh+ and CCP+

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15
Q

RA Treatments, how to approach

A

4 categories to know:

Start MTX (or other DMARD) even at first presentationt! can slow progression

  1. DMARD–everyone gets. MTX, Hydroxy 2nd line
  2. Anti-TNF–severe.
  3. Steroids–flares
  4. NSAIDs–symptomatic
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16
Q

RA refractory to MTX and hydroxychloroquine.

What to do next?

A

Start Anti-TNFs because failure of DMARDs.

Always get TB screen and vaccinate first!

17
Q

CREST vs systemic scleroderma

A

CREST: Think: SKIN AND GI, SPARES HEART AND KIDNEYS

CREST: Calcinosis, Raynauds, Esophageal dysmotility, Sclerosis, Telangiectasia

Scleroderma, systemic: CREST +
heart (pericarditis, restrictive)
kidneys (renovascular HTN)

18
Q

Myopathy DDx (5)

  • sxs differences? Pain vs weakness
  • lab results for each?
A

“SPISH”

  1. steroid induced–PAINLESS, prox weakness
  2. polymyalgia rh–pain and morning stiffness esp shoulders, NO WEAKNESS
  3. inflamm myopathy–pain, prox weakness
  4. statin-induced–pain, possible weakness
  5. hypothyroid–pain and prox weakness

ESR, CK

  1. nl, nl
  2. high, nl
  3. high, high
  4. nl, high
  5. nl , high
19
Q

Gonorrhea, disseminated sxs

A

Triad:

  • tenosynovitis–asymmetric, wrists, hands, finges
  • arthritis–migratory
  • dermatitis–macular; spares face, palms, soles
20
Q

Septic joint tx? non-gonococcal

A

Test: Naf, wait for cx/sens
IRL: Vanc

21
Q

You suspect septic joint, tap shows nothing on gram stain. Think what?

A

Gonorrhea is intracellular, may not show on G strain. Still do empiric double coverage (Ceftriaxone and Vanc)

Dx with NAAT. tx while testing

22
Q

Gout from Tumor lysis syndrome. What tx for ppx? If ppx didn’t work, use what?

A

Allopurinol

Rasburicase

23
Q

You dx Septic joint and tx. What else to think about?

A

Source?

  1. direct inoculation–trauma
  2. hematogenous (think endocarditis, IVDA, intra-abd abscess)
24
Q

Seronegative arthropathies

-name them

A

PAIR

Psoriatic arthritis
Ank Spond
IBD
Reiter’s reactive arthritis–can’t see, pee, climb tree

25
Q

psoriatic arthritis

  • which joints
  • what to be careful in tx
A

symmetric DIP, PIP (like OA)

-NO ORAL STEROIDS, topical good

26
Q

Reactive arthritis

  • dx–how do you know urethritis and arthritis is not gonococcal septic joint?
  • tx
A

Can’t see/pee/climb tree
-symmetric arthritis, as opposed to unilateral in gonorrhea

-Doxy for chlamydia, and NSAIDs

27
Q

Wegener’s sxs

A

“weCeber’s triad:”

  • nasopharynx
  • lungs–hemoptysis
  • kidneys–hematuria
28
Q

Vasculitis–list them by categories

A

large vessel: Temporal arteritis, Takayasu’s

med: PAN (Hep B), kawasaki’s
small: Wegener’s (triad), microscopic polyangiitis (wegener’s -nasopharynx), churg-strauss (asthma), HSP

29
Q

Kawasaki’s sxs

A

CRASH and burn

Conjunctivitis
Rash--truncal and hands
Adenopathy
Strawberry tongue
Hands (rash)

Fever 5+days

30
Q

Scleroderma renal crisis/sxs, think what?

A

Ace-i as treatment, always.

Tx the renovascular HTN

31
Q

Ank Spond.

tx?

A

NSAIDs first line, esp if only axial involvement

Etanercept if NSAIDs fail. works for axial and peripheral skeleton

Nonbiologic DMARDs (eg MTX, hydroxy) can be used only for peripheral arthropathy. Etanercept always tried first, these can be added on.

STEP 2CK Review (20 decks)

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