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MSK Biweekly 3 > Al-Mehdi Rheumatology > Flashcards

Al-Mehdi Rheumatology Flashcards

1
Q

mechanical wear and tear and damaged cartilage

A

osteoarthritis

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2
Q

chronic systemic inflammatory disease of synovial tissues

A

rheumatoid arthritis

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3
Q

seronegative (non-RF) and damaged enthesis (tendon to bone)

A

Anklyosing spondylitis

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4
Q

seronegative and is acquired sometimes by patients with psoriasis

A

psoriatic arthritis

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5
Q

seronegative and comes about after having an infection

A

reactive arthritis

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6
Q

gout, lesch-nyhan syndrome, and pseudogout are all what

A

crystal arthopathies

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7
Q

autoimmune inflammatory disease of synovial tissues; more prevalent in white females; SMOKING!!!

A

Rheumatoid arthritis

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8
Q

HLA associated with RA

A

DR4, DRB1*0404

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9
Q

smoking causes what that leads to RA

A

activation of peptidyl-arginine deiminase (PAD)
(Arginine to Citrulline)

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10
Q

citrullination of fibrinogen, type II collagen and filaggrin causes what in RA

A

autoantigen

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11
Q

2 types of autoantibodies formed in RA

A

anti-citrullinated and anti-cyclic citrullinated forms

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12
Q

what happens in RA that deals with plasma cells recognizing what as foreign

A

plasma cells class switch to IgG and then recognize it as foreign, so then they class switch again to IgM and attack its own product

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13
Q

type of hypersensitivity that RA is associated with

A

type III; IgG-IgM immune complex

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14
Q

where are the immune complexes in RA deposited and cause what

A

blood vessels and cause vasculitis

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15
Q

what 2 cells are on the synovial membrane

A

synovial macrophage
synovial fibroblast

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16
Q

what synovial membrane cell is activated by IFN-gamma

A

synovial macrophage

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17
Q

what synovial membrane cell is activated by IL-17

A

synovial fibroblast

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18
Q

MMP, TNF-a, IL-1, IL-6, PGE2, LTB4, and VEGF are all produced by what

A

the 2 synovial membrane cells

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19
Q

the products of synovial macrophages and fibroblasts lead to what 3 main things

A

tissue damage
inflammation
pain and swelling

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20
Q

what makes a ligand for RANK receptor on osteoclast that leads to bone erosion

A

synovial fibroblasts

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21
Q

symmetrical swelling, morning joint stiffness, and mainly deals with wrist

A

RA

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22
Q

anti-citrullinated Ab

A

early IgG

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23
Q

IgM Ab (RF) against what

A

IgG

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24
Q

involves PIP and DIP

A

OA

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25
Q

does NOT involve DIP

A

RA

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26
Q

bilateral PIP joint swelling and difficulty making a fist happens to the hand when

A

in early RA

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27
Q

what can also happen in RA when median n is compressed

A

carpal tunnel syndrome

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28
Q

flexion of PIP and hyperextension of DIP

A

boutonniere finger

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29
Q

flexion of MCP, extension of PIP, and flexion of DIP

A

swan neck finger

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30
Q

very little pain early on, main symptom is morning stiffness; pannus (thickening of synovial membrane)

A

RA

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31
Q

98% specificity for ACPA

A

RA

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32
Q

elevated ESR (means inflammation) and CRP (made by liver and means inflammation), order CBC w/ diff, ANA increased, and synovial fluid more than 2000 PMNs

A

RA

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33
Q

main diagnostic imaging you will see in RA

A

pannus

34
Q
A

RA

35
Q

EARLIEST SIGN OF RA

A

juxta-articular osteopenia

36
Q

symmetrical loss of joint space

A

RA

37
Q

loss of joint space in one compartment

A

OA

38
Q

cord compression of C1 and C2 can kill patient who has what

A

RA

39
Q

nodules, felty syndrome, secondary sjogren syndrome, and vasculitis are what

A

extra-articular manifestations in RA

40
Q

classic location of nodules for RA

A

olecranon bursa

41
Q

classic location of vasculitis in RA

A

palms and fingers

42
Q

RA + splenomegaly + neutropenia

A

felty syndrome (severe RA)

43
Q

DRYNESS (keratoconjunctivitis-dry eyes and xerostomia-dry mouth)

A

secondary Sjogren syndrome

44
Q

first line drugs for RA and felty syndrome

A

methotrexate
HCQ
glucocorticoids
SSZ

45
Q

drug used for RA that blocks clonal expansion of T cells; Dihydrofolate reductase inhibition!!!!!

A

methotrexate

46
Q

drug used to inhibit T cell clonal expansion; inhibits dihydro-orotate dehydrogenase!!!

A

Leflunomide

47
Q

only drug you can give a pregnant patient who has RA; blocks TLR-9 (blocks synovial macrophage)

A

HCQ

48
Q

used for RA and inhibits gene expression of all cytokines

A

glucocorticoids

49
Q

Baricitinib
Tofacitinib
Upadacitinib
(-tinibs)

A

block JAK/STAT (inhibit gene expression)

50
Q

used to treat RA and blocks B cells

A

Rituximab

51
Q

used to treat RA and blocks PGE2

A

Celecoxib

52
Q

first line anti-inflammatory drug for RA

A

SSZ

53
Q

blocks IL-1 and used to treat RA

A

Anakinra

54
Q

(-umabs) to treat RA
Inflixumab
Adalimumab
Golimumab
Certolizumab

A

block TNF-a

55
Q

TNFa decoy receptor used to treat RA

A

Etanercept

56
Q

drug used to treat RA and blocks RANKL (produced by synovial fibroblast) from binding to RANK on osteoclast

A

Denosumab

57
Q

biological drugs end in what

A

-mab and -cept
(monoclonal Ab’s and decoy receptors)

58
Q

what do you have to monitor when patient is on HCQ for RA (hydroxychloroquine)

A

eye

59
Q

what do you have to monitor when patient is on SSZ (sulfasalazine) for RA

A

LFTs, CBC

60
Q

what do you have to monitor when patient is on methotrexate for RA

A

LFTs, urine

61
Q

what do you have to monitor when patient is on Leflunomide for RA (used to inhibit clonal expansion of T cells)

A

LFT, blood pressure

62
Q

why you need to put patient on antibiotics for pharyngitis

A

to prevent acute rheumatic fever

63
Q

patient has redness, swelling, and tenderness of 1st MTP bilaterally from dancing

A

bursitis

64
Q

what are you at risk for developing if you dance a lot and already have bursitis

A

OA

65
Q

NO inflammation; happens from wear and tear of joints (obesity can cause this too); destroys cartilage

A

Osteoarthritis (OA)

66
Q

function of menisci

A

keep bone in joint

67
Q

climbing stairs is a main cause of what

A

OA

68
Q

brief morning stiffness, bouchard and heberden nodes, joint pain w/ activity; seronegative; CREPITUS

A

OA

69
Q

to diagnose OA

A

imaging

70
Q

look at R hip; diagnosis

A

OA

71
Q

A, B, C

A

A: Gout
B: RA (ulnar deviation)
C: OA

72
Q

what are you treating for OA

A

PAIN, not inflammation

73
Q

celecoxib, duloxetine, tramadol and even steroid injection used to treat what

A

OA

74
Q

this deals with osteopenia, while this deals with osteophytes

A

RA, OA

75
Q

seronegative, HLA-B27; extrasynovial inflammation (joint fusion)

A

seronegative spondyloarthritis

76
Q

pathognomonic for all seronegative spondyloarthritis

A

conjunctivitis, uveitis, urethritis, arthritis (can’t see and can’t pee, can’t climb a tree)

77
Q
A

Ankylosing Spondylitis

78
Q

How do RA and AS differ in terms of MHC/HLA association?

A

RA: MHC class II HLA-DRB1
AS: MHC class I HLA-B27

79
Q

DIP involved, psoriasis, sausage digits (dactylitis)

A

Psoriatic arthritis

80
Q

conjunctivitis, uveitis, urethritis, arthritis (can’t see and can’t pee, can’t climb a tree); and had a previous infection (won’t see microbe in joint)

A

Reiter Syndrome

81
Q

gonoccal monoarthritis will have arthritis from infection but not what

A

NO ocular symptoms

82
Q

Chlamydia, Salmonella, Shigella, Campylobacter can cause what

A

reactive arthritis

MSK Biweekly 3 (5 decks)

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