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DIT topics > arthritis > Flashcards

arthritis Flashcards

1
Q

caused by joint wear and tear → destroys articular cartilage

A

osteoarthritis

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2
Q

joint findings:
osteophytes - bone spurs caused by bone-on-bone
eburnation - polished, ivory-like appearance caused by bone-on-bone
heberden nodes (DIP)
bouchard nodes (PIP)

A

osteoarthritis

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3
Q

heberden nodes

A

DIP in osteoarthritis

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4
Q

bouchard nodes

A

PIP (prOximal = bOuchard) in osteoarthritis

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5
Q

common locations of osteoarthritis

A 
fingers
weight bearing areas (especially in obese):
knees
hips
spine
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6
Q

risk factors for osteoarthritis

A

age - wear to articular cartilage
obesity
trauma.joint deformity - misaligned joint

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7
Q

pain in weight bearing joints AFTER USE/END OF DAY

improves with rest

A

osteoarthritis

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8
Q

localized, noninflammatory joint disease with no systemic symptoms

A

osteoarthritis

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9
Q

treatment of osteoarthritis

A

1) acetaminophen - scheduled
2) NSAIDs
3) intraarticular glucocorticoid - temporary relief (knee)
4) hyaluronic acid - in synovial fluid
5) opioids - relieve pain only
6) knee/hip replacement if can’t walk (obese)

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10
Q

joint space narrowing - no cartilage on xray

A

osteoarthritis

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11
Q

systemic, autoimmune joint disease involving inflammatory destruction of the synovial joints

A

rheumatoid arthritis

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12
Q

joint disease that is a type III hypersensitivity reaction

A

rheumatoid arthritis

autoantibodies bind to soluble antigen in blood → form immune complexes →IC deposit in tissue

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13
Q 
female with: 
pannus formation of MCP + PIP (no DIP)
subq rheumatoid nodules 
ulnar deviation of fingers at PIP
subluxation
Baker cyst in popliteal fossa (synovial cyst behind knee)
A

rheumatoid arthritis

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14
Q

rheumatoid factor

A

IgM against IgG (anti-IgG antibody)
high FP for RA (low specificity)
if positive RF → do ACPA (anti-citrullinated peptide antibody, more specific, confirms RA)

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15
Q

MORNING STIFFNESS >30 min
improves with use
symmetric joints + systemic symptoms (fever, fatigue, pleuritic effusion, pericarditis)

A

rheumatoid arthritis

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16
Q

swan neck deformity

A

advanced rheumatoid arthritis sign (opposite of Boutonneire)
extension of PIP
flexion of DIP

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17
Q

Boutonniere deformity

A

advanced rheumatoid arthritis sign
extensor tendon on back of finger splits so PIP pokes through
flexion of PIP
extension of DIP

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18
Q

treatment for acute exacerbation of rheumatoid arthritis

A

NSAID
cox-2 inhibitor
short course of steroids

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19
Q

long-term treatment for rheumatoid arthritis (disease modifying anti-rheumatic drugs = DMARDs)

A

longer you wait - more irreversible damage
low dose MTX
hydrochloroquine
sulfasalazine
TNFα inhibitor: etanercept, infliximab, adalimumab, golimumab, certolizumab

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20
Q

precipitation of monosodium urate crystals

A

gout

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21
Q

precipitation of calcium pyrophosphte crystals

A

Pseudogout (calcium Pyrophosphate crystals)

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22
Q

is hyperuricemia required for the diagnosis of gout

A

NO
can have gout without hyperuricemia or
hyperuricemia without gout

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23
Q

acute inflammatory monoarthritis caused by monosodium urate crystals in joints

A

gout

24
Q

crystals are
needle shaped
negative birefingent under polarized light (yellow under parallel light, blue under perpendicular)

A

gout (yeLLow = paraLLel)

25
Q

conditions that cause underexcretion of uric acid → hyperuricemia → gout (most common cause)

A

usually idiopathic

loops or thiazide diuretics

26
Q

drugs that can cause gout

A

loop or thiazide diuretics

27
Q

conditions that can cause overproduction of uric acid → hyperuricemia → gout

A

purine-rich foods
Lesch Nyhan syndrome
treating leukemia, lymphoma: ↑ cell turnover (tumor lysis syndrome)

28
Q

asymmetric joint distribution, monoarthritis (one joint at a time)
cyclical attacks - comes and goes
swollen, red, painful joint
PODAGRA: painful MTP joint of big toe
TOPHI formation: nonpainful, uric crystals in external ear (most common), olecranon bursa, achilles tendon

A

gout

29
Q

arthritis that occurs after big meal or alcohol consumption

A

gout

alcohol metabolites compete for same excretion sites in kidney as uric acid →↓ uric acid excretion → hyperuricemia

30
Q

treatment of acute gout attacks

A

1) NSAIDs (indomethacin) - DOC
2) colchicine
3) prednisone for 4-5 days

31
Q

chronic treatment for gout (>1-2 attacks/year, control uric acid levels to prevent future attacks)

A

1) allopurinol - inhibit XO - DOC
2) probenecid
3) febuxostat - same MOA as allopurinol

32
Q

crystals are
rhomboid
weakly positively birefringent (blue under parallel light, yellow to perpendicular light)

A

pseudogout

Positively birefringent + calcium Pyrophosphate crystals = Pseudogout

33
Q

arthritis with chondrocalcinosis (calcification of articular cartilage - esp menisci) on xray

A

pseudogout

34
Q

arthritis involving large joints (knee usually)

>50 yo

A

pseudogout

35
Q

treatment of pseudogout

A

same as gout:
sudden, severe attack: NSAIDs
steroids: prednisone
colchicine

36
Q

what are the seronegative spondyloarthropathies

A 
PAIR
Psoriatic arthritis
Ankylosing spondylitis
Inflammatory bowel disease spondylitis
Reactive arthritis (reiter syndrome)
37
Q

syndrome that causes:
conjuncitivitis (or uveitis): pink eye
urtethritis (dysuria)
arthritis

A 
reactive arthritis (reiter syndrome)
Can't see, can't pee, can't climb a tree
38
Q 
arthritis of spine with negative rheumatoid factor (no anti-IgG antibody)
common in male with HLA-B27 (codes for HLA MHC class I)
A

seronegative spondyloarthropathies

39
Q

asymmetric + patchy, inflammatory arthritis (sometimes symmetrical) involving DIP joints, spine, SI joint
dactylitis (“sausage fingers”, inflammed finger)

A

psoriatic arthritis
may have psoriasis (asymmetric, patchy skin condition) without arthritis, both (1/3 psoriatic patients), or only psoriatic arthritis

40
Q

“pencil-in-cup” deformity on xray

A

psoriatic arthritis

41
Q

chronic inflammatory disease of spine + SI joints →
ankylosis (stiff spine due to fusion of SI joints, intervertebral discss, and/or facet joints) + uveitis (vascular layer of eye) + aortic regurgitation/conduction abnormalities/PVD/CHF

A

ankylosing spondylitis

42
Q

bamboo spine on xray

A

ankylosing spondylitis

calcification of bone outlining intervertebral discs

43
Q

↓spine mobility (including SI joint) beginning in 20-30 yo

improves with exercise

A

ankylosing spondylitis

44
Q

arthritis associated with IBD

A

IBD spondylitis
chron’s/UC
may have ankylosing spondylitis or peripheral arthritis

45
Q

arthritis after infection with:
chlamydia
GI infection: shigella (most common), salmonella, yersinia, campylobacter, clostridium)

A

reactive arthritis (reiter syndrome)

46
Q

STD that can cause a migratory arthritis with asymmetric pattern (a type of septic arthritis)

A 
Neisseria gonorrhoeae (can cause osteomyelitis too)
called gonococcal arthritis 
STD
Synovitis (knee)
Tenosynovitis (hand)
dermatitis (pustules)
47
Q

young sexually active patient with red, swollen, painful knee

A

Gonoococcal arthritis (N. gonorrhoeae)

48
Q

diagnosis of septic arthritis requires

A

arthrocentesis: ↑WBC, bacteria

49
Q

treatment of septic arthritis

A

IV antibiotics + surgery to clean out otherwise destructive

50
Q

organisms that can cause septic arthritis

A

S. aureus
Streptococcus
N. gonorrhoeae

51
Q

treatment of seronegative spondyloarthropathies

A

NSAID
steroids
DMARDs (also used in RA)
TNFα inhibitors (also used in RA)

52
Q

arthritis begins

A

juvenile idiopathic arthritis

53
Q

type of juvenile idiopathic arthritis characterized by:

severe symmetrical arthritis + dactylitis (inflammation of fingers)

A

polyarticular juvenile idiopathic arthritis

54
Q

type of juvenile idiopathic arthritis characterized by:
large joint involvement (doesn’t start in hips)
20-25% have uveitis

A

pauciarticular (few joints) juvenile idiopathic arthritis

55
Q

type of juvenile idiopathic arthritis characterized by:
begins with systemic sx (fever, rash, ↑WBC, anemia, heaptosplenomegaly, LAD) - looks like leukemia/lymphoma
arthritis presents later

A

systemic onset juvenile idiopathic arthritis (still’s disease)

DIT topics (115 decks)

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