Arthritis/Rheumatologic Conditions (MSK 10%) Flashcards
1
Q
RA or OA:
Morning stiffness lasting at least 60 min
A
RA
2
Q
RA or OA:
Worse after effort, evening stiffness
A
OA
3
Q
RA or OA:
Symmetric joint narrowing
A
RA
4
Q
RA or OA:
Soft, warm boggy, tender joints
A
RA
5
Q
Joints affected in RA:
Joints affected in OA:
A
Joints affected in RA: Wrists, MCP, PIP
Joints affected in OA: DIP, PIP thumb (CMC)
6
Q
Boutonniere deformity =
Seen in ___
A
flexion @ PIP, hyperextension @ DIP
Seen in RA
7
Q
Swan neck deformity =
Seen in ___
A
flexion @ DIP, hyperextension @ PIP
Seen in RA
8
Q
Felty’s Syndrome =
A
RA + splenomegaly + decreased WBC/repeated infection
9
Q
Caplan Syndrome =
A
Pneumoconiosis + RA
10
Q
Best initial test for RA
A
Rheumatoid factor (sensitive, NOT specific)
11
Q
Most specific test for RA
A
Anti-citrullinated peptide antibodies
12
Q
Tx of OA
A
1st line: Acetaminophen –> if fail, NSAID
Total joint replacement
13
Q
Pannus =
A
Hyperplastic synovial tissue that erode cartilage, subchondral bone, articular capsule, tendons, ligaments in RHEUMATOID ARTHRITIS
14
Q
Heberden nodes =
A
palpable osteophytes @ DIP in OSTEOARTHRITIS
15
Q
Bouchard’s node =
A
osteophytes @ PIP in OSTEOARTHRTIS
16
Q
RA or OA:
Osteophytes on xray
A
OA
17
Q
Tx of RA
A
Prompt initiation of DMARD (methotrexate, sulfasalazine, hydroxychloroquine)
NSAID for pain control
18
Q
Progressive loss of articular cartilage w/ reactive changes in bone –> pain and destruction of joint
A
Osteoarthritis
19
Q
Synovitis affecting multiple symmetric joints w/ bone erosion, cartilage destruction and joint structure loss d/t destruction by pannus
A
Rheumatoid arthritis
20
Q
Juvenile idiopathic arthritis (JIA) defined as: (3)
A
- < 16 y/o
- > 6 weeks duration of disease
- One of 3 subtypes: Systemic (Still disease), Pauciarticular, Polyarticular
21
Q
What type of JIA? Spiking fever Salmon-pink maculopapular rash Koebner phenomenon Minimal articular findings (What other findings? (5))
A
Systemic (Still disease)
Koebner phenomenon = skin lesions appearing on lines of trauma from scratching
Other findings: Hepatosplenomegaly, lymphadenopathy, leukocytosis, pericarditis, myocarditis
22
Q
What type of JIA?
Risk of developing iridocyclitis (anterior uveitis)
A
Pauciarticular: Involvement of <4 medium-large joints
AND
Polyarticular: symmetric involvement of >5 small/large joints
23
Q
Tx of JIA
A
NSAID, PT/OT
2nd line: methotrexate, leflunomide
24
Q
T/F: 80% of JIA patients progress to disabling arthritis into adulthood.
A
False. 80% of JIA patients remit w/o serious disability
25
Definitive dx of Septic Arthritis
Arthrocentesis: WBC >50,000, mostly PMNs
26
Tx of septic arthritis for gram + cocci
Nafcillin
Vancomycin if suspect MRSA
PCN allergy: Vancomycin, Clindamycin
27
Tx of septic arthritis for gram - cocci
Ceftriaxone
PCN allergy: Ciprofloxacin
Gonococcal usually don't need arthrotomy
28
Tx of septic arthritis for gram - rods
Ceftriaxone (3rd gen cephalosporin) + gentamicin (anti-pseudomonal AG)
29
Tx of septic arthritis if no organism seen
Nafcillin
OR
Vancomycin + ceftriaxone (+/- anti-pseudomonas)
30
"Pencil in cup" deformity
Psoriatic arthritis
31
(Symmetric/asymmetric) arthritis dactylitis ("sausage" digits)
Asymmetric
Psoriatic arthritis
BUT can also be symmetric DIP joints (like in RA)
32
+ HLA-B27 seen in (3)
Reactive arthritis
Psoriatic arthritis
Ankylosing spondylitis
33
Reactive arthritis MC seen in ___
Chlamydia
34
Keratoderma blennnorrhagica =
Seen in ___.
Other clinical manifestations (4)
= hyperkeratotic lesions on palms/soles
Seen in Reactive Arthritis
Other manifestations: conjuctivitis, urethritis, arthritis, mucosal ulcers (balanitis, stomatitis)
35
Tx of Reactive Arthritis
NSAIDs
36
T/F: Synovial fluid in Reatice Arthritis shows WBC 10,000-50,000 and positive bacterial culture.
False: WBC 1,000-8,000
| NEGATIVE bacterial culture (aseptic)
37
Tx of ACUTE gout
NSAID (Indomethacin) = 1st line
| Colchicine = 2nd line
38
Tx of CHRONIC gout
Allopurinol (inhibit xanthine oxidase --> reduce uric acid production)
Colchicine (only med that can be used for ACUTE and CHRONIC management)
39
Gout
Joint fluid analysis:
Serum uric acid level:
X ray:
- Rod/needle-shaped, negatively birefringent urate crystals
- Serum uric acid > 8
- "Mouse/rat bite" "punched-out" erosions
40
MC joint in:
Gout =
Pseudogout =
```
Gout = 1st MTP joint
Pseudogout = Knee
```
41
Pseudogout
X-ray:
Joint fluid analysis:
X-ray: Chondrocalcinosis (cartilage calcification)--> linear radiodensities
Joint fluid analysis: positively birefringent, rhomboid-shaped CPP crystals
42
Tx of Pseudogout
Corticosteroids = 1st line
| NSAIDs, Colchinine (prophylaxis)
43
Triad of manifestation of SLE
Joint pain (90%)
Fever
Malar "butterfly" rash
44
Mnemonic for SLE symptoms
```
"SOAP BRAIN MD"
S=serositis (pericarditis, pleuritis)
O=oral ulcers
A=arthritis
P=photosensitivity, pulmonary fibrosis
B=blood cells (hemolytic anemia, leukopenia, thrombocytopenia)
R=renal, Raynauds
A=ANA
I=immunologic (anti-Sm, anti-dsDNA)
N=neuropsych
M=malar rash
D=discoid rash
```
45
Best initial test for SLE:
| Most specific test(s) for SLE:
Best initial test for SLE: Anti-nuclear Ab (sensitive)
Most specific test(s) for SLE: Anti-dsDNA and Anti-Smith ab (100% specific, not sensitive)
46
Drugs that induce SLE (7)
What will these drug induced SLE patients be positive for?
```
Procainamide
Hydralazine
INH
Quinidine
Phenytoin
Etanercept
Sulfa-drugs
```
+ Anti-histone bodies
47
Tx of SLE
Regular exercise, sun protection
NSAIDs: msk complaints
Antimalarials (hydroxychloroquine, quinacrine): msk and cutaneous
Corticosteroids: disease flares
Methotrexate: arthritis, rashes, serositis, constitutional symptoms
48
Idiopathic inflammatory muscle disease of proximal limbs, neck, pharynx =
When skin is affected =
Polymyositis
| Dermatomyositis
49
Pathognomonic for Dermatomyositis (2)
Heliotrope (blue-purple) upper eyelid discoloration
Gottron's papules = raised violaceous scaly eruptions on knuckles
50
Ab specific for dermatomyositis
Ab specific for polymyositis (2)
Ab specific for dermatomyositis: Anti-Mi-2 Ab
Ab specific for polymyositis:
- Anti-Jo 1 Ab --> associated w/ interstitial lung fibrosis, "mechanic hands"
- Anti-SRP Ab
51
Elevated ___ & ___ seen in polymyositis and dermatomyositis.
Dx w/:
Aldolase*
Creatine kinase
Muscle bx: myopathic inflammatory changes
52
Tx of polymyositis, dermatomyositis
1st line: corticosteroids
| Methotrexate, azathioprine, IV Immune globulin
53
Idiopathic inflammatory condition causing synovitis, bursitis, tenosynovitis --> aching/stiffness of proximal joints (shoulder hip, neck) in pts ____ y/o
Closely related to ____
Polymyalgia Rheumatica
>50 y/o
Related to Giant Cell Arteritis
54
Clinical manifestation of Polymyalgia Rheumatica:
| (Unilateral/bilateral) (proximal/distal) joint pain/STIFFNESS in the (morning/evening) lasting ____ in ____areas.
BILATERAL PROXIMAL joint pain/STIFFNESS in the MORNING lasting > 30 MINUTES in PELVIC and SHOULDER GIRDLE areas.
(difficulty combing hair, putting on coat, getting out of chair)
55
Tx of Polymyalgia Rheumatica
low dose corticosteroids
56
Systemic vasculitis of medium/small arteries --> necrotizing inflammatory lesions
Type ___ hypersensitivity
Associated with ____
```
Polyarteritis nodosa (PAN)
Type III hypersensitivity
```
Associated with Hepatitis B** and C
57
Dx of Polyarteritis Nodosa
Tx?
Vessel/muscle biopsy
Renal/Mesenteric Angiography: microaneurysms w/ abrupt cut-off of small arteries
Tx: Steroids
Plasmapharesis in pts w/ HBV
58
T/F: Polyarteritis Nodosa is ANCA positive.
False. ANCA negative. (<20% are P-ANCA +)
59
Symptoms of Polyarteritis Nodosa
HTN, Renal failure
Fever, myalgia, arthritis
Neuropathy, Mononeuritis complex
Livedo reticularis
60
Systemic connective tissue d/o: deposition of collagen in skin --> skin thickening (sclerodactyl), lung, heart, kidney, GI tract
Sceroderma (systemic sclerosis)
61
CREST Syndrome =
| Associated w/ ___
```
Calcinosis cutis
Raynaud's phenomenon
Esophageal motility d/o
Scerodactyly (claw hand) **
Telangectasia
```
LIMITED Cutaneous Systemic Sclerosis
62
1. Ab associated with Limited Sclerosis/CREST Syndrome:
| 2. Ab associated w/ Diffuse Systemic Sclerosis:
1. Anti-Centromere Ab
| 2. Anti-SCL-70 Ab
63
T/F: Scleroderma is cured w/ high dose corticosteroids.
False. NO cure. Tx towards organ specific symptoms
64
Sjogren's Syndrome is associated w/ increased incidence of ____
lymphoma (Non-Hodgkin's lymphoma)
65
Schirmer test
Test for decreased tear production
| Used in dx of Sjogren's SYndrome
66
Sjogren's Syndrome: Ab+ ___, ___ and ____
AntiSS-A (Ro)
AntiSS-B (La)
RF
67
Tx of Sjogren's Syndrome
Artificial Tears
Pilocarpine (cholinergic drug) --> increase lacrimation, salivation
Cevimeline --> stimulate muscarinic chlinergic receptors
68
Widespread muscular pain, fatigue, muscle tenderness, headaches, sleep/memory problems
Fibromyalgia
*extreme fatigue, Sleep disturbances
69
Dx of Fibromyalgia
Diffuse pain in 11/18 trigger points for > 3 months
Biopsy: "moth-eaten" appearance type 1 muscle fibers, injury to muscle
70
FDA approved tx of Fibromyalgia
Other txs
Pregabalin (Lyrica)
TCA*, Cymbalta, SSRIs, Neurontin, Swimming
71
MC mechanism of injury of an ankle sprain
Inversion and plantar flexion
72
Name the level of disc herniation:
| Weakness in ankle dorsiflexion
L4 (between L3-L4)
73
Name the level of disc herniation:
| Sensory loss on plantar surface of foot
S1 (between L5-S1)
74
Name the level of disc herniation:
| Dorsum of foot, especially between 1st and 2nd toe
L5 (between L4-L5)
75
Name the level of disc herniation:
| Weakness in big toe extension
L5 (between L4-L5)
76
Name the level of disc herniation:
| Plantar flexion
S1 (between L5-S1)
77
Name the level of disc herniation:
| Loss of knee jerk
L4 (between L3-L4)
78
Name the level of disc herniation:
| Loss of ankle jerk
S1 (between L5-S1)
79
Name the level of disc herniation:
| Sensory loss of anterior thigh
L4 (between L3-L4)
80
Name the level of disc herniation:
| Sensory loss of lateral thigh/leg, hip, groin
L5 (between L4-L5)
81
Name the level of disc herniation:
| No diminished reflexes
L5 (between L4-L5)
82
Name the level of disc herniation:
| Walking on heel more difficult than walking on toes
L5 (between L4-L5)
83
Elbow/shoulder flexed @ 90 degrees w/ sharp anterior shoulder pain on passive internal rotation of humerus =
Tests for ____
+ Hawkins test
Impingement of subscapular nerve/supraspinatus b/w acromial process and humeral head
84
Arm fully pronated (thumb's down) w/ pain during forward flexion =
Tests for ____
+ Neer test
Impingement of subscapular nerve/supraspinatus b/w acromial process and humeral head
85
Posterior hip dislocation presents ___, (abducted/adducted), (externally/internally) rotated.
shortened, adducted, internally rotated
86
Anterior hip dislocation presents (flexed/extended), (abducted/adducted), (externally/internally) rotated.
flexed, abducted, externally rotated
87
Fractured femoral neck presents ___.
shortened, externally rotated
88
What cervical level?
| Pain in neck, shoulder, lateral arm, radial forearm
C6
89
What cervical level?
| Biceps and wrist extensors/pollicis longus weakness
C6
90
What cervical level?
| DTR changes in biceps reflex
C5
91
What cervical level?
| DTR changes in biceps and brachioradialis reflex
C6
92
What cervical level?
| Pain in neck, shoulder, medial border of scapula, lateral aspect of arm, dorsum of hand
C7
93
What cervical level?
| Sensory changes in dorslateral aspect of thumb and index finger
C6
94
What cervical level?
| Sensory changes in middle finger and dorsum of hand
C7
95
What cervical level?
| Triceps and finger extensors weakness
C7
96
What cervical level?
| Sensory changes in deltoid region
C5
97
What cervical level?
| Pain in neck, shoulder, anterolateral aspect of arm
C5
98
What cervical level?
| Biceps and deltoid weakness/atrophy
C5
99
Forced flexion and circumduction of knee joint =
Tests for ____
McMurray test
Medial meniscus tear
100
Pain after being seated for prolonged period =
Associated with ____
Tx:
Theatre sign
Patellofemoral syndrome
Tx: PT to strengthen quadriceps
101
TNF inhibitors for tx of RA that does not respond to initial therapy should be screened for ____.
Tuberculosis w/ PPD test d/t increased risk of developing opportunistic infection
102
HLA-DR4 associated with ____
Rheumatoid arthritis
103
Ottawa ankle rules=
Used for ___
1. Bony tenderness along posterior edge of lateral or medial malleolus
2. Bony tenderness over navicular
Determines if ankle x-ray should be obtained
104
Inflammatory causes of POLYarthritis (2)
SLE
| Rheumatoid arthritis
105
Inflammatory causes of OLIGOarthritis (2)
Reactive arthritis
| Psoriatic arthritis
106
Recommended calcium intake for postmenopausal women =
1,500 mg
