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PANCE > Arthritis/Rheumatologic Conditions (MSK 10%) > Flashcards

Arthritis/Rheumatologic Conditions (MSK 10%) Flashcards

1
Q

RA or OA:

Morning stiffness lasting at least 60 min

A

RA

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2
Q

RA or OA:

Worse after effort, evening stiffness

A

OA

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3
Q

RA or OA:

Symmetric joint narrowing

A

RA

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4
Q

RA or OA:

Soft, warm boggy, tender joints

A

RA

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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)

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6
Q

Boutonniere deformity =

Seen in ___

A

flexion @ PIP, hyperextension @ DIP

Seen in RA

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7
Q

Swan neck deformity =

Seen in ___

A

flexion @ DIP, hyperextension @ PIP

Seen in RA

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8
Q

Felty’s Syndrome =

A

RA + splenomegaly + decreased WBC/repeated infection

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9
Q

Caplan Syndrome =

A

Pneumoconiosis + RA

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10
Q

Best initial test for RA

A

Rheumatoid factor (sensitive, NOT specific)

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11
Q

Most specific test for RA

A

Anti-citrullinated peptide antibodies

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12
Q

Tx of OA

A

1st line: Acetaminophen –> if fail, NSAID

Total joint replacement

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13
Q

Pannus =

A

Hyperplastic synovial tissue that erode cartilage, subchondral bone, articular capsule, tendons, ligaments in RHEUMATOID ARTHRITIS

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14
Q

Heberden nodes =

A

palpable osteophytes @ DIP in OSTEOARTHRITIS

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15
Q

Bouchard’s node =

A

osteophytes @ PIP in OSTEOARTHRTIS

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16
Q

RA or OA:

Osteophytes on xray

A

OA

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17
Q

Tx of RA

A

Prompt initiation of DMARD (methotrexate, sulfasalazine, hydroxychloroquine)
NSAID for pain control

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18
Q

Progressive loss of articular cartilage w/ reactive changes in bone –> pain and destruction of joint

A

Osteoarthritis

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19
Q

Synovitis affecting multiple symmetric joints w/ bone erosion, cartilage destruction and joint structure loss d/t destruction by pannus

A

Rheumatoid arthritis

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20
Q

Juvenile idiopathic arthritis (JIA) defined as: (3)

A
  1. < 16 y/o
  2. > 6 weeks duration of disease
  3. One of 3 subtypes: Systemic (Still disease), Pauciarticular, Polyarticular
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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

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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

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23
Q

Tx of JIA

A

NSAID, PT/OT

2nd line: methotrexate, leflunomide

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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

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25
Q

Definitive dx of Septic Arthritis

A

Arthrocentesis: WBC >50,000, mostly PMNs

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26
Q

Tx of septic arthritis for gram + cocci

A

Nafcillin
Vancomycin if suspect MRSA
PCN allergy: Vancomycin, Clindamycin

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27
Q

Tx of septic arthritis for gram - cocci

A

Ceftriaxone
PCN allergy: Ciprofloxacin
Gonococcal usually don’t need arthrotomy

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28
Q

Tx of septic arthritis for gram - rods

A

Ceftriaxone (3rd gen cephalosporin) + gentamicin (anti-pseudomonal AG)

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29
Q

Tx of septic arthritis if no organism seen

A

Nafcillin
OR
Vancomycin + ceftriaxone (+/- anti-pseudomonas)

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30
Q

“Pencil in cup” deformity

A

Psoriatic arthritis

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31
Q

(Symmetric/asymmetric) arthritis dactylitis (“sausage” digits)

A

Asymmetric
Psoriatic arthritis
BUT can also be symmetric DIP joints (like in RA)

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32
Q

+ HLA-B27 seen in (3)

A

Reactive arthritis
Psoriatic arthritis
Ankylosing spondylitis

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33
Q

Reactive arthritis MC seen in ___

A

Chlamydia

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34
Q

Keratoderma blennnorrhagica =
Seen in ___.
Other clinical manifestations (4)

A

= hyperkeratotic lesions on palms/soles

Seen in Reactive Arthritis

Other manifestations: conjuctivitis, urethritis, arthritis, mucosal ulcers (balanitis, stomatitis)

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35
Q

Tx of Reactive Arthritis

A

NSAIDs

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36
Q

T/F: Synovial fluid in Reatice Arthritis shows WBC 10,000-50,000 and positive bacterial culture.

A

False: WBC 1,000-8,000

NEGATIVE bacterial culture (aseptic)

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37
Q

Tx of ACUTE gout

A

NSAID (Indomethacin) = 1st line

Colchicine = 2nd line

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38
Q

Tx of CHRONIC gout

A

Allopurinol (inhibit xanthine oxidase –> reduce uric acid production)
Colchicine (only med that can be used for ACUTE and CHRONIC management)

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39
Q

Gout
Joint fluid analysis:
Serum uric acid level:
X ray:

A
  • Rod/needle-shaped, negatively birefringent urate crystals
  • Serum uric acid > 8
  • “Mouse/rat bite” “punched-out” erosions
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40
Q

MC joint in:
Gout =
Pseudogout =

A 
Gout = 1st MTP joint
Pseudogout = Knee
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41
Q

Pseudogout
X-ray:
Joint fluid analysis:

A

X-ray: Chondrocalcinosis (cartilage calcification)–> linear radiodensities
Joint fluid analysis: positively birefringent, rhomboid-shaped CPP crystals

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42
Q

Tx of Pseudogout

A

Corticosteroids = 1st line

NSAIDs, Colchinine (prophylaxis)

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43
Q

Triad of manifestation of SLE

A

Joint pain (90%)
Fever
Malar “butterfly” rash

44
Q

Mnemonic for SLE symptoms

A 
"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
Q

Best initial test for SLE:

Most specific test(s) for SLE:

A

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
Q

Drugs that induce SLE (7)

What will these drug induced SLE patients be positive for?

A 
Procainamide
Hydralazine
INH
Quinidine
Phenytoin 
Etanercept
Sulfa-drugs

+ Anti-histone bodies

47
Q

Tx of SLE

A

Regular exercise, sun protection
NSAIDs: msk complaints
Antimalarials (hydroxychloroquine, quinacrine): msk and cutaneous
Corticosteroids: disease flares
Methotrexate: arthritis, rashes, serositis, constitutional symptoms

48
Q

Idiopathic inflammatory muscle disease of proximal limbs, neck, pharynx =
When skin is affected =

A

Polymyositis

Dermatomyositis

49
Q

Pathognomonic for Dermatomyositis (2)

A

Heliotrope (blue-purple) upper eyelid discoloration

Gottron’s papules = raised violaceous scaly eruptions on knuckles

50
Q

Ab specific for dermatomyositis

Ab specific for polymyositis (2)

A

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
Q

Elevated ___ & ___ seen in polymyositis and dermatomyositis.
Dx w/:

A

Aldolase*
Creatine kinase

Muscle bx: myopathic inflammatory changes

52
Q

Tx of polymyositis, dermatomyositis

A

1st line: corticosteroids

Methotrexate, azathioprine, IV Immune globulin

53
Q

Idiopathic inflammatory condition causing synovitis, bursitis, tenosynovitis –> aching/stiffness of proximal joints (shoulder hip, neck) in pts ____ y/o

Closely related to ____

A

Polymyalgia Rheumatica
>50 y/o

Related to Giant Cell Arteritis

54
Q

Clinical manifestation of Polymyalgia Rheumatica:

(Unilateral/bilateral) (proximal/distal) joint pain/STIFFNESS in the (morning/evening) lasting ____ in ____areas.

A

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
Q

Tx of Polymyalgia Rheumatica

A

low dose corticosteroids

56
Q

Systemic vasculitis of medium/small arteries –> necrotizing inflammatory lesions
Type ___ hypersensitivity

Associated with ____

A 
Polyarteritis nodosa (PAN)
Type III hypersensitivity

Associated with Hepatitis B** and C

57
Q

Dx of Polyarteritis Nodosa

Tx?

A

Vessel/muscle biopsy
Renal/Mesenteric Angiography: microaneurysms w/ abrupt cut-off of small arteries

Tx: Steroids
Plasmapharesis in pts w/ HBV

58
Q

T/F: Polyarteritis Nodosa is ANCA positive.

A

False. ANCA negative. (<20% are P-ANCA +)

59
Q

Symptoms of Polyarteritis Nodosa

A

HTN, Renal failure
Fever, myalgia, arthritis
Neuropathy, Mononeuritis complex
Livedo reticularis

60
Q

Systemic connective tissue d/o: deposition of collagen in skin –> skin thickening (sclerodactyl), lung, heart, kidney, GI tract

A

Sceroderma (systemic sclerosis)

61
Q

CREST Syndrome =

Associated w/ ___

A 
Calcinosis cutis 
Raynaud's phenomenon
Esophageal motility d/o
Scerodactyly (claw hand) **
Telangectasia

LIMITED Cutaneous Systemic Sclerosis

62
Q
  1. Ab associated with Limited Sclerosis/CREST Syndrome:

2. Ab associated w/ Diffuse Systemic Sclerosis:

A
  1. Anti-Centromere Ab

2. Anti-SCL-70 Ab

63
Q

T/F: Scleroderma is cured w/ high dose corticosteroids.

A

False. NO cure. Tx towards organ specific symptoms

64
Q

Sjogren’s Syndrome is associated w/ increased incidence of ____

A

lymphoma (Non-Hodgkin’s lymphoma)

65
Q

Schirmer test

A

Test for decreased tear production

Used in dx of Sjogren’s SYndrome

66
Q

Sjogren’s Syndrome: Ab+ ___, ___ and ____

A

AntiSS-A (Ro)
AntiSS-B (La)
RF

67
Q

Tx of Sjogren’s Syndrome

A

Artificial Tears
Pilocarpine (cholinergic drug) –> increase lacrimation, salivation
Cevimeline –> stimulate muscarinic chlinergic receptors

68
Q

Widespread muscular pain, fatigue, muscle tenderness, headaches, sleep/memory problems

A

Fibromyalgia

*extreme fatigue, Sleep disturbances

69
Q

Dx of Fibromyalgia

A

Diffuse pain in 11/18 trigger points for > 3 months

Biopsy: “moth-eaten” appearance type 1 muscle fibers, injury to muscle

70
Q

FDA approved tx of Fibromyalgia

Other txs

A

Pregabalin (Lyrica)

TCA*, Cymbalta, SSRIs, Neurontin, Swimming

71
Q

MC mechanism of injury of an ankle sprain

A

Inversion and plantar flexion

72
Q

Name the level of disc herniation:

Weakness in ankle dorsiflexion

A

L4 (between L3-L4)

73
Q

Name the level of disc herniation:

Sensory loss on plantar surface of foot

A

S1 (between L5-S1)

74
Q

Name the level of disc herniation:

Dorsum of foot, especially between 1st and 2nd toe

A

L5 (between L4-L5)

75
Q

Name the level of disc herniation:

Weakness in big toe extension

A

L5 (between L4-L5)

76
Q

Name the level of disc herniation:

Plantar flexion

A

S1 (between L5-S1)

77
Q

Name the level of disc herniation:

Loss of knee jerk

A

L4 (between L3-L4)

78
Q

Name the level of disc herniation:

Loss of ankle jerk

A

S1 (between L5-S1)

79
Q

Name the level of disc herniation:

Sensory loss of anterior thigh

A

L4 (between L3-L4)

80
Q

Name the level of disc herniation:

Sensory loss of lateral thigh/leg, hip, groin

A

L5 (between L4-L5)

81
Q

Name the level of disc herniation:

No diminished reflexes

A

L5 (between L4-L5)

82
Q

Name the level of disc herniation:

Walking on heel more difficult than walking on toes

A

L5 (between L4-L5)

83
Q

Elbow/shoulder flexed @ 90 degrees w/ sharp anterior shoulder pain on passive internal rotation of humerus =

Tests for ____

A

+ Hawkins test

Impingement of subscapular nerve/supraspinatus b/w acromial process and humeral head

84
Q

Arm fully pronated (thumb’s down) w/ pain during forward flexion =

Tests for ____

A

+ Neer test

Impingement of subscapular nerve/supraspinatus b/w acromial process and humeral head

85
Q

Posterior hip dislocation presents ___, (abducted/adducted), (externally/internally) rotated.

A

shortened, adducted, internally rotated

86
Q

Anterior hip dislocation presents (flexed/extended), (abducted/adducted), (externally/internally) rotated.

A

flexed, abducted, externally rotated

87
Q

Fractured femoral neck presents ___.

A

shortened, externally rotated

88
Q

What cervical level?

Pain in neck, shoulder, lateral arm, radial forearm

A

C6

89
Q

What cervical level?

Biceps and wrist extensors/pollicis longus weakness

A

C6

90
Q

What cervical level?

DTR changes in biceps reflex

A

C5

91
Q

What cervical level?

DTR changes in biceps and brachioradialis reflex

A

C6

92
Q

What cervical level?

Pain in neck, shoulder, medial border of scapula, lateral aspect of arm, dorsum of hand

A

C7

93
Q

What cervical level?

Sensory changes in dorslateral aspect of thumb and index finger

A

C6

94
Q

What cervical level?

Sensory changes in middle finger and dorsum of hand

A

C7

95
Q

What cervical level?

Triceps and finger extensors weakness

A

C7

96
Q

What cervical level?

Sensory changes in deltoid region

A

C5

97
Q

What cervical level?

Pain in neck, shoulder, anterolateral aspect of arm

A

C5

98
Q

What cervical level?

Biceps and deltoid weakness/atrophy

A

C5

99
Q

Forced flexion and circumduction of knee joint =

Tests for ____

A

McMurray test

Medial meniscus tear

100
Q

Pain after being seated for prolonged period =

Associated with ____
Tx:

A

Theatre sign

Patellofemoral syndrome
Tx: PT to strengthen quadriceps

101
Q

TNF inhibitors for tx of RA that does not respond to initial therapy should be screened for ____.

A

Tuberculosis w/ PPD test d/t increased risk of developing opportunistic infection

102
Q

HLA-DR4 associated with ____

A

Rheumatoid arthritis

103
Q

Ottawa ankle rules=

Used for ___

A
  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
Q

Inflammatory causes of POLYarthritis (2)

A

SLE

Rheumatoid arthritis

105
Q

Inflammatory causes of OLIGOarthritis (2)

A

Reactive arthritis

Psoriatic arthritis

106
Q

Recommended calcium intake for postmenopausal women =

A

1,500 mg

PANCE (20 decks)

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