Awesome Review Flashcards
Patient with Rheumatoid Arthritis for preoperative clearance
Check flexion/extension of cervical spine
Name 2 poor prognostic factors for RA
Elevated ESR
Elevated Rh factor (= nodules!)
Joint space loss/erosions
Progressive synovitis
Name 3 side effects of MTX
Hypersensitivity Pneumonitis! Pancytopenia Hepatotoxicity Nephrotoxicity Neurotoxicity/Seizures Pulmonary Fibrosis
Follow up labs every 3 months
Treat MTX induced Acute Renal Failure
Glucarpidase
Name the 5 TNF Alpha Inhibitors
Adalimumab Etanercept Infliximab Golimumab Certolizomab
If your rheumatoid patient on leflunomide, surprisingly gets pregnant, what can you give?
Cholestyramine to accelerate metabolism
If your patient has been taking 5 mg prednisone for 3 months, what diagnostic do you need to order?
DXA scan
Diagnose this:
Triad is fever, joint pain, salmon bumpy Rash
Associated with leukocytosis and increased ferritin, LAD
Still’s disease
Tx- steroids and Anakinra (IL1 receptor inhibitor)
Sjögren’s syndrome has increased risk of… (2) and associated with which NAGMA
Lymphoma including B cell and MALT
And
Celiac sprue
And distal Type 1 RTA
What is Schober Test and what disease is it associated with?
Ankylosing Spndylitis
While bending forward, there is no intervertebral space when there is normally 5 cm
Due to bamboo spine
What is Keratoderma Blenorrhagica and what disease is it associated with?
Hyperkeratotic rash on soles and palms, associated with reactive arthritis
Diagnose this:
Recurrent painful aphthous stomatitis, genital aphthous ulcers, joint pain, erythema nodosum
HLA B5
Pathergy
Behçet’s disease
If only mucocutaneous disease, use colchicine
If moderate to severe disease, use steroids
Diagnose this:
Xray of T spine shows:
Flowing ossification of anterior longitudinal ligaments
DISH
Diffuse Idiopathic Skeletal Hyperostosis
Diagnose this:
MRI showing double line sign
Avascular Necrosis or Bone Infarct
Type of crystals in Gout
Mono sodium urate
2 causes of Pseudo gout
Hyperparathyroidism and Hemochromatosis
Diagnose this: Shoulder pain XRAY- calcification of peri-articular cartilage/ligaments Blood tinged effusion Crystals on alizarin red stain
Milwaukee shoulder
Most commonly affected muscle in lateral epicondylitis
Extensor Carpi Radialis Brevis
Treat Dupuytren’s contracture
Collagenase injection
Otherwise surgery
Polymyalgia Rheumatica is also associated with which vasculitis?
Temporal arteritis
Tx PMR with low dose prednisone
Tx Temporal Arteritis with high dose prednisone
What is Crowned Dens Syndrome?
Neck pain, elevated inflammatory markers
XRAY showing calcification of cervical ligaments (eg- transverse of atlas and calcium deposits surrounding odontoid)
Made of hydroxyapatite or calcium pyrophosphate dihydrate
How to diagnose Takayasu disease?
Aortography which shows stenosis
What’s the diagnosis and treatment?
Fever, polyserositis, arthritis, erysipeloid rash around ankles
MEFV1 gene
Familial Mediterranean Fever
Colchicine to decrease cytokines
Long term complication of Familial Mediterranean Fever
AA amylodosis
Which Vasculitis?
Saddle Nose Deformity
Subglottic stenosis
Pulmonary Hemorrhage
Hint- affects sinus, lung and kidney
Granulomatosis with Polyangiitis/Wegners
pANCA
Also known as
Anti-myeloperioxidase
Seen in Churg Strauss/eosinophilia granulomatosis with polyangiitis & ulcerative colitis
c-ANCA
Also known as
Antiproteinase 3
Seen in Wegners/granulomatosis with polyangiitis
Which vasculitis? Migratory Pulmonary infiltrate Mononeuritis Multiplex Purpuric skin rash Seen with asthma, eosinophilia, allergic rhinitis
Eosinophilia granulomatosis with polyangiitis/Churg Strauss
Describe complement levels in SLE
Everything decreased
But C3 is more decreased than C4
CH50 is decreased
What serology test correlates with disease activity in SLE?
Anti double stranded DNA
Patient on Cyclosporine, develops HA, AMS, Seizures, Visual Loss
MRI shows enhancement in occipital lobes
Diagnosis and Treatment?
Posterior Reversible Encephalopathy Syndrome
Control BP
Serology in Generalized Systemic Sclerosis
ANA
Scl 70
Anti-topoisomerase
Antipolymerase III antibody
Anti Polymerase III antibodies predict increased risk for…? (3)
Diffuse thickening of skin
Cancer
Renal crisis
Serology and MHC for Polymyositis
Major Histocompatibility Complex
Anti Jo
HLA DR3
Serology for Dermatomyositis
Anti Mi2
If only ONE joint involved in acute gouty attack, what’s the treatment?
Intra-articular glucocorticoids
IgA deposition in skin is?
Henoch Schlonein- small vessel vasculitis
Polymyositis is associated with what lung disorder?
Interstitial Lung Disease
Must check CXR especially if (+) transfer RNA synthetase, anti Jo-1 Abs
Goal urate level in gout
Less than 6
However if you have tophaceous gout, keep your urate lowering agent despite the serum urate level
In giant cell arteritis aka temporal arteritis, what else can you give (in addition to prednisone) to decrease risk of visual loss?
Low Dose ASA
Diagnose this:
Lymphoplasmacytic infiltration and enlargement of pancreas, lymph nodes, salivary glands, periaortic region causing retroperitoneal fibrosis, kidneys and skin
IgG4 related disease
Patient with SLE
Presents with triad- hypoxemia, new pulmonary infiltrates, and decreasing hematocrit is what?
Diffuse Alveloar Hemorrhage
Dx via Bronch and Lavage
Dermatomyositis have increased risk of…?
Cancer!
Solid malignancies and NHL
If you have gout and HTN, what antihypertensive do you recommend?
ARB (Losartan) and CCB, lowers urate levels
Patient with diffuse cutaneous systemic sclerosis is at risk for malabsorption from what?
Bacterial overgrowth due to impaired peristalsis from underlying fibrosis
