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Rheumatology > Clin Med2 Final > Flashcards

Clin Med2 Final Flashcards

1
Q

What rheum disorders are more common in MEN than women?

A 
GOUT *(until menopause)
Ankylosing Spondylitis (2:1)
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2
Q

What dz do men = women?

A

Psoriatic Arthritis

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3
Q

Presentation of Fibromyalgia?

A

CHRONIC, DIFFUSE MSK pain w/o obvious pathological cause
Tenter points in ALL 4 quadrants of body (inc. axial skeleton)
Sleep disturbances
Severe fatigue/ exercise intolerance
depression, anxiety

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4
Q

Can an event trigger Fibromyalgia?

A

Usually no, but sometimes from trauma, emotional trauma, flu/illness, or withdrawl from steroids

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5
Q

What are the Historical requirements of fibromyalgia

A

Widespread body pain involving at least 3 quadrants
At least 3 mo duration
no other pain cause

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6
Q

What are the cardinal features of fibromyalgia

A

Chronic widespread pain greater than 3 months

tender points on exam

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7
Q

How do you dx fibromyalgia?

A

Pain at least 3 months of the:
R AND L sides
Axial skeleton (11/18 tender ponts)
pain at 4 kg

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8
Q

What are inflammatory syndromes?

A

Gout (MC)
Pseudogout
RA
Spondyloarthropathies

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9
Q

Non Inflamm syndromes

A

Osteoarthritis (MC)

Fibromyalgia

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10
Q

Tx of fibromyalgia

A

DO NOT USE SYSTEMIC STEROIDS
non drug tx: exercise, sleep, tx psych stress bc “mind-body” illness
drugs: anti-depressants (duloxetine, cyclobenzaprine)
Pregablin- anti-epileptic
Tramadol- mu-opiod receptor ligand
opioids are rare for pain tx

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11
Q

What diseases are worse with exercise/ as the day goes on?

A

Fibromyalgia and osteoarthritis
(hey, these are the non-inflamm ones too)
they can have am stiffness less than 30 mins

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12
Q

Worst upon awakening?

A

RA

PMR

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13
Q

Joint pain in OA?

A

early- worse w/ exercise

late- pain at rest

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14
Q

Timeframe for inflame am stiffness?

A

am stiffness greater than 30 minutes

and symptoms improve with activity

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15
Q

What is the #1 drug in the world that tx RA

A

Methotrexate

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16
Q

What are x-ray findings in RA of the hands and wrists?

A 
symmetrical joint space loss
PIP
MCP
corner erosions (mouse bites) @ small joints
may see soft tissue swell
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17
Q

Serologic testing for RA

A

+ RF plus + anti CCP + characteristic sx (swell, stiff)

means 98% likelihood the pt has RA

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18
Q

Real estate of RA

A

MCP and PIPs (NOT DIPS)
common in 2nd and 3rd digits, wrist and feet
usually b/L involvement

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19
Q

Real estate of OA

A

common at base of thumb, DIP and PIP (NOT MCP)
hand (70%), knee, hip and spine
usually unilateral joint involvement

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20
Q

Fibromyalgia associations (not part of dz though)

A 
Dizzy, HA
cognitive dysfxn
insomnia, severe fatigue
autonomic dysfxn
exercise intolerance
patesthesia
depression, anxiety
restless legs
irritable bladder
irritable bowel
endocrine imbalance
multiple sensitivities
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21
Q

Tx Temporal Arteritis

A

IMMEDIATELY give HIGH dose of PO corticosteroid (60mg prednisone) to reduce inflamm (before blindness)

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22
Q

PMR presentation

A 
symmetric shoulder girdle pain  (MC)
neck + pelvic + upper arm + thigh pain 
no pain during physical exam from palpating
wt loss, fever, malaise, difficulty standing + grooming
joint ROM: normal, MSK strength: nml
soft tissue swelling- knee, wrist, MCP
LE edema
carpal tunnel
Labs: ELEVATED ESR and CRP
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23
Q

Age group PMR

A

Onset is OVER 50.
Mean age 73
whites females mc too

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24
Q

Lupus Criteria

A 
Malar rash (butterfly)
Discoid rash- mild form (arm+ears)
Photosensitivity
Oral Ulcers
Arthritis
Serositis
Renal d/o
Neuro d/o
Hematologic d/o
immunologic d/o
antinuclear antibody

(** you need 4/11 criteria to have SLE, don’t have to be at once**)

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25
Q

DDX malar rash

A 
rosacea
dermatitis
glucocorticoid-induced atrophy
cholasma/melasma
bengin flushing
26
Q

explain the malar rash

A

(butterfly)- fixed erythema, flat or raised over malaria eminences (cheekbone)
SPARES NASOLABIAL FOLD
(vs rosacea- don’t spare it)

27
Q

Initial screening for inflamm autoimmune d/o

A

ANA is the FIRST STEP w/ reflex!!

if + then you get other tests

28
Q

Patterns

A

Spekled *SLE
Homogenous/diffuse =MC non specific tho
Rim/peripheral
nucleolar

29
Q

What are other tests for immunology d/o

A 
anti dsDNA (+ inc. lupus dx)
anti Sm
antiphospholipid ab (lupus anticoagulant)
anti Ro (heart block in SLE pt)
30
Q

What are lupus clusters?

A

Cutaneous, articular and renal manifestations (MC)
or
CNS, thrombotic and muscular sx (lesser extent)

31
Q

Myosisitis labs

muscle and liver enzyme vs liver only

A

elevated levels of serum muscle enzymes bc skeletal muscle inflammation
muscle: CPK, aldolase
muscle and liver: AST LDH
Liver only: ALT

32
Q

Sjogren’s

A

chronic systemic autoimmune inflammatory d/o characterize by lympocytic infiltration of endocrine glands

33
Q

Sjrogens presents

A

F> M 35-50yo
primary = xerostomia, keratoconjunctivitis sicca, hyposalivation

secondary= primary plus RA, SLE, scleroderma

34
Q

Target organ of Sjrogens

A

salivary and lacrimal glands

35
Q

S/Sx OA

A 
PAIN with increased use
stiffness less than 15 to 30 minutes
swelling
crepitus
limited ROM
36
Q

OA complaints by gender

A

F: knee and hand
M: hip

37
Q

Enthesitis

A

inflammation at insertion of tendon or bone

38
Q

Synovitis

A

inflammation of the synovial lining

39
Q

Disease progression over time non inflamm is ___ vs autoimmune is ____

A

progression over decades (slow)

autoimmune occur in a year or two

40
Q

Red Flags of back pain (14)

A 
Age greater than 50
significant trauma
neuro deficit
unexplained wt loss
substance abuse
ankylosing spondylitis
night pain
malignancy hx
systemic seroids
fever (over 100)
persistant pain
compensation issues
increase pain when recumbent
bowel and bladder dysfxn
41
Q

MC cause of LBP?

A

Idiopathic

42
Q

Best way to tx LBP?

A

AVOID BED REST!!! -old recommendation but NOT anymore

do symptomatic treatment
exercise helps prevent it!

43
Q

Pharm tx LBP?

A 
anti inflamm
tramadol
opioids
muscle relaxants (methocarbamol)
epidural steroid injxn
44
Q

LBP categories

A

acute less than 4 wks (pain control)
subacute 4-12 wks (pain control + activity)
chronic greater 3 mo (multidisciplinary)

45
Q

DDX LBP

A 
Mechanic
Rheumatologic
Endocrine
Neuro/Psych
Neoplastic
Reffered
46
Q

Spondyloarthritis is

A

seronegative (RF -) inflamm arthritis of the spine

47
Q

what if you untx spondyloarthritis

A

entire spine can be involved
it may fuse (bamboo) = increase risk spine deformity, fx, and disability
limited flexibility, “squaring” of lumbar and thoracic vertebrae, osteopenia, ossification

48
Q

what is involved in severe spondy?

A

HIPS!

may need b/l replacement

49
Q

Inflamm BP explain

A

stiffness, worse in morning, improves with exercise not relieved by rest

50
Q

Non inflamm BP explain

A

worse as day progresses, worsens with exercise

51
Q

Spondyloarthritis extra articular

A 
acute anterior uveitis (MC)
IBD
prostatitis (men)
aortic regurgitation
arrhythmias, conduction defects or complete heart block
52
Q

Synovial fluid crystal eval in gout:

A

monosodium urate- needle shape,
acute attack = intracellular
btwn/late attack = extracellular

53
Q

Synovial fluid crystal eval in pseudogout:

A

crystal - calcium pyrophosphate- rhomboid or rectangular shape,
dominant cell is neutrophils

54
Q

Hyperuricemia presents as

disclaimer: word vomit.

A

Purines come from same sources, same amounts as gout.
When there is renal compromise, the total body uric acid pool is altered. The miscible urate pool is expanded and “flows over” into an insoluble compromise and slightly more eliminated in the intestines to try to compensate
with uric acid overload, 2 outcomes
** 3/4 people have Asx hyperuricemia
** 1/4 people have GOUT

55
Q

Characteristic X ray finiding in pseudogout

A

Punctate linear deposits of CPPD crystals in the menisci and cartilage :
CHONDROCALCINOSIS

(knee + wrist)
pseuo = acute mono-arthritis

56
Q

Case present Older woman- what can she have? Could be: basic calcium phosphate hydroxyapatite deposition disease

A

MC in older women
“Milwaukee shoulder”- large non-inflame effusion with glenohumeral instability

(deposits of crystals in cartilage + tendons)
tx with NSAIDS, intra-articular steoids

57
Q

Temporal arteritis/giant cell arteritis:

A

MC systemic vasculitis
-vessels above the heart (primary branch of aorta, carotids)
age >50
jaw pain, tongue pain, amarosis fugax
lead to visual loss (ischemic optic neuropathy)

58
Q

Temporal arteritis gold std test

A

Temporal artery bx

59
Q

Henoch-schoenlin purpura

A

MC children

TRIAD: palpable purpura, abd pain, glomerulonephritis
self limiting

60
Q

Polyarteritis nodosa (PAN)

A

VERY rare!!
necrotize medium-small arteries ONLY
associated with HBV

multiple organs but SPARES: lung and glomerulus!
ANCA negative

tissue bx is best for dx

61
Q

Takayasu’s Arteritis

A 
"pulseless' dz in one wrist- not in other (asymmetrical BP too)
renovascular HTN
limb claudication
MC young females
HLA-class 1
MC @ aorta + branches
dx with Angiogram!!

Rheumatology (1 decks)

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