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Internal Medicine > Deja - Internal - Rheumatology > Flashcards

Deja - Internal - Rheumatology Flashcards

1
Q

7 diagnostic criteria for RA?

A
  1. Morning stiffness >1h.
  2. 3 or more joints with arthritis.
  3. One hand joint with arthritis.
  4. Symmetric arthritis.
  5. Rheumatoid nodules.
  6. Elevated RF.
  7. Radiographic evidence of erosive arthritis.
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2
Q

How many criteria must be positive for a diagnosis of RA?

A

4.

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3
Q

How long does each of the criteria need to be present to make a diagnosis?

A

At least 6 weeks.

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4
Q

What DMARDs are available for patients with RA?

A
  1. Methotrexate.
  2. Hydroxychloroquine.
  3. Gold compounds.
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5
Q

What are some newer biologic agents used to treat RA?

A
  1. Infliximab
  2. Etanercept
  3. Abatacept
  4. Rituxan
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6
Q

What is the MC type of arthritis?

A

Osteoarthritis.

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7
Q

What are the X-ray findings seen in OA?

A
  1. Narrowed joint spaces.

2. Osteophyte formation.

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8
Q

What is the treatment for OA?

A
  1. NSAIDs to relieve pain.
  2. Muscle-strengthening exercises.
  3. Steroid joint injection.
  4. Last resort is joint replacement.
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9
Q

Etiology of gout?

A
  1. Decr. urate excretion (high-protein diet, alcohol, diuretic use).
  2. Incr. urate production (genetic diseases, hemolysis, cancer).
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10
Q

What is the MC joint to be affected in gout?

A

1st MTP.

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11
Q

What is the classic radiographic finding in advanced gout?

A

“Rat-Bite” appearance.

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12
Q

How is gout diagnosed?

A

Fluid aspirated from the joint would reveal needle-shaped monosodium urate crystals with NEGATIVE birefringence under polarized light.

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13
Q

What is pseudogout?

A

Deposition of calcium pyrophosphate crystals in joints, causing inflammation.

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14
Q

Risk factors for pseudogout?

A
  1. Advanced age.
  2. Gout.
  3. Hemochromatosis.
  4. Extensive OA.
  5. Diabetes.
  6. Hyperparathyroidism.
  7. Hypothyroidism.
  8. Hypomagnesemia.
  9. Neuropathic joint.
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15
Q

Pseudogout - Signs and symptoms:

A

May present as an acute arthritis affecting one or multiple joints like gout, or it may present as a chronic polyarthritis similar to OA or RA.

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16
Q

What does joint fluid aspiration in pseudogout demonstrate?

A

POSITIVELY birefringent rhomboid crystals.

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17
Q

What joint is always affected in ankylosing spondylitis?

A

Sacroiliac joint.

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18
Q

How is SLE distributed based on race?

A

Black>White.

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19
Q

What is the mnemonic for diagnosing SLE?

A

DOPAMINE RASH

Discoid rash
Oral ulcers
Photosensitivity 
Arthritis >2 joints.
Malar rash
Immunologic criteria
Neurologic symptoms
ESR up (not part of the 11 criteria)

Renal disease
ANA
Serositis (pericarditis, pleurisy)
Hematologic

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20
Q

How many of the criteria must be present to make the diagnosis of SLE?

A

4 or more.

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21
Q

Pathognomonic heart disorder seen in SLE patients?

A

Libman-Sacks endocarditis.

22
Q

What autoantibody is most SENSITIVE for SLE?

A

ANA (it is NOT specific).

23
Q

What autoantibody is most SPECIFIC for SLE?

A
  1. Anti-ds DNA (very high titers are associated with renal involvement).
  2. Anti-SM antibody.
24
Q

What are lupus anticoagulant and anticardiolipin associated with?

A
  1. Thrombosis
  2. CNS lupus
  3. Thrombocytopenia
  4. Valvular heart disease
  5. Fetal loss
25
Q

Anticardiolipin can cause a falsely elevated result with which lab test?

A

Elevated PTT, but in reality SLE patients are more likely to develop blood clots.

26
Q

What drugs are known to cause-drug induced SLE?

A

SIQ CHaMP

Sulfasalazine
INH
Quinidine

Chlorpromazine
Hydralazine
a
Methyldopa, minocycline
Procainamide, Penicillamine
27
Q

What is the MC drug to cause lupus-like symptoms?

A

Procainamide.

28
Q

What are the signs and symptoms of scleroderma?

A
  1. Tight, thick skin.
  2. Raynaud.
  3. Dysphagia.
  4. Renal artery fibrosis.
  5. PHTN.
  6. Telangiectasias.
29
Q

What lab test is 80% sensitive for CREST syndrome?

A

Anti-centromere antibody.

30
Q

What lab test is highly SPECIFIC to scleroderma?

A

Anti-Scl-70 antibody.

31
Q

What is the treatment for scleroderma?

A

CAPS

CCBs
ACEIs
Penicillamine
Steroids

32
Q

Some findings associated with sarco?

A

GRUELLING

Granulomas
RA
Uveitis
Erythema nodosum 
Lymphadenopathy
Interstitial fibrosis
Negative TB test
Gamma-globulinemia
33
Q

What renal problem is associated with sarco?

A

Nephrolithiasis because of hypercalciuria.

34
Q 
Name the syndrome associated with the following: 
Conjunctivitis 
Uveitis
Urethritis 
Asymmetric arthritis
A

Reiter

35
Q

What is the mnemonic used to remember the associated findings of Reiter syndrome?

A

“Can’t see. Can’t pee. Can’t climb a tree”.

36
Q

2 forms of Reiter:

A
  1. Sexually transmitted.

2. Postinfectious: Campylobacter, Yersinia, Salmonella, Shigella.

37
Q 
What is the autoimmune syndrome associated with:
Apthous ulcers
Genital ulcers
Arthritis
Uveitis
Psychiatric symptoms
A

Behcet syndrome.

38
Q

Polymyositis - Signs and symptoms:

A
  1. Symmetric PROXIMAL muscle weakness.
  2. Dysphonia, and dysphagia.
  3. Patients have difficulty standing up from a chair or brushing their hair.
39
Q

Dermatomyositis - Classic signs:

A
  1. Symmetric PROXIMAL muscle weakness.
  2. Heliotropic periorbital rash.
  3. Shawl sign (erythematous macules on shoulder and upper back).
  4. Gottron papules (violacious papules on DIP joints).
40
Q

What autoantibody is associated with polymyositis and dermatomyositis?

A

Anti-Jo-1.

41
Q

What are the 4 criteria for polymyositis?

A
  1. UP CPK.
  2. PROXIMAL muscle weakness.
  3. Low amplitude potentials and fibrillations on EMG.
  4. Incr. muscle fiber size on muscle biopsy.
42
Q

2 peak incidences of myasthenia gravis?

A

Women –> 2nd to 3rd decades.

Men –> 5th to 6th.

43
Q

What can myasthenia gravis be associated with?

A

Thymomas or other autoimmune diseases.

44
Q

What are the signs and symptoms of myasthenia gravis?

A
  1. Muscle weakness and increasing fatigue with use.
  2. Proximal muscle weakness.
  3. Ptosis.
  4. Diplopia.
  5. Dysphagia.
45
Q

What is the classic test used to diagnose myasthenia gravis?

A

Edrophonium test (Tensilon test).

46
Q

What are the newer diagnostic methods for myasthenia gravis?

A
  1. Single-fiber EMG.

2. Anti-acetylcholine receptor antibody test.

47
Q

Myasthenia gravis is often associated with what other finding?

A

Thymoma.

48
Q

What blood test in the presence of myasthenia gravis is highly associated with the presence of a thymoma?

A

Anti-striated muscle (SM) antibody - present in >80% of patients younger than 40 with thymoma.

49
Q

What is the pathology in Lambert-Eaton syndrome?

A

There are autoantibodies to presynaptic calcium channels.

50
Q

How does Lambert-Eaton syndrome differ from myasthenia gravias?

A

Increased muscle use improves symptoms making muscles stronger.

51
Q

What classical physical findings can be found in RA?

A
  1. Boutonniere deformity.
  2. Swan neck deformity.
  3. Ulnar deviation.
  4. Pain in the PIP and MCP (NOT DIP!).
  5. Rheumatoid nodules.

Internal Medicine (106 decks)

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