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Clin Med 1 > Gout, SLE, arthritis, etc > Flashcards

Gout, SLE, arthritis, etc Flashcards

0
Q

Gout epidemiology

A

middle aged and elderly men, post-menopausal women

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1
Q

deposition of uric acid crystals in joints and connective tissue due to overproduction or underexcretion of uric acid

A

Gout

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2
Q

rapid onset, pain peaks w/in 8-12 hours.
Pain, redness, and swelling, usually in smaller lower extremity joints
Often recurrent

A

Gout

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3
Q

Stage 1 of Gout is?

A

acute gouty arthritis, triggered by acute change in uric acid
can resolves on its own w/t tx

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4
Q

Stage 2 of gout is? (3)

A

“intercritical gout”
intermittent attacks, same triggers
deposits in soft tissues as well

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5
Q

Stage 3 of Gout is?

A

chronic recurrent and tophaceous gout

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6
Q

Gout triggers (2+ and expand)

A

EtOH use

High purine consumption: organ meats, anchovies, mushrooms, spinach, asparagus, cauliflower, beans, seafood, peas

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7
Q

labs for gout? (4)

A

arthrocentesis, microscopic analysis
increased serum uric acid level
24h urinary uric acid secretion
radiography- joint erosions

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8
Q

Gout findings on mcroscopic analysis?

A

monosodium urate crystals that are negatively bifringent

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9
Q

Gout: 24h urine uric acid results?

A

> 800 mg/dL for overproducers

< 700 mg/dL for underexcreters

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10
Q

Gout tx (4)

A
  1. NSAIDs
  2. intra-articular steroids, oral steroids
  3. Colchicine- prophylaxis
  4. Uricosuric agents
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11
Q

Gout meds for underexcreters (2)

A

Probenecid 250mg BID

Allopurinol (Zyloprim) 100mg daily

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12
Q

Most common gout med?

A

Allopurinol (Zyloprim)

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13
Q

Gout meds for overproducers (2)

A

Febuxostat- Xanthine Oxidase inhibitor

Allopurinol

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14
Q

acute onset of erythema, pain, & swelling in the larger joints: knees, wrists, MCPs, hips. Attacks may be self-limiting

A

Calcium pyrophosphate dihydrate deposition disease (CPPD)

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15
Q

CPPD etiology

A

unknown

can be increased by trauma

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16
Q

CPPD labs and imaging findings (3)

A

Radiographic changes- Evidence of Ca2+ crystals- punctate and linear radiodensities in joint areas
Elevated neutrophils on CBC
Microscopic study

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17
Q

CPPD findings on microscopic study

A

positively birefringent rhomboid-shaped crystals

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18
Q

CPPD tx (3)

A
  1. NSAIDs
  2. colchicine 0.6 mg BID during acute inflammation
  3. removal of crystals by joint aspiration, intra-articular steroid injection
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19
Q

autoantibodies to nuclear & cytoplasmic antigens destroy cells –> tissue damage

A

Systemic Lupus Erythematous

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20
Q

fever, fatigue, joint pain, rash, weight loss, anemia, Raynaud’s
photosensitivity, polyarthritis, renal disorders, heme disorders, mucosal ulcers, serositis, neuro disorders

A

SLE

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21
Q

Raynaud’s phenomenon is?

A

Triphasic circulatory response in hands

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22
Q

SLE labs are? (7)

A 
Sed rate
Antinuclear antibody (ANA)
(+) Anti DNA antibody
(+) anti-Smit antibody
(+) anti-phospholipid antibody
urinalysis for renal damage
liver tests
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23
Q

SLE tx? (5)

A 
decrease sun exposure
NSAIDs (Naproxen, Celecoxib)
Antimalarials (Hydroxychloroquinine, Plaquenil)
Corticosteroids
Immunosuppressive drugs for severe cases
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24
Q

pt on medication w/ arthralgia, myalgia, malaise, fever, rash, serositis

A

Drug Induced SLE

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25
Q

labs for drug induced SLE (2)

A

+ antihistone antibodies

- anti-dsDNA & anti-Smith

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26
Q

drug induced SLE tx

A

discontinue drug, consider steroids

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27
Q

“Sicca syndromes”? and what do they indicate?

A

xerostomia, dry eyes, recurrent parotiditis

Sjögren’s syndrome

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28
Q

dry eyes/mouth, recurrent parotiditis, Raynaud’s phenomenon, myalgia, pulmonary disease, anemia, leukopenia, vasculitis, GI disease, arthritis

A

Sjögren’s syndrome

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29
Q

Sjogren’s labs? (4)

A

+ RF, + ANA
Anti-Ro/SS-A, Anti-LA/SS-B (Primary Sjogrens)
Anti-SS-C (Sjogrens related to SLE/RA)
Schirmer’s test for tear production

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30
Q

Sjogren’s tx? (3)

A

saliva & tear replacement
NSAIDs for arthralgias
steroids/immunosuppressants for severe cases

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31
Q

diffuse fibrosis of the skin & internal organs

A

Systemic Sclerosis/Scleroderma

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32
Q

overall tightening and thickening of tissues, narrowing of the small vessels

A

Scleroderma

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33
Q

CREST syndrome:

A 
Calcinosis cutis
Raynaud's phenomenon
Esophageal dysmotility
Sclerodactyly
Telangiectasias
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34
Q

Limited cutaneous scleroderma symptoms?

A

CREST syndrome

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35
Q

CREST + GI tract (weight loss), lungs (pulmonary fibrosis, pulm. HTN), renal failure, myocardial fibrosis

A

Diffuse cutaneous scleroderma

36
Q

polyarthralgias, Raynaud’s phenomenon, pigmentation changes, dysphagia, respiratory symptoms, cardiac symptoms, renal crisis

A

Scleroderma

37
Q

Labs for scleroderma

A

(+) ANA
Anti-centromere antibodies (ACA)
anti-SCL-70 (Scleroderma antibody)

38
Q

Scleroderma tx (3)

A

Symptomatic:
Raynaud’s- Ca2+ channel blockers (Nifedipine)
Esophageal disease (H2 blockers, PPIs, smaller meals)
Inhibitors for renal disease

39
Q

arthritis that occurs following an infection

A

Reactive arthritis

40
Q

reactive arthritis etiology

A

GI or GU organisms- Chlamydia is the most common

41
Q

Reiter’s triad

A

postinfectious arthritis
urethritis
conjunctivitis

42
Q

Reiter’s trad, prior sxs of diarrhea or urethritis, asymmetric knee swelling, arthritis of hands, mucosal ulcers,nail changes, genital lesions, lesions on bottom of foot

A

Reactive arthritis

43
Q

lesions on bottom of foot w/ reactive arthritis

A

keratoderma blennorrhagicum

44
Q

labs for reactive arthritis (5)

A 
ESR, CRP
\+ HLA-B27 Antigen
- RF antibody
- ACC antibody
arthrocentesis on affected joint- r/o other conditions
45
Q

Reactive Arthritis first line tx (3)

A

NSAIDs:
Indomethacin 50mg TID-QID
Naproxen 500mg BID-TID
Diclofenac 50 mg TID

46
Q

Reactive arthritis 2nd and 3rd line tx (2)

A
  1. steroids: intra-articular or systemic steroids

3. biologic agents: sulfasalazine, methotrexate, TNF inhibitor

47
Q

symmetric polyarthritis, morning stiffness > 1hr, pain & swelling at affected joints, synovial hypertrophy

A

Rheumatoid arthritis

48
Q

early sites of rheumatoid arthritis (4)

A

MCP & PIP joints of fingers
IP joints of thumbs
wrists
MTP joints of toes

49
Q

later findings of rheumatoid arthritis (5)

A 
ulnar deviation of MCP
Boutonierre deformity of PIP
Swan neck contractures (DIP flexion)
rheumatoid nodules
decreased ROM at elbow, hip, knee
50
Q

signs of systemic disease in rheumatoid arthritis (3)

A

rheumatoid nodules, episcleritis, atlantoaxial subluxation

51
Q

imaging findings for rheumatoid arthritis (purpose + 4)

A

Establish baseline of affected joints

soft tissue swelling, osteopenia, decreased joint space, subluxation/dislocations

52
Q

rheumatoid arthritis labs

A

ESR, CRP, CBC (anemia in chronic disease)
RF for prognostic value
+ Anti-CCP antibodies

(there are seronegative pts.)

53
Q

highly specific lab findings for rheumatoid arthritis

A

+ RF

+ Anti-CCP antibodies

54
Q

rheumatoid arthritis non-pharm tx

A

Preventative- exercise, nutrition, smoking cessation

55
Q

rheumatoid arthritis pharm txs

A

DMARDs: Methotrexate, sulfasalazine
NSAIDs
glucocorticoids
biologic agents: TNF-a, IL-1, IL-6

56
Q

epidemiology of Juvenile Idiopathic Arthritis (JIA)

A

< 16 y/o, M=F

57
Q

<5 joints involved at first, large joints may be swollen, tender, warm, w/out erytheme, uveitis

A

Pauciarticular (Oligoarticulr) JIA

58
Q

lab findings for pauciarticular JIA (2)

A

+ ANA

- RF

59
Q

Pauciarticular JIA tx

A

NSAIDs or intra-articular glucocorticoids

refer to Opthalmology for uveitis

60
Q

fever, rash, arthritis, LAD in pt <16 y/o

A

Systemic JIA

61
Q

lab findings for systemic JIA (4)

A

elevated ESR, CRP
leukocytosis
anemia
thrombocytosis

62
Q

Systemic JIA tx

A

NSAIDs

glucocorticoids & DMARDs for severe disease (high fever, pain)

63
Q

indications for tx of systemic JIA w/ glucocorticoids and DMARDs

A

high fever, pain

64
Q

> 4 affected joints during the 1st 6 mo. of illness, pt <16 y/o

A

polyarticular JIA

65
Q

polyarticular JIA epidemiology

A

peaks 2-5, 10-14 y/o

F>M

66
Q

indolent polyarthritis in younger children, more rapid onset in adolescents
Flexion contractures & weaknesses, bony erosions & joint destruction

A

Polyarticular JIA

67
Q

labs for polyarticular JIA (4)

A

may or may not have RF
elevated ESR
anemia
+ ANA

68
Q

polyarticular JIA tx

A

NSAIDs
DMARDs
Optional: glucocorticoids (systemic/intra-articular), physical therapy

69
Q

characteristic radiologic finding of rheumatoid arthritis

A

obliteration of the joint

70
Q

degeneration of cartilage & bone hypertrophy at articular margins

A

osteoarthritis

71
Q

pain exacerbated by activity, helped w/ rest. Morning stiffness >30 min.
Fingers, knee, hip, and spine are affected

A

Osteoarthritis

72
Q

Heberden’s nodes affect?

73
Q

Bouchard’s nodes affect?

74
Q

Heberden’s nodes, Bouchard’s nodes, 1st MCP, knee osteophytes/crepitus, decreased ROM at joints, hip pain referring to knee

A

osteoarthritis

75
Q

in OA, hip pain may refer to

76
Q

OA of the spine

A

cervical or lumbar spondylosis

Degenerative Disc Disease

77
Q

complications of lumbar spondylosis

A

spinal stenosis, slipping over the disc

78
Q

OA lab findings

A

All normal- X-ray more helpful

79
Q

diagnosis of OA is made how?

A

presence of typical symptoms
physical exam
normal labs
imaging features

80
Q

nonpharm OA txs

A

exercise, weight loss, rest, physical therapy

81
Q

pharm tx for OA (4)

A

1st line: Tylenol
NSAIDs
topical NSAID or capsaican
intra-articular glucocorticoids

82
Q

surgical tx for OA and indication

A

Failed other Txs

joint replacement, joint resurfacing

83
Q

widespread chronic musculoskeletal pain. Joint pain, swelling (but not present on exam), paresthetias. Fatigue
Secondary: headache, abd/chest wall/pelvic pain

A

Fibromyalgia

84
Q

morning stiffness or tiredness. Decreased attention span. Possible depression/anxiety

A

Fibromyalgia “fibro fog”

85
Q

Diagnostic findings for fibromyalgia?

A

bilateral tender points

86
Q

diagnosis of fibromyalgia based on?

A

11/18 tender points- positive, reproducible

87
Q

nonpharm fibromyalgia tx: (5)

A

education, treat mood disorders (psych), exercise program, physical therapy, trigger point injection

88
Q

pharm tx for fibromyalgia: (5)

A

Tricyclic antidepressant- Amitriptyline
Muscle relaxants: Flexeril
SNRIs: Duloxetine (Cymbalta), Milnacipran (Savella)
Pregabalin (Lyrica), Gabapentin (Neurontin)
SSRIs, NSAIDs, Tramadol (Ultram)

Clin Med 1 (18 decks)

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