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EOR - Internal Med > Internal Med - Ortho + Rheum > Flashcards

Internal Med - Ortho + Rheum Flashcards

1
Q

Widespread muscular pain, fatigue, muscle tenderness, headaches, poor sleep, and memory problems

A

Fibromylagia

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2
Q

Sx and clinical manifestations of Fibromylagia

A

Diffuse pain that is worse in the morning, extreme fatigue, stiffness, painful, tender joints, and SLEEP DISTURBANCES, symptoms often worsened with physical and psychological stress

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3
Q

Dx of fibromyalgia

A

Diagnosis of exclusion ; widespread pain index must be greater than seven,and the symptom severity scale must be greater than five for at least three months

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4
Q

Fibromyalgia on bx would show

A

Moth-eaten appearance of type 1 muscle fibers

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5
Q

Tx of Fibromyalgia

A

Stress reduction, sleep/exercise

Antidepressants (amitriptyline, SSRI, SNRI) Anticonvulsants (pregabalin, gabapentin)

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6
Q

FDA approved drugs for fibromyalgia

A

Duloxetine (cymbalta) milancipran (savella), pregabalin (lyrica)

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7
Q

Gout sx

A

MC = podagra (attack of MTP of the great toe) (70% of cases); pain, swelling, redness, exquisite tenderness. In chronic gout = tophi

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8
Q

Dx of gout

A

Arthrocentesis shows NEGATIVE birefringement crystals

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9
Q

Tx of gout

A

Drug of choice = Indomethacin TID; Colchicine; Allopurinol but dont start in acute gout attack

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10
Q

Gout symptoms in >60yo; large joints, lower extremity; no tophi

A

Pseudogout

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11
Q

Dx of pseudogout

A

Rhomboid shaped calcium pyrophosphate crystals - POSITIVELY birefringement

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12
Q

Tx of pseudogout

A

Same as gout; Colchicine prophy + NSAID acute attack

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13
Q

blood vessel disease characterized by inflammation of small and medium-sized arteries (vasculitis), which can restrict blood flow and damage vital organs and tissues

A

Polyartertitis Nodosa

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14
Q

Polyarteritis nodosa affects which age group MC

A

Middle aged men in their 40-50

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15
Q

a 45-year-old male with generalized symptoms such as malaise, fever, sore throat, and joint and muscle aches and pains. He also complains of numbness, tingling, sensory disturbances, and weakness. On physical examination, you notice the presence of tender lumps under the skin, especially on the thighs and lower legs. Laboratory testing is notable for a newly elevated creatinine of 2.6 mg/dL, erythrocyte sedimentation rate, and C-reactive protein. He is also seropositive for hepatitis B virus, ANCA-negative, and guaiac positive

A

Polyarteritis Nodosa

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16
Q

Polyarteritis nodosa is associated with

A

Associated with Hepatitis B and C - Increased microaneurysms with aneurysmal rupture leading to hemorrhage and thrombosis as well as organ ischemia or infarction

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17
Q

Skin manifestations of polyarteritis nodosa

A

Livedo, purpura, ulcers, gangrene, tender lumps under skin (MC thighs and lower legs)

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18
Q

Dx of polyarteritis nodosa

A

Biopsy = gold standard → Biopsy affected artery

Alternative = Arteriography → typical aneurysms in medium sized arteries

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19
Q

Labs in polyarteritis nodosa

A

Increased ESR; Classic PAN is ANCA negative and (P-ANCA positive)

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20
Q

Tx of polyarteritis nodosa

A

Steroids (prednisone) +/- Cyclophosphamide if refractory

Plasmapheresis in pts with Hep B virus

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21
Q

AFFECTING THE JOINTS causing PAINFUL synovitis, bursitis, and tenosynovitis - aching STIFFNESS of PROXIMAL JOINTS (shoulder, hip, neck) in patients > 50 years old

A

Polymyalgia rheumatica

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22
Q

How do you differentiate between Polymyalgia rheumatica and Polymyosititis

A
  • PMR is closely related to giant cell arteritis (temporal arteritis)
    • Joint pain versus muscle pain in polymyositis
    • STIFFNESS versus the weakness of polymyositis
23
Q

Polymyalgia rheumatica

A

ESR is elevated above 50 ; Temporal artertitis is confirmed with temporal artery biopsy

24
Q

Tx of polymyalgia rheumatica

A

Low dose steroids may be needed for up to 2 years and then slowly tapered; methotrexate

25
Q

chronic, idiopathic inflammatory DISEASE OF THE MUSCLE causing symmetrical, proximal, PAINLESS muscle weakness

A

Polymyositis

26
Q

How is polymyositis differentiated from polymyalgia rheum and dermatomyositis

A
  • Different from dermatomyositis which is characterized by inflammatory and degenerative changes in the skin and muscles
  • Differentiate from Polymyalgia Rheumatica (PMR) by lack of pain which causes stiff joints usually of the shoulder, hip, and neck
27
Q

Dx of Polymyositis and dermatomyositis

A

physical examination of muscle strength, blood tests for muscle enzymes, electrical tests of muscle and nerves, and is confirmed by muscle biopsy

28
Q

Lab findings in Polymyositis

A
  • ↑ Muscle enzymes: ↑ aldolase, creatine kinase; ↑ ESR, (+) muscle biopsy, abnormal EMG
  • (+) ANTI-JO 1 Ab: Myositis-specific Antibody-associated with interstitial lung fibrosis
    • “mechanical hands” hyperkeratotic cracked hands with a dirty appearance
  • (+) Anti-SRP Ab: signal recognition particle Ab
  • (+) Anti-Mi-2 Ab: specific for dermatomyositis
  • Muscle biopsy: endomysial involvement with PM
29
Q

Tx of polymyositis

A

Corticosteroids

30
Q

Autoimmune response to infection in another part of the body (Chlamydia +/- gonorrhea MC)

A

Reactive arthritis (reiter syndrome)

31
Q

Sx of reactive arthritis

A
  1. ASYMMETRIC inflammatory arthritis
  2. CONJUNCTIVITIS, UVEITIS, URETHRITIS, and ARTHRITIS (can’t see, can’t pee, can’t climb a tree!)
32
Q

Dx of reactive arthritis

A

Hx of infection, clinical exam, positive HLA-B27

33
Q

Dx of reactive arthritis

A

Hx of infection, clinical exam, positive HLA-B27

34
Q

tx of reactive arthritis

A

NSAIDs, Abx to treat infection (aka chlamydia tx)

35
Q

MORNING JOINT STIFFNESS > 30 minutes after initiating movement and improves later in the day

A

Rheumatoid arthritis

36
Q

RA vs OA sx

A

MORNING JOINT STIFFNESS > 30 minutes after initiating movement and improves later in the day (vs OA which gets worse throughout the day and if morning stiffness is present will be < 30 minutes)

37
Q

Sx of rheumatoid arthritis

A
  1. Small joint stiffness (MCP, wrist, PIP, knee, MTP, shoulder, ankle) worse with rest
  2. Symmetric arthritis: swollen, tender, and boggy joint
    1. Boutonniere deformity: flexion at PIP, hyperextension of DIP
    2. Swan neck deformity: flexion at DIP with joint hyperextension at PIP
    3. Ulnar deviation at MCP joint
    4. Rheumatoid nodules
38
Q

Dx studies of rheumatic arthritis

A
  1. (+) Rheumatoid Factor (sensitive but not specific); Increased CRP and ESR
  2. (+) Anti-citrullinated peptide antibodies (most specific for RA)
39
Q

Tx of rhuematic arthritis

A

DMARDs → Methotrex, plaquenil, sulfasalazine, leflunomide

40
Q

hronic, autoimmune, systemic, inflammatory disorder of unknown cause attacking the exocrine glands

A

Sjorgens syndrome

41
Q

5-year-old female patient complaining of inability to eat completely due to loss of teeth. Along with that the patient also complains of dryness of mouth, for 1 year, and dryness of eyes for 7-8 years. Extraoral examination showed bilateral parotid gland enlargement present on the right and left side of the parotid region.

A

Sjorgen syndrome

42
Q

Sjorgen syndrome sx

A

Dryness of the mouth, eyes, and other mucous membranes due to lymphocytic infiltration of the exocrine gland and secondary gland dysfunction

  • Salivary glands - xerostomia (dry mouth)
  • Lacrimal glands - dry eyes (keratoconjunctivitis sicca)
  • Parotid enlargement
43
Q

Dx of Sjorgens syndrome

A

ANA (especially anti-SS-A (R0) and anti-SS-B (La)

  • (+) Rheumatoid Factor (RF)
  • (+) Schirmer Test (<5mm lacrimation in 5 min)
44
Q

Tx of sjogens syndrome

A

tx sx like dry eyes - pilocarpine and cevimeline

45
Q

Triad of joint pain + fever + malar (butterfly rash) - fixed erythematous rash on cheeks and bridge of nose sparing nasolabial folds

A

Lupus

46
Q

44-year-old female with intermittent joint pain. The joint pain began about 13 months ago affecting primarily the joints in her hands, wrists, and feet. She expresses concern regarding worsening fatigue, muscle aches, and feelings of depression. The physical exam reveals tender, edematous bilateral wrists; painless oral ulcers; and erythematous maculopapular lesions on her face

A

Lupus

47
Q

Dx for lupus

A
  • (+) Anti-nuclear Ab (ANA): ANA best initial test (not specific)
    • (+) Anti-double-stranded DNA and Anti-Smith Ab: 100% specific for SLE (not sensitive)
48
Q

Tx of lupus

A

Manage with sun protection, hydroxychloroquine (for skin lesions), NSAIDs, or acetaminophen for arthritis

  • Pulse dose steroids; cytotoxic drugs (methotrexate, cyclophosphamide)
49
Q

Systemic connective tissue disorder causing thickened skin (sclerodactyly), lung, heart, kidney, and GI tract

A

Systemic sclerosis (scleroderma)

50
Q

Sx of scleroderma

A
  • ght, shiny, thickened skin due to fibrous collagen buildup
  • Limited cutaneous systemic sclerosis “CREST SYNDROME” - Calcinosis cutis, Raynaud’s phenomenon, esophageal motility disorder, sclerodactyly (claw hand), telangiectasia
    • affects the face, neck as well as distal to the elbow and knees
    • Raynaud’s phenomenon (60-70%) - worsens with smoking, gold, emotional stress. CCBs are the treatment of choice
    • Diffuse cutaneous systemic sclerosis - skin thickening of the trunk and proximal extremities
51
Q

Crest syndrome

A

Scleroderma

Calcinosis cutis, Raynaud’s phenomenon, esophageal motility disorder, sclerodactyly (claw hand), telangiectasia

52
Q

Labs associated with scleroderma

A
  • (+) ANTI-CENTROMERE AB: associated with limited crest disease and better prognosis
    • (+) ANTI-SCL-70 AB: associated with diffuse disease and multiple organ involvement (+) ANA
53
Q

Tx of scleroderma

A

DMARDs and Steroids

Tx raynauds with vasodilators (CCB and prostacyclin)

EOR - Internal Med (9 decks)

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