Jays rheum questions Flashcards by Jordan Haskins

what two ways can you diagnose OA?

1 knee pain + 5/8 conditions

2. knee pain with radiologic findings and 3/8 conditions

How well did you know this?

Not at all

Perfectly

72 year old smoking female patient c/o pain with use of her hand. Stiffness for 20 minutes in morning and aching. You note bony enlargements in 3 DIPs, no MCPs, thenar atrophy and squaring at the base of the thumb.
what is the dx?

How well did you know this?

Not at all

Perfectly

72 year old smoking female patient c/o pain with use of her hand. Stiffness for 20 minutes in morning and aching. You note bony enlargements in 3 DIPs, no MCPs, and squaring at the base of the thumb.
What color would you expect the synovial fluid to be?

Clear yellow

How well did you know this?

Not at all

Perfectly

Less than 2,000

How well did you know this?

Not at all

Perfectly

Why can the 72 year old be diagnosed with the ACR criteria?

She shows…

hard tissue enlargment of 2+ joints
hard tissue enlargment of 2+ DIP joints
< 3 swollen MCPs (r/o RA)
deformity of atleast 1 DIP;PIP joint.

How well did you know this?

Not at all

Perfectly

at what level does uric acid crystallize?

> 6.8mg/dl

however, that level can fluctuate based on body tempature (precipitates in cold places)

How well did you know this?

Not at all

Perfectly

What causes the gouty inflammation?

changes in environment of where the crystals are deposited resulting in uncoating of the protein and inciting an immune response.

How well did you know this?

Not at all

Perfectly

Squaring of the thoracic and lumbar vertebrae, elevated CRP and ESR, and HLA-B27 are associated with what?

Ankylosing spondylitis

treat with NSAIDS

How well did you know this?

Not at all

Perfectly

What are some extraarticular manifestations of AS?

Anterior uveitis, IBD, prostatitis, aortic regugitation.

How well did you know this?

Not at all

Perfectly

What autoimmune diseases present as ANA positive?

Lupus, scleroderma, polymyositis/dermatomyositis, RA, sjogrens syndrome, juvenile chronic arthritis, etc.

How well did you know this?

Not at all

Perfectly

since both regular gout and pseudo present w/ swelling, warmth, fever, leukocytosis and elevated ESR, how can you tell the difference on aspiration?

Gout: Monosodium urate monohydrate
Pseudo: calcium pyophosphate dehydrate cyrstals (CPPD)

How well did you know this?

Not at all

Perfectly

what is chondrocalcnosis?

the condition of having CPPD crystals, not having it doesnt mean you DO have pseudo, and not having doesnt mean you dont!

How well did you know this?

Not at all

Perfectly

if you cant ready the newspaper through the aspirated fluid, the disease course is likely….

inflammatory!

How well did you know this?

Not at all

Perfectly

what do you see on xray in OA?

joint space narrowing, bony sclerosis, ostephytes, and subchondral cyst formation

How well did you know this?

Not at all

Perfectly

while OA is ___(symmetric/assymetric), RA is __(symmetric/assymetric)?

OA = asymmetric
RA = symmetric

How well did you know this?

Not at all

Perfectly

most common cause of AVN?

Prednisone

How well did you know this?

Not at all

Perfectly

possible treatments for OA

NSAIDS, cox2s, DMEs, topicals, and the good ‘ol analgesic ladder

How well did you know this?

Not at all

Perfectly

what are the most common systemic factors that increase your chances of OA?

AGE! followed by gender, bone density, nutritional factors, and genetics. most common site in women is the knee and hand. MEN = hip

How well did you know this?

Not at all

Perfectly

A 76 yo f shows bilateral swelling of joints in her feet, wrists and hands. She says that it takes a while for stiffness to go away in the morning. What are the radiologic findiings you suspect?

Bony erosions, joint space narrowing, and possible Rheumatoid nodules in the lungs. THIS IS RA.

How well did you know this?

Not at all

Perfectly

What sero markers can you use to Dx RA?

Rheumatoid factor, anti-CCP antibodies, or both.

How well did you know this?

Not at all

Perfectly

what are mainstay treatments for RA?

NSAIDS.
DMARDS
Biological response modifiers (BIG RISK FOR INFECTION IN THESE ONES)

How well did you know this?

Not at all

Perfectly

T/F: physical signs and symptoms of RA correlate well the the progression of the disease

True

How well did you know this?

Not at all

Perfectly

87 yo female w/ sudden h/a, jaw claudication, tongue pain and fever. What is she at risk for?

irreversible blindness

How well did you know this?

Not at all

Perfectly

87 yo female w/ sudden h/a, jaw claudication, tongue pain and fever, you also note a slight bruit. What is the gold standard to make your diagnosis?

temporal artery biopsy

How well did you know this?

Not at all

Perfectly

what is the treatment for GCA/TA?

HIGH DOSE prednisone and ASA

how much time does it take for stiffness to subside in inflammatory vs. non inflammatory?

non-inflammatory: stiffness< 30, worse with activity. | inflammatory: stiffness > 30, improved with activity.

what condition show people with variable stiffness typically made worse with activity, increasing fatigue in the afternoon, and a wiped out feeling the next day?

fibromyalgia

a patient has terrible night pain in his hip from OA despite NSAIDS. he cant do normal activities anymore w/o terrible pain, is he indicated for a total hip?

yes

a patient developed positive ANA and discoid lupus after taking minocycline. How do see tx it?

d/c the drug, consider anti-histone antibodies and a 2-3 course of NSAIDS and steroids. WATCH OUT FOR fever, myalgias, rash, and arthritis. (Reactive arthritis)

What are some precipitating events for an acute flare of gout?

trauma, renal insufficiency, dieureteics, Beer, red meat, shellfish.

what are some treatments for gout?

NSAIDS, colchicine, and steroids

an 8 yo presents with high fever and a mild rash. On exam you find lymphadenopathy, hepatosplenomegaly, pleural effusions, and leukocytosis. What is their likely diagnosis?

Stills disease (systemic onset juvenile arthritis)

1. pink/clear synovial fluid = 2. yellow/clear & WBC<2000 = 3. what would you expect with an inflamed joint? 4. what would you expect with an infected joint?

1. trauma/blood 2. osteoarthritis (noninflammatory) 3. cloudy/yellow WBC 3-50k 4. purulent/cloudy WBC 5-300k

what other underlying pathologies do you suspect to be the cause of a patients CPPD crystals found on cytology? what are their treatments?

hyperparathyroidism, hemachromatosis. | treatments are same: nsaids, cox2s, cochicine.

is aspiration of pseudo gout therapeutic?

nope

what % of spinal compression fractures are asymptoamtic from OA?

70% | 30% are symptomatic

since most adult polymyositis and dermatomyositis present with symmetric proximal muscle weakness, elevevation in CK/aldolase/ast/alt/ldh, and fatigue, how can you tell the difference?

Dermatomyositis has the characteristic skin rashes (grotton's papules, or a heliotrope rash). WITH periungual involvement.

what are some risk factors for osteoarthritis?

malalignment, cengential/acquired abnormalitiies, joints loading, obesity.

what are some risk factors for osteoporosis?

Hx of fx as an adult, increased age, low BMD, 1st degree relative fx, low body body, smoker, steroid therapy. NSAIDS!

what are some treatments for stopping bone loss?

bisphosphonates (antiresportive side) | calcitonon is not recommended

what is approved for prevention of osteoporosis for women?

estrogen therapy!

what drug acts on increasing bone production?

teraperatide (PTH)

1 in 40k patients who receive bisphosphanates are at risk for.....

ONJ

what are some extra-articular manifestations of RA?

eyes (scleritis, keratoconjunctivitis) effusions to lung and/or pericardium lung fibrosis or nodules reactive lymphadenopathies splenomegaly. kidney and gut (amyloidosis) marrow (anemia/thrombocytopenia) muscle waisting, skin thinning and ulceration, peripheral neuropathy.

True or false: reducing purine intake can accomplish upto 1mh/dl decrease in serum uric acid.?

true

T/F: eating apples can increase uric acid levels?

true | fructose is the culprit

what does crest syndrome stand for?

calcinosis, reynauds, esophogeal dysmotility, sclerodactyl, telangiectasia.

what does CREST syndrome fall under?

CREST is a LIMITED scleroderma, which is much more common than diffuse

What is the most common presenting symptom of crest? and name a few other less common

FATIGUE stiff joints, loss of strength, pain, sleep disorder, skin discoloration. Major complications are pulmonary HTN and ILD.

A patient c/o arthritis for more than a month now in his knee, foot, and pain with urination. on x-ray you see calcaneal spurs and fluffly irregularity. What is the dx?

Reactive arthritis | Reiters syndrome

A patient c/o arthritis for more than a month now in his knee, and foot. on x-ray you see calcaneal spurs and fluffly irregularity. How do you treat reactive arthritis?

antibiotics, doxy! (hint: reiters is lower extremity..hips.knees.ankles) (classic presentation in achilles)

a patient comes in with arthritis, malar rash, photosensetivity, and nephopathy. What am I?

lupus | arthritis 83%, malar rash 54%, photo 41%

what are some other common manifestations of SLE?

ALL SITES WHERE ONE SYSTEM COMMUNICATES WITH ANOTHER, oral ulcers, serositis, siezures, pleural effusion, fever, raynauds, alopecia,

what is the general treatment for sle?

hydroxychloroquine (plaquenil)...steroid sparing agent.

what will SLE labs look like

``` hemo. anemia leukopenia lymphopenia tc-penia Anti-dsDNA or Anti-SM antibodies or Anti-phospholipid abs. ```

On SLE cytology what is the most specific? | speckled, rim/peripheral, nucleolar, or diffuse?

speckled! | rim/peripheral may also be seen but is not as common

what is the most specific antibody test for lupus?

Antibodies to dsDNA (70% sensetive, 95% specific) | A +SM is actually 100% specific but only 30% sensetive.

what is the problem with ANA testing for SLE?

its greatly sensetive, but not specific (high false positive rate from other diseases). but a negative ANA occurs in only 3% of those without (high negative predictive value)

how does treatment for enteropathic arthritis differ from ankylosing spondylitis?

they are the same. NSAIDS. | enteropathic will show IBS symptoms.

a 33 yo c/o chronic diffuse msk mpain with variable joint stiffness made worse with activity. she has terrible fatrigue during the day and after physical activity. Has h/a, IBS, dry mucous membranes (SICCA syndrome), esophogeal dysmotility, and non-dermatomal parasthesia. What is her treatment?

NSAIDS, then climb the analgesic ladder. Tramadol, SNRIs, tricyclics, etc.

think somatization syndrome instead of Fibromyalgia if they have pain to what 4 areas?

mid-forehead thumbnail volar surface of mid-forearm anterior mid-thigh

You determine that a patient has syndesmophytes and enthesitis. what disease do they likely have?

ankylosing spondylitis

how do you treat AS?

NSAIDS and TNFi's to help cover peripheral menifestations. sulfasalazine and steroids injections can also be used.

enthesisits affects the achilles tendon in what disease?

reactive arthritis

viral infections, autoimmune diseases, spondyloarthropathies, and miscellaneous are all common causes of.....

inflammatory polyarthritis

how can you dx AS?

combo xray findings that MUST Include the SI joint plus certain exam features (low back pain and stiffness > 3mo, limited ROM of L-spine, onset <45yo, HLA-B7 gene present) new york radiologic crtieria.

a patient presents with nail pitting with trasnverse ridging and onycholysis, and rash. You see changes to the elbows/knees/behind ear/gluteal cleft/unbilicus....what am I?

psoriatic arthritis

what is the buzzword for changes on xray in psoriatic arthritis that affect the DIP joint and PIP joint.

Pencil in cup deformity. thickening of the joint space and narrowing the the bony shaft. (oligoarticular, shows up in pts with regular ol psoriasis) give NSAIDS, TNFi

where do you see arthritis mutilans?

psoriatic arthritis (severe form)

An autoimmune inflammatory disorder characterized by lymphocytic infilatration of EXOCRINE glands!!!

Sjogrens syndrome

what are hallmark findings of sjogrens?

dry eye, dry mouth. check lacrimal and salivary glands.

what distinguishes primary from secondary sjogrens?

primary: conjunctivitis, sicca, xerostomia secondary: all the above + another rheumatologic condition (RA, SLE, Sclererma, PM/DM, etc)

a patient presents with widespread and quickly progressive skin thickening proximal to her elbows and signs of early organ disease. AND RAYNAUDS what does she have and what does it put her at risk for?

diffuse scleroderma, puts her at risk for renal cirtiis, pulmonary complications, and cardiac disease. (diffuse = skin + organ involvement) (limited = skin only with ILD exception)

what is the treatment for diffuse scleroderma?

treatment is difficult as there are no antifibrotic agents, use DMARDS and include symptomatic treatment.

treatment for raynauds include

CCBs, viagra PDEi, topical nitrates

most common presenting symptoms of systemic sclerosis (scleroderma)

fatigue, stiff joints, weakness, pain , sleep issues, skin discoloration

what is the variant of scleroderma that includes calcinosis, raynauds, esophogeal dysmotility, sclerodactyly, and telangiectasia.

CREST syndrome! (AKA "limited" cutaneous systemic sclerosis..not diffuse version)

what patient develops uveitis?

JUVENILE RA, ankylosing spondylitis, and reiters syndrome

difficulty holding arms up, combing hair, getting out of chair, walking up steps. may see a rash or difficulty swallowing

Idiopathic inflammatory myopathy (Aka MYOSITIS) | autoimmune attack on muscle with unknown cause

what lab test would you expect to see elevated in IID, or myositis?

CK | ast/alt/ldh and aldolase will also be elevated

a 52 yo lawyer and crew coach noticed he couldn't row anymore, and shows fatigue, muscle weakness which ISNT painful. Initial CK was normal, the 2nd doubled, and the 3rd was 2000. What is the most appropriate treatment for this patient?

Prednisone!

a 52 yo female c/o bilateral proximal muscle weakness mostly in shoulders and upper arms, tends to be worse in the morning. NORMAL ROM with some soft tissue swelling. What is the diagnosis? What do you expect the labs to show? Treatment?

Dx: Polymalgia rheumatic Labs show: elevated ESR, CRP (markers of inflammation) Normal CK Tx: steroids

10% of all patients with PMR have what other disease?

Giant cell/temporal arteritis | SO ASSESS FOR BRUIT, H/A, VISION LOSS, AORTIC INSUFFICIENCY,

if someone tests + ANA, what other lab tests should you perform?

``` checking for lupus! CBC for leukopenias and thrombocytopenia U/A for protein Anti-sm antibodies Anti-dsDNA antibodies ```