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Step 3 > Master the Boards: Rheumatology 2 > Flashcards

Master the Boards: Rheumatology 2 Flashcards

1
Q

Reactive Arthritis (Reiter syndrome) presentation

A

asymmetric Arthritis- can be any kind urethritis- sometimes genital lesions GI infection conjunctivitis keratoderma blennorrhagicum

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2
Q

common infections before reactive arthritis

A

Chlamydia, shigella, salmonella, yersinia, campylobacter

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3
Q

specific test for psoriatic arthritis

A

none

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4
Q

4 features of psoriatic arthritis

A

nail pitting DIP involvment Sausage shaped digits enthesitis- inflammation at tendinous insertion site

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5
Q

Tx for reactive arthritis

A

NSAIDS then steroid injection sulfasalazine for chronic abx do not treat the arthritis portion

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6
Q

Tx psoriatic arthritits

A

NSAIDs Then Methotrexate Resistant TNF-a, IL-17i Abatacept (T-cell inhibitor) Apremilast- phosphodiesterase inhibitor Ustekinumab treats psoriasis and psoriatic arthritis (IL 12 and 23 inhibitor)

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7
Q

why do TNF-a inhibitors reactivate TB

A

Old TB is encased in granulomas, which are held together by TNF.

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8
Q

5 common JIA features

A

Fever salmon colored rash polyarthritis Lymphadenopathy myalgia

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9
Q

labs JIA

A

very high ferritin elevated WBC negative RF and ANA- essential for DX

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10
Q

JIA tx

A

NSAIDS, if no response give steroids if persistent need IL-1i or TNF-a inhibitor to get off steroids

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11
Q

Whipple DZ symptoms

A

Joint PAin (most common) diarrhea fat malabsorption weight loss ocular involvment CNS involvement

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12
Q

Whipple biopsy shows

A

PAS +

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13
Q

Most specific test Whipple

A

PCR stool

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14
Q

Whipple tx

A

TMP/SMX, IV Ceftriaxone if CNS involvement

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15
Q

11 Criteria for Lupus and how many needed for DX

A

4 needed

  • Skin
    • Malar rash
    • photosenitive rash
    • oral ulcers
    • discoid rash
  • Arthralgia
    • in 90% of patients non errosive
  • Blood
    • Leukopenia, thrombocytopenia, hemolysis, any blood involvment counts as one
  • Renal
    • benign proteinuria- ESRD
  • Cerebral
    • Behavioral changes, stroke, seizure, meningitis
  • Serositis
    • pericarditits, pleurtic chest pain, pulmonary HRN, PNA, myocarditits
  • Serology
    • ANA(95% sensitive)
    • Double stranded DNA 60% sensitive
    • Each serological abnormality counts as 1!
    • EAS|
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16
Q

Drugs that cause drug induced lupus

A
  1. hydralazine
  2. procainamide
  3. isoniazid
17
Q

Drug induced lupus serologic findings

A

Antihistone and ANA

18
Q

IS there renal or CNS involvment in drug induced lupus

A

NO!

19
Q

Best initial test lupus

A
20
Q

Most specific Lupus test

A

ANti DS DNA 🧬

21
Q

which is more common w lupus hemolysis or anemia of chronic disease?

A

Anemia of chronic disease

22
Q

complement levels in lupus flare

A
23
Q

levels of anti ds dna lupus flare

A

⬆️

24
Q

Anti-ro(SSA) in mom puts baby at risk for

A

♥️ block

25
Q

Lupus TX

A
  1. Hydroxychloroquine-80% controled w this
  2. prednisore for acute flare ups
  3. NSAIDS for joint pain
  4. Azithropine, methotrexate, and cyclophosphamide for relapse upon cessation of steroids, if no response use belimumab, a B-cell inhibitor
  5. Steroids and mychophenolate mofetil for nephritis
26
Q

Belimumab class

A

B cell inhibitor

27
Q

Most accuate diagnostic test for Sjögren

A

lip biposy

28
Q

Sjögren serologic testing (4)

A
  1. ANA 95% sensitive, not specific
  2. RF 70% sensitive
  3. Anti Ro/SSA 50-65% sensitive but fairly specific
  4. Anti La/SSB 30-65% sensitive but fairly specific
29
Q

What cancer is Sjögren associated w

A

lymphoma

30
Q

Sjögren tx

A
  • Keep eyes and mouth moist
  • hydroxychloroquine and methotrexate and steroids if refractory
  • pilocarpine(systemic) and cevimeline(salivary) increase acytlcholine which increases oral and ocular secretions
  • sour candy can increase salivary production

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