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Step 3 > Master the Boards: Rheumatology 3 > Flashcards

Master the Boards: Rheumatology 3 Flashcards

1
Q

3 main Sx of scleroderma

A
  1. Skin- tight fibrous thickening- sclerodactyly
  2. Raynaud phenomenon(vascular hypersensitvity) white ➡️ blue ➡️ red, can be painful
  3. Joint Pain- mild and symmetrical
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2
Q

Tight skin+heart burn+ Raynaud dx

A

scleroderma

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3
Q

Additional findings in diffuse scleroderma (4)

A
  1. Lung: fibrosis and pulmonary HTN (leading cause of death)
  2. GI: esophageal dysmotility leading to reflux and sometimes barrels, PBC 15%, wide mouth colonic diverticula
  3. ❤️:restrictive cardiomyopathy and premature CAD
  4. Renal: Malignant HTN
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4
Q

Scleroderma serology

A

ANA + 95% but not specific

Antitopoisomerase (SCL-70) only present 30%

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5
Q

Tx for scleroderma

A
  • ACEi for HTN and renal involvement
  • Bosentan(endothelia antagonist), prostacyline analogs (epoprostenol/ iloprost), or sidenofil for pulmonary HTN
  • CCB for Raynaud
  • PPI for GERD
  • Cyclophosphimide for lung fibrosis
  • methotrexate or mychophenolate for skin thickening
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6
Q

Limited Scleorderma- CREST stands for

A 
Calcinosis of fingers
Raynaud 
Esophageal dysmotility
sclerodactyly
Telangiectasia
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7
Q

CREST syndrome serology

A

anti-centromere and sometimes antitopoisomerase (scleras-70)

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8
Q

Eosinophilic Fasciitis sx, and tx

A

eosinophillia
peau d’orange
sx worse with exercise
tx = steroids, 2nd line methotrexate

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9
Q

What does scleroderma have that Eosinophilic Fasciitis does not

A

Hand involvment
Raynaud
♥️,lung, kidney involvement

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10
Q

weakness + ⬆️ CPK+ ⬆️Aldolase+Biopsy =

A

Polymyositis

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11
Q

weakness + ⬆️ CPK+ ⬆️Aldolase+Biopsy +Rash=

A

Dermatomyosytisis

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12
Q

what muscles are weak in PM, DM

A

Proximal

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13
Q

3 rashes seen with Dermatomyosytisis

A

Gottron Papules on MCP’s
Heliotrope Rash- purple lesions around eyes
Shawl sign-shoulder and neck erythema

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14
Q

Diagnostic tests for PM/DM

A

Elevated CPK and Aldose
Abnormal electromyogram
for CCS order LFT’s and ANA
Biopsy is most accurate test

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15
Q

What does the presence of anti-JO-1 in DM/PM correlate with an increased risk for

A

Interstitial lung dz

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16
Q

Most common serious complication of DM/PM

A

Malignancy, more with DM. Frequently in cervix, breasts, lung, pancreas, and ovaries

17
Q

TX for DM and PM

A

steroids
refractory use azathioprine or methotrexate
still refractory try ritux or IVIG
hydroxychloroquine for skin findings

18
Q

which muscles foes inclusion body myositis target

A

both proximal and distal but distal upper extremity flexors are particularly affected- slowly progressive

19
Q

markers elevated in inclusion body myositis

A

elevated CK, confirm w biopsy

20
Q

Effective tx for inclusion body myositis

A

none

21
Q

Sx of mixed connective tissue dz (6)

A
  • Hand Edema
  • Synovitis
  • possible myositis and pulmonary HTN
  • Sclerodactyly, calcinocis, mlar rash, gottrans papules
  • Serositis and sicca symtoms (50%)
  • Kidney involvement (25%)
22
Q

Most Specific test MCTD

A

anti-U1 ribonucleoprotein (anti RNP)

23
Q

MCTD tx

A

steroids
azathioprine or methotrexate
Cyclophosphamide for ILD

24
Q

Fibromyalgia sx (5)

A
  • muscle aches and stiffness
  • trigger points on palpation
  • non refreshing sleep
  • exercise intolerance
  • depression and anxiety are common, cognitive fatigue
25
Q

Objective tests to confirm fibromyalgia

A

none

26
Q

Fibromyalgia tx

A 
Aerobic exercise
CBT
Milnacipran, duloxetine, pregabalin, gabapentin
TCA
NOT NSAIDS for first line
27
Q

Which is more prominent in polymyalgia rheumatica pain or weakness

A

pain

28
Q

5 specific symptoms polymyalgia rheumatica

A
  • Profound pain and stiffness of proximal muscles
  • stiffness worse in am
  • localized to muscles not joints
  • normal sleep
  • elevated ESR
29
Q

non specific sx polymyalgia rheumatica

A
  • fever
  • weight loss
  • malaise
  • normocytic anemia
  • Normal CPK, electromyogram, aldolase, and biopsy
  • no muscle atrophy
30
Q

polymyalgia rheumatica tx

A

steroids, usually works

31
Q

Age >50 + proximal muscle pain + increased ESR =

A

polymyalgia rheumatica

Step 3 (10 decks)

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