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PANCE > MSK/RHEUM > Flashcards

MSK/RHEUM Flashcards

1
Q

what is the most common arthropathy among adults and elderly

A

OA

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2
Q

how is OA defined

A

progressive loss of articular cartilage with reactive changes in the bone resulting in pain and destruction of the joint

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3
Q

Clinical features of OA

A

Decreased ROM, Joint crepitus and pain gradually worsening throughout the day and changes with weather
hard and bony joints

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4
Q

what are the common sites of involvement for OA

A

DIP (Heberden’s nodes)
PIP (Bouchards nodes)
Wrist, Hip, Knee, Spine

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5
Q

what do radiographs show with OA

A

asymmetric narrowing, subchondral sclerosis, cysts and marginal osteophytes

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6
Q

what is the treatment for OA

A

Weight reduction, moderate physical activity, Tylenol, NSAID are 1st line, Intra-articular steroids, viscuosupplement injection, bracing

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7
Q

what is rheumatoid arthritis

A

is a chronic disease with synovitis affecting multiple joints and other systemic extra-articulat manifestations

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8
Q

who is more affected by RA

A

females are more often affected than males with onset between 40-60 years of age.

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9
Q

what is the criteria for diagnosing RA

A

morning stiffness for >1hr for at least 6weeks
Arthritis and soft tissue swelling of >3joints and presents for at least 6 weeks
arthritis of hand joints for at least 6 weeks
symmetric arthritis for 6 weeks
subcutaneous nodules in specific places
Rheumatoid factor at a level above the 95th percentile
radiology changes of joint erosions or calcific changes

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10
Q

what lab findings are positive in RA

A

ESR and CRP are elevated
RF and Anti-CCP antibodies
radiographic findings show soft tissue swelling and juxta articular demineralization

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11
Q

what is the treatment for RA

A 
Consult rheumatologist 
PT/OT
NSAIDs with DMARDS
methotrexate initial DMARD used
Reconstructive surgery for severe cases
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12
Q

what serological test is most sensitive for RA

A

anti-CCP

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13
Q

what drugs are DMARDS that are used in RA

A

methotrexate, hydroxychloroquine, azothiprine

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14
Q

what are the symptoms of RA

A 
fever, fatigue, wt loss
joint stiffness
MCP, wrist, PIP, knee shoulder, ankle
worse in morning better with movement
swollen, tender, boggy, erythematous joints
Boutonniere deformity
Ulnar deviation at MCP
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15
Q

what is gout

A

inflammatory monoarticular arthritis caused by the crystallization of monosodium urate in joints
hyperurecemia is the hallmark of the disease

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16
Q

who is affected by gout

A

90% of patients are men over 30 and women are not affected until after menopause

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17
Q

what causes gout

A

increased production of uric acid
decreased excretion of uric acid
renal disease, NSAIDs, diuretics

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18
Q

what are the clinical features of gout

A

increased serum uric acid level
peak age of onset is between 40 to 60
sudden onset of exqusite pain where patient can not tolerate even a bed sheet on the toe
most often affects the big toe (podagra)
pain, erythema, swelling and warmth

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19
Q

what are tophi

where are they usually located

A

aggregations of urate crystals surrounded by giant cells in an inflammatory reaction

extensor surfaces of forearms, elbows, knees

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20
Q

how is gout diagnosed

A

joint aspirations under polarized light will show
needle shaped negatively shaped birefringent urate crystals
Serum uric acid is not helpful as it can be normal during an acute attack

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21
Q

what is the treatment for gout attack

A

bed rest,
NSAID (indomethacin)
Colchicine for pts who can not take NSAIDs
prednisone (7-10days)

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22
Q

what medication is used prophylactic therapy for gout

A

Allupurinol, probenecid,

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23
Q

what is pseudo gout

A

calcium pyrophosphate deposit in joints leading to inflammation

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24
Q

what are risk factors for pseudo gout

A

increases with age, and with OA of the joints
common in elderly with degenerative joint disease
hemochromatosis, hyperparathyroidism, hypothyroidism,

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25
Q

what are the symptoms of pseudo gout

A

most common joints affected are knees and wrists

classically monoarticular

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26
Q

how is pseudo gout diagnosed

A

joint aspiration will show weakly positively birefringent rod shaped and rhomboidal crystals

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27
Q

what is the treatment for pseudo gout

A

treat underlying disorder

symptomatic managament of NSAIDs, colchicine, steroid injections

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28
Q

what Systemic lupus erythematosus

A

autoimmune disorder characterized by inflammation and positive ANAs and involvement of multiple organs

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29
Q

what are risk factors for SLE

A 
Genetics
Sun exposure
Infections
Hormonal estrogen
drugs (procainamide, hydralazine, INH
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30
Q

SLE is most common in what patient

A

MC in young female

AA affected greater than whites

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31
Q

what are the clinical features of SLE

A 
Joint pain, Fever, Malar/butter fly rash
discoid lesions
pericarditis
renal disease
pleuritis
neurologic disease
32
Q

what is the criteria for the diagnosis of SLE

A

Need 4 of these:
Malar rash, Discoid skin lesions
Photosensitivity, Oral ulcers, Arthritis, Serositis
Renal Dz protein uria, Neuro Dz seizures, psychosis

33
Q

Lab results in SLE

A

Positive ANA sensitive but not specific
Anti-ds DNA and Anti-Sm are diagnostic of SLE but not very sensitice
Anti-Histone Ab are present in 100% of cases of drug induced SLE

34
Q

what is the treatment for SLE

A

avoid sun
NSAID for MSK complaints
Local or systemic steroids for acute exacerbations
hydroxychloroquine

35
Q

what is polymyositis

A

inflammatory disease of striated muscle affecting the proximal limbs, neck and pharynx

36
Q

who is more commonly affected by polymyositis

A

women

37
Q

what are the clinical features of polymyositis

A

proximal muscle weakness, dysphagia, over weeks Skin rash (malar) heliotrope (blue-purple) upper eyelid discoloration polyarthralgias and muscle atrophy

38
Q

what are the laboratory findings in polymyositis

A 
elevated CPK, aldolase
muscle biopsy will show myopathic inflammation
Anti-Jo-1
Anti-signal recognition particle
Anti-Mi2 antibodies
39
Q

what is the treatment for polymyositis

A

high dose steroids, methotrexate, azathioprine until symptoms resolve

40
Q

what is polymyalgia rheumatic

A

idiopathic inflammatory condition causing synovitis, bursitis and tenosynovitis

41
Q

what are the clinical features of polymyalgia rheumatica

A

aching/stiffness of proximal joints (shoulders, hips and neck)
MC in Femal >50
Closely associated with temporal arteritis

42
Q

what are the symptoms of Polymyalgia rheumatica

A

bilateral joint aching/stiffness >30min of the pelvic and shoulders with trouble combing hair, putting on coat and getting out of chair
profound morning Stiffness

43
Q

how is polymyalgia rheumatica diagnosed

A

clinical

elevated ESR

44
Q

whats is TX for PMR

A

steroids

45
Q

what is fibromyalgia

A

chronic nonprogressive course with waxing and waining in severity

46
Q

what is the key to the diagnosis of fibromyalgia

A

multiple trigger points that are tender to palpation, symmetrical
eighteen characteristic locations have identified

47
Q

how is fibromyalgia diagnosed

A

point tenderness in 11 of the 18 trigger points for >3 months
Biopsy will show moth eaten appearance

48
Q

what is the Tx for fibromyalgia

A

exercise
Pregabalin (lyrica)
TCA,Cymbalata
SSRI, Neurontin

49
Q

what is reactive arthritis

A

is asymmetric inflammatory oligoarthritis of lower extremities that is preceded by an infectious process that is remote from the site of arthritis (1-4 weeks) prior

50
Q

who commonly gets Reiters syndrome

A

HLA-B27 positive indiviuals

51
Q

what organisms are associated with reiters

A

Salmonella, shigella, campylobacter, chalmydia, yersinia

52
Q

what is the classic triad of reiters syndrome

A

arthritis, urethritis and ocular inflammation (conjuntivitis or uveitis
cant see, cant pee and can’t climb a tree

53
Q

how is reactive arthritis diagnosed

A 
synovial fluid for analysis
WBC 10,000-20,000
elevated ESR
Synovial fluid 1,000-8,000 cells/mm
synovial fluid is bacterially negative
54
Q

what is the treatment for reactive arthritis

A

NSAIDs first line
if no response then try sulfasalazine or azathioprine
Abx use is controversial

55
Q

what is polyarteritis nodosa

A

small and medium artery inflammation involving the skin, kidney and peripheral nerves and gut

56
Q

Who is affected by polyarteritis nodosa

A

Men generally between the ages of 40-60

associated with hepatitis B&C

57
Q

what are the clinical features of polyarteritis nodosa

A

fever, anorexia, weight loss, abdominal pain, peripheral neuropathy
Skin lesions palpable purpura and livedo reticularis
HTN, edema, oligouria and uremia

58
Q

how is polyareritis nodosa diagnosed

A

vessel biopsy or angiography

59
Q

Lab finding with polyarteritis nodosa

A

elevated ESR, CRP, proteinuria positive Hep B surface antigen

60
Q

what is the treatment for polyarteritis nodosa

A

high doeses of steroids
cytotoxic drugs and immunotherapy also may be used
treat HTN

61
Q

what is scleroderma

A

unknow cause and is characterized by deposition of collagen in the skin and less commonly in the kidney, heart and lungs

62
Q

who is affected by scleroderma

A

women

ages 30 to 50

63
Q

what are the clinical features of scleroderma

A

skin involvement affects 95% of the patients, changes most often start with the fingers swelling and the hands then the face
Raynauds is seen in 75% of the patietns
CREST
Calcinosis, Raynauds, Esophageal dysfunction, sclerodactyly, telangiectasias

64
Q

what lab finding are there with scleroderma

A

ANA is present in 90% of patients with diffuse scleroderma

Anticentromere antibody

65
Q

what is Tx for scleroderma

A

there is no cure

treatment is organ specific of PPI, ACE, CCB

66
Q

what is sjogrens syndrome

A

is an autoimmune disorder that destroys salivary and lacrimal glands
could also be a secondary complication of RA, SLE, Scleroderma or Polymyositis

67
Q

who is affected by sjorgrens

A

middle aged females

68
Q

what are the clinical features of sjogrens

A

mucous membranes are most affected, dry mouth, dry eyes, parotid gland enlargement

69
Q

what lab findings are there with sjogrens

A

RF present in 70% of cases, ANA in 60% of cases and Anti-RO

70
Q

what test evaluates secretions by the lacrimal gland

A

schirmers tear test

wetting of less than 5mm of filter paper in the lower eyelid for

71
Q

what is the treatment of sjogrens

A

artificial tears, and saliva, increased fluid intake, ocular and vaginal lubricants
pilocarpine

72
Q

what is juvenile idopathic arthritis

A

autoimmune mono or polyarticular arthritis

73
Q

what types of JRA are there

A

Pauci-articular 4 or fewer medium or large joints
systemic acute arthritis
polyarticular resembles adult RA with systemic joint involvement

74
Q

how is JRA diagnosed

A

RF+ in 15%
it is usually a clinical diagnosis
elevated ESR and CRP

75
Q

what is the treatment for JRA

A

NSAIDs

methotrexate, leflunomide

PANCE (8 decks)

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