MTB 2 CK - Rheumatology Flashcards
1
Q
Composition of Tophi
A
Deposits of urate crystals with foreign body reaction. From longstanding gout
2
Q
Most accurate diagnostic test for gout
A
Arthrocentesis (esp. to rule out infectious pathology)
3
Q
Best initial treatment for Osteoarthritis
A
Acetaminophen (if not controlled, use NSAIDs like aspirin)
4
Q
Corticosteroid role in management of gout
A
Used in Acute attack in pts. resistant to NSAIDs or those with c/i to NSAIDs (renal insufficiency)
5
Q
Colchicine role in management of Gout
A
Used in patients with c/i to both NSAIDs and Steroids in acute attack; Chronic management to prevent second attack
6
Q
Allopurinol role in management of gout
A
Used for chronic management (Febuxostat also acts via xanthine oxidase inhibition)
7
Q
Probenecid role in management of gout
A
Rarely used in chronic management (inc. secretion in kidneys)
8
Q
Rx for Hypertension in gout patient
A
Losartan (ARB) -also lowers uric acid; STOP thiazides
9
Q
Colchicine toxicity
A
Diarrhea, Neutropenia
10
Q
Allopurinol major toxicity
A
Stevens-Johnson rash»_space; Toxic epidermal necrolysis
11
Q
Risk factors for Pseudogout
A
Hemochromatosis and HyperPTHism; minor: DM, Hypothyroidism, Wilson’s (calcium salts deposition in articular cartilage)
12
Q
Athrocentesis revealing positively birefringent crystals in ________________ disease
A
CPPD disease (rhomboid shaped crystals)
13
Q
Athrocentesis revealing negatively birifringent crystals in _______________ disease
A
Gout (needle shaped crystals)
14
Q
Best initial drug for CPPD disease
A
Aspirin (NOT Acetaminophen -its inflammatory disease)
15
Q
Pegloticase mechanism of action
A
Dissolves uric acid (useful in gout)
16
Q
Signs of Cord compression with high fever and elevated ESR in _____________ pathology
A
S aurues epidural abscess
17
Q
Management of Pt. with a hx of cancer presenting with sudden onset neurologic deficit (sensory level)
A
Suspect cord compression (neurologic emergency)
18
Q
Sensitive Clinical sign of Cord compression
A
Point tenderness over vertebra
19
Q
Pain upon Straight leg raise clinical significance
A
disk herniation -50% chance only (can be present for other reasons too)
20
Q
No pain upon straight leg raise clinical significance
A
Disk herniation excluded -high sensitivity (negative PPV)
21
Q
Dorsiflexion of toe affected in ___________ nerve root compression
A
L5
22
Q
Dorsiflexion of foot affected in ____________ nerve root compression
A
L4
23
Q
Eversion of foot affected in ______________ nerve root compression
A
S1
24
Q
Best initial test for uncomplicated back pain
A
Do not image (unless serious pathology suspected)
25
Best initial test for back pain with compression or infection suspected
CXR
26
Most accurate test for back pain with compression or infection suspected
MRI (do CT myelogram if MRI is contraindicated -pacemaker)
27
MRI indications in case of pain upon straight leg raise
Do MRI if accompanied by neuro deficits (isolated SLT pain is 50% of times not herniation)
28
Rx for Cord compression
Steroids for decompression; chemo/radiation for tumor -surgical decompression if fails
29
Initial treatment for Epidural abscess
Steroids to control acute neurologic deficits, Vancomycin/Linezolid until sensitivity is found; then switch to oxacillin/nafcillin + Gentamicin >> surgical drainage if resistant
30
Treatment for Disk herniation
NSAIDs with ordinary mobility >> Steroid injection (resistant) >> Surgery (rarely needed)
31
Important diseases to rule out in suspected spinal stenosis
PAD (vascular studies and physical findings are normal)
32
Spinal Stenosis clinical picture
Person > 60yrs, pain while walking radiating to buttocks and thighs b/l, worse on extending back/walking downhill, relieve in cycling/bending
33
Most accurate test to diagnose Spinal Stenosis
MRI
34
Spinal Stenosis Management
Weight loss, pain meds, Steroid injections, PT/exercise >> Surgical dilation of spinal canal in 75%
35
Fibromyalgia clinical picture
Young woman, chronic generalized MS pain and tenderness with trigger points
36
Best initial treatment for Fibromyalgia
amitriptyline and Milnacipran (SNRI specifically for Fibromyalgia)
37
Systemic disease that can cause Carpal Tunnel Syndrome
Pregnancy, Diabetes, RA, Acromegaly, Amyloidosis, Hypothyroidism
38
Most accurate diagnostic test for Carpal Tunnel Syndrome
Electomyography, Nerve Conduction Testing
39
Best initial therapy for Carpal Tunnel Syndrome
Wrist splints, avoidance >> Steroid injections and surgically cutting the flexor retinaculum in resistant cases
40
Best initial therapy for Rotator Cuff tear
NSAIDs, rest and physical therapy
41
Surgery indications for rotator cuff tears
Complete tear, failure to respond to NSAIDs, steroids and physical therapy
42
Patellofemoral Syndrome clinical picture
Anterior knee pain at patella that is worse just after starting to walk after prolonged sitting
43
Causes of Patellofemoral Syndrome
Trauma, imbalance of quadriceps strength, meniscal tear
44
Surgical indications of Patellofemoral syndrome
NO indication (nothing to fix)
45
Pain of _________________ (Tarsal tunnel syndrome/Plantar Fasciitis) improves with use
Plantar fasciitis (tarsal tunnel pain worsens)
46
Plantar fasciitis clinical picture
Very severe pain at the calcaneus with point tenderness
47
Rx for Dupuytren Contracture
Collagenase injection, Triamcinolone
48
Episcleritis is a feature of _____________ chronic inflammatory disease
RA
49
Vertebral joint commonly affected in RA
C1 and C2 (leading to subluxation)
50
Factors for point-based diagnoses of RA
Joint involvement (up to 5), ESR/CRP (1), >6 wks (1), RF/CCP (1) (6 points = RA)
51
Most common cause of death due to RA
Coronary artery disease (due to vasculitis)
52
RA with splenomegaly and neutropenia in _____________ syndrome
Felty Syndrome
53
RA with pneumoconiosis and lung nodules in _______________ syndrome
Caplan Syndrome
54
Methotrexate indications in RA
Erosive disease (joint space narrowing, physical deformities, X ray abnormalities)
55
TNF-inhibitors indications in RA
As a combination with MTX as initial DMARDS, Disease unresponsive to MTX
56
Labs to accompany TNF-inhibitor therapy
PPD skin test
57
Steroids indications in RA
When NSAIDs do not control symptoms; while DMARDs take effect (Steroids do not halt progression)
58
MTX major toxicity
Lung, LIver and marrow toxicity
59
Hydroxychloroquine major toxicity
Retinal damage (do dilated eye exam)
60
Rituximab major toxicity
Infection (anti-CD20 antibody -useful in Hodgkins and in RA)
61
High fever of unknown origin in a young person accompanied with salmon colored truncal rash. Likely diagnoses is ______________
JRA (joint symptoms are relatively mild)
62
Immunologic labs that form SLE diagnostic criteria
Positive ANA, or any of: Anti-dsDNA, Anti-Sm, VDRL, Positive LE cell prep)
63
Xray findings in SLE arthritis
None (no deformation -just pain brings pt. to physician)
64
Diagnostic test for SLE with high NPV
ANA (sensitive -negatives are not false )
65
Diagnostic test for SLE with high PPV
Anti-dsDNA, Anti-Sm (specific -positives are not false)
66
Complement levels in SLE
Correlate with disease activity (drop with exacerbations); Dec. C3
67
Acute SLE flareup diagnostic labs
Dec. complement, rise in Anti -dsDNA
68
Hydroxychloroquine indications for SLE
mildly chronic disease limited to skin and joint
69
Steroids indication in SLE
Bolus prep used in acute flare ups, Nephrotic disease
70
SLE drug that controls progression
Belimumab
71
Rx for Lupus nephritis
Steroids, alone or in combination with Cyclophosphamide and Mycophenolate
72
2 main types of anti-phospholipid antibodies
Lupus anticoagulant and Anticardiolipin antibodies
73
Clotting profile in Antiphospholipid syndrome
high APTT, normal PT, normal INR
74
_________________ antibodies are associated with spontaneous abortion in Antiphospholipid sydnrome
Anti-cardiolipin
75
_________________ antibodies are associated with arterial/venous thromboses in Antiphospholipid sydnrome
Lupus anticoagulant
76
Best initial test for Antiphospholipid syndrome with clotting abnormality
Mixing studies
77
Most specific test for lupus anticoagulant
Russel viper venom test (RVVT) prolonged
78
Rx for abortion due to Antiphospholipid syndrome
Cannot stop an imminent abortion; heparin and aspirin for recurrence
79
Intestinal manifestations of Systemic sclerosis
Large-mouthed diverticuli
80
Renal manifestations of systemic sclerosis
Sudden hypertensive crisis
81
Role of anti-Scl70 positivity in systemic sclerosis diagnostics
high PPV (specific but not sensitive -present only in 30%)
82
Most sensitive test for Systemic sclerosis
ANA (high NPV but non specific)
83
_______________ (Dermatomyositis/polymyositis) is associated with cancer
Dermatomyositis (of ovary, lung, GI and Lymphoma)
84
Best initial test for Dermatomyositis/polymyositis
CPK and aldolase
85
Anti-Jo antibody positivity clinical significance
Often associated with lung fibrosis
86
Hepatobilliary condition associated with Sjogren's
Primary biliary cirrhosis
87
Most dangerous complication of Sjogren's
Lymphoma (up to 10%)
88
Best initial test for Sjogren's
Schirmer test (filter paper against the eye)
89
Most accurate test for Sjogren's
Lip or parotid gland biopsy showing lymphoid infiltration
90
Best initial blood test for Sjogren's
SS-A and SS-B (also present in SLE -sensitivity also only 65%)
91
PFT findings in PAN
NO findings (always spares the lungs)
92
Most common neurologic abnormality in PAN
Foot drop (also stroke in a young person)
93
Most accurate test for PAN
Biopsy of symptomatic site
94
Angiography findings in PAN
Beading/abnormal dilation of renal, mesenteric or hepatic artery
95
Test to differentiate polymyositis/dermatomyositis from Polymyalgia rheumatica
Normal CPK and aldolase in PMR
96
Wegener's is associated with positive _________________ (Anti-proteinase-3 Ab/Anti-myeloperoxidase Ab)
Anti-proteinase-3 (c-ANCA; Anti-myeloperoxidase associated with Churg Strauss)
97
Clinical picture of Wegener's lung involvement
Unresolving pneumonia not better with Antibiotics
98
Eosinophillia is most strongly associated with _______________ vasculitis
Churg Struass Syndrome (also has asthma)
99
Biopsy findings in HSP
Leukocytoclastic vasculitis
100
Lab findings to diagnose HSP
None (IgA levels not reliable) -clinical diagnoses + biopsy
101
chronic HCV infection is associated with increased _________ Ig levels
Cryoglobulins (Cryoglobunemia)
102
Cryoglobulinemia clinical findings
Joint pain, Glomerulonephritis, Purpuric lesions, neuropathy
103
Rx for Cryoglobulinemia
Treat underlying HCV with interferon/Ribavirin (steroids NOT effective)
104
IgM associated with EBV infection
Cold Agglutinins (cause hemolytic anemia in EBV, mycoplasma, lymphoma)
105
Characterstic Behcet Syndrome skin lesions
Pathergy -Sterile skin pustules from minor trauma (needlestick)
106
Oral and Genital ulcers; Erythema nodosum like lesions on the skin. Likely diagnoses
Behcet Syndrome (also can have ocular, joint and CNS lesions)
107
Characteristic clinical picture of seronegative spondyloarthropathy
Men
108
Backache and stiffness in young man that improves with activity and worsens with rest. Likely diagnoses
Early Ankylosing Spondylitis
109
Best initial test for Ankylosing spondylitis
Xray of Sacroiliac joint showing space narrowing
110
Most accurate test for ankylosing spondilitis
MRI
111
Bridging syndesmophytes over vertebral bodies seen in ________________ disease
Ankylosing spondylitis (causing bamboo spine)
112
Findings in psoriatic arthritis
Sausage digits (from enthesopathy), Nail pitting, Xray showing pencil-in-a-cup deformity of DIP
113
Best initial test for psoriatic arthritis
Xray of DIP
114
Rx Treatment order for Psoriatic arthritis
NSAIDs >> MTX >> Anti-TNF
115
Best initial test for Reactive arthritis
No specific test. Rule out Reactive arthritis and look for underlying cause (IBS, Chlamydia infection, GI infection)
116
Most Accurate test for Osteoporosis
Bone Densitometry (DEXA)
117
Osteopenia diagnostic criteria
T-score between 1 to 2.5 SD lower than normal
118
Osteoporosis diagnostic criteria
T-score below 2.5 SD lower than normal
119
Risk factors for Septic arthritis
Prosthetic joint > RA > OA
120
Best Initial therapy for Septic arthritis
Ceftriaxone and Vancomycin
121
Therapy for Septic arthritis with culture showing S aureus
Oxacillin, Nafcillin (beta-lactam sensitive), Linezolid, Daptomycin (resistant)
122
Management of Infected prosthetic joints
Removal first, Antibiotic for 6-8 wks, replacement
123
Distinct presentation of arthritis caused by Gonorrhea
Accompanied by rash and tenosynovitis, and with polyarticular involvement
124
Gonococcal arthritis diagnostics
Culture multiple sites -pharynx, rectum, urethra, cervix as well as joint and blood
125
Rx for Gonococcal arthritis
Third gen cephalosporin (ceftriaxone, cefotaxime, ceftizoxime); Fluroquinolones if determined sensitive
126
Lab diagnostics for recurrent gonorrhea
Complement levels for MAC
127
Risk factors for Osteomyelitis
Vascular insufficiency, DM, SCD (Salmonella)
128
Route of infection to bone is most commonly __________________ in adults
Contiguous (from nearby foot ucler in DM, for eg)
129
Route of infection is most commonly _______________ in adults
Hematogenous
130
Clinical picture of Osteomyelitis
Warmth, redness and swelling in the area that takes weeks to develop, with/without draining ulcer
131
Best initial test for Osteomyelitis
X ray; if normal, MRI
132
Most accurate test for osteomyelitis
Biopsy (also imp. to know sensitivity)
133
Emperic therapy for osteomyelitis
None (obtain culture on biopsy first and treat acc. to sensitivity -takes wks. to develop)
