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