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MTB > (Nisha) Rheumatology p189-204 > Flashcards

(Nisha) Rheumatology p189-204 Flashcards

1
Q

Chronic, slowly progressive, erosive damage to joint surfaces; loss of articular cartilage causing increasing pain with minimal or absent inflammation

A

Osteoarthritis

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2
Q

Increasing ____ and ____ to the joint increases incidence of DJD

A

Age, trauma

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3
Q

Does playing contact sports and obesity increase DJD?

A

Yes

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4
Q

What joints is DJD present in?

A

Weight bearing joints (knee, hip, ankle)

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5
Q

What joints are affected in osteoarthritis?

A

DIP> PIP and MCP

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6
Q

Heberden nodes

A

DIP enlargement

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7
Q

Bouchard nodes

A

PIP enlargement

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8
Q

Are lab tasts normal or abnormal in Osteoarthritis?

A

Normal

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9
Q

The most accurate test for osteoarthritis

A

Radiography of the affected joint

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10
Q

What will X-ray of affected joint show? (osteoarthritis)

A

Joint space narrowing, osteophytes, dense subchondral bone, bone cysts

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11
Q

How do you treat osteoarthritis?

A 
Weight loss & moderate exercise
Acetominophen (best initial analgesic)
NSAIDS
Capsaicin cream
Intraarticular steroids (if other medical therapy does not control the pain)
Hyaluronan injection in joint
Joint replacement if disease is severe
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12
Q

Absence of inflammation, normal lab tests, short duration of stiffness distinguishes _____ from _____

A

DJD, rheumatoid arthritis

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13
Q

Defect in urate metabolism with 90% of cases in men. (urate overproduction or underexcretion)

A

Gout

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14
Q

Causes of overproduction of urate?

A

Idiopathic
Increased turnover of cells (cancer, hemolysis, psoriasis, chemotherapy)
Enzyme deficiency (Lesch-Nyhan syndrome, glycogen storage disease)

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15
Q

Causes of under excretion of urate?

A

Renal insufficiency
Ketoacidosis or lactic acidosis
thiazides and aspirin

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16
Q

A 58 year old man comes in with fever and sudden excruciating pain, redness, and tenderness of the big toe at night after binge drinking. Dx?

A

Gout

17
Q

MTP joint of the great toe is the most frequently affected site in gout. True or false?

A

True. Can also occur in the ankle, feet, knees

18
Q

Presentation of chronic gout?

A

Tophi tissue (deposition of urate crystals)
Uric acid kidney stones
Long asymptomatic period between attacks

19
Q

What is the most accurate test for Gout?

A

Aspiration of the joint showing needle shaped crystals with negative birefringence on polarized light microscopy

20
Q

Treatment of Acute attack (Gout)

A

NSAIDS > colchicine - best initial therapy
Corticosteroids (steroids is the answer when no response to nsaids or contraindications to nsaids such as renal insufficiency)
Colchicine used in those who cannot use either NSAIDS or steroids

21
Q

Treatment of Chronic Gout?

A

Diet (decrease alcohol, high purine foods such as meat and seafood)
Stop thiazides, aspirin, and naicin (use losartan first for HTN)
Colchicine (effective at preventing second attack of gout and sudden fluctations in uric acid levels due to probenecid or allopurinol)
Pegloticase (dissolves uric acid)
Probenecid and sulfinpyrazone (increase excretion of uric acid) - rarely used

22
Q

Side effect of colchicine ?

A

Diarrhea, bone marrow suppression (neutropenia)

23
Q

TEN and Steven johnson syndrome is a side effect of what drug used for gout?

A

Allopurinol

24
Q

Best drug for BP in gout?

A

Losartan (ARB) lowers uric acid

25
Q

Calcium containing salt depositing on articular cartilage ?

A

Pseudogout (CPDD)

26
Q

Risk factors for pseudogout?

A

Hemachromatosis, hyperparathyroidism, diabetes, hypothyroidism, wilson disease

27
Q

What joints are affected in Pseudogout?

A

large joints. knee, wrist

28
Q

Are DIP and PIP affected in CPDD?

A

No

29
Q

Most accurate test for CPDD?

A

Arthrocentesis (positively birefringement rhomboid shaped crystals)

30
Q

CPPD treatment?

A

NSAIDS. severe disease (intraarticular steroids such as triamcinolone), colchicine prevents subsequent attacks

31
Q

a 80 year female comes in with painful joints (DIP, PIP, hip and knees). The pain worsens with use. Aspiration of synovial fluid shows <200 wbc, osteophytes and joint space narrowing. Dx?

A

Osteoarthritis

32
Q

A 40 year old man comes in with pain of the big toe after a night of binge drinking. Aspiration shows 2k-50k WBC, negatively birefringent needles. Dx?

A

Gout

33
Q

A 40 year old man with hx of hemochromatosis and hyperparathyroidism comes in with pain in his wrists and knees. Aspiration shows 2k - 50k WBC, positively birefringent rhomboids and chrondrocalcinosis on x-ray. Dx?

A

CPDD

34
Q

a 25 year old female comes to the clinic complaining of pain in the joints of her hands. She says the pain is severe in the morning and gets better with use. Aspiration shows 10k-20k wbc, antiCCP. Dx?

A

R.A

35
Q

A 18 year old male comes to clinic complaing of a hot knee joint. He has a fever of 102F. Aspiration shows >50k neutrophils. Dx?

A

Septic arthritis

36
Q

Lumbosacral strain treatment?

A

Nsaids

37
Q

Compression of the spinal cord is due to ?

A

malignancy, infection.

MTB (22 decks)

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