Ortho/Rheum

Question 1

Fibromyalgia definition

Answer 1

widespread multisite pain >3m with no other condition

Possibly d/t elevated substance P

Question 2

Fibromyalgia Dx

Answer 2

Diffuse pain in11/18 trigger points for >3m

Muscle biopsy: moth eaten appearance
DOE –> ESR, CRP, CBC

Question 3

Fibromyalgia Tx

Answer 3

NSAIDS
Amitriptyline/Fluozetine/Gabapentin
DO NOT use opioids/corticosteroids

Question 4

Gout etiology

Answer 4

extracellular fluid urate saturation

Hyperuricemia >6.8mg/dl

Attacks 2/2 purine rich food (ETOH, seafood, yeats

Question 5

Gout sx

Answer 5

Flares: monoarthropathy, severe joint pain, erythema,
- Podagra: 1st MTP joint involvement, knees, feet

Chronic: collection of fluid in soft tissue

May lead to renal failure

Question 6

Gout dx

Answer 6

Arhrocentesis: MSU Crystals, leukocytosis in synovial fluid

Elevated ESR/CRP

NEGATIVE BIREFRINGMNET

Question 7

Gout Tx

Answer 7

Acute: NSAIDS is 1st line
Colchicine 2nd line

Chronic: Allopurinol, Uloric, Colchicine

Question 8

Pseudogout

Answer 8

Calcium pyrophosphate deopsition in joints

MC knee

Question 9

Pseudogout Dx

Answer 9

Arthrocentesis: weakly positive, rhomboid shape synovial crystals

Xr: chondrocalcinosis

Question 10

Pseudogout tx

Answer 10

acute attacks: intraarticular steroids are 1st line, NSAIDS, colchicine

Chronic: NSAIDS, colchicine

Question 11

Polyarteritis Nodosa (PAN) etiology

Answer 11

Systemic vasculitis of medium/small arteries

Necrotizing inflammatory lesions

Question 12

PAN manifestations

Answer 12

Renal HTN/failure
Constitutional: fever, myalgias, arthritis, lungs spared
CNS: neuropathy,
Derm: livedo reticularis, purpura, reynauds, ulcers/nodules

Question 13

PAN dx

Answer 13

elevated EST
angiography: microaneurysms with abrupt cut off of small arteries

ANCA NEGATIVE

Question 14

PAN tx

Answer 14

corticosteroids

Question 15

Polymyalgia Rheumatica etiology

Answer 15

Idiopathic inflamm causing synovitis, bursitis, tenosynovitis

Closely related to giant cell arteritis

Question 16

Polymyalgia rheumatica manifestations

Answer 16

B/L proximal joint aching/stiffness
Morning stiffness >3 min of pelvic/neck/shoulder pain

NO muscle weakness

Question 17

Polymyalgia rheumatica Dx

Answer 17

Low dose corticosteroids
NSAIDS
Methotrexate

Question 18

Polymyostitis etiology

Answer 18

Idiopathic inflam muscle disease of PROXIMAL limbs, neck, pharynx

Question 19

Polymyositis manifestation

Answer 19

Progressive: symmetrical proximal muscle weakness, dyaphagia, skin rash, atrophy

Question 20

Polymyositis Dx

Answer 20

Increased muscle enzymes (ALDOLASE and CK)

Anti-Jo 1Ab –> mechanic hands
Hyperkeratotic, cracked hands
Lung fibrosis
Anti SRP Ab

Question 21

Polymyositis Tx

Answer 21

1st line: high dose corticosteroids

Question 22

Reactive arthritis etiology

Answer 22

Autoimmune response to an infection in another part of the body
MC: chlamydia/gonorrhea

Question 23

Reactive arthritis manifestations (triat)

Answer 23

Triad: conjunctivitis, urethritis, arthritis

Keratoderma blennorrhagium: hyperkeratotic lesions on palms and soles

Question 24

Reactive arthritis dx

Answer 24

+HLA-B27, leukocytosis, elevated ESR

Synovial fluid: WBCs, bacterial culture negative

Question 25

Reactive arthritis tx

Answer 25

NSAIDS

Question 26

RA etiology

Answer 26

chronic inflamm disease with symmetric polyarthritis, bone erosion, cartilage destruction

Question 27

RA manifestations

prodrome

Answer 27

Prodrome: constitutional sx (ie. fever, weight loss anorexia)

Small joint stiffness worse with rest

Morning stiffness > 60 minutes after movement

Question 28

RA systemic arthritis

Answer 28

Boutonnier deformity: flexion @ PIP, hyperextension @ DIP

Swan Neck: Flexion @ DIP, Hyperextension at PIP

Question 29

RA dx

Answer 29

+RA factor )best initial test)
+ANTI CYCLIC C-PEPTIDE Ab (most specific)
Arthritis >3 joints, morning stiffness, >6weeks

Question 30

RA tx

Answer 30

DMARDS: methotrexate 1st line
NSAIDS for pain control
Corticosteroids 2nd line

Question 31

Sjogren Syndrome manifestation

Answer 31

Autoimmune disorder that attacks exocrine glands

Exrostomia, dry eyes, parotid enlargment

Question 32

Sjogren Dx

Answer 32

\+HLA-DR52
ANA: antiSS-A (Ro)
antiSS-B (La)
\+RF
\+Schrimer test (tear production)

Question 33

Sjogren Tx

Answer 33

Artificial tears

Pilocarpine: cholinergic to increase lacrimation

Question 34

SLE etiology

Answer 34

young females 9:1, onset in 20-40s, AA, hispanic, native americans

Drug induced: procainamide, hydralazine, quinidine

Question 35

SLE manifestations (triad)

Answer 35

Triad: joint pain, fever, malar rash (pericardidits, pleuritis)

Discoid lupus: annular, erythematous patches on face/scalp
Glomerulonephritis, retinitis, oral ulcers, alopecia

Question 36

SLE dx

Answer 36

Anti-uclear Ab: ANA (best initial test)

+RF
+Anti double stranded DNA and +Anti-Smith Ab

Antiphospholipid Ab syndrome: increased risk of thrombosis

CBC: anemia, leukopenia, lymphopenia, thrombocytopenia

Question 37

SLE tx

Answer 37

Skin: sun protection, hydroxychloroquine
Arthritis: NSAIDS or APAP
Corticosteroids

Question 38

Scleroderma etiology

Answer 38

systemic connective tissue disorder: thickened skin, lung, heart, kidney, GI

Question 39

Scleroderma manifestations

Answer 39

CREST syndrome:

- calcinosis cutis, raynauds, esophageal motility disorder, sclerodactyly, telangectasia

Question 40

Scleroderma Dx

Answer 40

+Anti-centromere Ab: a/w CREST

+Anti SCL 70 Ab: diffuse disease

Question 41

Scleroderma Tx

Answer 41

Raynauds: CCBs

Acute management: DMARDS, corticosteroids