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SUMMED2 > Ortho Rheuma > Flashcards

Ortho Rheuma Flashcards

1
Q

Mrs. Tammy c/o min stiffness in morning, crepitus, min swelling in her knee. What may be seen on XR?

A
  1. Osteophytes, 2. Narrow Jt bone on bone 3. Cyst and sclerosis 4. Malalignment
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2
Q

What maybe expected with OA in >50yo?

A
  1. ESR ,40mm/hr 2. RF <1.40 3, Noninflmmatory markers. ESR and CRP normal
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3
Q

What are common on fingers with OA?What other jts affected>

A

Heberden’s nodes-Bumps on DIP or Bouchard’s nodes- PIP 1. Hands 1st CMC jt 2. Hips 3. Knees-2/2, 4. Feet ankle 1st MTP-2/2 5. Cervical and Lumbar. INC ROM joints. Wrist and should 2/2 to proximal OA 6. ASYMMETRIC

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4
Q

Who gets OA?

A
  1. Genetics- hip dysplasia 2. MC-Trauma- sport injury accidents 3. Obese inactive 4. Inflamm jt dz-gout 5. Neuropathy-metabolic dz 6. Avascular necrosis, 7.Paget’s dz-endocrinopathies
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5
Q

What condition is when Pt have autoimmune rxn and will have inflammation in the synovial lining and extra articular manifestations as well

A

RHEUMATOID Arthritis

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6
Q

What other CP will the Pt present with in RA?

A

LC for pt’s to have fatigue, low grade fever, heart, and lung issues 1. Chronic Sx 2. **AM stiffness >1hr 2. Swollen, red, warm, soft end feel. 3 SYMMETRICAL-MC Hand PIP, MCP. NOT DIP, Wrist and Elbow. 4- Knees and ANkles, feet 5. C-spine, RARE to rest*

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7
Q

Who gets RA?

A

F> M autoimmune 20-50

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8
Q

What are the consequences of untreated RA?

A

Deformities- Ex- mallet (DIP flx) and boutonniere deformity (PIP flx DIP ext). Bands slip off axis and pull jts

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9
Q

What are some extra articular CP of RA?

A

Pulmonary: pleuritis, interstitial fibrosis, nodules
Cardiac: pericarditis, premature CAD
Hematologic: anemia of chronic disease
Vascular: vasculitis Muscle: muscle wasting
Ocular: Sjögren’s syndrome, episcleritis, scleritis, scleromalacia perforans
Constitutional: fatigue, fever, weight loss VC

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10
Q

What is Sjogren Syndrome?

A

antibodies to lacrimal gland so pt’s don’t produce tears or saliva

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11
Q

What is considered definite RA?

A

> 6 of the Jt Distribution, Serology, Symptoms Duration, and APR.

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12
Q

What is used in Serology for RA?

A

ARPs-Abnormal CRP and ESR 2. RF, ACPA- neg, low, or high

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13
Q

What is joint distribution for critieia in RA?

A

1-Large jt, 2-10 Large jt 1-10+ small jts symptomacti

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14
Q

What are TX for RA?

A

1 Methotrexate- takes 6-8wk onset 2. PT, OT 3. NSAIDs 4. Injectable biologics 5. Steroids 6. Surgery

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15
Q

Mr. Mix is 38 yo M w/ LBP for >3 mo. C/C is **morning stiffness, **better w/ exercise. What is DDX?

A
  1. Ankylosing spondylitis 2. Mechanic back pain DX- BL sacroiliac joint sclerotic w/ pseud widening. Diminished Schober TEst- marks above and below sacrum. Normal Flex of spine marks should inc. ABN- less 5cm change
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16
Q

What condition is seronegative ASYMMETRIC reactive arthritis post infections diarrhea plus conjunctivitis or urethritis?

A

Reiter Syndrome-, shigella, salmonella, Campylobacter, yersinia, HIV, Chlamydia, Ureaplasma

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17
Q
  • Oligoarthritis (usually in the LE)
  • Sacroiliitis (unilateral or bilateral)
  • Spondylitis
  • Sausage digits
  • Enthesopathy (particularly Achilles tendon)
  • Plantar fasciitis
  • Conjunctivitis
  • Uveitis• Urethritis
  • Prostatitis
  • Cystitis
  • Keratoderma blennorrhagicum
  • Circinate balanitis
  • Oral ulcers
  • Aortic insufficiency
A

Location that may become Arthritic post infection

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18
Q

Pt has multiple jts inflamed, not symmetric. DIP is warm, red, in L hand. Swelling in all his nail jts? What is DDX?

A

Psoriatic Arthritis-similar to IBD yet in bowel

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19
Q

What is TX for PsA?

A

NSAIDs, DMARDS: sulfasalazine, methotrexate

Biologic Drugs: etanercept, adalimumab, infliximab

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20
Q

This condition is crystal induced arthritis d/t overproduction or underexcretion of uric acid?

A

Gout. MC 50% 1st MTP podagra, monoarticular. CP- Tophi- accumulation of uric acid. Lab- UA >6.8, Synovial Fluid w/ urate crystals

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21
Q

Who get gout?

A

M > F. 30-60y. Post menopause

22
Q

How do you TX Acute Gout?

A
  1. Most self limiting 1-2w 2. NSAIDs 200-500 Bid 3. Cox2 400mg BID 2day, then 200mg BID 4. Colchicine 1.2mg then 0.6mg 1hr later 5. Corticosteroids
23
Q

How do you TX Chronic Gout?

A
  1. > 2-3 attacks of gout, use a urate lowering drug: allopurinol, febuxostat, probenecid
  2. Goal uric acid <6.0
  3. Use a concomitant such as colchicine, NSAID, or low-dose corticosteroid for up to 6 months
24
Q

What is CPPD?

A

Crystal Deposition Dz: Pseudogout-same as Acute Gout TX

25
Q

Ms. Rho c/o fever, fatigue, wt loss, and oral ulcers. What is on DDX?

A

Systemic lupus Erythematosus

26
Q

What are REnal manifestation of SLE?

A
  • Focal proliferative glomerulonephritis
  • Diffuse proliferative glomerulonephritis
  • Membranous nephritis
  • Mesangial nephritis
27
Q

What are Pulmonary manifestation of SLE?

A
  • Pleuritis
  • Pneumonitis
  • Interstitial lung disease (pulmonary fibrosis)
28
Q

What are Cardiac manifestation of SLE?

A
  • Pericarditis
  • Myocarditis
  • Coronary vasculitis
  • Libman-Sacks endocarditis
  • Coronary artery disease
29
Q

What are Heme manifestation of SLE?

A
  • Leukopenia
  • Lymphopenia
  • Thrombocytopenia
  • Coombs-positive hemolytic anemia
  • Hypercoagulable state
30
Q

What are CNS manifestation of SLE?

A
  • Peripheral neuropathy
  • Cranial neuropathy
  • Mononeuritis multiplex
  • Seizures
  • Stroke
  • Organic brain syndrome (dementia-like picture)
  • Headaches
  • Depression
  • Psychosis
31
Q

What are ocular manifestations of SLE?

A
  • Conjunctivitis
  • Episcleritis
  • Sjögren’s syndrome
  • Central retinal artery occlusion
  • Cytoid bodies
32
Q

In order be DX with SLE how many of the following is needed: Malar rash, Discoid rash, Photosensity, Oral Ulcers, Arthritis, Serositis, Renal, CNS, Heme, Immunologic,and ANtinuclear Antibody

A

4 out of 11 simultaneously or serially

33
Q

What is diff w/ malar rash and discoid rash?

A

SLE triggered by sun exposure. Pt may have rash on cheeks-malar. Discoid- scarring no sun related

34
Q

What is treatment and CP with skin SLE?

A

Hypersensitive, Alopecia-will grow back. TX- Hydroxychloroquine, topical steroids

35
Q

How to differiat btwn RA and SLE and TX?

A

SLE- CP- small jts of hands w/o red, warmth or swelling TX- NSAIDs, hydroxychloroquine

36
Q

Which test for SLE is high sensitivity but poor bc we all produce them?

A

ANA antinuclear antibody. DO NOT ORDER

37
Q

Which test for SLE and has high specificity?

A

Anti-dsDNA Ab- 50% present, correlates with dz activity ANti-Sm- 10-20% will present

38
Q

Which lab findings relate to renal dz assoc w/ SLE?

A

DEC Complement C3,C4

39
Q

If a pt has heme dz and serositis,inflamed tissues lining the lungs (pleura), heart (pericardium), and the inner lining of the abdomen (peritoneum) and organs themself, then what are preventative and TX for this SLE?

A

NSAIDs, Corticosteroids

40
Q

If SLE is assoc with RENAL and CNS dz, what is TX?

A

corticosteroids, cyclophosphamide, azathioprine, mycophenolate mofetil

41
Q

What should be on DDX if pt is >55 with shoulder and hip aches, w/ fatigue and wt loss and fever?

A

Polymyalgia Rheumatica DX- INC ESR, CRP

42
Q

What should be on DDX if pt is >55 with headaches, jaw pain, vision changes, w/ fatigue and wt loss and fever?

A

Giant Cell Arteritis- TX 60 mg Prednisone

43
Q

How do you treat Polymyalgia Rheumatica And Giant Cell Arteritis?

A

Steroids very responsive

44
Q

What is chronic idiopathic widespread musculoskeletal pain >3m, w/o DX of other systemic condition?

A

Fibromyalgia

45
Q

WHat are CP of fibromyalgia?

A
  1. TTP with mild pressure 2. NORMAL-EBM of DEC levels of NT 3. Trigger by physical or emotional trauma, poor sleep 4. Fatigue 5. Paresthesias, swelling sensations 6. HA 7 Mode do 8 IBS-constipation diarrhea
46
Q

What are the common Locations for fibromyalgia?

A

Tender points 1. Lower sternomastoid, 2. 2nd costochondral, 3. lateral epicondyle, 4. trochanter, 5.knee, 6.suboccipital, 7.mid upper trapezius, supraspinatus, 8.buttock

47
Q

Which narcotics/opioid is avoided in TX of Fibromyalgia?

A

ALL. RARE-Ok to use tramadol- partial opioid TX- Exercise aerobic and stretching 2. CBT and education 3. Hydration 4. Pregabalin, gabapentin, 5. SNRI-duloxetine, milnacipran. TCA,SSRI 6. Hypnotics: amitriptyline, nortriptyline, zolpidem (sleep). 8- Levo for TSH

48
Q

What are your monoarthritis?

A

DDX- crystal induced-Gout pseudogout (CPDD). Infectious arthritis 2. Reactive Arthrisd 3. Osteoarthritis 4. Trauma

49
Q

What are your oligoarthritis?

A
  • Osteoarthritis
  • Psoriatic arthritis
  • Reactive arthritis
  • Pseudogout
  • Gout
  • Rheumatoid arthritis
50
Q

What are your polyarthritis?

A
  • Rheumatoid arthritis
  • Osteoarthritis (firm nodule)
  • Psoriatic arthritis
  • Pseudogout
  • SLE
  • Gonococcal arthritis
51
Q

What are your Ache san Pains?

A
  • Fibromyalgia
  • PMR
  • Hypothyroidism
  • Multiple soft tissue problems
  • Hyperextensibility syndrome

SUMMED2 (38 decks)

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