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q bank Flashcards

1
Q

signs of lumbar spinal stenosis

A
  • usually over 60yo
  • back pain that radiates to butt and thighs
  • may have numbness and parasthesias
  • worse during walking and lumbar extension, but flexion alleviates
  • pedal pulses are noral, as perfusion not affected
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2
Q

how to diagnose lumbar spinal stenosis

A

MRI

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3
Q

signs of lumbar disc herniation

A
  • acute onset back pain with or without radiation down one leg
  • pts usually recall an inciting event
  • as with stenosis, pain may be radiating and be associating with neurologic symptoms
  • however, in herniation, lumbar flexion and sitting will make pain worse
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4
Q

signs of fibromyalgia

A
  • young to middle aged women
  • widespread pain, fatigue, and cognitive/mood changes
  • fairly nl PE except for point muscle tenderness in areas such as the mid trapezius, lateral epicondyle, costochdonral junction, and greater trochanter
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5
Q

mgmt of fibromyalgia

A
  • exercise
  • good sleep hygiene
  • medications (eg: duloxetine, TCAs) reserved for pts who fail initial measures
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6
Q

adhesive capsulitis: cause and signs

A

aka frozen shoulder syndrome

  • glenohumeral joint loses its normal distensibility due to chronic inflammation, fibrosis and contracture of the joint capsule
  • can be idiopathic or secondary to uderlying conditions such as rotator cuff tendinopathy (most common), subacromial bursitis, paralytic stroke, DM, or humeral head fracture
  • shoulder stiffness out of proportion to pain
  • reduction of passive + active ROM
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7
Q

rotator cuff impingement or tendinopathy vs rotator cuff tear

A

impingement:
- pain with abduction and external rotation
- subacromial tenderness
- nl ROM w/ positive impingement tests (Neer, Hawkins)

tear:
- similar to above, but weakness with external rotation
- age >40

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8
Q

biceps tendinopathy/rupture

A
  • anterior shoulder pain
  • pain w/ lifting, carrying, or overhead reaching
  • weakness less common
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9
Q

glenohumeral oosteoarthritis

A
  • uncommon and usually caused by trauma
  • gradual onset of anterior or deep shoulder pain
  • decreased active and passive abduction and external rotation
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10
Q

clinical symptoms of SLE

A
  • constitutional: fever, fatigue and weight loss
  • symmetric, migratory arthritis
  • skin: butterfly rash and photosensitivity
  • serositis: pleurisy, pericarditis and peritonitis
  • thromboembolic events (due to vasculitis and antiphospholipid antibodies)
  • neurologic: cognitive dysfunction and seizures
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11
Q

SLE labs

A
  • heemolytic anemia, thrombocytopenia, and leukopenia
  • hypocomplementemia (C3 and C4)
  • anti-ANA (sensitive)
  • anti-dsDNA and anti-SM (specific)
  • renal involvement: proteinuria and elevated Cr
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12
Q

uses and SE of cyclophosphemide

A
  • immunosuppressant used in SLE, vasculitis and certain cancers
  • hemorrhagic cystitis, bladder carcinoma, sterility and myelosuppression
    to help avoid SEs: fluids, frequent voiding, and taking MESNA
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13
Q

subacrominal bursitis

A
  • result of repetitive overhead motions
  • pain with active ROM of the shoulder
  • pain w/ passive internal rotation and forward flexion at the shoulder
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14
Q

cause of isolated high alk phos

A
  • most likely Paget’s disease of bone
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15
Q

Paget’s disease of bone: pathophysiology

A
  • bone lesions are the result of defective osteoid formation at sites of high bone turnover resulting in hypertrophy of bonee
  • most commonly affected bones: skull, clavicles, pelvis and lone bones
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16
Q

complications of Paget’s disease

A
  • pathologic fractures
  • pain
  • osteosarcoma
  • neurologic symptoms
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17
Q

signs of ankylosing spondylitis

A
  • men age 20-30, HLA-B27
  • progressive back pain and morning stiffness for more than 3 months
  • extraarticular signs: anterior uveitis (monocular pain, blurring, and photophobia)
  • signs: reduced ROM in lower back and sacroiliac tenderness
    to confirm: film w/ sacroilitis
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18
Q

antibodies for rheumatoid arthritis

A
  • Rh factor

- anti-cyclic citrullinated peptide (anti-CCP)

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19
Q

meaning of seronegative spondyloarthropathies

A
  • test negative for Rh and anti-CCP
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20
Q

glutamic acid decarboxylase antibodies

A
  • seen in 70% of type 1 diabetics
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21
Q

synovial fluid in gout

A
  • leukocytosis (50% neutrophils)

- monosodium urate crystals, needle shaped and negatively birefringement under polarizing microscopy (blue)

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22
Q

synovial fluid in pseudogout

A

(calcium pyrophosphate dihydrate depsition)

- calcium pyrophosphate crystals: smaller, rhomboid-shaped, weakly positively birefringent

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23
Q

common arthritis seen with hypothyroidism

A
  • bilateral carpal tunnel syndrome (compression of the median nerve)
  • thought to be due to protein complex deposition within the perineurium and endoneurium of the median nerve
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24
Q

mechanism of kidney damage in SLE

A
  • immune complex mediated, they are deposited in renal glomeruli causing damage through ways such as complement activation (that
    s why serum C3 is decreased in SLE kidney disease and post-step glomerulonephritis)
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25
Q

typical cause of ACL injury

A
  • rapid deceleration or direction changes

- pivoting on lower extremity with foot planted

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26
Q

symptoms of ACL injury

A
  • pan: rapid onset, may be severe
  • popping sensation at time of injury
  • significant swelling (effusion/hemarthrosis)
  • joint instability
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27
Q

Pe and dx of ACL injury

A

PE: anterior laxity of tibia relative to femur (anterior drawer test)
dx: MRI

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28
Q

etiologies of vertebral compression fracture

A
  • trauma
  • osteoporosis, osteomalacia
  • infection (eg: osteomyelitis)
  • bone metastases
  • metabolic (eg: hyperparathyroidism)
  • paget disease
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29
Q

signs of vertebral compression fracture

A

chronic:
- painless
- progressive kyphosis
- loss of stature
acute:
- low back pain and decreased spinal mobility
- pain increasing with standing, walking, lying on back
- tenderness at affected level

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30
Q

effect of thiazides on uric acid

A
  • hyperuricemic effect resulting from hypovolemia-associated enhancement of uric acid reabsorption in the proximal tubule
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31
Q

tophi

A
  • in chronic gout, urate crystals may deposit in the soft tissues forming tumors called tophi
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32
Q

cause of Whipple’s disease

A
  • infection w/ gram + bacillus T. whippelii
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33
Q

signs of Whipple’s disease

A
  • chronic malabsoprtive diarrhea (steatorrhea, flatulence, abdominal distention) with protein-losing enteropathy, weight loss
  • migratory non-deforming arthritis
  • LAD
  • low-grade fever
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34
Q

diagnosis of Whipple’s disease

A
  • small intestinal biopsy and PCR showing PAS+ macrophages in the lamina propria containing non-acid fast gram + bacilli
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35
Q

signs of psoriatic arthritis: arthritis

A
  • DIP joints
  • asymmetric oligoarthritis
  • symmetric polyarthritis, similar to RA
  • arthritis mutilans (deforming and destructive arthritis)
  • spondylarthritides (sacroilitis and spondylitis)
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36
Q

signs of psoriatic arthritis: soft tissue and nails

A
  • enthesitis (inflammation at tendon insertion site to bone)
  • dactylitis (‘sausage digits’) of toe or finger
  • nail pitting and oncholysis
  • swelling of the hands or feet with pitting edema
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37
Q

signs of psoriatic arthritis: skin

A
  • arthritis preceds skin disease in 15% of patients

- skin lesions are present but no yet diagnosed in 15% of patients

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38
Q

symptoms of rheumatoid arthritis

A
  • insidious onset, multiple joint pain, stiffness and swelling
  • morning stiffness lasting hours, improves with activity
  • small joints (eg: PIP, MCP, MTP) commonly involved
  • monoarthritis (eg: knees, elbows) can also occur later
  • spares the DIp joint, unlike osteoarthritis
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39
Q

signs of rheumatoid arthritis

A
  • affected joints are tender to the touch, swollen, with limited range of motion
  • tenosynovitis of the palms ‘trigger finger’
  • rheumatoid nodules (esp on elbows)
  • cervical joint involvement can lead to spine subluxation –> spinal cord compression
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40
Q

labs and imaging for rheumatoid arthritis

A
  • anti-CCP (diagnostic testing)
  • high IgM rheumatoid factor
  • CRP and ESR correlate with disease activity
  • X-Ray: soft-tissue swelling, joint space narrowing and bony erosions
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41
Q

complications of rheumatoid arthritis and mgmt

A
  • osteopenia, osteoporosis, and bone fractures (because of increased levels of proinflammatory cytokines, steroids, and lack of physical activity)
  • degree of bone loss generally correlates with disease activity
    mgmt: exercise, calcium and vitamin D, minimization of steroids, and consideration of biphosphonates
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42
Q

initial treatment for OA

A

acetominopehn

43
Q

hydroxychloroquine: use and SE

A
  • effective for SLE patients with isolated skin and joint involvement
  • SE: retinopathy, corneal damage (eye exams required every 6 months)
44
Q

what diseases are associated with HLA-B27?

A

inflammatory bowel disease (esp UC)
ankylosing spondylitis

  • both are therefore associated with the other
  • both associated with pANCA as well
45
Q

signs of systemic sclerosis

A
  • scleroderma (dermal sclerosis with obliteration of skin appendages–hair follicles and sweat glands, and flexion contractures
  • raynaud’s
  • calcinosis cutis
  • hypertension (kidney involvement)
  • pulmonary arterial hypertension –> R heart failure
  • esophageal and gastric dysmotility –> GERD
46
Q

antibodies in systemic sclerosis

A
  • anti-ANA

- anti-topoisomerase I

47
Q

antibodies in primary biliary cirrhosis

A
  • antimitochondrial antibodies
48
Q

antibodies present in granulomatosis with polyangiitis (wegener’s)

A
  • ANCA
49
Q

antibodies in autoimmune hepatitis

A
  • anti-smooth muscle
50
Q

what diseases can have a positive Rh factor

A
  • RA
  • SLE
  • Sjogren syndrome
  • dermatomyositis
  • HCV
51
Q

signs of polymyositis

A
  • progressive proximal weakness of the lower extremities (difficulty with stairs or rising from a seated position)
  • then, proximal arm weakness (difficulty combing hair, working with hands overhead)
  • may also have dysphagia due to involvement of striated muscles of upper pharynx
  • weakness&raquo_space; pain, tenderness
52
Q

how to diagnose polymyositis

A
  • muscle biopsy: mononuclear infiltrate surrounding necrotic and regenerating muscle fibers
53
Q

criteria to diagnose OA

A
  • age >50
  • crepitus
  • bony enlargement
  • bony tenderness
  • lack of warmth / morning stiffness
  • if more than 3 criteria, specificity for OA is 69%
54
Q

etiology of lateral epicondylitis

A

aka tennis elbow

- repeated forceful wrist extension and supination (backhand in tennis, use of a screwdriver)

55
Q

signs of lateral epicondylitis

A
  • pain with supination or extension of the wrist

- point tenderness just distal to the lateral epicndyle

56
Q

diagnosis of Behcet’s

A
  • recurrent oral ulcers, plus 2 of the following:
    1. recurrent genital ulcers
    2. eye lesions (anterior uveitis, posterior uveitis)
    3. retinal vascularization
    4. skin lesions (erythema nodosu, acneiform ndules, and papulopustular lesions)
    5. positive pathergy test
57
Q

most common cause of acute back pain (and signs)

A
  • lumbosacral strain
  • acute onset of back pain after physical exertion
  • absence of radiation
  • presence of paraveterbral tenderness
  • negative straight leg raising test
  • normal neuro exam
58
Q

types of disease modifying antirheumatic drugs

A
  • methotrexate
  • leflunomide
  • hydroxychloroquine
  • sulfasalazine
  • TNF inhibitors
59
Q

types of TNF inhibitors

A
  • adalimumab
  • certolizumad
  • etanercept
  • golimumab
  • infliximab
60
Q

methotrexate: mechanism and side effects

A
  • purine antimetabolite
  • GI symptoms, oral ulcers or stomatitis, rash, alopecia, hepatotoxicity, pulmonary toxicity, and bone marrow suppression
  • folic acid supplementation reduces SE without loss of efficacy
61
Q

lefflunomide: mechanism and side effects

A
  • pyrimidine synthesis inhibitor

- hepatotoxicity, cytopenias

62
Q

hydroxychloroquine: mechanism and side effects

A
  • TNF and IL-1 suppressor

- retinopathy

63
Q

sulfasalazine: mechanism and side effects

A
  • TNF and IL-1 suppressor

- hepatoptoxicity, stomatitis, hemolytic anemia

64
Q

side effects of TNF inhibitors

A
  • infection
  • demyelination
  • congestive heart failure
  • malignancy
65
Q

symptoms of polymyalgia rheumatica

A

age >50

  • bilateral pain and morning stiffness > 1 moonth
  • involvement of 2: neck or torso, shoulders or proximal arms, proximal thigh or hip, constitutional (fever, malaise, weight loss)
66
Q

polymyalgia rheumatica: PE and labs

A

PE: decreased active ROM in shoulders, neck, hips
labs: ESR >40, sometimes >100, elevated CRP, normocytic anemia possible, around 20% can have nl studies

67
Q

treatment for polymyalgia rheumatica

A
  • low dose glucocorticosteroids
68
Q

what disease is associated with polymyalgia rheumatica?

A

giant cell arteritis

69
Q

synovial fluid in OA

A
  • less than 2000 WBCml
  • no organisms
  • no crystals
70
Q

X ray findings in OA

A
  • joint space narrowing
  • osteophytes
  • subchondral sclerosis/cysts
71
Q

when to start RA patients on DMARDs

A
  • ASAP as joint damage begins early in its course
  • NSAIDs or glucocorticoids should be used for initial temporary symptomatic relief while awaiting response to DMARD therapy
72
Q

next steps if RA patient is not responsive to methotrexate

A

one option:
- step up therapy: add biologic agent (aka: TNF inhibitor)

second:
- parallel therapy: add another nonbiologic (sulfasalazine, hydroxychloroquine)

73
Q

lumbar stenosis pathophysiology

A
  • degenerative condition where the spinal canal is narrowed, causing compression of one or more of the spinal roots
  • often results from:
    1. enlarging osteophytes at the facet joints
    2. hypertrophy of the ligamentum flavum
74
Q

what is enthesitis?

A
  • a condition in which inflammation and pain occur at the site of tendon and ligament attachment to bone
  • common finding in anklyosing spondylitis
  • typical sites of enthesitis include heels, tibial tuberosities, and iliac crests
75
Q

cause of gout

A

overproduction or underexcretion of uric acid (byproduct of DNA)

76
Q

podagra

A
  • acute, monoarticular arthritis affecting the first metatarsophalangeal joint (most common presentation of gout attack)
77
Q

definitive diagnosis of gout

A
  • joint aspiration: needle-shaped, negatively birefringent urate crystals and a WBC count of 2,000-5,000
78
Q

drugs for prevention of gout

A

allopurinol and probenecid

79
Q

drugs for acute gout attack

A

colchicine, NSAIDs, and steroids

80
Q

clinical features of dermatomyositis

A
  • muscle weakness (proximal, symmetric)
  • skin findings (Goltron’s papules, heliotrope rash)
  • interstitial lung disease
  • dysphagia
  • myocarditis
81
Q

diagnosis of dermatomyositis

A
  • increased CPK, aldolase, LDH
  • anti-RNP, anti-Jo1, anti-Mi2
  • when unsure: EMG, biopsy (skin/muscle)
82
Q

mgmt of dermatomyositis

A
  • high dose glucocorticoids + glucocorticoid sparing agent

- screening for malignancy

83
Q

what is associated with dermatomyositis?

A
  • internal malignancy (over 15%)

- most common: ovarian, lung, pancreatic, stomach, or colorectal cancers, or non-Hodgkin lymphoma

84
Q

primary vs secondary Raynaud’s phenomenon

A

primary: no underlying cause
secondary: connective tissue diseases, occlusive vascular conditions, sympathomimetic drugs, vibrating tools, hyperviscosity syndromes, nicotine

85
Q

treatment of raynoud’s

A
  • calcium channel blockers (eg: nifedpine, amlodipine)
86
Q

how to diagnose anklyosing sponylitis

A

plain Xray with fused sacoiliac joints and/or bamboo spine

87
Q

anserine bursitis

A
  • localized pain over the anteromedial part of the tibial plateau just below the joint line of the knee
  • pain is worse at night as pressure from knees while lying on side
  • valgus stress test neg ruling out damage to MCL
  • X-ray normal
88
Q

signs of disesminated gonococcal infection

A
  • polyarthralgias
  • tenosynovitis
  • vesiculopustular skin lesions
89
Q

what is pseudoclaudication? what causes it?

A
  • posture-dependent pain, such as with lumbar spinal stenosis
  • lumbar extension worsens pain (eg: walking downhill), lumbar flexion relieves pain (eg: walking while bent forward)
  • lower-extremity numbness and tingling, weakness
  • low back pain

(whereas vascular claudication is exertionally dependent)

90
Q

CREST syndrome

A 
- limited form of systemic sclerosis 
C = calcinosis (nodules on UE, can drain chalky material) 
R = raynaud's 
E = esophageal dysmotility
S = sclerodactyly
T = telangeictasias
91
Q

synovial fluid:

  • 0-200 WBC
  • 200-2,000
  • 2,000-5,000
  • > 50,000
A
  • normal
  • OA
  • inflammatory condition
  • septic
92
Q

most readily modifiable RF for OA

A
  • obesity, weight loss decreases joint pain, increases function, and slows progression of disease
93
Q

pathophysiology of secondary amyloidosis

A
  • complication of a chronic inflammatory condition (eg: chronic infections, inflammatory bowel disease, rhematoid arthritis) resulting in extracellular tissue deposition of fibrils into tissues and organs
94
Q

signs of secondary amyloidosis

A
  • asymptomatic proteinuria or nephrotic syndrome
  • cardiomyopathy with heart failure
  • hepatomegaly
  • mixed sensory and motor peripheral neuropathy and/or autonomic neuropathy
  • visible organ enlargement (eg: macroglossia)
  • bleeding diathesis
  • waxy thickening, easy bruising of skin
95
Q

diagnosis and treatment of secondary amyloidosis

A
  • abdominal fat pad aspiration biopsy

- tx underlying condition, colchicine for prevention and tx

96
Q

neuropathic claudication

A
  • used to describe lumbar stenosis

- exacerbation of leg symptoms while waalking (position and remain while standing still)

97
Q

signs of sarcoidosis

A
  • systemic illness, most often found incidentally on cxr
  • lungs (cough, dyspnea, bilateral hilar adenopathy and reticular opacities)
  • fever, weight loss
  • skin (erythema nodosum)
  • eyes (anterior uveitis)
  • joints (arthritis)
98
Q

cause of avascular necrosis of the femoral head

A
  • compromised blood supply

- chronic corticosteroid therapy, alcoholism, hemoglobinopathies

99
Q

signs of avascular necrosis of femoral head

A

progressive hip pain without restriction of motion range and normal radiograph on early stages

100
Q

RF for septic arthritis

A
  • abnormal joint: OA, RA, prosthetic joint, gout
  • age >80
  • diabetes
  • IV drug abuse, alcoholism
  • intra-articular glucocorticoid injections
101
Q

signs of septic arthritis

A
  • acute monoarthritis: hot, swollen, decreased ROM
  • fever
  • elevated ESR, CRP
102
Q

diagnosis of septic arthritis

A
  • blood cultures

- synovial fluid analysis: leukocytosis (>50,000) gram stain, culture

103
Q

initial treatment of septic arthritis

A

gram + cocci: vancomycin
gram - rod: third generation cephalosporin
negative microscopy: vanco (+3rd gen cephalosporin if immunocompromised)

Rheumatology (10 decks)

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