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Rhumatology > R1 > Flashcards

R1 Flashcards

1
Q

Systemic-Sclerosis pathogenesis?

A

 Progressive tissue fibrosis

 Vascular dysfunction

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2
Q

Clinical features?

A

 Fatigue and weakness
 Telangiectasia, Sclerodactyly, digital ulcer ,calcinosis cutis,pruritis and edema
 Arthralgia, myalgia, and contracture
 Esophageal dysmotility, dysphagia, and dyspepsia
 Raynaud’s Phenomena

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3
Q

Serology?

A

 Antinuclear
 Anti-topoisomerase I
 Anti- centromere

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4
Q

Complication?

A

 Lung: ILD, PAHTN
 Kidney: HTN, Scleroderma renal crisis
 Heart: Myocardial fibrosis, pericarditis, and pericardial effusion

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5
Q

Scleroderma renal crisis?

A

 Oligouria,MAHA,thrombocytopnia

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6
Q

Manometry?

A

Hypomotility with defective lower esophageal sphincter relaxation

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7
Q

Triads of disseminated gonococcus?

A

Disseminated arthralgia
Tenosynovitis
Painless pustular

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8
Q

Suprascapular nerve entrapment?

A

Compression of SSN at SS foramen(formed by TSS ligament and SS noch, found on superior mid scapular)

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9
Q

Cause?

A

Heavy backpack
Direct blow
Heavy weight lifting(ex.shoulder movt_)

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10
Q

Sx and Sign?

A

shoulder pain
defect in shoulder abduction(supraspinatus)
defect in shoulder ex.rotation(infraspinatus)
No other neurologic finding

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11
Q

Clinical features of RA?

A

Pain, Swelling, and morning stiffness in multiple joint
Small Joint(MCP,PIP, and MTP)
Spares DIP
Fever, weight loss, and anemia
Cervical S.(Subluxation & Cord compression)

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12
Q

Lab?

A

Positive RF & anti–CCP Ab.
C-RP and ESR(correlate with activity)
X-Ray: Soft tissue swelling, Joint space narrowing, and boney erosion

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13
Q

CM of Paget disease?

A

Asymptomatic(MC)
Headache, hearing loss
Spinal stenosis and radiculopathy

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14
Q

Laboratory?

A

Elevate ALP
Elevated B.Turnover marker(PINP, urine hydroxyproline)
Normal Ca, P and PTH

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15
Q

Pathogenesis?

A

osteolytic/mixed lytic/sclerotic lesion

B.Scan: Focal increase in uptake

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16
Q

Tx?

A

Biphosphonate

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17
Q

Pathogenesis?

A

Osteoclast dysfunction

High bone turnover

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18
Q

CM of SLE?

A 
fever, fatigue, and wt loss
symmetric migratory arthritis
butterfly rash and photosensitivity
pleuritis, pericarditis and peritonitis
thromboembolic sign(due to vasculitis and APA)
cognitive dysfunction and seizures
DMP and M nep
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19
Q

Laboratory?

A 
HA, thrombocytopenia and leukopenia
Low C3 & C4
ANA(sensitive)
Anti DNASE and ANTI smith(specific)
elevated proteinuria and creatinin
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20
Q

Arthritis Cxs in SLE?

A 
Polyarticular
Migratory
Symmetric
Morning stiffness(shorter than RA)
Normal joint X-ray
Pain exceeds the PE
Oral ulcer
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21
Q

antiphospholipid syndrome?

A

MC: occurs in SLE patient
Venous or Arterial TE(DVT/PE/IS/TIA)
Unexplained Px loss(abortion)
Preterm birth due to PI and PE

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22
Q

Laboratory?

A

LA(Paradoxical PTT elevation does not respond to plasma mixing)
Presence of SAb(Anti-cardiolipin and anti-B2G-1-Ab)

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23
Q

Risk factors for septic arthritis?

A 
OA,RA,Gout,Prostetic joint
Frequent IA GC injection
Age >80
DM
IV drug abuse
Alcoholism
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24
Q

CM?

A

Monoartheritis
Hot, painful, and tender joint
ROM decrement
Elevated ESR and CRP

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25
Q

Diagnosis?

A

SFA(WBC>50,000,culture and GS)

Blood culture

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26
Q

Initial treatment?

A

G+ Cocci–Vancomycin
G_ve–3rd gen.C
Negativ–Vanco +(3rdGC,if Immunocompromised)

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27
Q

Managment of RA?

A

Acute Sx.relief(NSAID & Predisolon)

DMARD–As soon as posible

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28
Q

DMARD?

A 
MTX(the first line, determine LFT before starting)
Leflunomide
Hydroxychloroquine
Sulfasalazine
TNF alpha inhibitors
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29
Q

MTX S/E?

A

Hepatitis–ALF/Cirrhosis: MC
Pancytopnia
Mucosal ulcers(stomatitis)
Avoid alcohol and give concomitant leucovorin

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30
Q

Leflunomide?

A

Pyrimidine Sx inhibitor
Hepatotoxicity
Cytopenias

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31
Q

Hydroxy chloroquine?

A

TNF and IL-1 inhibitor

Retinopathy

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32
Q

Sulfasalazine

A

TNF and IL-1 inhibitor
Hepatotoxicity
Stomatitis
H.Anemia

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33
Q

TNF inhibitor?

A 
Adalizumab,intracept...
Infection(TB)
Demyelination
CHF
Malignancy
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34
Q

Acute back pain < 4 weeks managment?

A

Moderate activity
NSAID & acetaminophen
Muscle relaxant and spinal manipulation

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35
Q

Subacute and chronic(>4 weeks)?

A

Intermitent NSAID & acetaminophen
Exercise (stretching, aerobic and strengthing)
Consider: TCA and Deloxitine

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36
Q

Secondary prevention?

A

Exercise

Education

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37
Q

case of vertebral compresion #?

A 
Trauma
Osteoporosis.Osteomylaisa
Bone metastasis
Metabolic(HPT)
Paget disease
osteomylitis
38
Q

CM?

A 
Acute
sudden Low Back pain & dec. spinal mobility after heavy lifting, coughing, and sudden bending 
Pain inc. In standing, walking, and lie back
tenderness at affected level
Chronic
Painless
Progressive kyphosis
Loss of stature
39
Q

Comp.

A

Increase future # risk

Hyperkyphosis: Protuberant Abd, early satiety, weight loss, and decrease respiratory capacity

40
Q

Ankle reflex and aging?

A

May be absent finding in Pt age > 70

41
Q

Mechanical cause of back pain and their caracter?

A

Muscle strain and disk degeneration

Tenderness on paraspinal area

42
Q

Inflammatory cause of back pain and cx?

A

MCC: Spondyloartherophaty(AP, SNA)
Worse at rest and better by activity
Sacroiliitis
Tenden site insertion Infn–cartilage destruction

43
Q

Osteoarthritis pathogenesis?

A

Non-inflamatory articular cartilage distraction

idiopathic but may Ass with joint injury and SD(hemochromatosis)

44
Q

CM?

A

Joint pain and stiffness
Herben(DIP) and Bouchard(PIP) joint area node-due to osteophyte
Wight being joint mainly affected

45
Q

Pul.A Complication of RA?

A

Fibrotic lung disease
Plural effusion
Lung nodule
Pul.HTN

46
Q

CVS?

A

Atherosclerosis and vasculitis

47
Q

MSK?

A

Osteopenia and osteoporosis

48
Q

Dermatology?

A

RA nodule(firm, SC non-tender nodule occur in pressure area)

49
Q

Hematology?

A

anemia

50
Q

CNS?

A

Neuropathy and Depression

51
Q

other?

A

Sjorgen
Raynaud’s
Scleritis
episcleritis

52
Q

X-Ray indication in Back pain?

A

Osteoporosis
Compression #
Suspected malignancy
Ankylosing spondilitis

53
Q

MRI–indication for back pain?

A

Sensory deficit
Motor deficit
Cauda equina syndrome
Suspected epidural abscess/infection

54
Q

Red flag sign in back pain requires imaging?

A

Sudden onset back pain with spine tenderness
History of cancer
constitutional symptoms(fever ,weight loss)
Trauma
Significant/Progressive neurologic deficit
Elevated infection risk(Recent inf,Imunocompromization,IV drug usage)

55
Q

Felty syndrome pathogenesis?

A

Long-standing Erossive RA complication

Marked by the formation of Ab against neutrophil and GCSF

56
Q

Clinical feature?

A

1) Rheumatoid arthritis(S.erosive Joint disease & deformity, R.Nodule, and vasculitis(mononeuritis multiplex, necrotizing skin lesion)
2) Netrophinia(ANC<2000)–Due to destruction by A.Ab–a recurrent bacterial infection
3) Splenomegaly(B/C traped Ab bound neutrophil)

57
Q

Diagnosis?

A

Ant-CCP and RF
Elevated ESR
Pheripherial smear and BM biopsy to r/o other causes

58
Q

Treatment?

A

Managing The RA will treat it

59
Q

Managment Raynaud’s phenomena?

A

Primary: Avoid aggravating factors(smoking,Cold T and emotional stress) & CCB for persistent symptoms
Secondary: Treat the underlying disease, CCB for persistent symptoms, and aspirin for patients at risk of hand ulcer

60
Q

Primary and secondary Raynaud’s phenomena D/C?

A

PR:start at young age15-30),symetric
SR:Start age >40.asymetric,hand ischemia sign

61
Q

Tests should do in patients with RP?

A 
CBC
Metabolic panel
ANA/RF
Urinalysis
ESR
Complement level
62
Q

adhesive capsulitis pathogenesis?

A

Loss of GH distensibility due to C.Inflamation, fibrosis, and contracture.

63
Q

manifestation?

A

Gradual onset shoulder pain
Shoulder stiffness
Defective both passive and active movement
Normal X-Ray
Risk increase in DM, Hypothyroid, and immobile patients

64
Q

RA treatment If symptoms persist for more than 6 months of treatment?

A

ADD TNF inhibitors

65
Q

Tophaceous gout?

A 
Multiple white nodule 
A common location is an area where tendon meet joints(finger)
Common in advanced gout
Due to UA crystal deposition in tissue
Can drain whitish choky discharge
66
Q

How to d/t from osteoarthritis (B & H) nodule and R.Nodule/

A

OAN: Bonny AT area of PIP and DIP
R.N: Occurs at pressure areas like wrist and post. ulna.
G.T: Occur in multiple joint areas

67
Q

Reactive arthritis triads?

A

Non-Gonococcal uretritis
Asymmetric oligoarthritis
Conjunctivitis

68
Q

Other Cxs?

A 
Mucosal ulcer
Seronegative
Sterile SFA
NSAID is the first line TX.
Knee and sacroiliac joint MC involved
69
Q

Sicca syndrome CXS?

A

Dry eye
Con..erosion–D.vision
Dry mouth
Common in women

70
Q

Cause?

A

Age-related: Usually, start age >75

Sjorgen S: Usually start at young age, ANA positive and systemic A.I disease sx. mainly SS

71
Q

Age-related SS managment?

A

due to gland atrophy
artificial tear
topical cyclosporine

72
Q

polymyalgia rheumatic symptoms?

A 
age > 50
bilateral joint pain mainly around tissue not joint
morning stiffness
2 joint involvement(with decrease AOM)
1)neck or torso
2)Shoulder or PUE
3)Pelvis or proximal Le
4)Constitutional symptoms(F,WL and fatigability)
May have associated TA
No tenderness
73
Q

LAB?

A 
Elevated ESR and CRP
15
15 
15% may have normal lab
Normocytic anemia
Symptoms respond to steroid
Normal CK(22-198)
74
Q

Whipple disease CM?

A

Chronic diarrhea
Non-deforming arthritis
LDP
May damage eye, cardiac, and CNS tissue

75
Q

Diagnosis?

A

PAS-positive macrophage in SI lamina porphyria

+PCR for G-ve T.whipli

76
Q

Disease-associated with pseudogout?

A

Primary HPT with chronic Ca elevation
Hypothyroidism
Hemochromatosis

77
Q

Cxs?

A

Due to CPP deposition
Commonly affect knee
SFA:rhomboid-shaped + birefringence cristal
X-Ray: Chondrocalcinosis

78
Q

CXS of back pain associated with malignancy?

A

Progressive
Worse at night
Unrelieved by rest
Focal vertebral tenderness

79
Q

Inflammatory back pain(AS) feature??

A 
Insidious onset age <40
Sx more than 3 month
Relived y exercise
Worse at night
Lumbosacral tenderness
Decrease range of motion
80
Q

Ankylosing spondylitis CM?

A 
MCC of inflammatory BP
Arthritis (sacroiliitis)
Reduced CE and spinal mobility
Enthesitis
Dactylitis(swelling of hand and finger)
Uveities
81
Q

complication?

A

osteoporesis
cauda equina
AR
Vertebral #

82
Q

Diagnosis?

A

Elevated ESR and CRP
HLAB-27
X-Ray(sacroiliac joint infn, vertebral bodies fusion)
If negative do MRI

83
Q

Goaty arteritis SFA?

A

Inflammatory
MSU cristal
Needle shaped % NBR(yellow to parallel light)

84
Q

Lateral epicondilitis CM?

A

Subacute or chronic Lateral elbow pain
Hx repetitive/forceful wrist extension
Peak incidence age 45-54

85
Q

Diagnosis?

A

Tenderness at Lat. epicondyle & P.E.Muscle
pain with resisted wrist extension/supination
Pain with passive wrist flexion

86
Q

Managment?

A 
Modified activity
Inelastic counterforce brace
NSAID
Stretching and progressive ex. resistance
Physical therapy
87
Q

Pathogenesis?

A

Non-inflammatory extensor tendinosis due to EX.Extensor muscle usage like tennis

88
Q

chondrocalcinosis in CPP arthritis?

A

Calcification of articular cartilage

89
Q

Acute goit atack treatment?

A

NSAID
Colchicine
Glucocorticoids

90
Q

Urate lowering medication(Alllopirinol and febuxostat) indication?

A

Recurrent gout

Gout complicated by topi and uric acid stone

91
Q

Does practice doing reduce future got attacks?

A

Wight reduction BMI<25
Low-fat diet
Lower seafood and red meat intake
Protein intake preferably from vegetable and low-fat dairy product
Avoidance of organ rich food(liver and sweat bread)
Avoidance of beer & distilled sprint
Avoid diuretic if posible

92
Q

Managment of ostoarteritis?

A

exercise and wt loss–If the symptom persists–Topical NSAID—If still persist—Surgery, Chronic pain managment

Rhumatology (4 decks)

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