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Orth Rotation > Reumatology > Flashcards

Reumatology Flashcards

1
Q

How is Drug induced lupus diagnosed?

A

Positive Anti-nuclear antibodies & (hallmark) Positive Anti-histone antibodies
Hypocomplementemia & anti-double stranded DNA is not seen!

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2
Q

What are 4 drugs that induce lupus?

A

Procainamide (most common), Hydralazine, Isoniazid & Quinidine

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3
Q

What is systemic lupus erythematosus?

A

A systemic relapsing & remitting autoimmune diseases characterized by the body recognizing nuclear antigens as foreign and developing antibodies to them. Resulting in antigen-antibody complex formation and deposition in organ = inflammation & cellular apoptosis.

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4
Q

Is complement increased or decreased in lupus?

A

Decreased. Complement (C3 & C4) works to clean up after cellular apoptosis. Since this is high in lupus the complete is all used up.

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5
Q

Hematologic manifestation of lupus include?

A

leukopenia, thrombocytopenia, anemia

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6
Q

Blood cell desturction in SLE is caused by a

A

type II hypersensitivity reaction

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7
Q

Based on the pathopsyology of lupus, it is charaterized as a ?

A

type III hypersensitivity reaction

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8
Q

What is the triad of lupus?

A

joint pain, fever & malar rash

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9
Q

What is the cause of morbidity & mortality in patients with lupus?

A

Kidney involvement (glomerulonephritis)

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10
Q

what is the drug used to treat actue lupus flare up? What is a notable side effect of this drug?

A

Hydroxychloroquine.
retinal toxicity

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11
Q

What is the treatment for severe lupus with organ involvement?

A

High does glucocorticoids or pulses IV methylprednisolone w immunosuppressive (cyclophosphamide or mycophenolate mofetil)

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12
Q

When is belimumab a monoclonla antibody that inhibits B-cells used?

A

SLE is unresponsive to other therapies.

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13
Q

What labatory finding is most specific to rhuematoid arthritis?

A

Positive Anti cyclic citrullinated peptide

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14
Q

What is the treatment for RA?

A

DMARD: methotrexate to slow diease progression +/- NSAIDs for symptomatic relief

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15
Q

What is osteoarthritis ?

A

1)loss of articular cartilage
2)joint degeneration
3)minimal or absent inflammation
4)hypertrophy of bone at articular margins

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16
Q

clinical manifestation of OA?

A

1) pain with usage (relived w rest)
2) joint stiffness (Am stiffness <30mins, evening stiffness)
3)restricted movement

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17
Q

What is heberden node?

A

Enlargement of the DIP joint. common in OA

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18
Q

What is bouchard node?

A

Enlargement of the PIP joint seen in OA.

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19
Q

What are the 3 main findings of OA on x-ray?

A

1) asymmetric joint space narrowing
2)marginal osteophytes (bone spurs)
3)Subchondral bone sclerosis +/- bone cysts.

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20
Q

What is the 1st line treatment for reactive arthritis ?

A

NSAIDs

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21
Q

What are some causes of reactive arthritis?

A

Chlamydia (MCC)
GI: shigella, salmonella, yersinia & campylobacter

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22
Q

What is the presentation of fibromyalgia?

A

PAIN: chronic widespread pain & stiffness at multisite

NON-RESTFUL SLEEP + COGNITIVE DISTURBANCES: fibro fog, headache, neurologic sxs such as numbness

EXTREME FATIGUE: persistent moderate-severe mental or physical fatigue worse w mild exertion

PSYCHIATRIC DISTURBANCES: Anxiety &/or depression

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23
Q

What is the 1st line treatment for fibromyalgia?

A

1st line is conservation holistic management such as Good sleep hygiene, Aerobic exercise & cognitive therapy

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24
Q

What is the 1st line medication used if conservative managment fails in fibromyalgia?

A

Amitriptyline

Duloxetine & pregabalin can be used as well.

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25
Q

____________arteritis is a large-vessel vasculitis associated with polymyalgia rheumatica.

A

Temporal arteritis

26
Q

What is the preferred treatment for polymyalgia rheumatica?

A

Low does prednisone 15-20 mg PO once daily x 7 days

27
Q

Patients with polymyalgia rheumatica do/dont present with flu like sxs.

A

Patients with polymyalgia rheumatica do present with flu like sxs such as low grade fever, fatigue, weight loss.

28
Q

Erythrocyte sedimentation rate levels are (decreased/increased/unchanged) in polymyalgia rheumatica.

A

Erythrocyte sedimentation rate levels are increased in polymyalgia rheumatica.>50 9s specific.

29
Q

Muscle strength is (decreased/increased/unchanged) in polymyalgia rheumatica.

A

No muscular weakness. will have 5/5 strength.

30
Q

Polymyalgia rheumatica is an inflammatory muscle disorder that involves pain and stiffness in the ________ and ______ often with fever, malaise and weight loss.

A

Polymyalgia rheumatica is an inflammatory muscle disorder that involves pain and stiffness in the shoulders and hips, often with fever, malaise and weight loss.

31
Q

What is the presentation of polymyalgia reumatica?

A

Bilateral muscle pain/stiffness + limited range of motion in joints: shoulder and hips
Morning stiffness lasting >60 mins

32
Q

What is polymyositis?

A

Immune mediate inflammation & degeneration of proximal muscles

33
Q

What is the difference between polymyalgia rheumatica & polymyositis?

A

Polymyalgia rheumatica: bilateral pain and stiffness of the shoulder and hips. Muscle strength is maintained.
polymyositis: bilateral proximal muscle atrophy and weakness.

34
Q

What is the gold standard diagnosis of polymyositis?

A

Muscle biopsy: endomysial mononuclear inflammatory infiltrate & muscle fiber necrosis

35
Q

Anti-signal recognition particle antibodies is specific for ?

A

polymyositis

36
Q

What is the relationship between creatinine kinase and aldolase with polymyositis & polymyalgia rheumatica?

A

Creatinine kinase and aldolase will be increased in polymyositis.
In polymyalgia rheumatica, the creatinine kinase and aldolase will be unchanged.

37
Q

What are skin changes found in dermatomyositis?

A

Gottron papules: raised violaceous scaly patches on the surface on fingers
Heliotrope rash: edematous bluish purple discoloration of upper eyelids.

38
Q

A positive finding of Anti-Jo 1 ( anti-histidyl tRNA Synthetase antibody) antibody is signifcant for what diagnosis?

A

Polymyositis

39
Q

What is scleroderma “hard skin”?

A

Abnormal collagen deposition throughout the body results in fibrosis of the skin, muscles, soft tissue & internal organs.

40
Q

What is the most common scleroderma type of presentation? What does the memorable mnemonic associated with this type stand for?

A

Limited cutaneous systemic scleroderma is the most common type.
-thight shiny thickened skin confined to face, neck and distal elbows and knees.

C: calcinosis cutis
R: Raynaud’s phenomenon
E: esophageal dysfunction
S: sclerodactyly
T: Telangiectasia

41
Q

What is the treatment for raynaud phenomenon ?

A

vasodilators: calcium channal blockers = Nifedipine

42
Q

What is the antibody associated with limited type scleroderma ?

A

Anti-centromere antibodies

43
Q

What is the antibody associated with diffused scleroderma?

A

Anti-SCL 70 & Anti topoisomerase I antibodies

44
Q

What does CREST stand for ?

A

C: Calcinosis cutis: calcium deposits in skin

R: Raynaud phenomenon: blood vessel spasms in response to cold. Risk of digital ulcerations

E: Esophageal dysfuction: acid reflux & decreased esophageal motility

S: Sclerodactyly: thick, tight, shiny, smooth skin w no wrinkles on fingers & hands. Fingers can curl in wards like a claw.

T: Telangiectasias: dilation of capillaries causing red marks on skin surface

45
Q

What is sjogren sybdrome?

A

Autoimmune disease affecting the salivary & lacrimal gland result in dry eye and mouth.

46
Q

What is the gold standard for sjogren syndrome?

A

Lip tissue biposy: + lymphoid inflitration w glandular & ductal atrophy

47
Q

What is the schirmer test? What does a positive test look like?

A

Schirmer test is a test used in the diagnosis of sjogren syndrome. A positive test would be decreased tear production <5mm

48
Q

What are some treatment options for sjogren syndrome?

A

Dry eyes: artificial tears, cyclosporine
Cholinergic drugs: pilocarpine or cevimeline (all work to increase tear production & saliva)

49
Q

What is the 1st line therapy for GOUT?

A

indomethacin 1st line, colchicine & glucocorticoids for acute gout

50
Q

What type of crystal deposition are found in gout?

A

monosodium urate crystals due to uric acid build up.

51
Q

What is found on joint aspiration of 1st metatarsophalageal affect by gout?

A

negatively birefringent needle-shaped crystals

52
Q

What is the most common urate lowering medication used in gout?

A

Allopurinol: the goal is to get urate levels <6mg/dL
Probenecid can also be used

53
Q

Cervical changes caused by rheumatoid arthritis can result in?

A

C1-C2 (atlantoaxial) instability or subluxation . cervical spine radiography is required in patient with RA who will be undergoing intubation & sedation

54
Q

What tool is used to measure bone density ?

A

Dual-energy x-ray absorptiometry
A T-score of -1.0 to -2.49 = osteopenia

55
Q

What are the most common joint affected by gout vs pseudogout?

A

Gout: 1st great toe
Pseudogout: knee

56
Q

What is the synovial fluid finding of pseudogout?

A

Positively birefringent calcium pyrophosphate crystals

57
Q

Rate bite erosions is assoicated with?

A

Rate bite erosions or punched out erosions are x-ray findings of gout

58
Q

Chondrocalcinosis (Cartilage calcification) of a knee joint is associated with?

A

White line of chondrocalcinoisis is a x-ray finding of pseudogout

59
Q

A 55-year-old woman presents to her primary care clinic with complaints of chronic dry eyes. She has also noticed a dry mouth, bad breath, and swelling on the side of her cheeks. Physical exam is notable for dry mucosal membranes and parotid gland enlargement. Lab work reveals positive rheumatoid factor and positive anti-Ro antibodies. What complication is this woman at risk of developing?

A

This woman has sjogren syndrome. she is at risk of developing non-hodgkin lymphoma. Patients with severe symptoms and parotid gland enlargement are at the greatest risk for developing lymphoma.

60
Q

What ist a complication of hydroxychloroquine?

A

Chronic use to treat lupus can lead to corneal & macular toxicity

61
Q

Lupus nephritis is treated with corticosteroids as well as

A

immunosuppressant such as cyclophosphamide, mycophenolate mofetil, or azathioprine

Orth Rotation (5 decks)

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