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CM2 Exam 2 > Rheum 2- Paulson > Flashcards

Rheum 2- Paulson Flashcards

1
Q

A chronic clinical syndrome of generalized musculoskeletal pain often accompanied by fatigue, disordered sleep, multiple somatic
symptoms, cognitive problems, and psychiatric symptoms

A

Fibromyalgia

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2
Q

What are some symptoms of fibromyalgia?

A
  • Chronic pain/stiffness, usually widespread
  • Involves all 4 quadrants of the body
  • Pain often described as worst around neck, shoulders, low back, and hips

Common associated complaints: sleep disturbance, fatigue, muscle weakness, paresthesias, cognitive disturbance, headache, depression, anxiety, irritable bowel syndrome, dry mouth, pelvic pain, bladder symptoms, tinnitus, multiple chemical hypersensitivities, TMJ issues

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3
Q

What will a patient with fibromyalgia present with on exam?

A

Exam is normal apart from pain at tender points

11 of 18 tender points and symptoms of widespread pain (above and below the waist, and both sides of the body)

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4
Q

What labs and imaging do you order in a patient with fibromyalgia?

A

Of little benefit to make the dx because fibromyalgia does not cause any lab abnormalities

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5
Q

What are some non-medication interventions for a patient with fibromyalgia?

A
  • Pt education and even giving a patient a dx could help
  • good sleep hygiene
  • low impact exercises
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6
Q

What medication could you give to a patient with fibromyalgia?

A

TCAs: Amitriptylines
SNRIs: duloxetine (cymbalta)
SSRIs: fluozetine (prozac)
Anticonvulsants: pregablin (lyrica)

“ACL” Amitriptyline, Cymbalta, Lyrica

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7
Q

What is something important for a patient with fibromyalgia to keep them improving QOL and disease process?

A

Close PCP f/u

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8
Q

Inflammatory condition associated with pain and stiffness of the hips and shoulders

A

Polymyalgia Rheumatica

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9
Q

Headache, jaw claudication, and visual symptoms associated with elevated ESR that can cause blindness

A

Giant cell Arteritis aka Temporal Arteritis

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10
Q

Polymyalgia Rheumatica coexists with what other disease?

A

Giant cell Arteritis

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11
Q

__________increases the risk of GCA where as _________ decreases the risk of GCA

A

Smoking, diabetes (DD diabetes, decrease)

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12
Q

What diseases are associated with polymorphisms of HLA-DR

alleles.

A

PMR & GCA

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13
Q

A patient presents with pain and stiffness in the shoulder and pelvic areas and that she is having trouble combing her hair because movement worsens her pain. What disease is this?

A

PMR

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14
Q

Despite pain and stiffness with movement, patients with PMR should have _________ muscle strength

A

normal

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15
Q

These are classic symptoms of what disease? headache, scalp tenderness, *jaw claudication, visual changes

A

GCA

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16
Q

Physical exam of this disease shows temporal artery can be thickened, tender, prominent, or normal appearing. You can also see an abnormal fundoscopic exam and cardio exam can show asymmetry of pulses in arms, aortic regurg and or bruits

A

GCA

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17
Q

What labs will be elevated in both GCA and PMR?

A

ESR & CRP

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18
Q

What is the gold standard way to diagnose GCA?

A

Temporal artery biopsy is gold standard

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19
Q

If GCA suspected, but a unilateral biopsy is negative, what should you do?

A

contralateral bx

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20
Q

What is the treatment for PMR?

A

Prednisone start low and can increase after 7 days if no response (usually a rapid improvement is seen)

Then once stable can taper. BUT beware, these patients can have flares

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21
Q

Should you treat a GCA patient before you get the bx results back?

A

YES b/c goal is to prevent permanent blindness

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22
Q

What is the tx for GCA?

A

Prednisone 40-60 mg PO daily

This is HIGH DOSE PRED and you need to remember the dosing

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23
Q

What lab increases faster with acute inflammation

A

CRP

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24
Q

What should you do if a patient with GCA has a flare?

A

Flares common- increase prednisone by 10 mg. Inflammatory markers are helpful

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25
Q

Chronic vasculitis mostly affecting the aorta and main branches

A

Takayasu Arteritis (TA)

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26
Q

This disease is mc in Asian women

A

Takayasu Arteritis (TA)

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27
Q

These symptoms (of vascular insufficiency) are commonly seen in what disease?

Claudication, cool extremities, subclavian steal syndrome can lead to syncope, BP differential, arthralgias, skin lesions, pulmonary manifestations, abdominal pain/diarrhea/GI hemorrhage, angina pectoris

A

Takayasu Arteritis (TA)

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28
Q

A patient with TA would have what findings on PE?

A

BP differential (usually at least 10 mmHg), diminished, asymmetrical arterial pulses in arms/legs, bruits, may have synovitis in large joints, renovascular hypertension

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29
Q

A patients labs come back and show elevated ESR and CRP. Based on symptoms and physical exam you suspect TA. What will confirm your dx?

A

Diagnosis: Suspected with clinical features, then imaging showing arterial luminal narrowing or occlusion with wall thickening

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30
Q

What is the tx for TA?

A

Prednisone

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31
Q

Asymmetric polyarthritis that develops after a GI or GU infection, typically of large lower extremity joints

A

Reactive Arthritis (ReA)

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32
Q

This rheum disease is associated with the HLA-B27 gene

A

Reactive Arthritis (ReA)

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33
Q

How can you get Reactive Arthritis (ReA)?

A

From GI (think GI bugs) or GU tract (chlamydia)

34
Q

What are some symptoms of Reactive Arthritis (ReA)?

A

Symptoms of diarrhea or urethritis (1-4 weeks earlier)

35
Q

In a patient with asymmetric arthritis usually involving large weight bearing joints (knee, ankle) which may persist, you should suspect which disease? (you could also get dactylitis from this disease = sausage toe)

A

Reactive Arthritis (ReA)

36
Q

What other horrible symptoms can Reactive Arthritis (ReA) cause?

A

Uveitis, conjunctivitis, musculotaneous peeling of toes and heels, peeling and pitting of nails

37
Q

What labs would show for a patient with Reactive Arthritis (ReA)?

A

Elevated ESR/CRP, + stool culture or urethral swab because of GI/GU, synovial fluid analysis could slow elevated WBC, mostly neutrophils

38
Q

Treatment for Reactive Arthritis (ReA)?

A
  • Treat underlying infection

- Arthritis tx mainstay: NSAIDS (if no improvement then glucocorticoids triamiciolone, prednisone or DMARDs)

39
Q

Systemic autoimmune disease that commonly affects the lacrimal and salivary glands, resulting in mouth (xerostomia) and eye dryness (keratoconjunctivitis sicca)

A

Sjӧgren Syndrome

40
Q

Sjӧgren Syndrome could be ___________ or _________ to another autoimmune disease

A

Primary or secondary

41
Q

What is an ocular manifestation of Sjӧgren Syndrome called?

A

keratoconjuntivitis sicca.

42
Q

What test do you do for Sjogrens that can help determine keratoconjuntivitis sicca?

A

Schrimer test showing decreased tear production (where that measuring paper is put in eye to see how much tears come out)

43
Q

What is a mouth manifestation of Sjӧgren Syndrome called?

A

Xerostomia

44
Q

What test do you do for Sjogrens that can help determine xerostomia?

A

Saxon test (chew on dry sponge) or sialometry (spit saliva in tube and measure)

45
Q

If RF factor is elevated, is this indicative of a certain single disease?

A

No, RF is elevated in lots of things and not specific for one disease

46
Q

Which disease has a positive ANA, RF and positive antibodies for SS-A (anti-Ro) and SS-B (anti-La)?

A

Sjӧgren Syndrome

47
Q

What do the labs show in a patient with Sjӧgren Syndrome?

A
  • Most patients have positive ANA
  • Many have positive antibodies for SS-A (anti-Ro) and SS-B (anti-La)
  • Many positive for RF
48
Q

This test has long been considered a gold standard for Sjogrens but in real life, is often saved for patients when diagnosis is
unclear

A

Salivary gland bx

49
Q

A positive salivary gland bx in Sjogrens would be greater than _____ per 4 mm squared

A

1

50
Q

What are the dx criteria for a patient with Sjogrens?

A

1.) The patient has an objective test of dry eye (Schirmer or abnormal surface staining) or xerostomia (Saxon or whole sialometry).
–Or imaging consistent with glandular abnormalities seen in SS
2.) The patient has anti-Ro/SSA and/or anti-La/SSB antibodies, a
positive lip biopsy, or an established rheumatic disease
–Or anticentromere antibodies
–Or ANA ≥1:320 + positive RF

51
Q

Oral treatment for sjogrens?

A

Symptomatic

  • good hydration, sugar free candy/gum
  • artificial saliva
  • spicy foods
  • avoid acidic beverages
52
Q

Ocular treatment for Sjogrens?

A
  • ATs or ointment at night
  • ocular cyclosporine
  • punctal plugs
53
Q

Systemic meds for Sjogrens that rheum would typically prescribe?

A
  • Immunosuppressive therapy =Hydroxychloroquine
    & Methotrexate
    -You will probably have referred to rheumatology at this point if the patient has systemic disease
54
Q

Chronic, systemic inflammatory disorder with synovitis of joints that can lead to joint destruction, deformity and disability

A

Rheumatoid Arthritis (RA)

55
Q

Systemic necrotizing vasculitis that usually affects medium-sized or small muscular arteries

A

Polyarteritis nodosa (PAN)

56
Q

PAN can affect any organ, but skin, muscle, peripheral nerves, kidneys, GI tract, heart are commonly affected BUT _______ are commonly spared

A

lungs

57
Q

This disease can be associated with Hep B

A

PAN

58
Q

True/False: veins are mostly involved in PAN

A

False. Veins are not involved, just arteries causing thrombosis, and ischemia or infarction of tissue

59
Q

Lower extremity ulcerations are classic in this disease?

A

PAN

60
Q

what is the mc organ impacted in PAN and what are the associated clinical features?

A

Renal mc affected & HTN and renal insufficiency (because involvement of renal arteries leads to RAAS system activation which = HTN)

61
Q

Abdominal pain is common in this disease, escpecially after eating “intestinal angina”

A

PAN bc lumen is narrowed so blood supply cut off to GI

62
Q

Mononeuritis multiplex (foot drop) is common in this dz

A

PAN

63
Q

Labs in PAN depends on which body part is involved, but what are some common lab findings?

A
  • Elevated CRP/ESR
  • May have abnormal LFTs
  • May have elevated Cr
  • Anemia
  • CK may be elevated if muscle involved
64
Q

How do you diagnose PAN?

A

Biopsy of involved organ

65
Q

What would a bx of PAN show?

A

Necrotizing inflammation of medium-

sized arteries

66
Q

An angiogram for PAN would show what?

A
  • Many small aneurysms. “rosary sign”

- Irregular constrictions of larger vessels and occlusion of smaller vessels

67
Q

You diagnose a patient with PAN and they also have hepatitis. What would be the treatment?

A

Antiviral

68
Q

What is the treatment for a patient with a mild case of PAN (meaning without any cardiac or GI probs)?

A

Corticosteroids alone

-Prednisone

69
Q

What is the tx for PAn in a patient with mod-severe disease?

A
  • Initial: high-dose corticosteroids (same as above) + immunosuppressant
    (cyclophosphamide) (IV or oral)
70
Q

This disease causes morning stiffness >30 min and this is a classic sign. It also accompanies symmetric swelling of the joints that are tender and painful

A

RA

Helps differentiate between osteoarthritis and RA

71
Q

What are the mc joints affected in RA?

A

PIP, MCP, MTP

72
Q

This disease causes weird hand manifestations such as ulnar deviation of the MCP joints, swan neck deformity and boutonniere deformity

A

RA

73
Q

What disease would you see rheumatoid nodules in?

A

RA

74
Q

What is felty syndrome?

A

Splenomegaly, Neutropenia. RA

75
Q

What does SANTA stand for in felty syndrome?

A 
S- splenomegaly
A- anemia 
N- neutropenia 
T- thrombocytosis 
A- arthritis
76
Q

What is the most specific bloodwork for RA?

A

anti-CCP antibodies

And RF factor is only + in 8-% of patients and can be elevated in other diseases too (not specific to RA)

77
Q

What imaging should you get on a patient with RA?

A

Xray but if early in the disease, likely normal

78
Q

What are the criteria for dx of RA?

A
  • Inflamm arthritis involving greater than or equal to 3 joints
  • positive RF factor & or anti-CCP
  • Elevated ESR/CRP
  • Duration of greater than or equal to 6 weeks
  • You have excluded other causes
79
Q

This medication for RA is helpful for both symptom relief and for slowing the rate of joint damage

A

Corticosteroids

Prednisone

80
Q

This RA med is not recommended for long-term use or for monotherapy

A

Corticosteroids

81
Q

What is the best DMARD used for RA?

A

Methotrexate (remember to give folic acid) and check for pregnancy as it is teratogenic

CM2 Exam 2 (8 decks)

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