Rheum Flashcards
HLA-DR3
a/w DM-1, systemic lupus erythematosus and Graves’ disease.
HLA-B27
a/w ankylosing spondylitis, Reiter’s syndrome (arthritis, urethritis, and conjunctivitis).
HLA-B51
a/w Behçet’s syndrome.
HLA-D11
a/w Hashimoto’s disease
HLA-DR2
a/w Goodpasture’s syndrome and multiple sclerosis.
Pancreatic tumors, hyperparathyroidism, and pituitary tumors (prolactinoma/ ACTH/GH-secreting adenomas)
Type I multiple endocrine neoplasia (MEN-I), AD
Recurrent peptic ulcers due to excessive gastrin secretion by a gastrinoma, either in the pancreas or elsewhere in the gastrointestinal tract
Zollinger-Ellison syndrome causes
Hypercalcemia, hypophosphatemia, and elevated levels of serum parathyroid hormone
Hyperparathyroidism
Medullary thyroid cancer, pheochromocytoma, and hyperparathyroidism
MEN 2A: type IIA multiple endocrine neoplasia
Medullary thyroid cancer, pheochromocytoma, and mucosal neuromas
MEN 2B: type IIB multiple endocrine neoplasia
Depressed mental status and hypothermia, and can also involve bradycardia, hypotension, hypoglycemia, and hyponatremia
Myxedema coma: hypothyroid emergency
CREST Sx? Rx?
Calcinosis (IVF), Raynaud’s (CCB), Esophageal dysmotility (PPI), Sclerodactyly, and Telangiectasias
AL Amyloidosis a/w?
Multiple Myeloma, Waldenstroms Macroglobullinemia
AA Amyloidosis a/w?
Chronic infl dz/inf- Rheumatoid arthritis, IBD, TB, Osteomyelitis
Antimitochondrial
1° biliary cirrhosis
Anti-smooth muscle
Autoimmune hepatitis
Anti-U1 RNP (ribonucleoprotein)
Mixed connective tissue disease
CREST syndrome sx? Elevated ab?
Calcinosis, Raynaud’s phenomenon, Esophageal dysmotility, Sclerodactyly, Telangiectasias. Elevated anti-centromere and/or anti-nucleolar autoantibodies.
Cytoplasmic Anti-Neutrophil cytoplasmic autoantibody
Wegener’s granulomatosis, sinusitis, lungs and kidneys
anti-Scl-70 antibody (anti-DNA topoisomerase I)
diffuse cutaneous systemic sclerosis (DCSS); widespread skin involvement, rapid progression, early visceral involvemen; death from pulmonary fibrosis
AntiCentromere antibody
Limited scleroderma—limited skin involvement confined to fingers and face. Also with CREST involvement
Anti-Smith autoantibodies, anti–double-stranded DNA autoantibodies, ANA
Systemic lupus erythematosus (SLE)
Anti-SSA, anti-SSB (anti-Ro, anti-La)
Sjögren’s sx w dry eyes, dry mouth, and enlarged salivary glands
p-ANCA (MPO-ANCA)
Microscopic polyangiitis, Churg-Strauss syndrome
Antimicrosomal, antithyroglobulin
Hashimoto thyroiditis
Anti-glutamate decarboxylase
Type 1 diabetes mellitus
Antihistone
Drug-induced lupus
Anti-Jo-1, anti-SRP, anti-Mi-2, +ANA
Polymyositis, dermatomyositis
Anti-desmoglein
Pemphigus vulgaris
Anti-hemidesmosome
Bullous pemphigoid
Anti-cardiolipin, lupus anticoagulant
SLE, antiphospholipid syndrome
Anti-dsDNA, anti-Smith, ANA (not specific)
SLE
Rheumatoid factor (antibody, most commonly IgM, specific to IgG Fc region), anti-CCP (anti- cyclic citrullinated peptide)
Rheumatoid Arthritis; sx>6months, morning joint stiffness >1hr, joint swelling, involes PIP/MCP, spares DIP
Daycare/school teacher p/w 10days of b/l arthalgia/arthritis of PIP/MCP/wrists/knee/ankle, fatigue, intermittent diarrhea, mild itchy skin patches; dx?
Parvovirus B19 (B19 IgM), self resolves in 2-3 weeks
Drugs that cause lupus-like sx w/ malar rash, fevers, arthritis, positive ANA
Procainamide, hydralazine, isoniazid, minocycline, propylthiouracil, lithium, carbamazepine, and phenytoin.
2 wks Post BM transplant maculopapular rash on hands, feet, face, bloody diarrhea, elevated ALT/AST; rx?
GVHD Graft vs Host Dz w/ donor T-cell activation
Rhabdomyolysis labs?
Elevated K, Cr, BUN (BUN:Cr
F >50yo p/w Pain and stiffness in shoulders hips w morning stiffness, mild fever, malaise, and wt loss, fatigue; elevated ESR, CRP, normal CK.
Polymyalgia rheumatica (PMR) a/w temporal (giant cell) arteritis; Rapid response to low-dose corticosteroids (prednisone 10-20mg).
F 20–50 YO. Chronic, widespread msk pain a/w stiffness (improves w use), paresthesias, poor sleep, and fatigue.
Fibromyalgia; rx regular exercise, antidepressants (TCAs, SNRIs), and anticonvulsants. (amitriptyline 1st, fluoxetine, chlorpromazine, cyclobenzaprine.)
F p/w progressive symmetric proximal muscle weakness, “can’t comb hair” (involves shoulders), Elevated CK; dx? ab? Rx?
Polymyositis, characterized by endomysial inflammation with CD8+ T cells, positive ANA, anti-Jo-1, anti-SRP, anti-Mi-2 antibodies; rx steroids
Pt p/w uveitis, urethritis, and arthritis; penile ulcer, Dx? a/w?
Reactive arthritis (Reiter’s, seronegative spondyloarthropathy); Post-GI (Shigella, Salmonella, Yersinia, Campylobacter) or Chlamydia; a/w HLA-B27, RF/ANA negative
Pt. p/w exertional dyspnea cxr b/l basilar reticulonodular infiltrates, elevated antitopoisomerase or anti-Scl-70 and ANA, normal anti-centromere ab
interstitial pulmonary fibrosis from diffuse cutaneous systemic sclerosis (DCSS)
45yof p/w fatigue, myalgia, proximal muscle weakness, sluggish ankle reflex, normal ESR, elevated CK, dx?
Hypothyroid myalgia, check TSH
10 yof p/w wk of high-spiking fevers, arthritis, salmon-colored macular rash lymphadenopathy, HSM; dx?
Systemic-onset juvenile rheumatoid arthritis (JRA)
Enlarged DIP (Heberden’s) and PIP (Bouchard’s) joints, w joint space narrowing, subchondral sclerosis, osteophytes, and subchondral cysts.
Osteoarthritis
Smoker p/w lower lobe lesion, wt loss, symmetric proximal muscle weakness, erythematous rash on dorsum of fingers and upper eyelids; dx?
Dermatomyositis, paraneoplastic (a/w malignancies); inflammatory damage of muscle fibers w/ elevated CK, (Gottron’s fingers)
Pt. w celiac dz p/w pruritic herpetiform rash of small erythematous vesicular papules; dx/rx?
Dermatitis Herpetiformis; rx Dapsone and gluten free
Recurrent nasal discharge, post nasal drip, anosomia, asthma hx, NSAID use; dx?
Aspirin associated nasal drip with Nasal Polyps
sinusitis, hemoptysis, hematuria, red cell casts; CXR: large nodular densities.
Granulomatosis with polyangiitis (Wegener); focal necrotizing vasculitis, n. granulomas in the lung, n. glomerulonephritis; rx cyclophosphamide, corticosteroids.
Necrotizing vasculitis involving lung, kidneys, skin with pauci-immune glomerulonephritis and palpable purpura, mononeuritis multiplex
Microscopic polyangiitis, rx cyclophosphamide and corticosteroids.
Asthmatic p/w sinusitis, palpable purpura, peripheral neuropathy (wrist/foot drop), eosinophilia, pulmonary infiltrates; dx, rx?
Churg-Strauss syndrome; p-ANCA, IgE; Can also involve heart, GI, kidneys (pauci-immune glomerulonephritis)
Recurrent oral aphthous and genital ulcers, eye lesions, skin lesions, and a positive pathergy test (a pinprick that turns into a pustule)
Behçet’s dz, systemic vasculitis that affects arteries and veins of all sizes
25yoF p/w absent or decreased brachial artery pulse, subclavian bruit, pain along the vessels, unequal pulses, claudications
Takayasu’s arteritis, also known as “pulseless disease
44yoF p/w headaches, fever, anemia, tender temporal regions, elevated ESR, alkPhos, IgG, complement, normochromic anemia
Temporal arteritis, also known as giant cell arteritis; high dose steroids
wart-like vegetations on both sides of valve.
Libman-Sacks endocarditis - SLE
Pt. p/w RHF, GERD, HTN, thick skinned swollen fingers, elevated antitopoisomerase or anti-Scl-70 and ANA, normal anti-centromere ab
Systemic sclerosis (DCSS) (widespread Scleroderma), fibrosis of pulmonary (RHF), esophagus (GERD), kidneys (HTN)
Minutes post transfusion hypotension, respiratory distress and shock; dx/rx?
IgA deficiency anaphylactic reaction; rx intramuscular epinephrine w/ respiratory support
Within an hour post blood transfusion p/w fever, chills, flank pain, hemoglobinuria; dx?
ABO mismatch hemolytic transfusion reaction, may progress to DIC
SE for Cyclosporine and Tacrilimus (Calcineurin inhibitors)
Nephrotoxic, HypERkalemia, HTN, tremor; Hirsutism and gum hyperplasia unique ot Cyclosporine
SE for Mycophenolate (IMDPH purine synthesis inhibitor)?
Bone Marrow suppression
SE for Azathioprine (purine analogue)?
Dose related leukopenia, diarrhea, hepatotoxicity
