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Step 2 CK > Rheum > Flashcards

Rheum Flashcards

1
Q

MCC of joint degeneration

A

Osteoarthritis (DJD)

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2
Q

Where is DJD syptomatic

A

Weight bearing joints

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3
Q

What joints of the hand are most affected by OA

A

DIP

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4
Q

What are DIP enlargements in OA called

A

Heberden nodules

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5
Q

What are PIP enlargements in OA called

A

Bouchard nodules

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6
Q

Are there lab abnormalities in DJD

A

No

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7
Q

Most accurate test for DJD

A

Radiography of affected joint

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8
Q

XR findings in OA

A

Joint space narrowing
Osteophytes
Dense subchondral bone
Bone cysts

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9
Q

Most important rx in OA

A

Weight loss

Exercise

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10
Q

Best initial analgesic in OA

A

Acetaminophen

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11
Q

Other rx in OA

A 
NSAIDS
Capsaicin
Intraarticular steroids
Hyaluronan injection
Joint replacement
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12
Q

Who gets gout

A

M>F

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13
Q

What causes overproduction of uric acid

A

Idiopathic
Increased cell turnover - cancer, hemolysis, psoriasis, chemo
Enzyme deficiency- lesch-nyan, GSDs

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14
Q

What causes underexcretion of uric acid

A

Renal insufficiency
Ketoacidosis, lactic acidosis
Thiazides and aspirin

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15
Q

Presentation of gout

A

Man, sudden excrutiating pain, redness, tenderness of big toe at night after binge drinking beer

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16
Q

Most frequently affected site in gout

A

MTP of great toe

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17
Q

Where do tophi most often occur (can occur anywhere)

A

Cartilage
SubQ tissue
Bone
Kidney

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18
Q

Most accurate test for gout

A

Aspiration of joint

Shows negatively birefringent needle shaped crystals under polarized light

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19
Q

WBC count in gout

A

2000-50000

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20
Q

Why tap the joint in gout

A

Exclude infection

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21
Q

What labs are gouty attacks associated with

A

Elevated, uric adic, ESR, leukocytosis

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22
Q

Best initial therapy of acute gouty attack

A

NSAIDs

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23
Q

When to give steroids in acute gout

A

No response to NSAIDs

Contraindication to NSAIDs

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24
Q

When to give Colchicine in acute gout

A

Can’t use NSAIDS or steroids

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25
Q

Colchicine AE

A

Diarrhea and BM suppression

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26
Q

Diet management of chronic gout

A

No EtOH
Lose weight
Less meat, seafood

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27
Q

What to use for HTN management in chronic gout

A

Lorsartan

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28
Q

Why give colchicine in chronic gout

A

Prevent subsequent attacks

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29
Q

Action of allopurinol

A

Decrease production of uric acid

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30
Q

Action of pegloticase

A

Dissolves uric acid

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31
Q

Gout drugs contraindicated in renal insufficiency

A

Probenecid
NSAIDs
Sulfinpyrazone

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32
Q

Action of probenecid and Sulfinpyrazone

A

Increase excretion of uric acid

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33
Q

Allopurinol AE

A

Toxic epidermal necrolysis
Stevens-Johnson
Hypersensitivity

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34
Q

Common risk factors for CPPD

A

Hemochromatosis

Hyperparathyroidism

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35
Q

Other associations w/ CPPD

A

DM
Hypothyroidism
Wilson

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36
Q

What does CPPD affect

A

Large joints

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37
Q

WBC count in DJD

A

200

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38
Q

Best initial therapy for CPPD

A

NSAIDs

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39
Q

What diseases to exclude in lower back pain

A

Spinal cord compression

Disk herniation

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40
Q

Features of spinal cord compression

A

Hx CA
Sudden onset focal neuro deficit
Point tenderness on spine w/ percussion

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41
Q

MCC epidural abscess

A

Staph aureus

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42
Q

Location for disk herniations

A

L4/5, L5/S1

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43
Q

Best initial test for disk herniation

A

Straight leg raise (very specific)

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44
Q

Effects of L4 loss

A

Motor - Dorsiflexion of foot
Reflex - Knee jerk
Sensory - Inner calf

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45
Q

Effects of L5 loss

A

Motor - Dorsiflexion of toe

Sensory - Inner forefoot

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46
Q

Effects of S1 loss

A

Motor - Eversion of foot
Reflex - Ankle jerk
Sensory - Outer foot

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47
Q

Best initial test for cancer w/ compression, infection, fractures

A

Plain XR

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48
Q

Most accurate test for cancer w/ compression, infection, fractures

A

MRI

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49
Q

MRI for lower back pain w/ SLR +

A

No

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50
Q

Back pain w/ Hx CA

A

Cord compression

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51
Q

Back pain w/ fever, high ESR

A

Epidural abscess

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52
Q

Back pain w/ bowel/bladder incontinence, ED

A

Cauda equina syndrome

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53
Q

Back pain under 40 worse at rest, improves w/ exercise

A

Ankylosing spondylitis

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54
Q

Back pain w/ pain/numbness of medial calf or foot

A

Disk herniation

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55
Q

Rx cord compression

A

Glucocorticoids (don’t wait for test results)

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56
Q

Rx cauda equina

A

Surgical decompression

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57
Q

Rx disk herniation

A

NSAIDS and continue regular activity

Steroid injection if that doesn’t work

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58
Q

Presentation of lumbar spinal stenosis

A 
Over 60
Back pain on walking radiating to buttocks and thighs
Worse when walking downhill
Pulses NL
Better when leaning forward
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59
Q

Dx test for lumbar stenosis

A

MRI

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60
Q

Rx lumbar stenosis

A

Weight loss, NSAIDs

Surgical dilation

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61
Q

Features of fibromyalgia

A

Young women

Tenderness w/ trigger pts at traps, medial knee, lateral epicondyle

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62
Q

Associations w/ fibromyalgia

A

Stiffness, numbness, fatigue
HA
Sleep disorder

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63
Q

Best initial therapy for fibromyalgia

A

Amitryptilyne

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64
Q

Other fibromyalgia treatments

A

Milnacipran and pregabalin

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65
Q

Causes of carpal tunnel aside from mechanical

A 
Pregnancy
DM
RA
Acromegaly
Amyloidosis
Hypothyroidism
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66
Q

Features of carpal tunnel

A

Pain in hand
Atrophy of thenar eminence
Worse at night

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67
Q

PE findings of carpal tunnel

A

Tinel sign

Phalen sign

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68
Q

Most accurate test for carpal tunnel

A

Electromyography

Nerve conduction testing

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69
Q

Best initial therapy of carpal tunnel

A

Wrist splints

Can give NSAIDs

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70
Q

Curative for carpal tunnel

A

Surgical decomression

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71
Q

What is dupuytren contracture

A

Hyperplasia of palmar fascia causing contracture of 4th and 5th fingers

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72
Q

Associations of dupuytren contracture

A

Genetic

Alcoholism and cirrhosis

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73
Q

Rx dupuytren contracture

A

Triamcinolone, Lidocaine, collagenase

Surgery if functionally impaired

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74
Q

Features of rotator cuff injury

A

Inability to flex and abduct shoulder
Worse when lying on it
Severe tenderness on insertion point of supraspinatus

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75
Q

Most accurate dx test for rotator cuff injurt

A

MRI

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76
Q

Rx rotator cuff injury

A

NSAIDS, rest, PT

Surgery for complete tears

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77
Q

Causes of patellofemoral syndrome

A

Trauma
Imbalance of quadriceps strength
Meniscal tear

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78
Q

Features of patellofemoral syndrome

A

Pain in front of knee
Worse when walking up and down stairs
Worse after prolongued sitting

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79
Q

Rx patellofemoral syndrome

A

PT and strength training

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80
Q

Features of plantar fasciitis

A

Pain at bottom of foot near calcaneus
Worse in morning, improves with steps
Point tenderness at insertion

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81
Q

Rx plantar fasciitis

A

Stretching
Arch supports
NSAIDs
Steroids if above fail

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82
Q

Presentation of RA

A 
B/L symmetrical joint involvement
Morning stiffness = inflammation
Nodules
Ocular sx
Lung involvement
Vasculitis
Cervical joint involvement
Baker cyst
Pericarditis
Carpal tunnel
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83
Q

What to screen for in RA before anesthesia/Intubation

A 
Cervical involvement (C1, C2)
Can cause para/quadriplegia
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84
Q

What joint is spared in RA

A

DIP

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85
Q

What are the hand deformities in RA

A

Boutonniere

Swan neck

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86
Q

What is related to poor prognosis in RA

A

High RF

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87
Q

More specific than RF in RA

A

Anti-cyclic citrulinated peptide (Anti-CCP)

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88
Q

What kind of anemia is in RA

A

Normocytic (can be AOCD)

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89
Q

Why do arthrocentesis in RA

A

Initially when Dx not clear

Can have 5000-50000 WBCs but no crystals so exclude gout

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90
Q

Dx criteria for RA (6 or more pts = RA)

A

Joint involvement (up to 5)
ESR/CRP (1)
Longer than 6wks (1)
RF or Anti-CCP (1)

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91
Q

Components of Felty syndrome

A

RA
Splenomegaly
Neutropenia (prone to G+ infection)

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92
Q

Components of Caplan syndrome

A

RA
Pneumoconiosis (interstitial lung disease)
Lung nodules

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93
Q

MCC death in RA

A

CAD

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94
Q

What is the purpose of DMARDs in RA

A

Stop progression

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95
Q

What is “erosive” RA

A

Joint space narrowing
Physical deformity
XR abnormalities

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96
Q

Best initial DMARD

A

MTX

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97
Q

MTX AE

A

Liver tox
BM suppression
Pulm tox
May cause flare

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98
Q

What to monitor w/ MTX

A

LFTs and CBC every 2-3 months

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99
Q

First line DMARD if MTX fails

A

TNF inhibitors

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100
Q

AE TNF inhibitors

A

Reactivation of TB

Infection

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101
Q

When to use Rituximab

A

Long term control

Anti-TNF fail

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102
Q

What does Rituximab do

A

Remove CD20 lymphocytes from circulation

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103
Q

When to use Hydroxychloroquine in RA

A

Monotherapy in mild disease

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104
Q

Hydroxychloroquine AE

A

Toxic to retina

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105
Q

When to use sulfasalazine, leflunomide, abatacept

A

Combo w/ MTX if anti-TNF fails

106
Q

Sulfasalazine AE

A

BM tox
Hemolysis in G6PD
Rash

107
Q

Best initial therapy for pain control in RA

108
Q

When to use steroids in RA

A

NSAIDs don’t work

Bridge while waiting for DMARDs to take effect

109
Q

AE gold salts in RA Rx

A

Nephrotic syndrome

110
Q

Features of Juvenile RA

A 
Spiking fever (>104)
Salmon coloured rash on chest and abd
Splenomegaly
Pericardial effusion
Mild joint sx
111
Q

Dx test for JRA

A

No clear one

112
Q

Rx JRA

A

Aspirin or NSAIDs
Steroids if fail
Anti-TNF is steroids fail

113
Q

Causes of drug-induced SLE

A

Hydralazine
Isonizid
Procainamide
Quinidine

114
Q

Which drugs causing SLE can be ANA neg

A

Hydralazine

Quinidine

115
Q

Ab associated w/ drug induced SLE

A

Anti-histone

116
Q

Skin manifestations of SLE

A

Malar rash
Discoid rash (raised)
Photosensitivity
Oral ulcers

117
Q

Joint manifestations of SLE

A

Arthritis

No deformity or erosion

118
Q

Chest manifestations of SLE

A

Serositis (inflammation of pleura and pericardium)

119
Q

Renal manifestations of SLE

A

Mild proteinuria to ESRD
MC glomerulonephritis is membraneous
Must do Renal Bx

120
Q

Neuro manifestations of SLE

A

Psychosis
Seizures
Stroke

121
Q

Heme manifestations of SLE

A

Hemolytic anemia

AOCD more common

122
Q

Abs in SLE

A

Anti-dsDNA
Anti-Sm
False positive VDRL
Positive LE cell preparation

123
Q

Ab in mixed connective tissue disease

124
Q

Additional findings in SLE (not in criteria)

A

Mesenteric vasculitis
Raynaud
APL
Alopecia
PN, alveolar hemorrhage, restrictive lung disease
Photophobia, cotton wool spots, blindness

125
Q

Most sensitive test for SLE

A

ANA - if ned, then definitely NOT SLE

126
Q

Most specific tests for SLE

A

Anti-dsDNA

Anti-Sm

127
Q

Ab in neonatal SLE

128
Q

What is seen in acute SLE exacerbations

A

Drop in complement (C3, 4, CH50)

Rise in Anti-dsDNA

129
Q

Rx acute SLE flare

A

High dose Steroid bolus

130
Q

Rx mild chronic lupus

A

Hydroxychloroquine

131
Q

Rx progression of lupus

132
Q

MCC death young pt w/ SLE

133
Q

MCC death old pt w/ SLE

A

MI (2/2 accelerated atherosclerosis)

134
Q

Rx lupus nephritis

A

Steroids
Cyclophosphamide
Mycophenolate

135
Q

2 types of APL

A

Lupus anticoagulant

Anticardiolipin Ab

136
Q

What does APL affect

A

Both arteries and veins

Arteries > veins

137
Q

Important association w/ APL

A

Multiple spontaneous abortion

138
Q

Coag profile in APL

A

Clotting w/ elevated PTT and NL PT

139
Q

Don’t confuse APL w/

A

Syphilis

False positive VDRL or RPR

140
Q

Best initial test for APL

A

Mixing study

141
Q

Most specific test for APL

A

Russell viper venom test for lupus anticoagulant

142
Q

When to rx APL

A

Only when symptomatic

143
Q

Rx thrombosis in APL

A

Heparin then warfarin (like normal)

144
Q

When can anticardiolopin be the cause of spontaneous abortion

A

2 or more 1st trim events or single 2nd trim event

145
Q

How to prevent recurrence of spontaneous abortion in ABL

A

Heparin and Aspirin

146
Q

Breakdown of scleroderma subtypes

A

Diffuse (20%)

Limited (80%)

147
Q

Manifestations of limited scleroderma

A

CREST syndrome

148
Q

CREST stands for

A 
Calcinosis
Raynaud
Esophageal dysmotility
Sclerocadtyly
Telangiectasia
149
Q

Who gets Scleroderma

A

Women 20s-40s

150
Q

100% of scleroderma pts have

A

Raynaud

Skin manifestations

151
Q

MCC secondary raynaud

A

Scleroderma

152
Q

Precipitation of raynaud

A

Cold

Emotional stress

153
Q

Renal manifestation of scleroderma

A

Sudden hypertensive crisis 2/2 ARF

154
Q

Lung manifestations of scleroderma

A

Restrictive lung disease

Pulm HTN

155
Q

MCC death in Scleroderma

A

Pulm fibrosis

156
Q

Dx tests in Scleroderma

A

ANA
ESR is NL
Scl-70 (most specific)
Anti-centromere

157
Q

Rx scleroderma

A

MTX slows underlying disease

158
Q

Rx renal sx in scleroderma

159
Q

Rx esophageal dysmotility in scleroderma

160
Q

Rx raunaud in scleroderma

161
Q

Rx pulm fibrosis in scleroderma

A

Cyclophosphamide

162
Q

Rx pulm HTN in scleroderma

A

Bosentan
Sidenafil
Prostacyclin

163
Q

Features of inflammatory myopthies

A

Proximal muscle weakness
Difficulty getting up from seated
Difficulty walking up stairs
Dysphagia

164
Q

Presentation of dermatomyositis

A

Malar involvement
Shawl sign
Heliotrope rash
Gottron papules (MCP, PIP)

165
Q

CA site associations w/ dermatomyositis

A

Ovary
Lung
GI
Lymphoma

166
Q

Best initial test for inflammatory myopathies

A

CPK

Aldolase

167
Q

Most accurate test for inflammatory myopathies

168
Q

What are Anti-Jo Abs associated with in inflammatory myopathies

A

Pulm fibrosis

169
Q

Rx inflammatory myopathies

A

Steroids

MTX, azathioprine, IVIG, Mycophenolate if fail

170
Q

Role of hydroxychloroquin in rx of inflammatory myopathies

A

Skin lesions

171
Q

What does Sjogren’s attack

A

Lacrimal and salivary glands

172
Q

Who gets Sjogren’s

173
Q

Associations w/ Sjogren’s

A 
RA
SLE
PBC
Polymyositis
Hashimoto's
174
Q

Presentation of Sjogren’s

A

Dryness of eyes and mouth
“Sand in the eyes” - Keratoconjunctivits sicca
Dental caries from lack of saliva
Dyspareunia from vaginal dryness

175
Q

Most dangerous complication of Sjogren’s

176
Q

Best initial test for Sjogren’s

A

Schirmer test

177
Q

Most accurate test for Sjogren’s

A

Lip/Parotid Bx

178
Q

Best initial blood test for Sjogren’s

179
Q

What is seen on rose bengal test for Sjogren’s

A

Abnormal corneal epithelium

180
Q

Best initial therapy for Sjogren’s

A

Water the mouth

181
Q

Other rx Sjogren’s

A

Sugar-free gum
Fluoride
Artificial tears
Pilocarpine and Cevimeline to increase Ach

182
Q

What is common about all vasculitides

A

Fever
Malaise
Wt loss
Arthralgia/Myalgias

183
Q

Association with PAN

A

Hep B, C

Spares the lungs

184
Q

Features of PAN

A 
Glomerulonephritis
Foot drop (peroneal nerve palsy)
Stroke in young person
ABD pain worse w/ eating
Lower extremity ulcers
185
Q

What is mononeuritis multiplex

A

Multiple peripheral neuropathies of large nerves

186
Q

Most accurate test for PAN

A

Bx of symptomatic site

187
Q

What is seen in angiography of PAN

188
Q

Other lab features of PAN

A

Anemia
Leukocytosis
PANCA

189
Q

Rx PAN

A

Prednisone

Cyclophosphamide

190
Q

Features of polymyalgia rheumatica

A 
>50
Pain stiffness in shoulder, pelvis
Can't comb hair, rise from chair
Elevated ESR
Normochromic normocytic anemia
191
Q

Lab findings in PMR

A

Normal CPK, Aldolase

192
Q

Rx PMR

193
Q

Features of temporal arteritis

A 
Visual Sx
Jaw claudication
Scalp tenderness
HA
Decreased arm pulses
194
Q

Most accurate test for temporal arteritis

A

Affected artery Bx

195
Q

Rx giant cell arteritis

A

Steroids BEFORE Bx result

196
Q

Features of Wegener’s

A

Upper and lower resp tract findings

Renal insufficiency

197
Q

Presentation of Wegener’s

A 
Sinusitis
Otitis media
Mastoiditis
Oral/Gingival involvement
Unresolving PN even w/ ABX
198
Q

Best initial test for Wegener’s

199
Q

Most accurate test for Wegener’s

A

Bx (Lung > Renal)

200
Q

Rx Wegener’s

A

Prednisone

Cyclophosphamide

201
Q

Associations w/ PANCA

A

Churg-strauss
Microscopic polyangiitis
PAN

202
Q

Features of Churg Strauss

A

Asthma

Eosinophilia

203
Q

Most accurate test for Churg-Strauss

204
Q

Rx churg strauss

A

Prednisone

Cyclophosphamide

205
Q

Features of Henoch-Schonlein

A

GI
Purpura (Painless, palpable)
Arthralgias
Hematuria

206
Q

Most accurate test for Henoch-Schonlein

A

Bx of lesion

207
Q

Rx Henoch-Schonlein

A

Spontanteous resolution

Steroids

208
Q

Associations w/ cryoglobulinemia

A

Chronic hep C
Endocarditis
Sjogren’s

209
Q

What complement is decreased in SLE

210
Q

What complement is decreased in Hep C

211
Q

Abnormal lab test in cyoglobulinemia

A

RF positive

212
Q

Rx Cryoglobulinemia

A

Rx underlying cause

213
Q

Features of Behcet

A 
Asian/Middle eastern
Painful oral and genital ulcers
Ocular lesions
Arthrits
CNS lesions mimicking MS
Pathergy
214
Q

Rx Behcet’s

A 
Steroids
Wean off w/
- Azathioprine
- Cyclophosphamide
- Colchicine
- Thalidomide
215
Q

3 seronegative spondyloarthropathies

A

Ankylosing spondylitis
Psoriatic arthritis
Reactive arthritis

216
Q

Features of seronegative spondyloarthropathies

A 
Men under 40
Spine involvement
Negative RF
Inflammation at tendon attachment points
Uveitis
HLA B27
Rx w/ steroids
217
Q

Features of Ankylosing spondylitis

A 
Young man
Backache and stiffness radiating to buttocks
Flattening of normal spine curvature
Decreased chest expansion
Pain at achilles
218
Q

Back pain quality in Ankylosing spondylitis

A

Worse w/ rest

Relieved w/ activity

219
Q

Other Ankylosing spondylitis findings

A

Arthritis - hips, shoulders, knees
AV block, aortic insufficiency
Uveitis

220
Q

Best initial test for Ankylosing spondylitis

A

XR of SI joint

221
Q

Most accurate test for Ankylosing spondylitis

222
Q

Best initial therapy for Ankylosing spondylitis

A

Exercise program and NSAIDs

Anti-TNF if NSAIDs fail

223
Q

Characteristic findings in psoriatic arthritis

A

Sausage digits

Nail pitting

224
Q

Besst initial test for psoriatic arthritis

A

XR of joint showing pencil in cup deformity

225
Q

Best initial therapy for psoriatic arthritis

A

NSAIDs
MTX when no response
Anti-TNF when MTX fails

226
Q

Reactive arthritis occurs secondary to

A

IBD M=F
STI M>W
GI infection

227
Q

Features of Reactive arthritis

A

Joint pain
Ocular findings
Genital abnormalities

228
Q

What finding is unique to Reactive arthritis

A

Keratoderma blennorhagicum

Looks like pustular psoriasis

229
Q

Dx Reactive arthritis

A

Tap joint to r/o septic arthritis

230
Q

Rx Reactive arthritis

A

NSAIDs

Sulfasalazine if they fail

231
Q

Features of osteoporosis

A

Older woman

Vertebral fractures leading to shorter height

232
Q

Most accurate test for osteoporosis

A

DEXA
Penia - 1-2.5
Porosis - >2.5

233
Q

Best initial therapy for osteoporosis

A

Vit D and Ca

234
Q

Other Rx osteoporosis

A

Bisphosphonates - >2.5
Estrogen - postmenopausal
Raloxifene - reduces risk of breast CA and decreases LDL
Teriparatide - New matrix formation
Calcitonin - decreases risk of vertebral Fx

235
Q

Bisphosponates AE

A

Osteonecrosis of jaw

Esophagitis

236
Q

Teriparatide AE

A

Osteosarcoma

Hypercalcemia

237
Q

Greatest risk of septic arthritis

A

Prosthetic joint

Septic arthritis doesn’t really affect undamaged joints

238
Q

Other risk factors for septic arthritis

239
Q

Top 3 etiologies of septic arthritis

A

Staph - 40%
Strep - 30%
G- rods - 20%

240
Q

Best initial and Most accurate test for septic arthritis

A

Joint aspiration (arthrocentesis)

241
Q

Features of joint aspirate in septic arthritis

A

5000-100000 WBCs
G stain
Cx
Blood Cx

242
Q

Best empiric therapy for septic arthritis

A

Ceftriaxone

Vanco

243
Q

Imaging findings on prosthetic joint infection

A

Lucency around implantation

Physically loose joint

244
Q

Rx prosthetic joint infection

A

Remove joint
ABX 6-8wks
Replace joint

245
Q

MC organism in prosthetic joint infection

246
Q

When is gonococcal arthritis more frequient

A

During menses

247
Q

Unique features of gonococcal arthritis

A

Polyarticular
Tenosynovitis
Petechial rash

248
Q

What to Cx to maximize sensitivity in gonococcal arthrits

A

Pharynx
Rectum
Urethra
Cervix

249
Q

Best empiric therapy for gonococcal arthritis

A

Ceftriaxone
Cefotaxime
Ceftizoxime

250
Q

What to test for w/ recurrent gonorrhea infection

A

Terminal complement deficiency

251
Q

MCC osteomyelitis

252
Q

MCC osteomylitis specific to sickle cell

A

Salmonella

253
Q

Spread of osteomyelitis

A

Peds - Hematogenous

Adults - Contiguous

254
Q

What to look for to suspect osteomyelitis

A

DM pt w/ ulcer

255
Q

Best initial test in osteomyelitis

256
Q

Most accurate test in osteomyelitis

257
Q

Most important step if XR is NL

A

MRI (bone scan if contraindicated)

258
Q

What is the purpose of ESR in osteomyelitis

A

Monitor response to therapy

259
Q

Rx Osteomyelitis

A

Abx against the organism found

260
Q

Only oral therapy for osteomyelitis

A

Ciprofloxacin - Only use if organism is sensitive

261
Q

AE Fluoroquinolones

A

Achilles tendon rupture

Contra in pregnant and kids

Step 2 CK (21 decks)

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