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Rheum Flashcards

1
Q

Pt presents with compression fx and Dexa of -2.7

A

Osteoperosis
T score < -2.5 is diagnostic
Due to reduction in bone formation

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2
Q

40-45 male smoker with tortuous “corkscrew” lower leg veins. Dx?

A

Thromboangiitis obliterans (Beurger dz)
Pathophys due to smoking
presents with phlebitis and can have Raynaud phenomenon

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3
Q

Pt with septic arthritis has no organisms on gram stain. Tx?

A

vanco and ceftriaxone
No organisms on Gram stain doesn’t change your tx
Covers Staph and Gonorrhea

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4
Q

Auricular chondritis, seronegative inflammatory arthritis, ocular inflammation, respiratory tract chondritis, inner ear dysfunction

A

Relapsing polychondritis

Inflammatory dz of cartilage

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5
Q

Anti-dsDNA b

A

SLE
Steroids are used when pt has: renal involvement, CNS syx, pericarditis, thrombocytopenia, or hemolytic anemia
Other syx can be managed by NSAIDs

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6
Q

Backpain without neurologic findings

A

Lumbosacral muscle strain

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7
Q

Proximal muscle rash + heliotope rash

A

Dermatomyositis
Anti Jo 1
Workup - EMG, rules out other causes of muscle weakness
Tx - Prednisone

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8
Q

Autoimmune syx with Anti-U1-ribonucleoprotien (U1-RNP)

A

Mixed connective-tissue dz (MCTD)

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9
Q

40 y/o male gets back pain that improves with exercise and wakes him up at night

A

Ankylosing spondylitis
RF -, HLA-B27 +
Schober test on PE to measure mobility of the lumbar spine

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10
Q

Respiratory tract and kidney vasculitis, c-ANCA +. Granulomatous inflammation on bx

A

Wegner granulomatosis

Tx - Cyclophosphamid and prednisone

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11
Q

Older male presents with b/l worsening of hearing. Also weird hx of fx’s. Concerning for?

A

Paget dz (osteitis deformans)
Increased bone turnover and abn architecture
Syx - skeletal malformation, deafness, nerve compression, fx’s and high Alk Phos

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12
Q

Poorly controlled T2DM presents with warm erythematous foot that she cannot ambulate well with. Decreased pinprick and vibratory sensation.

A

Charcot Joint (neuropathic arthropathy)

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13
Q

Older pt has muscular discomfort especially of the shoulder and pelvis. Hard to find a comfortable position. Strength 5/5

A

Polymyalgia rheumatica

Strong association with temporal arteritis

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14
Q

Limited active and passive range of motion in the shoulder after the arm has been immobilized for several weeks

A

Adhesive capsulitis
More common in older women, DM’s
Self-limiting

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15
Q

Anticentromere Ab

A

CREST (Calcinosis, Raynaud phenomenon, Esophargeal Dysmotility, sclerodactyly, telangiectasia)
Systemic (cutaneous) scleroderma

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16
Q

Why do sarcoid pts have hypercalcemia?

A

Granulomatous dz -> increased production of calcitriol (1,25-diOH, active vitD)

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17
Q

Tx for ankylosing spondylitis

A

Anti-TNF alpha

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18
Q

Tx for Paget dz

A

Bisphosphonates

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19
Q

Tx for pseudogout

A

Colchicene

Inhibit PMN microtubule formation to impair phagocytosis, migration, and chemotaxis

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20
Q

What is deposited in pseudogout?

A

calcium pyrophosphate dihydrate crystal deposition dz

Rhomboid, weak positive birefringence under polarized light

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21
Q

What easy lab test is helpful in dx’ing temporal arteritis?

A

ESR

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22
Q

Anti-La, Anti-Ro

A

Sjogren syndrome

Dry mouth, dry eye

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23
Q

Most common cause of bone metastasis in a female?

A

Breast cancer

Lung cancer is also osteolytic

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24
Q

Hematuria + Hemoptysis

A

Goodpasture

Anti-GBM antibodies

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25
What pulmonary findings can scleroderma pts develop?
Interstitial lung dz and Pulmonary HTN
26
Skin finding in sarcoidosis?
Erythema nodosum Painful subq pretibial nodule Erythema noduosum + hilar adenopathy + acute arthritis Indicates a good prognosis
27
COD is systemic scleroderma?
Pulmonary fibrosis | Pulmonary HTN
28
Which tendon is injured in lateral epicondylitis (tennis elbow)
Extensor carpi radialis brevis | Forceful and repetitive extension of supination of the hand
29
SLE pt with livedo reticularis. Dx and other key findings
Antiphospholipid Ab syndrome (APLS) | Hypercoagulable state with prolonged aPTT
30
Tx for fibromyalgia?
Amitriptyline
31
In what scenario are OCP's contraindicated in a SLE pt?
When + for antiphospholipid Abs
32
Best way to treat OA?
Exercise and weight loss
33
Gout pt presents with a joint nodule that does not transilluminate
Tophaceous gout Deposited uric acid crystals surrounded by granulomatous inflammation Tx: allopurinol prevents worsening, remove surgically
34
Heme onc dz with lytic bone lesions
Multiple myeloma
35
Pt presenting with uveitis and b/l hilar lymphadenopathy
``` Lofgren syndrome (acute form of sarcoidosis) ```
36
Work up for primary Raynaud pehnomenon?
Nail fold microscopy
37
Pt deposits fibrils into all kinda of tissues, especially the heart
Amyloidosis PMH usually for MM, chronic inflammatory dz, lymphoma, dialysis Can cause restrictive cardiomyopathy, low EKG voltages, and speckles on echo
38
Pt with dysphagia, proximal LE weakness, eleveated CRP and creatinine kinase
Inclusion body myositis | Muscle bx - endomysial inflammation and basophilic-rimmed vacuoles in the sarcoplasm
39
Migratory arthralgia, necrotic pustules, dysuria
Gonococcal arthritis | IV or IM ceftriaxone
40
1st line tx for carpal tunnel?
Wrist splint for 2-6 weeks | Steroid injections or surgery is indicated when thenar atrophy is present
41
Paraneoplastic process with bone pain, clubbing, synovial effustions, periostosis of the tubular bones
Hypertrophic pulmonary osteoarthropathy | CXR to i.d. lung cancer
42
Sciatic pain that is produced when sitting or internal rotation of the thigh
Piriformis syndrom | Compression of the sciatic n. as it exits the greater sciatic foramen inferior to the piriformis m.
43
Osteomalacia is a defect in?
Bone mineralization Hypophosphatemia SLE or Sjogren's -> renal tubular dz (non ag acidosis) -> poor bone mineralization
44
New mother has pain on thumb abduction and extension
de Quervain tenosynovitis Tendonitis of the abductor pollicis longus and extensor pollicis brevis Finkelstein test
45
How can you prevent recurrent attacks of pseudogout?
Colchicine | rhomboid, weak positive birefringence
46
What test should you order if you suspect ILD in a scleroderma pt?
High resolution CT | Reticular opacities, ground-glass opacification, fibrosis
47
Common comorbidity of spondylarthritis and sacrolitis?
IBD | Tx - sulfasalazine
48
Young pt reports sensation of catching of the knee. Dx and work up?
Meniscal tear | MRI of the knee
49
Common bone finding in a SLE pt that has been on chronic steroids?
Osteonecrosis Pain in the groin, thigh, or butt that is worse with activity Xray may be normal but MRI is more sensitive
50
Cyst found in the back of the knee
Popliteal cyst | "Baker cyst"
51
Most significant RF for osteoperosis
History of prior fracture
52
What exams are indicated in a pt with a mid clavicular fx?
Neurovascular exam | Identify injury to the brachial plexus or subclavian a.
53
Female athlete with low caloric intake and amenorrhea is at risk for?
Stress fractures | Due to low density
54
Common triggers of acute gout?
Alcohol Surgery/trauma Dehydration Medications (diuretics, abx)
55
Tx for Giant cell arteritis and complete vision loss?
High dose IV glucocorticoids (methylprednisolone) x3days followed by po gluco's
56
Extraarticular involvement in ankylosing spondylitis?
Reduced chest expansion/mobility Enthesitis (tenderness at tendon insertion sites) Dactylitis (swelling of fingers/toes) Uveitis (unilateral eye pain and photophobia)
57
What are complications of supracondylar fractures?
Brachial a. injury Median n. injury Cubitus varus deformity Compartment syndrome/volkmann ischemic contracture
58
Needle shaped crystals with negative birefringent (yellow parallel, blue perpendicular)
Gout | Urate crystals
59
Following a surgery pt has pain out of proportion to injury, pain increases on passive stretch, swelling and tense skin, parethesia
Compartment syndrome Pain worse with passive movement, does not respond to narcotics Time to fasciotomy largest indicator of prognosis
60
Osteoarthritis pt with unilateral neck pain and numbness of the posterior surface of the forearm
Cervical spondylosis | caused by an osteophyte
61
Pt with knee injury stands on one leg with knee slightly bent and on internal rotation the knee elicits a locking sensation and significant pain
Medial meniscus tear Thessaly test Confirm dx with MRI
62
Causes of spinal stenosis
Degenerative arthritis of the spine (OA) Degenerative disk disease Thickening of ligamentum flavum
63
Young female SLE pt presents with unilateral weakness, negative CSF
Antiphopholipid syndrome SLE + CVA 3 antiphospholipid antibodies (anticardiolipin, anti-beta2-glycoprotein 1, lupus anticoagulant)
64
Most common cause of asymptomatic elevation of alkaline phosphate in an elderly pt?
Paget dz of the bone
65
acute back pain + point tenderness following a trauma
Vertebral compression fracture
66
What causes prepatellar bursitis?
S. aureus Get aspirate for cell count and Gram stain If - -> NSAIDS If + -> I/d and abx
67
Sharp, localized pain and tenderness over the anteromedial part of the tibial plateau just below the medial joint line of the knee
Pes anserinus pain syndrome Valgus will be negative, Xrays normal Caused by abn gait, overuse, or trauma
68
Pt has DVT syx with a crescent ecchymosis distal to the medial malleolus
Popliteal (Baker) cyst | bruise = crescent sign
69
Common colplicaiton of temporal arteritis
Aortic aneurysms | Follow with serial CXR's
70
Which causes of gout due to increased urate production?
Primary idiopathic Myeloproliferative/lymphoproliferative disorders Tumor lysis syndrome Hypoxanthine guanine phosphoribosyl transferase deficiency
71
Which causes of gout are due to under secretion?
CKD | Thiazide/loop diuretics
72
1st line tx for RA
Methotrexate (DMARD) | Need HBV, HCV, and TB screening prior to starting
73
What should be monitored for a pt taking hydroxychlorquine?
Eye exams | Risk of retinopathy
74
CXR with hilar adenopathy w/ or w/o reticulonodular inflitrate. Noncaseating granulomas on bx
Sarcoidosis Hypercalcermia Tx - glucocorticoids
75
Knee with laxity under valgus stress
Medial collateral ligament
76
A pt with compartment syndrome is at risk of what when receiving succinylcholine?
``` Hyperkalemia/ cardiac arrythmias Succinylcholine depolarizes (binds post synaptic R to cause influx of Na+ and efflux of K+) -> increased K+ in the serum Rhabdo due to compartment syndrome also increases risk of hyperkalemia ```
77
Paget dz is a dysfunction in which cell?
Osteoclasts | Elevated Alk Phos
78
If a alkylosing spondilitis pt has back pain after a trauma, be suspicious for?
Vertebral compression fx They are predisposed to osteoperosis HLA-B27 Aortic regurg is common
79
What should be ordered to confirm diagnosis of polymyositis?
Muscle bx | Mononuclear infiltrate surrounding necrotic an regenerating muscle fibers
80
Pt presents with palpable purpura, arthralgia, Renal Dz, Peripheral Neuropathy. Elevated LFTs, NL C3, low C4
Mixed Cryoglobulinemiasyndrome Mixed because C3 is WNL Associated with chronic HCV
81
Cyclophosphamide increases the risk of?
Bladder carcinoma Hemorrhagic cystitis sterility Myelosuppression
82
Respiratory distress + neuro dysfunction + petechial rash after a long bone fx
Fat emoblism | Tx - supportive
83
Pt has chronic diarrhea, weight loss, migratory arthritis, lymphadenopathy and SI bx with periodic acid-Schiff (PAS)-positive macrophages
``` Whipple's Disease Tropheryma whippelii (GNR) ```
84
Pt presents with foot pain. Clicking sensation when the 3rd and 4th metatarsal heads are squeezed together
Morton Neuroma | RF's runners that are increasing their training, poor running mechanics, or female with eating disorder
85
Erythema nodosum + arthralgias
Sarcoidosis | Get a CXR
86
Pt receiving DMARD for RA develops mouth sores. Why?
Methotrexate toxicity Antimetabolite agent AE's: Hepatotoxicity, stomatitis, cytopenias Folic acid supplementation is recommended while taking MTX
87
Young asian female with fever, arthralgia, weight loss with numbness/pain in UE x 6 months and elevated ESR
Takayasu arteritis | Tx - glucocorticoids
88
A diagnosis of RA increases a patients risk for?
Osteoperosis Osteopenia Bone fx
89
Monoarthritis + Hyperparathyroidism + chronic hypercalcemia?
Pseudogout | Rhomboid-shpaed positve birefringent calcium phosphate crystals

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