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Clinical Medicine > Rheum > Flashcards

Rheum Flashcards

1
Q

two specific circumstances where methotrexate is commonly used

A

RA, its usualyl a first line drug

SLE when there is significant arthritis

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2
Q

Systemic lupus erythematosus description

A

an inflammatory autoimmune disease typically affecting women caused by antinuclear antibodies that leads to trapped antigen complexes in blood vessels

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3
Q

SLE therapy

NSAID

A

depends on symptms

NSAIDs for joint pain

hydroxychloroquine for joint pain, rash, fatigue

steroids for arthritis, serositis, major organ involvement

methotrextate for arthritis

leflunomide arthritis, rash, major organ involvement

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4
Q

angiogram findings with polyarteriris

A

multiple anuerysms with tapered narrow and skip areas

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5
Q

diagnosis of psoriatic arthritis

A

Elevated ESR

normochromic, normocytic anemia

hyperuricemia with significant skin involvement

normal rheumatoid factor

pencil cup deformitity at the PIP on xray

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6
Q

SLE therapy

steroids

A

steroids for arthritis, serositis, major organ involvement

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7
Q

fibrocartiliaginous joints

A

synarthrosis with limited movement

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8
Q

ankylosing spondylitis clinical presentation

A

limited ROM in the lumbar spine, hips, shoulder

synovitis in the knees, achilles, plantar fascia

up to 25% will have anterior uveitis

pain and stiffness that lasts for hours and is made better with activity

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9
Q
A

uveitis

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10
Q

what is this and what causes it

A

chondrocalcinosis

gout or arthritis

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11
Q

Dx of fibromyalgia

A

clinical presentation

exclusion of other factors (hypothyroid, hep c, vitamind D deficiency)

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12
Q

PE findgs for psoriatic arthritis

A

dactlyitis

enthesitis

skin lesions

nail dystrophy/pitting

sacroilitis

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13
Q

why are eye or pulmonary involvement or vasculitis common in RA

A

b ecause RA is an inflammatory systemic disease

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14
Q

top three treatment for myositis

A

steroids

methotrexate

azathioprine

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15
Q

management of OA

A

medication, rest, exercise, diet, surgery, aids

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16
Q

biologics defined for RA

A

genetically engineered molecules that work on specific targets

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17
Q

splinter hemorrhages

cause

A

vertical hemorrhages under the nails

can be caused by vasculitis or bacterial endocarditis

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18
Q

GI protective strategies for NSAIDs

A

cox 2 nsaid

nsaid with PPI

nsaid with misprostol

nsaid with H2 blocker

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19
Q

radiographic findings associated with OA

A

narrowed joint space, osteophytes, subarticular cysts

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20
Q

proteoglycans

A

glucosamine and chondriotin

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21
Q

Dx of giant cell arteritis

A

elevated ESR and CRP

most patients will have normochromic normocytic anemia with thrombocytosis

temporal artery biopsy that shows thickening

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22
Q

patient presents with a gout flare up and they are curently not on allopurinol

should you start it?

what if they are in a flare up and on allopurinol

A

no, don’t start it during an acute flaire

no, don’t stop it during a flare if you are already on it

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23
Q

Rhabdomyolysis

A

a syndrome of acute necrosis of skeletal muscle indicated by myoglobinuria and elevated creatine kinase

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24
Q

T/F the risk of CVD in patients with RA is the same as with diabetes

A

treu

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25
Q

Takayasu’s arteritis clinical presentation

A

fatigue, fever, weight loos

vascular damage

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26
Q

GI involvement with PSS

A

esophagitis

distal motor function

small bowel and colon hypomobility with malabsorption and psuedo obstruction

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27
Q
A

saddlenose deformity

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28
Q

two distinctive features of Lupus rash

A

usually involves face and hands and gets worse with sun exposure

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29
Q

Osteoarthritis defined

A

a degenerative disorder of the joints that produces minimal articular inflammation and no systemic symptoms

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30
Q

skin changes assocaited with limited sclerodactyl

A

early diffuse fingers welling

slow progression

involves hands below wrists and mouth

telangectasias common

subcutaneous calcium present see a the sights of trauma

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31
Q

renal conditions associated with PSS

A

major cause of death if untreated

more likly to be in patients with friction rubs, rapid progression, no raynauds

requires BP monitoring and poss treatment with ACE inhibitors

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32
Q

what is the age and gender bias of systemic lupus

A

female to male 8:1

usually between 20-50 but can be any age and usuallly more mild in elderly

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33
Q

pathogenesis of SLE

A

excessive helper T activity with low suppressor T leading to prolferation of B cellls and autoantibody production

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34
Q

ankylosing spondylitis treatment

A

exercise and physical activty

NSAIDs

TNF inhibitors

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35
Q

why is acute gout not treated with allopurinol

A

it can precipitate episodes by blocking urate pathways

only used for chronic gout

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36
Q

four types of spondyloparhtopathies

A

ankylosing spondylitis

psoriatic arthetis

reactive arthritis

arthritis from IBD

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37
Q

septic arthritis (gonococcal) signs and symptoms

A

prodromal migratory poly arthraligias

tenosynovitis

purulent monoarthritis

skin lesion

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38
Q

why is rapid treatment of Granulomatosis with polyangiitis important

A

because one renal involvement starts it progresses quickly

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39
Q

renal involvement owith polyerarteritis

A

segmental necrotizing glomerulonephritis

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40
Q

osteoarthritits clinical presentation

A

decreased ROM

crepitus

pain in the morning that goes away in 15 minutes then come back

tends to effect load bearing joints

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41
Q

safety issues associated with TNF vlockers

A

adminstration reactions

opportunistic infections

malignancy

demyelination

hematologic abnormalities

congestive heart failure

lupus like symptoms

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42
Q

what will hapen to compliment during active lupus

A

C3 and C4 will be decreased because you have a lot of cell death

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43
Q

therpay for polyarteritis

A

steroids, cyclophosphamide

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44
Q

calcium pyrophosphate dihydrate (CPPD)(pseudogout) clinical presentation

A

painful inflammation similar to gout (red, swollen, hot, tender)

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45
Q

differentiate between fibromyalgia and RA

A

FM has trigger points and an absence of articular pathology

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46
Q

polymyalgia rheumatica clinical presentation

A

stiffness in the shoulder worse after rest and in the AM

usually bilateral, proximal, and symmetrical

systemic symptoms

most often presents in women

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47
Q

heliotrope rash

typical distribution

A

a rash indicative of dematomyositis

usually in shawl type pattern over the chest and eyes (places exposed to sunlight)

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48
Q

syndesmophytes

A

calcification of ligaments see in ankylosing spondylitis

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49
Q

what two features do scleroderma and crest have in common

A

raynauds phenomena and positive ANA

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50
Q

FANA test

A

fluorescent ANA

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51
Q

what percent of people with SLE have APA

how many have APA syndrome

A

30-40%

less

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52
Q

Direct Coombs

A

hemolytic anema

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53
Q

are narcotics generally effective for managing PFS

A

no, PFS is neuropathic pain that nacrotics don’t work well on

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54
Q

blood work associated with myositis

A

elvated CPK, serum aldolase, sgot

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55
Q

key indicator of diffuse proliferative glomerular nephritis

A

sudden jump in BP

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56
Q

T/F antiphospholipid antibody syndrome may exist without SLE

A

true, 5% of people have low level APA

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57
Q

differentiate between radiographic finds of gout and RA

A

they will both have bite out lesions but gout will have less joint narrowing and speculed appearance

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58
Q

key for RA treatment

goal

A

early and aggresive treatment

put patient in remission

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59
Q

reactive arthritis clinical presentation

A

urethritis, conjuctivitis, oligoarthritis, mucous ulcers in conjuction with an STI or gastroenteritis

often effects large joints of the lower body

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60
Q

causes of OA

A

physical stress

abnormal healing after injury

biochemical/genetic factors

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61
Q

normal components of a joint

A

water

cartillage

bone

muscle

ligaments

nerves

vasculature

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62
Q

osteonecrosis

A

bone death that can be associated with corticosteroid use and SLE, among other things

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63
Q

five clincal presentation of psoriatic arthritis

A
  1. symmetrical polyarthritis like RA with usually fewer joints
  2. oligoarticular form that leads to significant destruction of joints
  3. assymetric for that affects the DIP and leads to nail deformities (pitting, onycholysis)
  4. arthriris mutilans
  5. spondylitc form with sacroiliitis and spondylosis
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64
Q

treatment of sjogrens

A

salagen/evogen

tear duct ablation

plaquenil

nsaids

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65
Q

raynauds associated with limited scleroderma

A

always presents, usually years before skin changes

incolves all the fingers

calcium channel blocker can be effective to control vasospasm

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66
Q

dactylitis

A

swelling “sausage fingers” that are assocaited with recative arthritis, ankylosing spondylitis, and psoriatic arthitis

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67
Q

explain cox 2 and cox 1 in respect to NSAIDs

A

cox 2 is an inducible enzyme that acts on inflammatory sites, inhibition of this will increase the function of NSAIDs

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68
Q

how is gout DX

A

negatively birefringent needle shaped crystals

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69
Q

differiate between scleritis and conjuctivitis

A

scleritis wil go all the way to the iris

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70
Q

diagnosis of sjogrens

A

positive schirmer test

postive rose bengal stain

abnormal salivary gland or lip biopsy

positve RA or ANA or SSA/SSB

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71
Q

levamisole associated purpura

A

vasculitis caused by tainted cocaine that presents as retiform purpura and cutaneous necrosis over the ears, extremities, and cheeks

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72
Q

three functionsof disease modifying anti-rheumatic drugs (DMARDs)

A

reduces symptoms and signs of RA

reduce functional disability

retard radiographc progression

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73
Q

Granulomatosis with polyangiitis treatment

A

initial induction of remission with rituxumab or cyclophosphamide with corticosteroids

maintenance

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74
Q

juxaarticular erosion

A

a classic xray sign of RA cuased by the synovium wrapping around the adjacent edges of bone

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75
Q

differentiate between crest and scleroderma

A

sclereoderma is wide spread especially over the trunk and is much less common

Crest is just the face, neck, and distal extremities and is much more common

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76
Q

pulmonary involvement wth PSS

A

restrictive pulmonary fibrosis

usually bibasilar in the lungs

if there is an inflammatory component it may response to cyclophosphamide

usually indicated by a gigh SCL 70

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77
Q

treatment for acute gout

A

colchicine

NSADs (indocin)

steroids

nutrition

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78
Q

septic arthritis (gonococcal) Dx

A

high leukocyte count in the synovial fluid

positive gonorrhea cultures in the urethral, throat, cervix, or rectum

good response to IV antibiotics

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79
Q

Anti-neutrophil cytoplasmic antibody (ANCA) tests for

A

wegeners, almost 100% specific

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80
Q

neuro conditions associaed with lupus

A

headaches

sz

coma

psych

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81
Q

symptoms of RA

A

morning stiffness greater than 1 hour

diffuse fatigue and aching

subcutaneous nodules

eye involvement

pulmonary involvement

vasculitis

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82
Q

knee problems that commonly effect the knee

A

anserine bursitis

prepatellar bursitis

baker’s cyst

chondromalacia patella

OA

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83
Q

why can ESR be misleading when diagnosing arthritis

what about rheumatoid factor

A

ESR will go up with age, up to 1/2 their age

rheum factor will also go up

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84
Q

differentiate between pleural effusion caused by RA and heart failure

A

RA effusion will have more protein

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85
Q
A

swelling of the synovial sack of the knee

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86
Q

three types of crystal arthritis

A

gout

pseudogout

hydroxyapatite

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87
Q

why is using colchincine and allopurinol in gout treatment a good idea

A

colchincine is stopping crystal formation why allopurinal decreases uricemia

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88
Q

age and gender bias of scleroderma

A

3-4x more common in women, typically onset 30-50

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89
Q

Microscopic polyangitis Dx

A

ANCA positive

microscopic hematuria

proteinuria

red blood cell casts

segemental necrotizing glomerulonephritis

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90
Q

polymyalgia rheumatica Dx

A

Clinical presentation without any other explanation

ESR markedly elevated

temporal artery biopsy if suspected GCA

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91
Q

acute bacterial arthritis

Dx

is xray useful

A

aspriation of synovial fluid with a leukocyte count greater than 2000/mcL, usuallyl over 50,000 mcL

it can help exclude gout due to lack of crystals, but joint aspriation is best

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92
Q

ANA Profile (patterns)

DS DNA

antihistone

anticentromere

anti SCL

A

SLE (homogeneous, Rim)

drug induced SLE (homogeneous, rim)

Crest

PSS (nucleolar)

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93
Q

primary and secondary indications of sjogren’s syndrome

A

primary: dry eyes, mouth, common in older women
secondary: associated to another connective tissue disease (lupus, scleroderma, etc)

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94
Q

what is needed before a diagnosis for fibromyalgia can be made

A

other conditions with suggestive history need to be excluded

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95
Q

most patients with lupus present with what three things

less common signs

A

fatigue, rash, joint pain

renal, neuro, hematological disorders

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96
Q

diarthroidal joints

A

synovial joint

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97
Q

Antiphospholipid syndrome DX

A

venous and arterial occlusions

positive ANA with no features of SLE

repeated SAB

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98
Q

Vectra DA

A

Ra

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99
Q

gottrons papules

A

discrete red papules found over the knuckles of people with juvenile dermatomyositis

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100
Q

T/F inflammatory joint disease tend to have stiffness in the morning that quickly goes away

A

false, that is more typically osteoarthritis

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101
Q

what type of drug is Hydroxychloroquine (plaquenil)

conditions it is used to treat

A

DMARD

RA, cutaneous and systemic lupus, scleroderma and CREST, sjogrens

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102
Q

What makes TNF blockers a risky treatment for people who have been exposed to TB

what can you do to combat this

what is alternative treatment

A

usually reactive of latent TB

PPD yearly, CXR area with fungal disease

MTX with isoniazid

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103
Q

heberdens nodes

A

hard bony swellings of the DIP common in osteoartritis

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104
Q

what is a typical cause of early onset OA

A

abnormal type II collagen

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105
Q

conditions associated with uveitis

A

granulamatosus

spondyloarthtitis

behcet disease

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106
Q

why is it useful to add control points when looking for trigger points for PFS

A

to rule out a significant psychological issue

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107
Q

possible enviromental triggers of scleroderma

A

vinyl chloride

contaminated tryptophan

trichlorethylene

silicone

epoxy resin

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108
Q

lab monitoring for methotrexate

A

baseline CBC with platelets, liver enzymes, renal function, CXR

maintenance CBC (8-12 weeks), liver enzymes (4-8), renal function every 6 momths

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109
Q
A

raynauds

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110
Q

first choice drug for RA

what is an important supplement with this

A

methotrexate

inclusion of folic acid to decrease toxicity rate

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111
Q

Sjogren syndrome is strongly correlated with what

A

increased incidence of lymphoma

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112
Q
A

giant cell arterities

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113
Q

describe Granulomatosis with polyangiitis

A

a type of vasculitis that causes dysfunction in the respiratory tract and glomerulonephritis caused by vasculitis, granulomatous inflammation, and necrosis

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114
Q

aggrivating factors for PFM

A

cold or humid

poor sleep

physical/mental fatigue

excess physical activity

lack of exercise

stress

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115
Q

ESR tests for

>100 might indicate what

how to get the upper limit lab value

A

OA vs RA

PMR, GCA, Wgeners

divide age by 2

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116
Q

limb changes associated with Kawasaki disease

A

edema, desquamtion, erythema of the palms and soles, induration of the hands and feet

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117
Q

fibromyalgia symptoms

A

point tenderness

fatigue

stiffness

anxiety

headaches

irritable bowel

parethesia

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118
Q

acute bacterial arthritis

defined

A

acute monoarticular arthritis usually seen in weight bearing joints that have previous joint injuries or injections

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119
Q

Dx of polymyositis

A

elevated muscle enzymes and aldolase

myopathic inflammation on biopsy

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120
Q

why is plaquenil useful in RA treatment

A

can be combined with other drugs

minimal side effects other than occasional GI

+5yrs has small risk of retinal toxicity

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121
Q

drug monitoring for NSAID use

A

annual monitoring for hepatic and renal function

annual monitoring of CBC

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122
Q

clinical presentation of fibromyalgia

A

nonarticular muscloskeletal pain

fatigue

sleep distrubance

trigger points

for at least three months

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123
Q

indicators of a prognosis in RA

A

reduced function

early xray changes

more joints

age

high rheumatoid factor

prolonged high ESR

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124
Q

treatment for wegener’s granulomatosus

A

steroids

cyclophosphamide

methotraxate

rituximab

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125
Q

what causes anemia in RA

A

hepcidin is elevated preventing iron from being made into HgB leading to anemia

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126
Q

scleritis

A

inflmmatory condition of the sclera associated with RA, vasculitis, granulomatosus, and henoch schonlein purpura

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127
Q

two specific uses for Hydroxychloroquine (plaquenil)

A

in RA as mild treatment or combination therapy

SLE to help with joint pain, rash, fatigue, and combination therapy with steroids for flares

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128
Q

other organs affected by polymyositis

A

joint, lungs, heart, GI

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129
Q

age and gender bias with polyarteritis

A

usually fatal, more common in men

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130
Q

ABx treatment for infectious arthritis

A

nafcillin + mysin (only 3 days due to ototoxicity)

ancef

vancomycin

may need debridment

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131
Q

how is cuteneous lupus diagnosed

where will you usuallly see lesions

does it scar?

A

DX by skin biopsy because ANA is usually negative

face, scalp, arms, upperchest

it can

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132
Q

muscle biospy findings associted with myositis

A

perivascular infiltrate of inflammatory cells

used to rule out inclusion body myositis

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133
Q

what is a definitive test for RA

A

CCP test, if its high you have RA

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134
Q

T/F 90% of drug included lupus will go away

common causes

what is the common presentation

A

true

progainamide, isoniazid, TNF blockers

inflammation of serous membranes (pericarditis, peritonitis, etc)

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135
Q

two less frequent systems affected by wegeners

A

skin (nodules, palpable purpura, ulcerations)

arthritis

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136
Q

telangiectasias

A

red spidery veins commonly seen on the nose, mouth, and chin; part of CREST syndrome

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137
Q

ESR >100 means what likely conditions

A

GCA

wegeners granulomatosus

lymphoma

mets to bone

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138
Q

what is this

what is the prognosis

A

a type of limited scleroderma know as morphea

generally it has very good outcomes

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139
Q

musculoskeletal conditions associated with limited scleroderma

A

polyarthralgias common but not very inflammatory

no fricition rubs

mostly confined to hands

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140
Q

lower respiratory conditions associated with wegener’s granulomatosus

A

SOB, hemopytsis, cavitating lesions, tracheal lesions

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141
Q

ANA Profile (patterns)

Sm (smith)

SSA

SSB

RNP

A

SLE, UCTD (speckled)

Sjogrens, SLE (speckled)

Sjogrens (speckled)

UCTD, SLE (speckled)

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142
Q

podagra

A

gout attacking the first MTP joint of the foot

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143
Q

dactylitis

A

swollen fingers

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144
Q

osteoarthritis treatment

A

weight loss

exercise

nsaids

joint injections (steroid or synovial fluid)

joint replacement

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145
Q

ankylosing spondylitis Dx

A

Elevated ESR and CRP

HLA-B27 +

sacroilitis and bamboo spine on radiograph

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146
Q

most common bacteria causing infectious arthritis

A

staph, strep, gram negative bacilli

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147
Q

Systemic lupus erythematosus treatment

A

exercise

sunblock

NSAIDs

antimalarials

topical or oral steroids

MTX

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148
Q

Rheumatoid factor (RF) test for

what might increase RF without underlying pathology

A

inflammation, COPD, HCV, Lupus

age

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149
Q

secondary raynauds can be caused by what rheumatic disease

A

scleroderma

SLE

polymoysitis

sjogren

vasculitis

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150
Q

why would you test someone who SLE for APA

A

when they present with some kind of clotting probelm

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151
Q

calcium pyrophosphate dihydrate (CPPD)(pseudogout) Dx

A

CPPD crystals in joint fluid (positively bifringent)

fine, linear calcifications on xray

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152
Q

where is synovitis usually found with Lupus

A

similar to RA, small joints of the hands and feet

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153
Q

relationships between raynauds and PSS

A

usually present first with skin changes to follow

increased risk of gangrene or infarct

usually seen at 1 or 2 fingers

those who don’t have it have worse surivival

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154
Q

Sjogren syndrome treatment

A

keeping the eyes/mouth/vagina moist

pilocarpine can increase saliva flow

cyclosprine for eye symptoms

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155
Q

labs to monitor the progression of SLE

A

smith antigen antibodies

double stranded DNA antigens

depressed compliment

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156
Q

clinical factors associated with gout

A

more than on acute arthritis attack

development of maximal inflammation within 1 day

monoarticular arthritis

painful or swollen joint

erythema

suspected tophus

hyperuricemia

subcortical cysts without erosions

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157
Q

psychological management of PFS

A

stress management

biofeedback

relaxation

group/individual therapy

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158
Q

negative findings on PE for PFS

positive

A

muscle weakness, neurological exam, joint exam

trigger points, mild swelling, skin tenderness on pinch, hyperemia of skin

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159
Q

differentiate between GI involvement with limited vs PSS

A

uncommon to have lower GI involvement in limited

commonly has biliary cirrhossi

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160
Q

Granulomatosis with polyangiitis clinical presentation

A

usually presents with upper and lower respiratory symptoms with glomerulonephritis that takes place over 4-12 months

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161
Q

T/F low dose aspirin is bad for gout

A

true, it can exacerbate but high dose aspirin is a useful therapy

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162
Q

CXR findings associated with wegener’s granulomatosus

lung biopsy

A

nodules and cavititing infiltrate

necrotizing granulomatous process

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163
Q

giant cell arteritis treatment

should you wiat for biopsy before treatment

A

immediate high dose steroids with a 1-2 month duration

no

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164
Q

drugs for PFS

A

tricyclic antidepressants

muscle relaxers

SSRI

SNRI

antianxiolytics

gabapentin

tramadol

narcotics

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165
Q

types of uveitis

how do you differentiate

A

anterior, intermediate/posterior

anterior will have redness and dilated cillary vessels that go right up to the iris

posterior will have more vision defects (blurred vision, floaters0

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166
Q

what is the only condition that is treated with indomethacin

A

gout and pseudogout

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167
Q

polymyalgia rheumatica treatment

A

low dose corticosteroids for up to one year

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168
Q

treatment of psoriatic arthritis

A

NSAIDs work for mild cases

methotrexate, biologic DMARDS, TNF inhibitors for severe cases

surgery for end stage arthropathy

corticosteroids and antimalarials should be avoided

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169
Q

C-Reactive Protein tests for

what can confound the results

A

general marker for inflammation (RA, PMR) that is more specific than ESR

truncal obestity

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170
Q

antiphospholipid syndrome clinical presentation

A

thrombosis

SAB

171
Q

rheumatoid arthritis clinical presentation

A

morning stiffness that take hours to go away

symmetrical poly arthritis that tends to effect the small joints

subcutaneous nodules

dry mucous membranes

scleritis

172
Q

gender and age bias of PMR

what is it associiated with

A

over 50

women more than men

associated with giant cell arteriris

173
Q

clinical presentation of giant cell arteritis

A

elderly patient

unilateral headache

scalp tenderness

jaw claudication

throat pain

diplopia

shoulder pain and stiffness from PMR

174
Q

other uses for TNF

A

IBS

ankylosing spondylitis

psoriatic arthritis

175
Q

what are the number 1 and two causes of a swollen, red joint

A

infection and crystal arthritis

176
Q
A

purpura

177
Q

saddle nose deformity

A

a destruction of the nasal cartiliage found in Wegener’s granulomatosis

178
Q

reactive arthritis

A

joint pain including ehtesitis, uveitis, urethritis, cervicitis usually precipitated by a GI/GU infection

179
Q

T/F TNF blockers lead to production of anti-nuclear antibodies and drug induced lupus

A

true

180
Q

why do many patients with RA have osteporosis

A

their inflammatory condition accelerates osteoclast activity

181
Q

labs for PSS

A

SCL antibody (40%)

ESR usually normal

anemia is rare

mild increase in IgG

30% + RA factor

182
Q

Anti-cyclic citrullinated peptide antibody (CCP antibody) tests for

A

RA, may be more sensitive to early onset than RF and CCP

183
Q

define scleroderma

A

Chronic multi-system disease usually involving the skin, lungs and GI tract as well as the renal system.

includes widespread small vessle vacsculopathy and fibrosis

184
Q

T/F renal involvement is common with limited scleroderma

A

false

185
Q

Sjogren syndrome clincial presentation

A

dry eyes and mouth

enlarged parotid glands

186
Q

age and gender bias for ankylosing spondylitis

A

onset in late teens but takes 10 years to diagnose

more common in men

187
Q

Muscle Enzymes CPK, CK-MB, CK-MM, SGOT (AST), Aldolase test for

can be increasd by

A

myositis, PMR/GCA

can be increased by statins

188
Q

systemic symptoms associated with joint pain that indicate a possible inflammatory disease

A

fever

rash

dry eyes/mouth

stomatitis

raynauds

pleuropericardial symptoms

189
Q

renal involvement associated with wegener granulomatosus

A

proteinuria, hematuria, casts, focal segment glomerular nephriris on biopsy

190
Q

SS of psoriatic arthritis

A

joint pain (depends on presentation)

psoriasis, usually years before ijoint involvement

191
Q

calcinosis cutis

A

deposits of calcium found under the skin see in CREST syndrome

192
Q

why cant you treat arthritis associated with IBD interleukin blockers

A

because the make IBD wose

193
Q

extraglandular symptoms of sjogrens

A

fatigue, synovitis, rash, vasculitis, biliary cirrhosis, renal tubule acidosis, pancreatic insufficiency

194
Q

organisms that can cause reactive arthritis

A

salmonella, shigella, chlamydia

195
Q

symptoms of OA

A

pain localized to characteristic joints that is made worse by activity

stiffness in the AM lasting <15 that gets better with activity

gradual and additive onset

acute intermittent flares

196
Q

HLA-B27 test for

A

ankylosing spondylitis

197
Q

vascular damage indicators associated with Takayasu’s arteritis

A

diminished pulses

unequal BP

carotid bruits

limb claudication

HTN

198
Q

PE findings with wegener’s granulomatosus

A

systemic symptoms

Upper res

lower res

eye

199
Q

treamtne for psoriatic arthritis

A

NSAIDs

TNF blockers

IL blockers

200
Q

treatment for osteonecrosis

A

no weight bearing or joint replacement if damage is too severe

201
Q

what is the only rheumatologic condition that is treated by IVIG

A

myositis

202
Q

cardiac involvement in PSS

A

significant cause of death is biventricular myopathy, CHF, and arrhythmais

203
Q

what is undifferentied conntective tissue disease used for

A

it is kind of a catch-all for people who might have mild signs and symptoms

204
Q

risk with colchicine preventative treatment of gout

A

can cause aplastic anemia

205
Q

why is caffeine important to avoid in PFS

A

sleep distruption and vasoconstriction

206
Q

progressive systemic sclerosis findings

A

40% 10 yrs survival rate

diffuse skin involvement with major organ involvement

raynauds not always present but usually follows

207
Q

what is the benefit of TNF blockade for RA treatment

A

significant immprovement of S&S with methotrexate

significant improvement of functionality with MTX

stos joint damage

may decrease CV events

208
Q

T/F sjogens patients are at higher riskf for leukemia

A

false, lymphoma

209
Q

what is this

what condition is usually first see with this

A

sacroilitis

ankylosing spondylitis

210
Q

labs for OA

imagings

A

nothing specific, ESR and rheumatoid factor appropriate with age

look for bondy sclerosis, loss of cartiliage, osteophytes

211
Q

isses tha tend to be found in the shoulder

A

subacromial bursitis

adhesive capsilitis

OA

rotator cuff tear or tendonitis

biceps tendonitis

212
Q

Serum Compliment – C3, C4, and others tests for

A

SLE

213
Q

classifications of lupus

A

cutaneous

drug induced

neonatal

anti-phospholipid antibody syndrome

SLE

undifferentiated connective tissue disease

214
Q

calcinosis might mimic what other joint ocnditions

how can you tell the difference

A

gout

gout crystals are radiolucent

215
Q

treatment for Kawasaki disease

A

IVIG

aspirin

methylprednisolone

TNF

MTX

216
Q

why is rapid treatment of GCA more important than PMR

A

GCA causes blindness and PMR does not

217
Q

relaionship beween gout and kidnets

A

renal failure leads to hyperuricemia

hyperuricemia my lead to crystal deposition on renal parachyma

associated with HTN

can lead to urate stones

218
Q

descrie polymyositis

A

inflammatory disease of the striated muscle fo the limbs, neck, pharynx commonly found in women and associated with an occult malignancy

219
Q

Serum Uric Acid

A

hyperuricemia related to gout

220
Q

labratory features of SLE

A

leukopenia, usually lymphopenia

anemia

thrombocytopenia

hypergammaglobulinemia

ana

compliment

221
Q

Anti-nuclear antibodies (ANA) (titer) 1:160 or > tests for

A

SLE

RA

Sjogrens

Hepatitis

222
Q

treatment of polymyositis

A

high dose methotrexate, steroids, or azathioprine

223
Q

describe sjogren syndrome

A

an autoimmune condition that attacks the lacrimal and salivary glands that usually affects women between the ages of 40 and 60

224
Q

Rhabdomyolysis treatment

A

IV fluids

mannitol

225
Q

pathophysiology of fibromyalgia

A

abnormal signalling of the afferent nerve pathway in the dorsal horn

226
Q

course of rheumatoid arthritis

A

chronic disease with acute flairs

progressive deformties and disability

progression is variable but major loss usually within 2 years

associated with shortened life expectancy

227
Q

types of biologics for RA

A

TNF blockers

IL6 blockers

IL3 blockers

T cell blockers

B cell blockers

228
Q

triggering agents for SLE

A

sunlight

diet

infections

stress

medications (sulfa antibiotics)

229
Q

Serum Protein Electrophoresis used for

A

commonly used for multiple myeloma but cann be used to look for hypergammaglobulinemia that would indicate SLE

230
Q

rheumatoid arthritis Dx

A

aspiration of joint fluid to exclude gout or septic arthritis

ESR and CRP elevation

RF and anti-CCP antibodies will be positive in many cases

juxtarticular lesions and soft tissue edema

231
Q

HP/PE findings with ankylosing spondy

A

back pain worse in the AM, better with exercise

extra articular symptoms

232
Q

how to differentiate viral arthritis from RA

A

RA will cause erosions

presence of causative agents

IgM antibodies against parovrius

+ anti CCP antiboides point to Ra

233
Q

describe Kawasaki disease

A

systemic vasculitis precipitated by an infection or genetic predisposition that causes infiltration of plasma cells into the walls of the vessels

234
Q

catastrophic ntiphospholipid syndrome

A

the 1% with Antiphospholipid syndrome that will progress to diffuse thromboses, thrombotic microangiopathy, and multi organ system falure

235
Q

characteristics of myositis

A

symmetric proximal muscle weakness without pain

systemic symptoms

dysphagia

pulmonary and cardiac symptoms

periorbital edema

236
Q

criteria for RA diagnosis

A

6 points for diagnosis

small joint synovitis

  1. 1-3 joints 2 pts
  2. 4-10 3 pts
  3. more than 10 5 pts

positive RF/CCP (2 pts)

Elevated ESR/CRP (1pt)

Lasts for more than 6 weeks (1pt)

237
Q

enthesopathy

A

inflammation of the attachment points of tendons associated with ankylosing spondylitis and psoriatic arthritis

238
Q

treatment for scleroderma

A

calcium channel blockers for raynauds

ace inhibitors for renal crisis

steroids for myositis

nsaid and plaquenil for synovitis

239
Q

common side effects of methotrexate

A

mucositis

transient elevated liver enzymes

leukopenia

thrombocytopenia

240
Q

diagnostic tests for infectious arthritis

A

synovial fluid: gram stain, low glucose, elevated leukocyte count

blood: culture, elevated ESR and leukocyte count

241
Q

describe takayasu’s arteritis

A

early adulthood vasculitis of the aorta and major branches with frequent relapse

242
Q

treatment for GCA

A

usually high dose steroids for one month

may require immunosuppressive therapy such as MTX

resolves 6-24 months

243
Q

describe the CREST syndrome associated with limited scleroderma

A

calcinosis cutis

raynauds

esophageal dysfunction

sclerodactyly

teleangiectasia

244
Q

what constitutes chronic gout

A

10years of acute intermittent gout

tophi deposition

chronic swollen joints

joint destriction

absolutly require allopurinol or uloric

245
Q

Systemic lupus erythematosus clinical presentaton

A

photosensity malar or discoid rash

oral ulcers

arthtitis

serositis

renal disease

hematologic or immunologic or neurologic disorders

246
Q

neurological involvement of polyarteriis

A

mononeuropathy

diffuse poly neuropathy

CVA

247
Q

Systemic lupus erythematosus Dx

A

clinical presentation

CBC (anemia, leukopenia/cytosis, thrombocytopenia)

BUN/creatinine

UA

ESR compliment

248
Q

Sjogren syndrome Dx

A

Rheumatoid factor in 70%

ANA in 60%

anti-Ro antibodies in 60%

schrimir test for lacrimal glands

biopsy of the lower lip to confirm fibrosis and lymphcyte infiltration

249
Q

T/F hyperuricemia is only present in people with active gout

what can be done wit these peole

A

false, 5% of asymptomatic people have it

don’t treat but consider removing exacerbating factors

250
Q

hematology associated with SLE

A

hemolytic anemia

leukopenia

thrombocytopenia

251
Q

what is the correlation between PMR and GCA

A

if you have PMR, you have a 10% chance to have GCA

252
Q

Felty syndrome

A

a small subset of RA that features splenomegaly and neutropenia accompanied by severe, destructuve arthritits

253
Q

age and gender bias associated with wegener’s granulomatosus

A

found in young to middle aged adults

slightly more common in men

254
Q

dermatomyositis

A

a variant of polymyositis that affects the skin

255
Q

describe fibromyalgia

A

a central pain disorder is mainly found in women and may occur with RA, SLE, or sjogrens

256
Q

gouty arthritis DX

A

joint fluid analysis for urate crystals (rod shaped, negatively bifringent)

high serum uric acid is correlated but not diagnostic (flares can happen with normal serum testing0

257
Q

education in regard to PFS

A

explain diagnosis

explain importance of lifestyle changes

explain lack of disability

258
Q

describe giant cell arteritis

A

systemic arteritis affecting the medium and large vessels usually afflicting patients over 50 and coexisting with polymyalgia rhematica

259
Q

nonspecific complaints that might indicate fibromyalgia

A

anxiety

depression

headaches

IBS

dysmenorrha

paresthesia

260
Q

cutaneous involvement of polyarteritis

A

palpable purpure

livedo reticularis

splinter hemorrhages

261
Q

what type of arthritis is often found in the wrist

A

rheumatoid

262
Q

age and gender bias for psoriatc arthritis

A

30-50, even distribution between men and women

263
Q

Total Hemolytic Compliment (THC) (CH50)

A

a low value might indicate autoimmune disease

264
Q

characteristics of infectious arthritis

A

monoarticular

rapid onset

red/warm/swollen

265
Q

LFT – AST/ALT

A

tests liver function after DMARDs or biologics

266
Q

underlying diseases associated with psuedogout

A

hyperparathroid

hemochromatosis

hyperthyroid

amyloidosis

hypomagnesiemia

hypophophatasia

267
Q

viruses that can cause arthritis

A

parovirus

chikingunya fever

Hep B or C

268
Q

what is the most common vasculitis disease

A

GCA

269
Q

musculosketal issues with PSS

useful therapies

A

polyarthragies

friction rubs suggest poor prognosis

flexion contractures common

nsaids, plaquenil, steroids

270
Q

monarticular joint disease

A

septic

crystal

DJD

traumattic effusion

271
Q

Pott disease

A

spinal turberculosis usually seen in immigrants

272
Q

synovium

A

synovial membrane

273
Q

describe psoriatic arthritis

A

arthritis preceed by psoriasis that is typically assymetical and can resemble RA or ankylosing spondylitis

274
Q

Tuberculous arteritis

A

infection of peripheral joints from TB that can last week so or months and present like septic arthritis

275
Q

nutrition changes for fibromyalgia

A

eat at least three protein rich meals a day

avoid caffine

drink water

lose weight

276
Q

T/F RA doesn’t affect the neck

A

false, it can cause subluxation of C1-2 though it may take year to develope

277
Q

describe microscopic polyangitis

A

vasculitis of the small blood vessels that presents with palpable purpura, splinter hemorhages, vesicobulbous lesions, lung and renal involvement

278
Q

age and gender bias of gout

A

older men >50 with a poss genetic Hx, DM/HTN/hyperlipid

279
Q

clinical presentation of scleroderma

A

polyarthralgia

skin chnages

esophageal dysfunction

280
Q

describe reactive arthritis

A

an assymetrical arthritis of the lower extremities that typically strikes after a GI or GU infection

281
Q

what is hydroxychloroquine used for in SLE

A

decrease flares

prevent organ involvement

manage steroid dose

282
Q

rare but major side effects of methotrexate

A

interstitial pneumonitis

liver fibrosis of cirrhosis

infection

EBV induced lymphoma

283
Q

Kawasaki disease Dx

A

clinical presentation

neutrophilia

elevated CRP

thrombocytopenia

no specific test

284
Q

describe calcium pyrophosphate dihydrate (CPPD)(pseudogout)

A

deposits of CPPD in the fibrous and hylaine cartilage of a joint causeing chrondrocalcinosis that commonly affect the wrist, knee, and elbow

285
Q

mucous membranes assocaited with kawasakis

A

erythema, swelling and fissuring of the lips, strawberry tounge

286
Q

what differentiates limited scleroderm from PSS

A

usually live longer (70% 10 yr survival)

anticentromere antibody rather than anti SCL 70

always have raynauds

sclerodactyl to the wrist

287
Q
A

telangiectasias

288
Q

raynaud phenomenon

A

paroxysmal digital ischemia caused by vasospasm in response to cold and emotional stress

289
Q

alternative physical therapies for PFS

A

stim

massage

physical therapy

chiropractic

triggerpoint injections

290
Q

joint issues that tend to be found in the back

A

muscle strain

lumbar herniation

scoliosis

spinal stenosis

OA of the back

291
Q

reactive arthritis Dx

A

at least half of patients will be HLA-B27 positive

culture negative serous fluid

xrays may show permanent and progressive joint disease

292
Q

therapy for cutaneous lupus

A

topical steroids

hydroxychloroquine

intralesional steroid injection

thalidomide

leflunomide

293
Q

5 renal conditions associated with lupus

A

mesangial glomerulonephritis

focal glomerular nephritis

diffuse proliferative glomerular nephritis

ditto with necrosis

membranous glomerulonephritis

294
Q

what muscles are typically effected by myositis

A

the shoulders

295
Q

what joints of the hand will OA usually present in

RA

A

OA will usually be in the DIP and PIP

RA will usualyl be in the DIP and MCP

296
Q

enthesopathy

A

inflammation of the attachment of a tendon to bone

297
Q

Etanercept (Enbrel) is what type of drug

what can it treat

special considerations

A

TNF inhibitor DMARD

almost everything (RA, AS, PA, sjogrens, Wegeners)

increased risk for infection, TB, lymphoma, etc

298
Q

Tuberculous arteritis Dx

A

synovial fluid smears and culture

synovial biopsy

299
Q

what labs will have abnormal results in PFS

A

functional MRI

FM/2 blood test

300
Q

Dx of pseudogout

A

presnts as gout, DJD, RA

chondrocalcinosis on xray

positively birefringent rod shaped crystals

more likley to be found in a damaged knee

301
Q

upper respiratory conditions associated with wegener’s granulomatosus

A

sinusitis, nasal and oral ulcerations, saddlenoe deformity

302
Q

biopsy findings for polyarteritis

A

acute inflammatory infiltrate with polymorphonueclear leukocyots and fibroid necrosis

303
Q

treatment for pseudogout

A

NSAIDs

colchicien for acute attacks

steroids

304
Q

differentiate between Arava and methorexate

A

arava is very similar in terms of effect and side effects but it does’t cause any pulmonary toxicity and may elevate BP

305
Q

what type of cutaneous lupus that forms scars

A

discoid

306
Q

what categories are present in the diagnostic critrea for RA

A

joint involvement (more points for more joints)

serology

duration of symptoms (longer is more points)

acute phase reactants (ESR and CRP)

307
Q

most common symptoms related to GCA

A

debilitating temporal headache

308
Q

Anti-cyclic citrullinated peptide antibody (CCP antibody) tests for

A

RA, more specific that RF but less sensitive

309
Q

risk factors for GI complcations with NSAIDs

A

older

HX ulcer and GI bleed or prior side effect

high dose NSAIDs

use with prednisone

CVD

antacids

310
Q

three variants of scleroderma

A

progressive systemic sclerosis

crest

morphea

311
Q

DIP psoraitic arthrtis

oligoarthicular involvement

polyarthritis involvement

spondlytis involvement

arthritis mutlilans

A

5%

70%

15%

5% but another type increases incidence by 40%

5%, destroys the joint

312
Q

cutaneous PE findings associated with myositis

A

heliotrope rasj

gottrons papules

sun sensitive rash

313
Q

lab tests for GCA

A

ESR >50, usually >100

elevated CRP

elevated LFTs (30%)

abnormal temporal artery biopsy

314
Q

specific types of vasculitis

A

PMR/Giant cell arteritis

polyarteritis

wegeners granulomatosus

polyarteritis

315
Q

lab tests for DIL

A

> antihistone antibodes

compliment is normal

anti-dna antibodies negative

316
Q

triad of wegener’s granulomatosus

A

URt, LRT, renal involvement

317
Q

when will the first attack of acute gout occur

describe the onset

how long does it last

A

between 40-60

classic acute onset usually monoarticular

7-10 days

318
Q

rheumatoid arthritis treatment

A

low dose steroids to act as a bridge

methotrexate

best therapy is usually methotrexate with a biologic DMARD (TNF blocker)

319
Q

what is the issue with treating cyclophosphamide for wegener’s

A

it is oncogenic

320
Q

characteristics of psoriatic arthritis

A

enthesitis and dactylitis

321
Q

describe ankylosing spondylitis

A

seronegative spondyloarthropathy that leads to eventual fusion of the vertebrae through syndesmophyes

322
Q

T/F raynauds will get better over time

A

false, it is a fixed lesion

323
Q

labs for wegener’s granulmatosis

A

anti neutrophil cytoplasmic antibodies f

324
Q

describe gouty arthritis

A

a recurring monoarticular arthritis caused by urate cystals in the joints that typically has an acte on set

325
Q

what does IL-6 do

A

induces the final maturation of b cells into plasma cells

regulates the immune response to antigens

326
Q

T/F combination therapy with DMARD and biologic is contraindicated for RA

A

false, they are more effective

327
Q
A

calcinosis

328
Q

when will allopurinol be needed for lifelong treatment of gout

A

for urate over producers

329
Q

GI involvement of polyarteritis

A

ischemic bowel

elevated LEFTs

330
Q

T/F ANA is a definitive test for ESL

A

Positive ANA correlates with diagnosis but a negative does not exclude

331
Q

Kawasaki disease clinical presentation

A

fever with four of the following

conjuctivitis

mucous membrane change

rash

cervical lymphadenopathy

peripheral limb changes

332
Q

classic presenation of a malar rash spares what

A

the nasolabial fold

333
Q

T/F TNF blockers are contraindicated in CAD

A

false, they are contraindicated in CHF

334
Q

common joints of OA

A

DIP, PIP, 1st CP, spine, hips, knees

335
Q

clinical features of SLE

A

fatigue

fever

cutaneous rash

synovitis

oral ulcers

pleural/pericardial inflammation

336
Q

Takayasu’s arteritis Dx

A

ESR/CRP elevation

MRI to detect vasculitis

CTA to see narrowing

337
Q

EMG findings associated with myositis

A

increased insertional activity

fibrillations

polyphasic motor unit potentials of low amplitude

338
Q

what is the only hypercoagulable condition that will cause venous and arterial clot besides APA

A

factor V leiden mutation

339
Q

pharmaceutical treatment for OA

A

NSADs

ice, heat

joint injection

340
Q

Microscopic polyangitis treatment

A

corticosteroids with cyclophosphamid or rituximab

341
Q

jak-stat inhibitors

A

small molecules that can stop the signaling molecules released by IL-6 from activating genes and producing RNA

342
Q

Cox 2 inhibitors Celecoxib (Celebrex) are considerded what type of drug

what are they used for

what makes them special

A

an NSAID

OA

it blocks COX-2 enzyme to decrease prostaglandin formation and inflammation with less stomach distress than typical

343
Q

acute bacterial arthritis

signs and symptoms

A

acute pain, swelling, heat in the affected joint worsening several hours

systemic symptoms

344
Q

treatment for infectious arthritis

A

joint aspiration or synovial biopsy

treat with ABx to prevent damage and spread to other joints

345
Q

what is Rituximab (Rituxan)

what is it used to treat

it is especially effective in what circumstance

A

biologic TNF inhibitor considered a DMARD

RA, SLE, spondyloarthropathies, Behcet’s disease, sjorgrens, wegeners

SLE when there is kidney or major organ involvement

346
Q

gouty arthritis signs and symptoms

A

rapid onset of pain, typically with tender, warm, swollen, dusky red areas in the feet, ankles, and knees

347
Q

APA therapy

A

APA and no clots - no Rx

APA and clots - coumadin with an INR 3-4 unless platelets are <50,000

continue anticoagulation even when APA negative

348
Q

synovium

A

the inner lining of a synovial joint capsule that secretes synovial fluid

349
Q

CREST scleoderma is an acronym for what

A

Calcinosis

Raynauds

Esphageal dysmotility

sclerodactyl

telangiectasias

350
Q

T/F upper cervical vertebrae can be involved in RA

A

true

351
Q

Antiphospholipid antibody tests for

A

APA syndrome in people autoimmune issues

352
Q

composition of cartilage

A

70% water

type II collagen

proteoglycans

chondrocytes

353
Q

livedo reticularis

A

mottled purple discoloration of the skin caused by blood clots tha lead to swollen venules in the skin

354
Q

psoriatic arthritis types

A

spondylitis

RA like

Oligoarthritis

arthritis mutlialsn

355
Q

what can methotrexate be used for

A

RA

SLE

Myositis

PMR/GCA

Wegeners

spondyloarthropathies

356
Q

what does sjogren syndrome attack

A

exocrine glands (sweat, spit, tears, mucosa, pancreatic)

357
Q

radiographic findings associated with RA

A

soft tissue swelling

bite juxtarticular lesions with no crystals

crooked fingers

358
Q

drugs used to treat RA

A

TNF inhibitors

ACE inhibitors

DMARDs

chemo drugs

Gold Salts

IL-1 receptor agonists

359
Q

systemic features of scleroderma

A

Reflux

hypomobile GI tract

pulmonary fibrosis

pulmonary HTN

renal involvement

360
Q

why is it important to rule out inclusion body myositis

A

because it doesn’t respond well to treatment, patients just get worse and die

361
Q

treatment for ankylosing spondy

A

nsaids

steroids

sulfasalazine, MTX, axathioprine

TNF inhibitors

IL 17A inhibitors

362
Q

catastrophic APA syndrome

treatment

A

an emergeny clotting disorder with a high likelihood of death, gangrene in limbs or organs

pulse solumedrol, IV cytoxan, rituxan, plasmapheresis

363
Q

Henoch-Schonlein Purpura

classical presentation

A

a systemic vasculitis associated with IgA deposites in vessel walls, often precipitated by group A strep exposure

palpable purpura in the legs, arthralgia, nausea, colic, melana

364
Q
A

syndesmophytes

365
Q

radiographic findings indicative of gout

A

no early signs

late signs will have have a bite out lesion under a rim of cortical bone with a splintered apperance

combined with a tophus they are diagnostic of gout

366
Q

boutoneirre deformity

A

PIP flexion with DIP extension associated with rheumatoid arthrtiits

367
Q
A

scleroderma

368
Q

important indicator of sacriolitis on Xray

A

both sides of the SI joint must be effected

369
Q

three common clinical signs of psoriatic arthritis

A

symmetric arthritis that resembles RA with DIP involvement

pitting of the nails and onycholysis

sausage fingers cause by tenosynovitis of the flexor tendon

370
Q

bouchards nodes are indicative of what

A

usually OA but RA can sometimes present with more gelatinous cysts

371
Q

labs for polyarteritis

A

elevated ESR/CRP

leukocytosis

screen for hep b and C

372
Q

where will RA frequently be seen first on radiograph

A

around the ulnar styloid because there is no cartilage there to protect the bone

373
Q

polyarticular joint disease

A

RA

spondyloarthopathies

undifferentiated connective tissue disease

DJD

gout

374
Q

charactericstics of APA syndrome

A

spontaneous abortions

venous and arterial thrombeses

thrombocytopenia

livedo reticularis

375
Q

septic arthritis (gonococcal) defined

what is the most common sign

A

a migratory inflammaltion of the wrist, ankle, knee, and elbow caused by gonorrhea

tenosynovitis and characteristic skin leasion

376
Q

sclerodactyl

A

localized thickening of the skin over the hands, part of the CREST syndrome

377
Q

eye conditions associated with wegener’s granulomatosus

A

episcleritis, uveitis

378
Q

what is the hallmark conditions for ankylosing spondy

A

sacroilitis #1

enthesopathy and dactylitis common

peripheral synovitis

379
Q

lab findings for ankylosing spondy

A

elevated CRP/ESR

sclerosis on SI oblique xrays

syndesmophytes

HLA B27

380
Q
A

sclerodactyly

381
Q

raynauds phenomena

cause

progression

A

arterial spasm that causes reduced blood flow

lupus, scleroderma, thyroid conditions

pallor, rubor, normal

382
Q

important lab finding for gout

A

uric acid in blood below 6

383
Q

what organs are usualyl affected by polyarteritis

A

any organ, but skin, nerves, joints, GI, kidents are most common

lungs are usually spared

384
Q

what causes renal tubule acidosis in sjogrens

A

the inability of the kidneys to secrete bases

385
Q

PE findings with GCA

A

acute or subacute onset with systemic symptoms

temporal headaches

scalp tenderness

jaw claudication

visual loss

aortic arch syndrome

thickened or tender temporal arteries

ischemic optic atrophy

386
Q

PE for chrondromalacia patella

A

push down on the knee cap will hurt

387
Q

common places for gouty tophus

A

thumb, big toe

388
Q

T/F RA lung nodules can look like lung cancer

A

true

389
Q

what percent of gout is from undersecretion

overproduction

A

90

10

390
Q

labs for gout

A

hyperuricemia determined by 24 hr urine

391
Q

swan neck deformity

A

extension of the PIP with flexion of the DIP caused by RA

392
Q

clinical presentation of polymyositis

A

insidious, painless muscle weakness

dysphagia

skin rash (malar or heliotrope)

polyarthralgia

muscle atrophy

393
Q

ANA Profile (routine)

patterns

tests for

A

rim, speckled, diffuse, homogeneous, nucleolar

SLE

394
Q

osteoarthritis Dx

A

radiographs showing assymetrical joint narrowing, subarticular cysts, osteophytes

395
Q

types of joint injections for OA

A

steroids

hylan products (synvisc)

396
Q

extrarticular symptoms associated with ankylosing spondy

A

uveitis, psoriatic and reactive rask, IBD, aortitis, apical pulmonary scarring

397
Q

pulmonary involvement of limited scleroderma.

treatment

A

Pulmonary hypertension late in the disease

poor prognosis, usually leasds to right side heart failure

viagra, iloprost, tracleer

398
Q

Glucosamine and chondroitin are used for what type of arthritis

flax seed

A

OA

RA

399
Q

lab studies for PMR

treatment

A

ESR >50 or elevated CRP

rapid low dose steroids will usualyl resolve in 6 months to 2 years

400
Q

regional joint pain associated with the hip

A

OA

trochanteric bursitis

referred apin from the back

401
Q

diagnostic criteria for acute gout

A

urate crystals in the joint fluid

OR

tophus with urate crystals

OR

6 clinical factors

402
Q

Granulomatosis with polyangiitis diagnosis

A

slight anemia

mild leukocytosis

elevated acute phase reactants

proteinuria

RBC’s in blood

red cell casts

403
Q

PMR indications on PE

A

systemic symptoms

stiffness with activity

muscle pain around the shoulder and hip

404
Q

gouty arthritis treatment

A

elevation and rest

diet and alcohol reduction

NSAIDs (indomethacin) for intial treatment

colchicine

allopurinol

405
Q

other syndromes assocaited with fibromyalgia

A

tension headaches

primary dysmenorrhea

irritable bowel

406
Q

TNF blocking drugs

A

ETANERCEPT

ADALIMIMAB

INFLIXIMAB

GOLIMIMAB

CERTOLIZIMAB

407
Q

T/F bursitis pain is worse at night

A

true

408
Q

treatment of scleroderma

A

PPI for reflux

ACE inhibitors for renal disease

avoid triggers

CCB for raynauds

immunosuppresants for pulmonary HTN

409
Q

Takayasu’s arteritis treatment

A

steroids

methotrexate or DMARDs as needed

410
Q

bouchards nodes

A

cysts that form on the PIP due to bone spurs

411
Q

common causes of osteomyelitis

A

hematogenous

infection

vascular insufficiency

412
Q
A

purpura from wegeners granulomatosus

413
Q

reactive arthritis treatment

A

phyiscal therapy

NSAIDs

ABx to reduce the chance of getting the disorder but don’t allieviate symptoms

414
Q

differntiate between spondyloarthropathies and other artritis

A

spondy tends to get better with exercise

415
Q

“more tolerable NSAIDs

A

nabumetone

salsalate

etodolac

416
Q

acute bacterial arthritis

causes

A

bacteremia (typically with staph)

joint damage

compromised immunity

lost of skin integrity

417
Q

four types of myositis

A

polymyositis

dermatomyositis

myositis associated with connective tissue disease

inclusion body myositis

418
Q

rheumatoid arthritis defined

A

an auto immune disease that attacks the synovium and produces extra articular manifestations

419
Q

alleiviating factors for PFS

A

warm/dry weather

hot shower

restful sleep

moderate activity

stretching

massage

420
Q

prevenative therapy for gout

A

colchicine

NSAIDs

probenecid

allopurinol

steroids

421
Q

labs for limited sclerodema

A

95% have anticentromere antibodies

ESR usually normal

anemia is rare

422
Q

skin changes associated with progressive systemic scleroderma

A

early presentation with diffuse swelling and stiffness of the fingers

rapid progression

usualy involves skin above the wrist

rarely see telangetasias or subcutaneous calcium

423
Q

the differnece between irritable bowel and inflammatory bowel

A

inflammatory bowel has noctural bowel movements

424
Q

DMARDs

A

hydrocholoquine

methotrexate

leflunomide

azathioprine

Clinical Medicine (11 decks)

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