Rheum Flashcards

Question

What is the treatment for Polymylagia Rhematica?

Answer 1

Oral Prednisone in high doses | Temporal artery biopsy

Answer 2

Occurs post infection with Chlamydia, Campylobacter, Salmonella, Shigella, and Yesinia

Answer 3

Noninfectious Urethritis Arthritis Conjunctivitis

Answer 4

Treat symptoms and the underlying infection: Antibiotics NSAIDs Corticosteroids DMARDs --> only if NSAIDs and corticosteroids are ineffective; methotrexate or SULFASALAZINE (for GI)

Answer 5

``` Red Eye Pain worsens when reading Progressive and occurs over a few hours Blurred vision Photophobia Excess tear production Abnormally shaped pupils ```

Answer 6

< 16 Arthritis in one or more joints Duration of disease > 6 weeks Joint inflammation, contractures, and joint damage Periods of no symptoms and then quick onset of symptoms

Answer 7

Repeated fevers of 103 with fluctuating slamon collor rash Inflammation of the intenral organs and joints Anemia Leukocytosis

Answer 8

Arthritits in 5 or more joints with major symptoms of pain in the knees, ankles, wrists, and fingers Constant pain

Answer 9

Arthritis in 4 or fewer joints withint the first 6 months of onset 50% of kids F>M Those diagnosed before age 7 have the best change of disease subsiding High risk of uveitis Large joints are effected

Answer 10

Involves ligaments as well as the spine | Aka Spondyloarthritis

Answer 11

Positive ANA Synovial fluid Class II inflammatory X-rays show soft tissue swelling, periarticular osteoporosis, growth disturbances, and loss of joint space

Answer 12

Polymyositis Dermatomyositis Inclusion Body Myositis

Answer 13

Proximal muscle weakness and upper and lower limbs bilaterally Difficulty raising arms, lifting objects, or combing hair Trouble climbing stairs and getting up from sitting Systemic Symptoms: GI --> dysphagia, bloating, and constipation Cardiac --> arrhythmias and condition defects Pulmonary --> Aspiration pneumonia, INterstitial lung disease, and bronchiolitis Renal --> ATN

Answer 14

Leukocytosis Elevated CK and LDH ANA and myositis antibodies

Answer 15

There is no cure! Corticosteroids for inflammation --> Prednisolone 1mg/kg/day for 4-8 weeks Monitor CK levels and muscle strenght ``` Immunosuppresive agents --> Only give these if there is no repsone to steroid within 4 weeks of treatment or if there are extra-skeletal manifestations Azathioprine Cyclophosphamide Chlorabucil Cyclosporine ``` ``` IVIG INflixumab Rituximab Diet Consults ```

Answer 16

Heliotrope Rash --> purple discoloration on upper eyelids, flat red rash on cheeks and upper trunk Grotton's papules --> raised violaceous scaly rash on knuckles Dilated capillary loops at the base of the fingernails irrgular cuticles "dirty" horizontal lines that resemble mechanics hands after a day of work

Answer 17

Perivascular and perimysial inflammation

Answer 18

Asymmetrical weakness Falling is common due to quadriceps weakness and artophy Facial muscle weakness but not ocular Weakness and atrophy of distal muscles, especially the foot extensors and deep finger flexors Cannot tie a knot or hold a gold club Dysphagia and choking Progresses slowly over the years

Answer 19

Resistant to Immunotherapy so give --> Azathioprine + Prednisolone for a few months

Answer 20

Deposits of uric acid crystals into tissues

Answer 21

``` Men Women after menopause People with kidney disease Obesity HTN Hyperlipidemia Diabetes Family History ```

Answer 22

increased uric acid levels in the blood Causes by clinical renal disorders like renal insufficiency or a decreased GFR

Answer 23

Excessive dietary purine intake from red meat, organ meat, or shellfish Alcoholic beverages especially beer

Answer 24

Arthrocentesis --> will show intracellular uric acid crystals with negative birefrinence under polarized light microscopy Elevated serum uric acid levels > 6.8 --> not if only finding though 24 hour urine --> underexcretors with have normal levels and overproducers will have elevated levels

Answer 25

``` Occiput Low cervical Trapezius Supraspinatus 2nd rib Lateral epicondyle Medial fat pad of the knee Greater trochanter Upper glute ```

Answer 26

``` Giant Cell (temporal) arteritis Takayasu Arteritis ```

Answer 27

``` Limb claudication Assymetric blood pressures Absence of pulses Bruits Aortic dilation ```

Answer 28

``` Polyarteritis Nodosa (PAN) Kawasaki ```

Answer 29

``` Cutaneous nodules Palpable purpura Livedo reticularis Digital gangrene Mononeuritis multiplex Acute foot/wrist drop Microaneurysms Abdominal pain Decreased appetitie ```

Answer 30

``` Microscopic Polyangitis (MPA) Granulomatosis with Polyangitits (Wegener's) IgA Vasculitis (henoch-schonlein) ```

Answer 31

``` Palpable purpura Vesiculobullous lesions Urticaria Glomerulonephritis Alveolar hemorrhage Splinter hemoorhahes Uveitis Episcleritis Scleritis Cutaneous extravascular necrotizing granulomas ```

Answer 32

presence of 3/5 of the following: > 50 at onset New onset localizaed headache Tenderness or decreased pulse of temporal artery ESR > 50 Biopsy revelas necrotizing arteritis with predominance of mononuclear cells or a granulomatosus process with multinucleated giant cells

Answer 33

3 of the following: ``` Otherwise unexplained wt. loss greater than 4 k LIvedo reticularis Testicular pain or tenderness Myalgias (excluding hip or shoulder) Weakness of leg muscles Tendnerss of leg muscles New onset diastolic BP > 90 Elevated levels of BUN Biopsy of small or medium sized arteries contains polymorphonuclear cells Mononeuropathy or polyneuropathy ```

Answer 34

Presence of fever > 5 days wihtout any other explaination with at least 4/5 of the following: Bilaterally bulbar conjunctival injection Oral mucous changes, including injected pharynx or fissured lips, or strawberry tongue Peripheral extremity changes including erythema of palms/soles, edema of hands and feet, and periungal desquamation Polymorphous rash Cervical LAD

Answer 35

MANDATORY TO HAVE PURPURA WHICH IS PALPABLE AND IN CLUSTERS Must have one or more of the following: Abdominal pain that is usually diffuse with acute onset Arthritis or arthralgia that is acute onset Renal involvment of proteinuria or hematuria Leukocystoclastic vasculitis or proliferative glomerulonephritis with predominant immunoglobulin A deposition

Answer 36

FATIGUE fever LAD UNintentional wt. loss or gain

Answer 37

``` Malar rash Discoid rash Bullous lesions patchy or diffuse alopecia Photosensitivity Panniculitis Palpable purpura Raynaud's Livedo reticularis Childbain lupus ```

Answer 38

``` Conjunctivitis Sicca symptoms Photophobia Blindness Retinal Vasculitis Optic Neuritis ```

Answer 39

``` Symmetrical arthritis Polyarthritis Nonerosive arthritis Jaccoud's arthropathy Myalgia AVN ```

Answer 40

``` Pericarditis Myocarditis Premature atherosclerosis Conduction system abnormalities Libman-Sacks endocarditis ```

Answer 41

Dyspnea or pleuritic CP suggestive of pleuritis Pneumonitis Pulmonary HTN Diffuse alveolar hemorrhage

Answer 42

``` Peritonitis Hepatitis Pancreatitis Mesenteric vasculitis Intestinal pseudo-obstruciton ```

Answer 43

history of miscarriages

Answer 44

``` Proteinuria LE edema HTN Glomerulonephritis ARF Interstitial nephritis Antiphospholipid nephropathy ```

Answer 45

Anemia of chronic disease Leukopenia Thrombocytopenia Arterial/venous thrombosis

Answer 46

``` Seizures Headaches Psychosis Cognitive dysfunction Peripheral Neuropathy Myelopathy ```

Answer 47

Acute cutaneous lupu Erytehmatous (ACLE) Subacute cutaneous lupu Erythematosus (SCLE) Chronic Lupus Erythematosus (CCLE) Nonspecific

Answer 48

MALAR RASH = butterfly rash maculopapular rash = areas that are photosensitive Non-scarring alopecia

Answer 49

papulosquamous or annular Scaly Psoriaform Most photosensitive Occurs on torso and limbs and spares face Anti-Ro and Anti-La positive Induced by medications like HCTZ or terbinafine

Answer 50

Discoid lupus = raised, erythematou placques with adherent scale Lupus panniculitis = deep, firm nodules with predilection for scalp, face, arms, buttocks, and thigh Childbain lupus that resembles frostbite

Answer 51

``` Vasculitis Purpura Livedo Reticularis Raynaud's Alopecia Urticaria Nail-fold periungal capillaries Bullous lesion ```

Answer 52

SOAP BRAIN MD Must have presence of 4 of these criteria

Answer 53

Pleuritis Pericarditis patients are 40X higher risk of MI and accelerated atherosclerosis

Answer 54

patients with long standing SLE and they have joint deformities like Boutonniere's or Swan neck but on x=ray there are no bony erosions It is due to ligament laxity

Answer 55

Hemolytic anemia with reticulocytosis Leukopenia < 4000 on > 2 occasions Lymphopenia < 1500 on > 2 occasions Thrombocytopenia < 100,000 on > 2 occasions in the absence of offending drugs Get COOMBS workup

Answer 56

Persistent proteinuria > 0.5 grams/day or > 3+ on dipstick Urine exam will show cellular casts that are either RBC, HgB, Granular, tibular, or mixed

Answer 57

Renal biopsy

Answer 58

Nephritis | Serum Creatinine > 2.4

Answer 59

ANTI-dsDNA ANTI-SM COmplement = disease activity they will be low

Answer 60

Seizures | Psychosis

Answer 61

``` Hydralazine Quinidine Carbamazepine Isoniazid Methyldopa Minocycline Chlorpromazine Procainamide Phenytoin INfliximab Etanercept Adalimumab Simponi Cimzia ```

Answer 62

linear patch of scleroderma on scalp/face

Answer 63

Morphea - single or multiple patches of hard skin form on the trunk especially in kids and spontaneously disappear Linear scleroderma - linear bands of hard skin across face, single arm, or leg

Answer 64

Limited Cuteanous =80% of patients; CREST | Diffuse cutaneous = 20%; internal organs

Answer 65

Edematous stage = shiny and loose skin folds Inflammatory stage = Thickening continues; destroys normal sweat glands; intense itching Atrophic Stage = very tight, joint contractures causing hands to come in

Answer 66

Patient must have one major criteria or > 2 minor criteria: Major --> Proximal scleroderma Minor --> Sclerodactyly, digital ischemia with digital pitting scars or atrophy of finger pads, or bibasular pulmonary fibrosis

Answer 67

lung disease

Answer 68

Unknown trigger leads to vascular endothelial cells in the exocrine glands in genetically predisposed patients Lymphocytes are attracted into the gland and are activated Cytokines are released Gland inflammation and destruction occur causing the sicca symptoms and parotid swelling

Answer 69

Keratoconjunctivitus sicca and xerostomia

Answer 70

Complication of anotehr systemic autoimmune disease like SLE, RA, or primary biliary cirrhosis

Answer 71

Ocular staining score of at least > 3 Biopsy of salivary glands showing lymphocytic sialadenitits Positive Anti-Ro or Anti-La OR positive RF and Positive ANA Patients must have 2 citeria

Answer 72

Characterized by bone formation at the site of involved joint Contained within the bone = subchondral sclerosis Protrudes from the parent bone = Osteophytes

Answer 73

RA Indicates underlying inflammation Characterized by tiny, marginal, irregularly shaped lytic lesions in or around the joint surfaces

Answer 74

Characterized by joint swelling, osteopenia, and destruction of long, contiguous segments of the articular cartilage

Answer 75

Occurs on weight bearing joints such as hips, knees, humerus, feet, and hands

Answer 76

Post-traumatic infection

Answer 77

Associated with inflammation and synovial proliferation

Answer 78

These cause susceptible joint ``` Muscle strength of quadriceps femoris Physical activity/occupation --> constant use Joint injury --> ACL tear increases risk Joint alignment Leg length inequality ```

Answer 79

Knee mal-alignment

Answer 80

Obesity Diet Bone Metabolism

Answer 81

Age --> older Sex --> WOmen Genetics Ethnicity

Answer 82

``` IV drug use Chronic Steroid use Joint replacement Recent joint trauma Diabetes ```