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Step 2 Rotation Cards > Rheum > Flashcards

Rheum Flashcards

1
Q

causes of acute joint pain (typically just 1 joint)

A

trauma
infection
crystal
reactive

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2
Q

athrocentesis of OA

A

serous
<2000 WBCs, 25% PMNs
no crystals

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3
Q

athrocentesis of septic joint

A

pus opaque white fluid
>50,000 WBCs
+ gram stain and culture - if no staph check for gonorrhea

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4
Q

arthrocentesis of inflammatory joint

A

cloudy
>2000 - <50,00 WBCs (10,000)
>50% PMNs
+/- crystals

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5
Q

+ ANA =

A

SLE

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6
Q

+ RF

A

RA

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7
Q

+ anti citrullinated c peptide

A

RA

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8
Q

+ ds DNA ab

A

SLE and lupus nephritis

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9
Q

+ Anti histone ab

A

drug induced lupus

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10
Q

+ anti centromere

A

scleroderma

CREST

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11
Q

+ topoisomerase (Scl 70)

A

systemic scleroderma

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12
Q

+ smooth muscle ab

A

autoimmune hepatitis

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13
Q

anti Ro

anti La

A

sjogrens

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14
Q

anti Jo ab

A

polymyositis

dermatomysositis

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15
Q

anti mitochondrial ab

A

Primary biliary sclerosis

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16
Q

SLE path

A

autoimmune complex
F > M
Black > white

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17
Q

SLE presentation

4/11

A 
Malar rash - butterfly - (spares nasolabial folds)
Discoid rash 
Serositis (pleuritic CP) 
Oral ulcers
Arthritis (large joints) 
Photosensitivity (sunburn)
Blood (amenia, thrombocytopenia)
Renal failure (nephritis) 
ANA + 
Immunologic 
Neuro (cerebritis, psychosis, AMS)
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18
Q

complications of SLE

A

endocarditis - vegetations on both sides of the valve

ESRD

Miscarriages

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19
Q

dx of SLE

A

1st - ANA (sensitive but not specific)
2nd - ds DNA (nephritis), anti smith, antihistone (drug induced)

ESR and CRP
complement levels - low C3 and low C4

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20
Q

tx of SLE

A

hydroxychloroquine - ADR - retinopathy

steroids (flare)

nephritis - IV cyclophospamide –> oral mycophenolate

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21
Q

drug induced lupus

path and pt presentation

A

path - antihistone

presentation - rash and pain after taking a medication

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22
Q

dx and tx of drug induced lupus

A
  • medication reconciliation
  • antihistone ab

tx - remove offending agent

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23
Q

medications that cause drug induced lupus

A

hydralazine
procainamide
methyldopa

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24
Q

lupus nephritis

path and pt presentation

A

path - ds DNA abs
pt - asx - U/A micro –> proteinuria
or
pt - HTN, massive proteinuria, hematuria

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25
Q

dx and tx of lupus nephritis

A

dx - biopsy

tx - IV cyclophosphamide –> oral mycophenolate

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26
Q

path of RA

A

autoimmune (F>M) [45 years old]

pannus grows –> erosions of joint

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27
Q

Dx criteria for RA

A 
joints 
morning stiffness >60min 
nodules 
imaging 
blood  - CCP>Rf
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28
Q

joints in RA

A

small joints affected - hands and feet
swanneck deformities
crooked bent fingers

> 3 joints = symmetric

NO DIP involvement

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29
Q

nodules in RA

A

late finding in dz

biopsy –> cholesterol

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30
Q

imaging in RA

A

morning stiffness + C1 and C2 pain –> c spine x-ray

erosions, periarticular osteopenia

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31
Q

tx of RA

A

NSAIDs (ibu, meloxicam) - (never monotherapy)
+
DMARDs - 1) MTX, 2) leflunomide, 3) hydroxycholoroquine 4) sulfasalizine
- combine DMARDS before you go to biologics
- pregnant use (3) or if no erosion present

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32
Q

tx of Severe RA

A

NSAIDS + DMARDs + Biologics (TNF alpha inhibitors) - inflixumab, rituximab, etanerept)

before giving biologics - vaccinate, test for tb, fungal exposure?

+/- steroids if flare (prednisone)

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33
Q

FELTY syndrome

A

splenomegaly
RA
Neutropenia

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34
Q

scleroderma path

A

collagen deposition

anti centromere - CREST
anti topisomerase - scl 70

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35
Q

scleroderma CREST

A

C - calcinosis - HTN
R - raynauds
E - esophageal dysmotility - unrelenting GERD
S - sclerodactyl - no wrinkles, tense,
T - telengiectasias - gi bleed/iron def anemia

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36
Q

complications of scleroderma

A

Pulmonary arterial HTN
Constrictive pericarditis
Slceroderma renal crisis - tx = ACE -I

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37
Q

tx of scleroderma renal crisis

A

ACE-I

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38
Q

diffuse cutaneous systemic sclerosis

A

CREST + visceral involvement

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39
Q

tx of CREST ISSUES

A

Raynauds –> CCV
esophageal dismotility —> PPI
Sclerodactyl –> Penicillamine

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40
Q

Nephrogenic systemic sclerosis

A

occurs after receiving Gallidinium and MRI

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41
Q

sjogrens path

A

lymphoplasmocytic infiltration of the exocrine glands

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42
Q

pt presentation of sjogrens

A

dry eyes - keratoconjuctivitis - SICA
dry mouth - Xerostomia
parotid swelling

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43
Q

sjogren dx

A

1st - ANA
2nd - Ro and La abs
3rd schimer test –> can they make tears

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44
Q

tx of sjogrens syndrome

A

artificial tears

artificial saliva

45
Q

path behind dermatomyositis and polymyositis

A

dermatomyositis –> complex deposition dz - risk of malignancy

polymyositis –> T cell dz

46
Q

presentation of polymositis and dermatomyositis

A

proximal muscle weakness
heliotrope rash - face
gottrons papules

47
Q

dx of polymyositis and dermatomysotis

A

increased CK –> EMG –> biopsy (best)

abs - anti Mi and anti Jo

48
Q

things that increase uric acid

A

etoh
red meat/ seafood
fructose

49
Q

pseudogout

A

(+) birefringent
rhomboid shape
costocalcinosis
calcium pyrophosphate

50
Q

tx of pseudogout

A

colchicine
NSAIDs
Steroids

51
Q

gout

A

(-) birefringent
needle shaped
monosodium urate

  • decreased elimination - tx - propenecid
  • increased production - tx - rasbirucase
52
Q

tumor lysis syndrome can lead to

A

increased production of uric acid

prophylaxis with IVF and allopurinol

53
Q

management of Gout

A

lifestyle modifications
allopurinol or febuxostat

colchicine (#1), NSAIDs, steroids

54
Q

things that lead to gout

A

Tumor lysis syndrome
CKD
alcohol
thiazide diuretics

55
Q

management of staph infected septic arthritis

A

naficillin

- unless MRSA –> vanco or linezolid

56
Q

what type of joints does SLE have a predilection for

A

large joints

57
Q

ankylosing spondylitis

A

M > F
sacroilitis - low back pain - gets better with use - morning stiffness

dx - lumbar spine - bamboo spine

tx - NSAIDs, local steroids, TNF alpha I

58
Q

psoriatic

A

psoriasis and arthritis
M > F
nail pitting

tx - NSAIDs, local steroids, DMARDs, TNF alpha I

59
Q

Reactive

A

M > F
STD hx
urethretis + arthritis
tendon pain

if conjuctivitis present = reiters syndrome

60
Q

tx of reactive arthritis

A

if infectious - azithro or doxy + ceftriaxone

if not infectious - NSAIDs + time

61
Q

IBD related arthritis

A

hx of crohns or UC + arthritis

tx - treat the IBD arthritis gets better

62
Q

giant cell arthritis

A

path - large vessel dz
Arteries : external carotid, ophthalmic, temporal
Women >50 y/o
jaw claudication, vision changes (amarosis fugax) , temporal tenderness

63
Q

dx and tx of giant cell arthritis

A

dx - biopsy granulomas but dont wait for this begin tx

tx - steroids

64
Q

takaysu arteritis

A

<40 y/o, also large vessel
aorta and its branches - femoral, subclavian

pulselessness

dx - angiogram
tx - steroids

65
Q

Polyarteritis nodusa (PAN)

A

medium vessels, gut renal skin
ASSOCIATED WITH HEP B

mesenteric ichemia, renal failure, purpura or painful nodules

66
Q

dx and tx of PAN

A

dx - angiogram -> aneurysms of medium vessels

tx- steroids + cyclophosphamide

67
Q

mononeuritic multiplex

A

associated with PAN

painful asymmetric peripheral nerve pain

68
Q

cryoglobulinemia

small vessel

A

ASSOCIATED WITH HEP C

palpable purpura
dx –> cryoglobulins, decreased complement

tx - plasmophoresis if severe
steroids and cyclophosphamide

69
Q

Wegeners

A

small vessel
ANCA associated

Hemoptysis, hematuria, nose issues

dx -C-ANCA, biopsy –> lung
tx - steroids + cyclophosphamide

70
Q

Henoch Schloein Purpura

A

palpable purpura, GI symptoms

dx - biopsy - leukocytoclastic vasculitis

tx - steroids

71
Q

neonatal lupus

A 
skin lesions
cardiac abnormalities (av block, transposition of great vessels) 
valvular and septal defects
72
Q

SLE valve issues

A

libman sacks endocarditis

vegetations on both sides of the valve

73
Q

C-ANCA

A

wegeners granulomatosis

74
Q

P-ANCA

A

polyarteritis nodusa

75
Q

lupus anticoagulant

A

antiphospholipid syndrome

76
Q

ADR of hydroxchloroquine

A

retinal toxicity

77
Q

the most common cause of death in SLE pts

A

opportunistic infections and renal failure

78
Q

diffuse scleroderma

A

rapid onset
widespread skin involvement - more skin involved worse prognosis
antitopoisomerase (scl 70) ab

79
Q

antiphospholipid syndrome

A 
hypercoagulable states 
recurrent venous thrombosis 
recurrent arterial thrombosis 
recurrent fetal loss 
thrombocytopenia
80
Q

anticentromere antibody

A

limited CREST scleroderma

81
Q

most common cause of death in scleroderma

A

pulmonary involvment

82
Q

complication of scleroderma

A

occult malignancy

increased risk for NHL

83
Q

deformities in RA

A 
boutonnier deformities (PIP) 
swan neck

C1-C2 subluxation and instability

84
Q

felty syndrome

A 
S- splenomegaly 
A- arthritis (RA) 
N- neutropenia 
T- thrombocytopenia 
A- anemia
85
Q

ADR of MTX

A

bone marrow suppression
elevated LFTs - hepatocellular injury
GI upset, ulcers, stomatitis
mild alopecia

86
Q

precipitants of acute gouty attack

A 
decreased temperature 
stress 
dehydration 
starvation 
excessive alcohol intake
87
Q

features of OA

A

heberdens nodes

brouchard nodes

88
Q

radiograph of gout

A

punched out erosions with an overhanging rim of cortical bone in advanced disease

89
Q

complications of gout

A

nephrolithiasis

degenerative athritis

90
Q

medications to avoid in gout

A

aspirin - can aggravate it

tynelol no anti inflammatory properties

91
Q

uricosuric drugs

A

probenecid
sulfinpyrazone

indicated if <800mg/day uric acid

92
Q

xanthine oxidase inhibitor

A

allopurinol

> 800mg/day

93
Q

dx of pseudogout

A

joint aspirate - weakly positively birefringet, rod shaped and rhamboid crystals in synovial fluid

calcium pyrophosphate

94
Q

radiographs of pseudogout

A

chondrocalcionosis

cartilage calcification

95
Q

muscles affected in both polymyositis and dermatomyositis

A

proximal muscle
neck flexors
shoulder girdle
pelvic girdle muscles

96
Q

unique features of dermatomyositis

A

heliotrope rash - face - on nasal bridge

gottrons papules - scaly lesions over the knuckles

97
Q

dermatomyositis has an increased risk for

A

malignancy

98
Q

muscle biopsy of polymyositis

A

endomysial

99
Q

muscle biopsy of dermatomyositis

A

perivascular and perimysial

100
Q

tx of fibromyalgia

A

exercise low intensity

TCS (amitryptilline)

101
Q

Most common extra articular manifestations in ankylosing spondylitis

A

anterior uveitis

cardiac (AV heart block and aortic insufficiency)

102
Q

complications of ankylosing spondylitis

A 
restrictive lung dz 
cauda equina syndrome 
spine fracture with cord injury 
osteoporisis 
spondylodisetis
103
Q

reiter syndrome

A

athritis
conjuctivitis
urethritis

104
Q

signs of psoriatic arthritis

A

sausage digits

nail pitting

105
Q

churg strauss syndrome

A

vasculitis of multile organts
prominent resp tract findgins (asthma)
eosinophilia

p-ANCA

106
Q

wegeners granulomatosis

A

renal dz - mcc of death

vasculitis predmoninantly involving kidneys and upper and lower resp tract

sinusitis
glomerulonehpritis
ESR high and C-ANCA

107
Q

behcet syndrome

A

autoimmune
painful sterile oral and genital ulcerations
eye involvment

108
Q

bergers diz

A

smoker
phlebitis
autoamputationa and gangrene risk

Step 2 Rotation Cards (14 decks)

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