Rheum Flashcards
What’s the first choice medication for RA?
Mtx
What’s the mechanism of action for methotrexate? Supplement with what medication?
Dihydrofolate reductase inhibitor; folate
What organ toxicity (3) is there for methotrexate?
Marrow suppression, pneumonitis, and hepatotoxicity
Avoid rx methotrexate In conjunction with what medication?
Trimethoprim-sulfamethoxazole
Which 2 RA meds can be used in pregnancy?
Hydroxychloroquine and sulfasalazine
Sulfasalazine causes what side effect in men?
Decreased sperm count
Which gene test should be checked before administering azathioprine to prevent dangerous bone marrow suppression?
TPMT gene test (thiopurine S-methyltransferase)
With osteoarthritis, what would you expect the ESR and CRP levels to be?
Normal (versus elevated in rheumatoid arthritis)
Needle-shaped, (-) birefringent crystals Dx of?
Gout (monosodium urate crystals)
What’s the mechanism of action for methotrexate? Supplement with what medication?
Dihydrofolate reductase inhibitor; folate
What is the most sensitive method of diagnosing avascular necrosis?
MRI
With systemic lupus erythematosus exacerbation, what would you expect the complement (high/low), anti-dsDNA (pos/neg) and ESR (high/low) levels to be?
Low complement, pos anti-dsDNA, high ESR
Rapid fire assoc:Rhomboid crystals, (+) birefringent
Pseudogout (calcium pyrophosphate dihydrate crystals)
Which agent used in the treatment of rheumatoid arthritis requires frequent eye exams?
Hydroxychloroquine
Rapid fire assoc:Polished, “ivory-like” appearance of bone at cartilage erosion
Eburnation (osteoarthritis resulting in bony sclerosis)
What is the most specific test for diagnosing rheumatoid arthritis?
Anti-citrullinated protein(anti-CCP) antibody
What is the leading cause of death inpatients with systemic lupus erythematosus?
Cardiovascular disease
Painful fingers/toes changing color from blue to white to red with cold or stress
Raynaud phenomenon (vasospasm in extremities)
What would you expect pleural effusion glucose level to be in individuals with rheumatoid arthritis?
Less than 30 mg/dl
Dry eyes, dry mouth, arthritis Dx?
Sjogren syndrome (autoimmune destruction or exocrine glands)
What rheumatological condition can often be associated with temporal arteritis?
Polymyalgia rheumatica(PMR)
What is the most common extra-articular manifestation of rheumatoid arthritis?
Subcutaneous Rheumatoid nodules
Rapid fire assoc: Anticentromere antibodies
Scleroderma (CREST)
Rapid fire assoc: Anti-topoisomerase antibodies
Diffuse systemic scleroderma
Urethritis, conjunctivitis, arthritis in a male
Reactive arthritis associated with HLA-B27
Rapid fire assoc:”Bamboo spine” on x-ray
Ankylosing spondylitis (chronic inflammatory arthritis: HLA-B27)
What is the initial diagnostic test to check in an individual you suspect to have temporal arteritis?
ESR
What is the goal uric acid level to prevent further attacks in patients with gout? Goal w/tophi?
Less than 6mg/dl, less than 5
Rapid fire assoc:Antineutrophil cytoplasmic antibodies (ANCAs)
Microscopic polyangiitis and eosinophilic granulomatosis with polyangiitis (Churg-Strauss syndrome) (MPO-ANCA/p-ANCA); granulomatosis with polyangiitis (Wegener; PR3-ANCA/c-ANCA)
What is the initial diagnostic test to check of an individual you suspect of having polymyositis?
Creatine phosphokinase (CPK)or Creatinine kinase (CK)
Rapid fire assoc:Antihistone antibodies
Drug-induced SLE (eg, hydralazine, isoniazid, phenytoin, procainamide)
Rapid fire assoc:Anti-IgG antibodies
Rheumatoid arthritis (systemic inflammation, joint pannus, boutonniére deformity)
Rapid fire txt: Kawasaki disease
IVIG, high-dose aspirin
What class of medication is the first-line treatment of renal crisis in scleroderma?
ACE inhibitors
What HLA marker can often be associated with ankylosing spondylitis?
HLA-B27
Patient who uses cocaine and has a weak handshake. What is the likely diagnosis?
Inclusion body myositis
Rapid fire txt: Chronic gout
Xanthine oxidase inhibitors (eg, allopurinol, febuxostat); pegloticase; probenecid
Patient with rheumatoid arthritis on leflunomide decides she wants to get pregnant. What is the best next step in management?
Give cholestyramine for 9-11 d for leflunomide wash out
Rapid fire txt: Acute gout attack
NSAIDs, colchicine, glucocorticoids
Patient with polymyositis is on high dose steroids. CPK levels are improving but weakness worsening. What to do?
Taper down on the steroids
If pts with osteoarthritis present with morning stiffness, what length of time should it not exceed?
30 minutes
Of the MCP, PIP, and DIP joint, which of the following is least likely to be involved with rheumatoid arthritis?
DIP joint
Greater than what value is the WBC count expected to be in cases of septic arthritis?
More than 50,000/uL
what is the Initial step for a patient symptomatic for Atlanto-odontoid subluxation?
Cervical spine X Ray with flexion and extension views.
Antibody in diffuse systemic sclerosis?
Anti SCL 70. AntiTopoisomerase.
Cytoplasmic vacuolization in muscle is Seen with what dz that also has elevated CK?
Chronic accumulation of colchicine in ckd patients
What are the components of felty syndrome?
Rheumatoid arthritis, neutropenia, splenomegaly
What dz is suggested by aggressive destruction of the glenohumeral joint & rotator cuff and has a hemorrhagic effusion?
Basic calcium phosphate deposition dz, Milwaukee shoulder
