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Step 2 > Rheum HY > Flashcards

Rheum HY Flashcards

1
Q

Pt presents with:
HTN (200s/100s)
Low Platelets ( <50k)
Cr 3 elevated!
and has h/o Scleroderma (affects entire length of limb)
Dx/Treatment?!

A

Scleroderma renal crisis
Ace-I
(Lisinopril)

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2
Q

Nail pitting,
digital ischemia in cold weather (raynouads),
chronic heartburn (esophageal dysmotility).

Dx?
MCCOD?

A

CREST Scleroderma
Pulm HTN

(aka Limited Cutaneous Scleroderma)

Vasculopathy → pulmonary arteries lumen becomes fibrosed & narrowed.

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3
Q

Classic rheumatologic drug to avoid with scleroderma

A

Steroids
(increase risk of renal crisis)

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4
Q

Order of pulmonary manifestation of diffuse scleroderma

A

1st: Interstitial lung disease (fine crackles)
2nd: Pulm HTN

(s/t alveolar basement membrane fibrosis)

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5
Q

Hand ± wrist joint pain/swelling improves with use
Nail Pitting
Sausage digits (fingers or feet)
Dx?

A

psoriatic arthritis

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6
Q

40-50s Female
Finger (MCP/PIP) pain + Stiffness better w/ movement
Bilateral wrist/hand joint pain/swelling
No skin findings
↑ ESR
(–) Rheumatoid Factor
(+) Anti-CCP

Dx/Tx (1st/2nd line)?

A

Rheumatoid Arthritis
Methotrexate
TNF Inhibitors (if failed MTX)
*infliximab, etanercept, adalimumab

(negative Anti- RF/CCP/ANA do not r/o RA)

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7
Q

20-30s yo
Bilateral wrist/hand joint pain/swelling
Oral Ulcers

Dx/Tx?

A

SLE
Hydroxychloroquine

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8
Q

50+ yo Female
Bilateral pain & morning stiffness of, Neck, Shoulders, Hips, etc.
Joints have ↓ ROM
Fatigue, weight loss, ↑ ESR
Dx/Tx?

A

Polymyalgia rheumatica
Low Dose Prednisone (Glucocorticoid)

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9
Q

Methotrexate side effects (2)
screening (2)

A

Hepatotoxic
Pulmonary Fibrosis

(get initial LFTs & CXR)

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10
Q

Hydroxycholoquine side effect?
Screening?

A

Retinopathy

(get yearly eye exams)

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11
Q

TNF inhibitor side effects (2)

A

Malignancy (lymphoma)
Infections
(Granulomatous illness → Listeria; Legionella)

FYI: legionella tx FQ or Macrolide

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12
Q

25M with low back pain that is relieved with morning exercise.
Dx/Dxt/Tx

prognosis?

A

Ankylosing Spondylitis
X-Ray of Sacroiliac joints (Bamboo/fusion)
→ If negative, MRI of Sacroiliac Joints
NSAIDs

(Normal Life Expectancy)

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13
Q

29M with weeks of R knee pain, pain at the achilles tendon insertion (Enthacitis), psoriasiform lesions on the palms/soles
(+) recent h/o either:
- STI
- diarrhea
- glans penis ulcer

Dx/Tx?

A

Reactive Arthritis
NSAIDs

(only give ABxs if signs of infection: Fever, ↑ wbc, discharge)

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14
Q

Acute worsening of SLE symptoms
Dx/Tx?

A

Lupus Flair
IV Corticosteroids

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15
Q

Pt presents with new joint pain, pleuritic chest pain, and fever.
Recently placed on Hydralazine (Isoniazid)
Dx/Tx?

A

Drug-Induced Lupus
Stop the offending medication

(anti-Histone antibodies)
OTHERS: sulfonamides, Etanercept, phenytoin, procainamide

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16
Q

Neonate presents with Bradycardia (<60 bpm)
Dx/Etiology?

A

3rd degree heart block
Maternal SLE

(anti- Rho & anti-La IgG antibodies damage fetal conducting system)

17
Q

Butterfly rash beneath the nose/lower lip that worsens with sun exposure + chronic joint pain.
Dx?

A

SLE

18
Q

SLE pt with Hgb 8 & (+) Coombs test
Dx?
T__HSR

A

Auto-immune Hemolytic Anemia

(Type 2 HSR s/t ABs against own blood)

19
Q

What SLE Antibody is associated with kidney damage/disease activity?

A

Anti DS–DNA antibodies

20
Q

30s yo Female with:
Hypercoagulable (thromboembolic) state/sequelae
or
Unexplained Fetal loss
Positive ANA ± RPR
Dx?

A

Antiphospholipid antibody syndrome

(can also present w/ Mitral insufficiency: Holosystolic apex)

RPR is a false (+)

21
Q

33F with a 2 week history of painful/burning neuropathy
(+) abdominal pain
(+) weight loss
Angiography → segmental aneurysmal dilation of the SMA & IMA.

Dx/NBSIM + classic finding?
organ spared?

A

Polyarteritis nodosa
Biopsy affected organ
Bx finding → HepB surface Ag
Lungs spared
─
(Extra info)
Tx: Steroids or HBV therapy , if (+)

22
Q

Dry eyes/mouth
Parotid enlargement
Raynauds/ Interstitial lung dz
h/o auto-immune disease
Dx/Dxt/Tx? (lower yield)

A

(dry eyes + parotids = END of STORY)
Sjögren syndrome
Pilocarpine (+ Vit D)
Artificial tears/saliva
Anti Ro/La → Salivary gland biopsy

(Autoimmune destruction of exocrine glands)

23
Q

Antihistone antibodies are specific for ____.

A

drug-induced lupus

24
Q

African American patients are most commonly affected by limited cutaneous (CREST) Systemic Sclerosis.
_____ is present in approximately 90% of patients and typically precedes pulmonary HTN sxs by several years.

A

Raynaud phenomenon

Pulmonary arterial HTN → nl PFTs

25
Q

Considerable overlap between diffuse cutaneous SS (dcSS) and limited cutaneous SS (CREAST).
Both may present with:
- Raynaud phenomenon
- esophageal dysmotility (+ GERD)

But dcSS has skin thickening of the ___ & interstitial lung disease.

A

thickening trunk

26
Q

≥40F
proximal muscle weakness
otherwise normal neurologic exam
elevated creatine kinase
± elevated ESR
Dx/DxT/Tx?

dx can be s/t ___ do age appropriate screening

A

Polymyositis
Muscle Biopsy
Prednisone

(can be s/t paraneoplastic syndrome; do age-appropriate cancer screening)

27
Q

50+ y.o. Female
Low grade fever + malaise
Stiffness in shoulders, hips, neck, or extremities
Elevated ESR/CRP
Normal CK
Dx/Tx/Association

A

Polymyalgia Rheumatica
Low dose Prednisone
Association w/ giant cell (temporal) arteritis

28
Q

Presents with fever and the following triad of symptoms:
Migratory polyarthritis
Erythema nodosum
Bilateral hilar lymphadenopathy (fullness)
Dx/Tx

A

Lofgren syndrome (Sarcoidosis)
Glucocorticoids

29
Q

Review Sarcoid Features
Flip card.

A
30
Q

_____ antibodies are present in myasthenia gravis, which is characterized by muscle fatigability (weakness increases with repeated activity) and involves oculobulbar muscles in addition to proximal limb muscles.

A

Acetylcholine receptor

31
Q

LOW YIELD: syndrome characterized by
recurrent oral and genital ulcers
+ Skin and ocular problems
MCCOD: Thrombosis

A

Behçet syndrome

32
Q

Long-term cyclophosphamide use is associated with what 2 negative side effects?

A

Hemorrhagic cystitis
bladder cancer

33
Q

Myopathies
* Dermatomyositis
* Polymyositis
* Inclusion body myositis
present with muscle weakness w/o pain
↑ CK
EMG: polyphasic, short-duration, low-amplitude APs
First-line tx:

A

Glucocorticoids

34
Q

Symmetric proximal muscle weakness + skin findings
*Upper eyelids (heliotrope rash)
* Extensor surfaces of the hands rash
↑ CK
EMG: polyphasic, short-duration, low-amplitude APs

A

Dermatomyositis
(F>M)

35
Q

50 yo Male pt Asymmetric proximal & distal muscles weakness
↑ CK
EMG: polyphasic, short-duration, low-amplitude APs

A

Inclusion body myositis
(M>F)

36
Q

Symmetric proximal muscle weakness w/o skin findings
↑ CK
EMG: polyphasic, short-duration, low-amplitude APs

A

Polymyositis
(F>M)

37
Q

For TNF inhibitors (RA or IBD pt on Infliximab, etc.)
Bugs to screen for before starting:
Malignant complication with chronic use:
2 classic opportunistic infections:
Tx for RA when pregnant:

A

Screen for Hep B, TB, Hep C, HIV

Chronic use → Lymphoma risk

Opportunistic infx → Legionella or Listeria (Granulomatous illness)

RA pregnancy tx→ Hydroxychloroquine

38
Q

LUQ fullness and WBC of 1k
in a pt with Rheumatoid Arthritis
dx?

A

Felty Syndrome

(Triad: RA + Splenomegaly + neutropenia)

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