Rheum in STEP 1 Book

Question 1

What happens to joints in Osteoarthritis?

Answer 1

Wear and tear destroys articular cartilage

Question 2

What does Osteoarthritis look like in patients?

Answer 2

Sclerosis, bone spurs, Heberden nodules in DIPs, Bouchard nodes (PIP), no MCP involvement

Question 3

What can predispose for osteoarthritis?

Answer 3

Age, obesity, and joint trauma

Question 4

What should trigger you to an Osteoarthritis case?

Answer 4

Pain in weight bearing joints, cartilage loss begins medially, noninflammatory

Question 5

How do you treat Osteoarthrits?

Answer 5

Acetaminophen
NSAIDS
Intra-articular glucocorticoids

Question 6

What causes RA?

Answer 6

Autoimmune reaction mediated by cytokines and type 3 and 4 hypersensitivity reactions

Question 7

What do the joints look like in RA?

Answer 7

Pannus formation
Subcutaneous rheumatoid nodules
Ulnar deviation of fingers
Swan neck and Boutonniere deformities

Question 8

RA has strong association with HLA what?

Answer 8

HLA DR4

Question 9

Patient key characteristics that can help focus in on RA?

Answer 9

Morning stiffness more than 30 minutes
Systemic symptoms
Symmetric joint involvement

Question 10

Treatment for Rheumatoid Arthritis?

Answer 10

NSAIDS
Glucocorticoids
TNF-a inhibitors

Question 11

Sjogren’s syndrome destroys what?

Answer 11

Exocrine glands such as salivary and lacrimal with lymphocytic infiltration

Question 12

What primary disorder can Sjogren’s be associated with?

Answer 12

RA

Question 13

Complications of Sjogren’s?

Answer 13

Dental carries
Lymphoma (parotid enlargement)
Mucosa associated Lymphoid Tissue (MALT)

Question 14

Patient findings in Sjogren’s?

Answer 14

Inflammatory joint pain
Decreased tears or saliva
Antinuclear antibodies SS-A SS-B
Bilateral parotid enlargment

Question 15

What crystal causes gout?

Answer 15

Monosodium urate crystals

Question 16

What two things can cause hyperuricemia?

Answer 16

Underexcretion

Overproduction

Question 17

Which is the more likely cause of hyperuricemia?

Answer 17

Underexcretion

Question 18

Shape and color of gout crystals?

Answer 18

Needle shaped and yellow under parallel light, blue under perpendicular. - birefringent

Question 19

Symmetric or asymmetric in gout?

Answer 19

Asymmetric

Question 20

Classic manifestation of Gout?

Answer 20

Swollen, red, and painful MTP joint of big toe

Question 21

In Gout tophi normally form where?

Answer 21

External ear, olecranon bursa, or Achilles tendon

Question 22

Interaction between uric acid metabolism and alcohol?

Answer 22

Alcohol metabolites compete for same excretion sites in kidney as uric acid which leads to acid buildup in blood

Question 23

Treatment for Gout?

Answer 23

NSAIDS
Glucocorticoids
Xanthine oxidase inhibitors

Question 24

What crystals are involved in Psuedogout?

Answer 24

Calcium pyrophospahte

Question 25

Which joint does Pseudogout normally hit?

Answer 25

Knee in those older than 50

Question 26

What color are Pseudogout crystals?

Answer 26

Blue when parallel to the light

Question 27

Disease associated with Psuedogout?

Answer 27

Hemochromatosis Hyperparathyroidism Osteoarthritis

Question 28

Treatment for Pseudogout?

Answer 28

NSAIDS Glucocorticoids Colchicine for prophylaxis

Question 29

Common causes for infectious arthritis?

Answer 29

Staph aureus Streptococcus Neisseria gonorrhoeae

Question 30

How does Gonococcal arthritis present?

Answer 30

Migratory arthritis with asymmetric pattern

Question 31

3 main symptoms of Gonococcal arthritis?

Answer 31

Synovitis (Knee) Tenosynovitis (Hand) Dermatitis (Pustules) (STD mnemonic)

Question 32

What are seronegative spondyloarthropathies?

Answer 32

Arthritis without RF, strong association with HLA B27 that occurs more often in males

Question 33

What gene is coded for by HLA B27?

Answer 33

MHC Class 1

Question 34

Diseases that fall into the category of Seronegative spondyloarthopathies? (PAIR mnemonic)

Answer 34

Psoriatic arthritis Ankylosing Spondylosis Inflammatory Bowel Disease Reactive Arthritis (Reiter's Syndrome)

Question 35

What does Psoriatic Arthritis present as?

Answer 35

Asymmetric and patchy involvement | Sausage fingers

Question 36

Anylosing spondylosis presents as?

Answer 36

Chronic inflammatory disease of spine and sacroiliac joints, Stiff spine, vertebral fusion, uveitis, aortic regurgitation

Question 37

Inflammatory bowel disease presents as?

Answer 37

Inflammatory diseases such as Chron's disease and ulcerative colitis often accompanied by ankylosing spondylitis or peripheral arthritis

Question 38

Classic triad of Reiter's Syndrome? (Can't see, can't hear, can't bend my knee")

Answer 38

Conjunctivits Urethritis Arthritis

Question 39

What can trigger Reiter's syndrome ?

Answer 39

Post-GI infection

Question 40

Classic presentation of SLE?

Answer 40

Rash, joint pain, and fever

Question 41

What type of hypersensitivity reaction is SLE?

Answer 41

Type 3

Question 42

Common causes of death in SLE?

Answer 42

Cardiovascular disease (Wart like vegetations on heart valves) Infections Renal disease

Question 43

Anti-dsDNA antibodies in SLE say what?

Answer 43

``` Poor prognosis (renal disease) Specific ```

Question 44

Antihistone antibodies sensitive for what?

Answer 44

Drug induced lupus

Question 45

Immune complex formation causes what changes to complement?

Answer 45

Decrease in C3, C4, and CH50

Question 46

How to you treat SLE?

Answer 46

NSAIDs Steroids Immunosuppressants Hydroxychloroquine

Question 47

What is Antiphospholipid syndrome?

Answer 47

Primary or secondary autoimmune disorder most commonly in SLE

Question 48

What lab findings are there in Anti-phospholipid syndrome?

Answer 48

Lupus anticoagulant Anti-cardiolipin Anti-B2 glycoprotein antibodies

Question 49

How do you treat Anti-phospholipid syndrome?

Answer 49

Systemic anticoagulation

Question 50

Anticardiolipin and Lupus anticoagulant can cause what?

Answer 50

False positive VDRL and prolonged PTT

Question 51

RASH OR PAIN mnemonic for SLE?

Answer 51

``` Rash Arthritis Soft Tissues Hematologic disorders Oral/nasopharyngeal Renal Disease, Raynaud's Photosensitivity, Positive VLDR Antinuclear antibodies (ANA) Immunosuppresents Neurologic disorders ```