Rheum/MSK Flashcards by Aaron Sircy

What Rheum disease has daily fever, rash, and arthritis? This eventually resolves but does recur

What lab value is elevated?

Adult Still Disease (Ferritin Level)

Pediatric Onset is the Systemic Juvenile Idiopathic Arthritis

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Rheumatoid Patients that have chronic steroid use should be evaluated for what?

Osteoporosis

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Thick skin over the hands, elevated BP, Raynaud Phenomenon, elevated BP 200+, elevated Creatinine, what should be given?

Captopril, ACE inhibitor, Scleroderma Renal Crisis

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What is positive ANA and positive Anti-centromere?

Limited Cutaneous Systemic Sclerosis

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Ankylosing Spondylitis have a higher rate of what GI problem?

Inflammatory Bowel Disease

Look out for abdominal pain, diarrhea, or change in bowel habits

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If patients have Sjogren Syndrome related oral dryness and candy does not work, what is the next best medications?

Cevimeline or Pilocarpine

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Systemic Sclerosis -> interstitial lung disease, what is the mainstay of treatment?

Mycophenolate Mofetil

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What rheum pathology has the following:

Renal Vasculature problems (pathology has “beads on a string”, nodular skin lesions, abdominal pain, and mononeuritis multiplex

Usually associated with Hep B and/or Hep C

Pan Nodularis

Remember Mesenteric Ischemia can occur as well!

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Rheumatoid Arthritis + Neutropenia + Splenomegaly is what?

Felty Syndrome

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Lupus Nephritis, systemic disease, patient’s get steroids and what two other drugs?

Hydroxychloroquine and Mycophenolate

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Multiple episodes of abdominal pain, rash, arthritis that resolve after 1 week, grandparents had a similar work up. What is this?

What is a treatment?

Familial Mediterranean Fever

Colchicine, decrease inflammation and amyloid protein

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Acute gout, without any kidney disease. What is the first line?

Colchicine

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Proximal and Distal Muscle Weakness, over a long period of time, autoimmune, what might this be?

Inclusion Body Myositis
Unresponsive to immunosuppression

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Polymyositis has what distinct muscle characteristic?

Proximal Muscle weakness, happens fairly quickly, happens over a period of weeks

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Granulomatosis with Polyangitis (GPA), what is the treatment?

Steroids and Rituximab

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What is this?

Discoid subacute cutaneous lupus

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Skin and joint problems while taking Minocycline, what is this? Think about autoimmune issues

Drug induced Lupus

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Patient has mixed osteolytic changes, back pain, and elevated ALP, what is this?

Paget Disease of the Bone

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Lupus Perino is a skin manifestation seen in some patients with what disease?
Are these rashes photosensitive

Sarcoidosis

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Pustular Lesions and visible telangiectasia that does not spare the nasolabial fold is what?

Rosacea

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Dermatomyositis patients that are using steroids, what two medications should be looked at to decrease overall steroid use?

Methotrexate or Azathioprine

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Small Intestinal Bacterial Overgrowth has usual hallmark signs?

Explosive diarrhea, right after a meal

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Small Intestinal bacteria overgrowth is detected and treated how?

Glucose, Hydrogen, and Lactulose Breath Tests

Antibiotics, every month rotating which ones are given

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Poorly Controlled Ankylosing Spondylitis, can develop what kidney pathology?

Renal Amyloidosis

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Poorly Controlled Ankylosing Spondylitis via NSAIDS, what is the next medication?

Etanercept

What is this?

Acute Lupus Flare

How long after an enteric infection or a bout of nongonococcal urethritis or cervicitis with reactive arthritis occur?

2-3 weeks

What two medication groups can cause a dry mouth?

Anti-depressants and Anti-histamines, mouth breathing are common causes of dry mouth

Contraindications to allopurinol therapy, what is the next medication?

Febuxostat, best in moderate to severe CKD

Fibromylagia, what is the best treatment of choice?

Pregabalin | Otherwise, exercise is #1

What type of secondary arthritis should be suspected when arthritis of an early age occurs? Think about bad liver and testicular infertility, as well

Hereditary Hemochromatosis

Pregnant patients having a Lupus flare, what is the best treatment?

Prednisone treatment

HLAB 57:01, has be tested for what anti-viral evaluation?

Abacavir

HLAB 58:01, has to be tested for what medication evaluation in Hans-Chinese patients?

Allopurinol Hypersensitivity

Giant Cell Arteritis/Severe RA treatment, to spare using steroids, what should be used?

Tocilizumab | IL-6 inhibitor

Sjogren's Syndrome, what is the patient at an increased risk for of getting? (Think cancer type)

B-cell and MALT Lymphoma

Osteoarthritis, initial treatment, what is the best medication, Tylenol or NSAID?

NSAID

Does a patient have to have a positive antibody histone to have and SLE drug induced reaction?

What is +ANA, +anti-Scl-70, anti-RNA pol III, and anti-topoisomerase I?

Diffuse Cutaneous Systemic Sclerosis

What is the anti-U1 RNP and ANA positive?

Mixed Connective Tissue Disease

# Most likely disease with the following antibodies +ANA, +anti-jo-1, +anti-synthetase

Polymyositis or Dermatomyositis

What is a + ANA, + anti-centromere antibodies?

Limited Cutaneous SS

What is + ANA, + anti-topoisomerase I (anti- scl-70) and anti-RNA polymerase III?

Diffuse Cutaneous SS

Churg Strauss has a positive what type of antibody?

+ Anti-myeloperoxidase antibodies

Behcet Disease is associated with what HLA?

HLA B51

Anterior Uveitis, chronic oral aphthae, skin hyperpigmentation, erythema nodosum, and autoimmune is what?

Behcet Disease

Physical exam shows Rash (Silvery scale) on red patches, Nail pitting, Dactylitis, and Arthritis Multilans (Digital Shortening due to resorptive arthritis, pencil in cup), what is this?

Psoriatic Arthritis

Lymphocytic infiltration of salivary glands and lacrimal glands, collections of focal lymphocyte aggregates, what disease is this?

Sjogren Syndrome

Hand Xray that has hook-like osteophytes and squared off bone ends as well as chondrocalcinosis, what is this?

Hemochromatosis Arthropathy/Arthritis

What is seen in the XR hand?

Gout XR hand can also show bone erosions with overhanging edges

Hand Osteoarthritis of the first CMC joint, what is the first line treatment?

Joint Orthoses, hand brace

What medication can help with low back pain, not tylenol or NSAID?

Duloxetine

Patient has an anatomical snuff box fracture, what test should be done after a negative X-ray?

MRI Hand, concern for scaphoid fracture

Sjogren's Syndrome has increased risk of what cancer?

Non-Hodgkin Lymphoma

What is the MOA of Secukinumab? When is it used?

IL-17 inhibitor, used with active psoriatic arthritis refractory to 2 different TNF inhibitors

What is the first line medication for Fibromyalgia?

Amitriptyline

Can Methotrexate be continued during pregnancy?

No, should be stopped 3 cycles before starting to conceive

Tocilizumab can be a treatment for Rheumatoid Arthritis. What is the MOA? What should be monitored while taking the drug?

IL-6 inhibitor Lipid Profile

Limited Cutaneous Systemic Sclerosis and Raynaud Phenomenon that has failed multiple therapies, what should be given, almost last line?

lloprost Prostacyclin PGI2 analogue, dilates systemic and pulmonary arterial vascular beds

Joint culture that shows cells of 50K to 150K, PMN > 75% is what?

Septic Joint

Tofacitinib is being considered for RA treatment. The patient has +TB skin test. No active symptoms, what should be done?

Latent TB should be treated before Medication initiation

Fibromyalgia, what is a mainstay of treatment?

Exercise and CBT, is #1

Rheumatoid Arthritis that has not improved with max methotrexate. What is the next step?

Adalimumab, TNF inhibitor

How long must a Fibromyalgia patient have symptoms in order to have the diagnosis?

3 months

A patient is taking Alemtuzumab for Psoriasis, what is a side effect?

Thyroiditis

A patient has decreased reflexes what is one or two causes? | Not related to nerve pathways and lesions

OTC or elevated Magnesium

Autoimmune Hepatitis has what antibody?

+Smooth Muscle Antibody titers +LKM-1

What is the first line and second line treatment for Autoimmune Hepatitis?

1) Steroids 2) Azathioprine

Primary Biliary Cholangitis has what positive antibody? What is the treatment?

anti- Mitochondrial antibody (AMA) titer Urosodeoxylic acid

What is this disease? Think autoimmune

Psoriasis "pencil in cup"

What is this disease? Think routine patient

Osteoarthritis, "sea gull wing"

What shoulder pathology has orange/red clumps, hydroxyapatite arthropathy, and history of trauma to the shoulder (sometimes)? What does the synovial fluid look like?

Milwaukee Shoulder, Basic Calcium Phosphate Deposition

When Giant Cell Arthritis is being treated what determines if IV steroids will be given or not?

eye symptoms If eye symptoms -> IV steroids No eye symptoms -> PO steroids

Transplant associated gout is associated with the use of what medication?

Cyclosporine

What is the uric acid goal when patients are treated with allopruinol?

Serum Urate level less than 6

Calcium Pyrophosphate Deposition can be associated with what 4 underlying metabolic disorders?

Hemochromatosis Hyperparathyroidism Hypothyroidism Hypomagnesemia

What primary bone cancer has "popcorn calcifications", treatment is excision only?

Chondrosarcomas

What primary bone cancer has "sunray spiculation", "Codman's triangle"? This disease is biphasic. This disease shows up in the really young and really old.

Osteosarcoma

What primary bone cancer has "an onion ring sign"? This comes from malignant neural crest cells. This typically high grade.

Ewing Sarcoma

Primary Bone cancers can metastasize, where do they typically infect? (General Body Part)

Lungs

Anti-Smith antibody is most specific to what disease?

Lupus

Anti-dsDNA antibody correlates with what disease Severity?

Lupus Kidney disease

Anti-La/SSB antibody correlates to what?

Sjogren Syndrome (Sicca Syndrome) and Neonatal SLE

What does anti-CCP antibody correlate too?

Rheumatoid Arthritis

Anti-Jo-1 antibody correlates to what?

Polymyositis and Anti synthetase syndrome

P-ANCA (anti-MPO antibody) correlates to what?

Eosinophilic granulomatosis with polyangiitis (Churg Strauss syndrome) and MPA

C-ANCA (anti-PR3 antibody) coreelates to what?

Granulomatosis with polyangiitis (Wegner's Syndrome)

Anti-Ro/SSA antibody correlates to what three things?

Sjogren Syndrome, Neonatal Heart Block, and subacute cutaneous lupus

Anti-histone antibody correlates to what?

Drug-induced SLE

Anti-SCL-70 antibody correlates to what?

Systemic Sclerosis and pulmonary fibrosis/diffuse cutaneous Scleroderma

Procainamide Minocycline Hydralazine Quinidine Isonazid What can these four drugs cause or be responsible for?

Lupus Medication reaction (elevated anti-histone)

What medication should a Lupus patient take?

Steroids and Hydroxychloroquine, ok for pregnancy Will take 2 months to 6 months for maximum effect, need eye doctor follow up

Lupus Nephritis, what should the patient be on?

Cellcept (Mycophenolate) If proliferative GN -> prescribe IV cyclophosphamide

Hydroxychloroquine, azathioprine, cyclosporine, tacrolimus, colchicine, and prednisone are Lupus medications that are safe in what?

Pregnancy

Methotrexate and leflunomide are not allowed in what female medical state?

Pregnancy

How long does a women need to be on lupus medications before considering pregnancy?

6 months

Lupus Flare vs. Pre-Eclampsia, what labs will be seen?

Anti-dsDNA is elevated in Lupus, uric acid is low, elevated urine calcium Lupus will have low C3 and C4, as well Tx: Given Prednisone -> Lupus Flare

Dermatomyositis patients have an increased risk of what?

Adenocarcinoma of almost any organ

Fibromyalgia, treatment is usually SSRI, CBT, and PT. What is the next step if someone needs further medication?

Pregabalin

Ankylosing spondylitis can cause kidney problems, long term. How does this occur?

Renal Amyloidosis and IgA nephropathy