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CM2 Exam 2 > Rheum Pt Three- Paulson > Flashcards

Rheum Pt Three- Paulson Flashcards

1
Q

Juvenile Idiopathic Arthritis (JIA) is basically RA in _________

A

kids

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2
Q

JIA is a spectrum of chronic arthritides in patients who are _______ years old that involve at least _______ joint and have lasted for at least ______ weeks

A

≤ 16, 1 joint, 6 weeks

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3
Q

How many joints are involved in Oligoarticular JIA aka pauciarticular JRA?

A

less than or equal to 4 joints

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4
Q

What joint is mc involved in Oligoarticular JIA aka pauciarticular JRA?

A

Knees

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5
Q

What is a lab that will be elevtaed in Oligoarticular JIA aka pauciarticular JRA?

A

+ ANA (60%) and ESR/CRP may be mildly elevated

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6
Q

Those kiddos with Oligoarticular JIA aka pauciarticular JRA are at inscreased risk of ________ and must have regular _____-______ exams until the age of 18

A

uveitis, slit-lamp exams

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7
Q

Oligoarticular JIA aka pauciarticular JRA is often symmertric or asymmetric joint invovlement?

A

Asymmetric

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8
Q

A patient and child comes in and the mother states she has noticed that the child is all of a sudden walking funny and she has swelling in the knee. What should you be suspicious of?

A

Oligoarticular JIA aka pauciarticular JRA

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9
Q

Polyarticular JIA involves how many joints?

A

greater than or equal to 5

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10
Q

What lab is typically elevated in Polyarticular JIA?

A

ESR usually pretty high and pt will have a positive RF

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11
Q

Seropositive polyarticular JIA resembles the adult version of what disease?

A

RA and positive RF

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12
Q

Seropositive polyarticular JIA is symmertric or asymmeteric?

A

Symmetric arthritis, usually the small joints of hands and feet

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13
Q

Does seropositive polyarticular JIA have extraarticular invovlement?

A

Yes: rheumatoid nodules, Felty syndrome, vasculitis, lung disease can occur.

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14
Q

This type of polyarticular JIA is common in younger childre, affects larger joints (knees, ankles, wrists) and has NO extraarticular features

A

Seronegative polyarticular JIA

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15
Q

A patient presents with a fever that seems to wax and wane throughout the day and the patient has developed a “salmon-colored evanescent macular rash.” What disease should you be concerned about?

A

Systemic Onset JIA (SOJIA) aka Still’s disease

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16
Q

Paitents with Systemic Onset JIA (SOJIA) aka Still’s disease can have _______ which can be fatal

A

MAS (macrophage activation syndrome)

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17
Q 
This type of arthritis involves at least 1 joint (often in the small or medium joints and is asymmetric). It can be common to see these as well:
• DIP synovitis
• Dactylitis
• Nailpitting
• Psoriatic rash or FH of psoriasis
A

Psoriatic arthritis

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18
Q

Psoriatic arthritis can also be associated with acute anterior ________ so patients need regular screenings

A

uveitis

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19
Q

This type of jeuvenile arthritis causes sacroiliac tenderness and is associated with HLA-B27. You will commonly see inflammation at site of attachment of tendon/ligament to bone

A

Enthesitis-related JIA

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20
Q

Are labs helpful in the dx of juvenile arthritis?

A

—Clinically diagnosed
• No specific lab or imaging test to definitively confirm diagnosis, though they can guide you in the right direction.
• Exclude other possibilities

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21
Q

What are initial mainstays of therapy for juvenile arthritis while the patient is being referred to rheum?

A

NSAIDs & intraarticular joint injections
(Ibuprofen, Naproxen)
-intraartic triamicolone acetate

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22
Q

Patients with SOJIA may need this type of treatment for initial symptom control?

A

Steroid

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23
Q

What is a last resort tx for jeuvenile arthritis?

A
  • DMARD (Methotrexate)

- Biologics (Infliximab)

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24
Q

Patients with MAS would need what treatment urgently?

A

Cephalosporins & steroids

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25
Q

Which juvenile arthritis has the highest mortality?

A

SOJIA have the highest mortality

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26
Q

This is a chronic, systemic autoimmune disorder with fibrosis of the skin and other
organs and it literally means “hard skin”

A

Systemic Sclerosis (Scleroderma)

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27
Q

What is CREST syndrome? What does it stand for?

A

It is the limited (better outcome) form of Scleroderma

C- Calcinosis cutis 
R-Raynauds 
E- Esophogeal immotility
S- Sclerodactyly 
T- Telangictasias
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28
Q

What type of scleroderma has a worse outcome?

A

Diffuse type

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29
Q

Raynauds is often the first sign of what disease?

A

Scleroderma

30
Q

When you see “watermelon stomach” think of what disease?

A

Scleroderma

31
Q

Pericarditis is a common manifestation in what disease?

A

Scleroderma

32
Q

This clinical manifestation of Scleroderma can lead to malignant HTN and can lead to death

A

Scleroderma renal crisis (SRC)

33
Q

What labs are elevated in scleroderma?

A
  • ANA usually positive (>95%)
  • Anti-SCL-70 positive in 1/3 with diffuse disease and 20% with CREST
  • Poor prognosis
34
Q

What imaging should be done in a patient with scleroderma to detect lung changes? What other test should be done to check lungs?

A

CT, PFTs

35
Q

What imaging should be done to monitor a patient with scleroderma for pHTN?

A

echo

36
Q

Treatment for scleroderma?

A

Treatment is targeted to organs affected

37
Q

Treatment for scleroderma in a patient with diffuse skin involvement and/or systemic involvement?

A

Immune process targeted: glucocorticoids, methotrexate, mycophenolate mofetil (MMF), cyclophosphamide, IVIG

38
Q

Treatment for scleroderma in a patient with Raynauds?

A

CCB (nifedipine)

39
Q

______ disease is the leading cause of mortality in scleroderma?

A

lung

40
Q

This autoimmune disease is most commonly known for fatigue, joint pain and a rash

A

SLE (Lupus)

41
Q

Lupus has the highest prevalence in _________ females

A

childbearing

42
Q

Butterfly rash sparing the nasolabial folds and triggered by the sun?

A

Acute cutaneous lupus erythematosus (ACLE)

43
Q

Which type of lupus is the most photosensitive of all SLE rashes?

A

Subacute cutaneous lupus erythematosus (SCLE)

44
Q

AKA discoid lupus with raised, erythematous plaques with a scale and commonly with mucosal ulcerations

A

Chronic cutaneous lupus erythematosus (CCLE)

45
Q

This organ is commonly involved in lupus?

A

Renal –lupus glomerulonephritis

46
Q

What is the mc eye manifestation in lupus?

A

Keratoconjunctivitis sicca

47
Q

What labs would you expect to see in lupus?

A
  • ANA almost always positive
  • Anti- dsDNA
  • Anti-Sm
48
Q

What are some medications that can cause drug-induced lupus?

A

Procainamide, hydralazine, isoniazid, chlorpromazine, methyldopa, minocycline, quinidine

“Please hide in car my mini quinidine” mnemonic

Lab abnormalities and clinical manifestations usually normalize when drug is discontinued

49
Q

Treatment for patient with cutaneous lupus?

A

Initial: topical glucocorticoids. Start low potency >medium -> high

May need hydroxychloroquine if need systemic meds

50
Q

Treatment for patient with musculoskeletal lupus?

A

NSAIDs & Tylenol

May add hydroxychloriquine

51
Q

Treatment for patient with serositis (lung/cardiac?) lupus?

A

NSAIDs and/or low-mod glucocorticoids

May add hydroxychloriquine or PO colchicine if persistent or recurrent

52
Q

Autoimmune myopathy characterized by proximal muscle weakness

A

Polymyositis

53
Q

How do you differentiate between PMR and Polymyositis?

A

PMR mostly associated with pain and polymyositis is generally just muscle weakness

54
Q

This disease causes a symmetric, gradual and progressive leg weakness that spreads to the arm with proximal muscle weakness and fatigue.

A

Polymyositis

55
Q

CK will be elevated in which disease?

A

Polymyositis

56
Q

What is the gold standard test for Polymyositis?

A

Muscle biopsy is the gold standard for inflammatory myopathies

57
Q

What is the treatment for Polymyositis?

A

Prednisone with osteoporosis prophylaxis

58
Q

This type of arthritis is associated with psoriasis

A

Psoriatic arthritis

59
Q

You may see nail pitting, ridging, and onycholysis in this type of arthritis?

A

Psoriatic arthritis

60
Q

“pencil cup deformity” is common in which disease?

A

Psoriatic arthritis and imaging (xray) would show this

61
Q

What term is this and what disease is it associated with?

Deforming, destructive arthritis

A

Arthritis mutilans

Psoriatic arthritis

62
Q

What term is this and what disease is it associated with?

Sacroiliitis & spondylitis

A

Spondyloarthritis

Psoriatic arthritis

63
Q

What term is this and what disease is it associated with?

Inflammation at the site of insertion of tendons

A

Enthesitis

Psoriatic arthritis

64
Q

What term is this and what disease is it associated with?

Flexor tendons of hands, extensor carpi ulnaris, & others

A

Tenosynovitis

Psoriatic arthritis

65
Q

What term is this and what disease is it associated with?

“Sausage digit”- diffuse swelling of an entire finger or toe

A

Dactylitis

Psoriatic arthritis

66
Q

What imaging do you get for psoriatic arthritis?

A

xray

67
Q

Medication for a patient with psoriatic arthritis with less than 4 joints involved and patient isnt in much discomfort?

A

NSAIDs (Naproxen, Celebrex)

68
Q

Medication for a patient with psoriatic arthritis and more severe and unresponsive to NSAIDs

A

DMARDs (Methotrexate or sulfasalazine), Biologic TNF inhibitors (etanercept, infliximab)

69
Q

Beware of treating psoriatic arthritis and immunosuppression because why??

A

Immunosuppression, reactivation of latent TB

70
Q

What medication should NOT be used in a psoriatic arthritis patient?

A

Don’t use PO steroids- can cause a flare of pustular psoriasis

CM2 Exam 2 (8 decks)

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