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1. PPS Board Prep_Mar > RHEUMA > Flashcards

RHEUMA Flashcards

1
Q

Strong predictor of the presence of rheumatic disease

Arthritis or athralgia

A

Arthritis

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2
Q

Malar rash that spares the nasolabial folds:

A

SLE

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3
Q

Malar rash that crosses the nasolabial folds
(Diffuse facial rash)

A

JDM

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4
Q

Gottron papules and heliotrope rashes

A

JDM

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5
Q

Which NSAID can cause snakk, hypopigmented depressed scars occuring in areas of minor skin trauma?

A. Aspirin
B. Naproxen
C. Indomethacin
D. Celecoxib

A

B. Naproxen can cause Pseudoporphyria
Tx: Discontinue naproxen

> Ibuprofen has been asstd w causing aseptic meningitis esp in lupus patient

Salicylates no longer used d/t hepatotoxicity and Reye Syndrome

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6
Q

Anti-malarial drug used in the treatment of rheumatic diseases

A

Hydroxychloroquine
> usedin SLE, JDM
> can be use in cutaneous manifestations of diseases and lupus flares

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7
Q

Most significant potent adverse effect of Hydroxychloroquine

A

Retinal toxicity:
> IRREVERSIBLE color blindness

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8
Q

MC rheumatic disease in childhood

A

JIA

> MC subtype: Oligoarthritis
2. Polyarthritis
3. SystemicJIA

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9
Q

Classic for sJIA

A

Salmon-colored lesions
> linear or circular
> distributed all over the trunk and prox extremities
> Non pruritic and migratory lasting <1hr

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10
Q

Isolated involvement of which joint almost NEVER a presenting sign of JIA

A. Elbows
B. knees
C. hip
D. IPJ, DPJ

A

C. Hip

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11
Q

Juvenile arthritis vs spondyloarthritis

A

Spondyloarthritis involves axial skeleton joints (sacroiliac) and hips

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12
Q

Inflammation of the small joints of the __ is highly suggestive of ERA (enthesitis-related arthritis)

A. wrists
B. Fingers
C. Foot
D. Hips

A

C. Foot - tarsitis

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13
Q

Typical presentation of reactive arthritis?

A. A/Symmetrical
B. Oligo/Polyarticular

A

Asymmetric, oligorarticular
> predilection for lower extremities

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14
Q

Most commonly affected joint in septic arthritis

A
  1. Knee
  2. hip
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15
Q

MC etiology of septic arthritis

A

S. aureus

> If adolescent, can be N. gonorrhea

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16
Q

Characteristic of septic arthritis

  1. Mono/Polyarticular
  2. A/febrile
A

Monoarticular
high grade fever

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17
Q

Characteristic of ARF

  1. Small/large joints
  2. Non-/Migratory
A

Affects large joints
Migratory

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18
Q

JRA criteria (ACR classification) (4)

A
  1. Age <16yo
  2. Persist arthritis in one or more joints
  3. Lasting =>6weeks
  4. Exlcusion of other forms of JIA
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19
Q

Features of Systemic JIA

A
  1. Fever pattern - quotidian
  2. Evanescent rash (appear at the height of fever)
  3. organomegaly - hepato, spleen
  4. LN enlargement
  5. Serositis
  6. ANA/Rf NEGATIVE
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20
Q

Features of oligoarticular JIA

A

> MC type of JIA
less than 4 jts
highest incidence of uveitis (30%) especially in ANA +
ASYMMETRIC, large joints are affected

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21
Q

Features of polyarticular JIA

A

> more than 5 jts affected, SYMMETRICAL

22
Q

Reiter’s syndrome

A

Can’t pee, can’t see, can’t climb a tree
1. urethritis
2. conjunctivitis
3. arthritis

> under juvenile ankylospondyloarthropathy, reactive arthritis

23
Q

MC inflammatory myositis in children

A

JDM

24
Q

Hallmark of SLE

A
  1. Generation of autoab directed against self-ag, particularly nucleic acids
  2. multiorgan disease
25
Q

Drug-induced lupus with definite association:

A. Hydralazine
B. Cephalosporins
C. Midazolam
D. Hydroxychloroquine

A

A. Hydralazine

HIPP
Hydralazine
INH
Procainamide
Penicillamine

Minocycline, methyldopa, diltiazem, chlorpromazine, etanercept, infliximab, adalimumab, IFN A

> reversible
M=F
anti-histone ab
slow drug acetylation

26
Q

TRUE or FALSE.
ANA is highly specific for detecting SLE.

A

FALSE.
> ANA is very sensitive (95-99%) but has poor specificity (50%) in detected SLE.
> Anti-dsDNA is specific for SLE.

27
Q

Presence of these antibodies is associated with Neonatal Lupus (3)

A

Anti-SSa, anti-SSb or anti-RNP

28
Q

Cardiac finding in Neonatal Lupus

A

Congenital Heart Block
> Most feared complication
> may lead to cardiomyopathy
> prolonged PR interval
> irreversible 3rd deg heart block
> can be detected via fetal echo at 16wks
> fetal bradycardia from heart block –> hydrops fetalis

29
Q

Autoab associated with drug-induced lupus

A

Anti-histone

30
Q

Autoab highly specific to detect SLE and correlates w disease activity

A

Anti-dsDNA

31
Q

MC cause of death within 1st several yrs of diagnosis of SLE

A

Infections and complications of glomerulonephritis and neuropsychiatric diseases

Over the years, atherosclerosis and malignancy are the MC causes of death

32
Q

TRUE or FALSE. Neonatal lupus is an autoimmune disorder of neonates and infants.

A

FALSE

> It is not an autoimmune disease of the fetus but instead results from passively acquired autoimmunity when maternal IgG autoab cross the placenta and enter fetal circulation

33
Q

Mainstay treatment for significant manifestations of SLE

A

Corticosteroids

34
Q

Period of greatest vulnerability to detect congenital heart block in neonatal lupus

A

18-24 wks AOG

35
Q

Most common first symptom in patients with JDM

A

Rash
> erythema in sun-exposed areas after exposure to UV light
> if rash is over the chest and neck = shawl signs

36
Q

Rash: blue-violet discoloration of the eyelids asstd w periorbital edema

A

Heliotrope rash

37
Q

Bright pink or pale, shiny, thickened or atrophic plaques over the PIJ and DIJ, occ on the knees and elbows, small jts of toes and ankle malleoli

A

Gottron papules

38
Q

Diagnosis of JDM

A

Classic Rash + WMEM (any 3)

> weakness: symmetrical, proximal
Muscle enzyme elev
EMG: short small polyphasic, fibrillations, +sharp waves
Muscle biopsy: necrosis and inflammation

39
Q

Children w classic rash of JDM but no muscle weakness or inflammation

A

Amyopathic JDM or dermatomyositis sine myositis

40
Q

Most common type of scleroderma seen in 95% of children

A

Juvenile localized scleroderma
> AKA morphea
> MC subtype: linear scleroderma

41
Q

Most frequent initial symptom in systemic sclerosis. Symptoms?

A

Raynaud phenomenon
> Classic triphasic sequence: BCE
blanching, cyanosis, erythema of the digits induced by cold or stress
Mechanism: CSD
1. arterial vasoconstriction (hypoperfusion, pallor- blanching)
2. venous stasis (cyanosis)
3. reflex vasodilation (erythema)

42
Q

Most frequent initial symptom of Behcet Disease

A

Painful oral ulcers

43
Q

Classic symptom of Sjogren Syndrome (2)

A
  1. Dry eyes (keratoconjunctivitis sicca)
  2. Dry mouth (xerostomia)

> rare in children
common in middle aged women
chronic inflamm autoimm dse - plasma and lymphocytic infiltration of exocrine glands

44
Q

MC manifestations of Sjogren syndrome in children

A

Recurrent parotid gland enlargement and parotitis

> Sicca syndrome (dry mouth, painful mucosa, sensitive to spicy, halitosis, dental caries) seen in adults

45
Q

MC organ affected by AA Amyloidosis

A

Kidneys

46
Q

Saccular aneurysms seen in what phase of Kawasaki Disease?

A

1st phase: neutrophilic necrotizing arteritis

2nd phase: subacute/chronic vasculitis - Fusiform aneurysm

47
Q

Principle criteria of Kawasaki Disease

A

CRASH+ Burn
1. Fever 38deg, at least 5 days
2. Conjunctivitis, bilateral non exudative w limbal sparing
3. Rash - polymorphic
4. Adenopathy - unilateral cervical at least >1.5cm
5. Strawberry tongue - erythema of oral and pharyngeal mucosa, dry cracked cherry lips
6. Hands and feet - edema and erythema

48
Q

Highest risk of sudden death is seen in which phase of Kawaski disease?

A
  1. Subacute phase
    * periungual desquamation of fingers and toes: 2-3 wks
    * thrombocytosis
    * development of CAA
    * highest risk of sudden death
    * lasts 3 weeks
  2. acute febrile phase
    * fever lasting 1-2wks
    * acute phase: perineal desquamation
  3. Convalescent phase
    * all clinical signs of illness disappeared
    * continues until ESR returns to normal
    * 6-8wks after onset of illness
49
Q

Best time to give live vaccination to a patient who received IVIG administration?

A

> IVIG may interfere with the immune response to live-virus vaccines as a result of specific antiviral antibody
So the measles-mumps-rubella and varicella vaccinations should generally be deferred until 11 mo after IVIG administration
non live vaccines don’t need to be delayed

50
Q
A

1. PPS Board Prep_Mar (16 decks)

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