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Ortho- UWorld > Rheuma > Flashcards

Rheuma Flashcards

1
Q

Transient Synovitis

A

Hip pain with limp
Recent viral Infection
Normal to mildly elevated CBC, CRP, ESR
Well appearing child, Afebrile ( or low grade fever)
Able to bear weight

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2
Q

CF of septic Arthritis ?

A

Monoarticular Joint pain erythema
warmth
Decreased ROM
Febrile ( high grade fever)
Ill-appearing
high WCC and Infl. markers
Unable to bear weight

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3
Q

If CF are unclear, how to diff. between Transient synovitis and SA ?

A

Ultrasound

In transient synovitis: bilateral joint effusion

In SA: Unilateral joint effusion that will need arthrocentesis.

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4
Q

MC infective organisms of SA ?

A

Staph Aureus
Group A strep
N. gonnorhhea (g-ve).

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5
Q

Rx of SA ?

A

Vancomycin, to cover gram -ve add Ceftriaxone

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6
Q

DD of a limp

A
  1. Transient Synovitis
  2. leg-calve-perthes disease
  3. Slipped capital femoral head
  4. SA
  5. Juvenile Idiopathic Arthritis
  6. Developmental Dysplasia
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7
Q

DD Diagnosis of Swollen Knee

A
  1. Juvenile Idipathic Arthritis
  2. SA
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8
Q

CF of JIA ?

A

MC oligoarticular joint pain, in a toddler that is worse in the Morning and a limp, swelling of joint

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9
Q

What are the 3 major types of JIA?

A

Oligaarticular <4
Polyarticular multiple
systemic

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10
Q

What is Oligoarticular JIA asc with ?

A

Uveitis with positive ANA abs.

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11
Q

Lab Results in case of JIA ?

A

high WCC, ESR and CRP
-ve RF, ANA ( if positive increases risk of Uveitis)
HLA-B27

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12
Q

Rx of JIA ?

A

To restrict Inflammation
NSAID, Joint Injection of CS, Methotrexate in later stages

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13
Q

What does the Systemic JIA involve

A

Fever, salmon rash on the body

fever spike only x1/ day

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14
Q

What is the pre-requiste of Diagnosis of JIA ?

A

A prerequisite for the diagnosis of all forms of JIA is:
arthritic symptoms begin before the age of 16 and last ≥ 6 weeks.

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15
Q

What is the Other name of Systemic JIA ?

A

Still disease

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16
Q

What is sensitivity

A

Among the patients with a disease how many will have a positive test
Sen= TP/ TP+FN

sensitive means it will be detected

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17
Q

What is specificity

A

among the patients with no disease how many have a negative test
Spec= TN/ TN + FP

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18
Q

What type of Ab. is seen in Diffuse scleroderma ?

A

SCL-7 or topoisomerase I or Anti-RNA polymerase III and ANA positive

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19
Q

What type of Ab. do we see in limited Scleroderma

A

Anti-centromere Ab.

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20
Q

What is Ankylosing spodylitis

A

Seronegative inflammation of the joints, that decreases joint mobility and causes its fusion. Mainly affects Axial spine and sacroiliac joint

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21
Q

How does Ankylosing Spondylitis present ?

A

Lower back pain
Improves with Excericise however not with rest
worse a night
Sacroiliac joint pain, limited chest expansion
MC in patients <40 y.o
symptoms > 3 weeks

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22
Q

What is Enthesitis ?

A

Inflammation of tendons and ligaments where they attach to bones.
Common in Ankylosing Spondylitis

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23
Q

What is the MC enthesitis ?

A

Achilles Tendon

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24
Q

What are the Radiographic features of Ankylosing Spondylitis ?

A

Bamboo spine ( fusion of intervertebral discs)
Syndesmophytes (paravertebral ossification)
ossification of intervertebral discs

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25
Q

What are the seronegative spondyloarthropathis

A

PAIR
p: Psoriatic arthritis
A: Ankylosing spondylitis
I: IBD asc Arthritis
R: Reactive Arthritis

they are RF -ve, but HLA B-27 positive

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26
Q

In which population is Ankylosing Spobdylitis MC in ?

A

Young patients

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27
Q

Lung ft. test in ankylosing spondylitis ?

A

Restrictive lung disease
with decreased FEV1 and FVC
Normal lung compliance and elasticity
Normal DLco

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28
Q

CF of systemic sclerosis

A

Shiny skin
tight skin,
Initial presentation: Raynaud phenomena
ILD
pericarditis or Pericardial effusion
Esophageal Dysmotility
Tighter/ smaller Mouth

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29
Q

What is the pathogenesis. of SSC

A

Endothelial dysfuction, activation of Fibroblasts by realease of FGF and IL13 that activates B-cells and release Immunoglobulins.

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30
Q

Difference between DCSSC and LcSSC

A

Diffuse: high risk of affecting the viscera
Anti-scl 70 and Anti RNA polymerase III
Interstitial lung Disease

Limited: less risk to affect the viscera
Anti-centromere Ab.
Pulmonary HTN.

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31
Q

What is a metaphyseal corner fracture of the humerus a sign of

A

Non-accidental Trauma

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32
Q

What are the drugs used as Disease Modifying

A

Methotrexate
Hydroxychloroquine
Sulfazaline

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33
Q

Mechanism of action Methotrexate ?

A

Inhibits folate reductase, that inhibits DNA synthesis

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34
Q

SE of Methotrexate ?

A

Folate deficiency ( Stomatitis, Macrocytic anemia)
hepatotoxicity
Pulmonary fibrosis

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35
Q

SE of Hydozychloroquine ?

A

Retinopathy

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36
Q

What is RA ?

A

Chronic, inflammatory rheumatoid disease
symmetrical
symp > 6 weeks
Affects small joints (wrists, hands, feet) / PIP and MCP
elevation of ESR and Crp
Cardinal signs of erythema, fever, swelling, pain loss of function
Worse in the morning better with movement ( as you move you are washing out the inf. debris).

Joint effusion: mainly neutrophils. ( in Acute flares).

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37
Q

What is the RF ?

A

IgM Abs. against Fc postion of IgG.

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38
Q

CF of RA ?

A

Joint pain ( PIP,MCP and wrist) Ulnar deviation
stiffness worse in the morning than in the evening
Rheumatoid nodule ( in skin and lungs)
Pulmonary fibrosis ( basal)
pan carditis
Scleritis and episcleritis (and not uveitis).
Baker’s cyst
Carpal tunnel syndrome

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39
Q

Pleural effusion in RA are of what type

Transudate or exudate ?

A

Exudate

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40
Q

Lab in RA ?

A

+VE RF and Anti-citrullinated Protein

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41
Q

What are the infl. cytokines released in RA ?

A

TNF-alpha and IL-1

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42
Q

What are patients with RA at risk of ?

A

Osteopenia and osteoporosis
(because of pannus that is inflammatory, releasing Inf. markers that erode)

Producing proteases that destruct cartilage and Bones.

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43
Q

What Interleukin is released with Ankylosing Spondylitis

A

IL-17
( treat with NSAID, celexocib, if not efficient can use TNF-alpha inh etanercept)

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44
Q

What is Osteoarthritis ?

A

Non-inflammatory, chronic disease of the joints as a result of wear and tear.
No cardinal signs, no constitutional symptoms, nomrla WCC and inf. markers.

Joint aspiration shows WCC >200, <2,000 ( mainly Lymphocytes because its chronic).

Morning stiffness < 30mins.

Pain worsens with use i.e worse in the evening

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45
Q

RF increase risk of OA ?

A

Obesity, age, repeated Trauma and Occupation

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46
Q

With OA the pain is —– in the evening ?

A

worse

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47
Q

What is the Radiologic Findings of Osteoarthritis ?

A

Osteophytes ( bony projections)
Subchondral bony sclerosis
joint space narrowing

48
Q

What are the findings of OA on Physical Examination ?

A

Crepitus
Osteophytes
Bouchard ( PIP) and heberden nodes (DIP)
Non-inflammatory effusion
Limited ROM.

49
Q

Management of OA ?

A
  1. NSAID/ COX 2- Inhibitor
  2. Acetaminophen
  3. exercises and Quads strengthening
  4. Tramadol
    4.Opiates
    5.Last resort: Arthroplasty
50
Q

Patients with APS can be misdiagnosed with ?

A

Syphillis

Because both test for cardiolipin, positive VDRL and PRP.

51
Q

What is APS ?

A

Autoimmune disease, related to presence of Abs against phospholipid layer of anti-coagulants

like C-protein, S-protein and Anti- thrombin III.

52
Q

CF of APS ?

A

Thrombosis ( DVT, arterial thrombosis, TIA and CVA)
Recurrent miscriages and pre-eclampsia

53
Q

What is APS associated with ?

A

Other AI diseases like SLE

54
Q

What are the Abs. seen in APS ?

A

Anti-cardiolipin
Anti-Beta2 glycoprotein
Anti-lupus anticoagulant

55
Q

What type of thrombosis is seen in APS ?

A

Unprovoked thrombosis ( young age < 50, no malignancy, no recent histroy of immobilization)

56
Q

Features of Anti-phospholipid syndrome

A

spontaneous abortion
hypercoagulable state ( thrombosis)
Prolonged aptt ( because of Lupus anti-coagulant).

57
Q

Rx of APS ?

A

Life-long Heparin/ Warfarin

58
Q

Abs of SLE ?

A

Anti ANA ( specific)
anti-dsDNA
Anti-smith
activation of Antibody and immune complexes lead to decreased c3 and c4.

59
Q

What Abs are positive in neonatal lupus syndrome ?

A

Anti Rho-SSA Abs.

60
Q

What is Takayasu arteritis ?

A

Inflammation and sclerosis of large arteries like aorta and its branches

61
Q

CF of Takayasu arteritis ?

A

BP discrepencies
Pulslesness
arterioocclusive manifestation (claudication, syncope, ..)
Impaired vision
Raynaud Phenomena
HTN

62
Q

Vessel Diseases based on Vessel Size ?

A
  1. Large vessels: Takayasu arteritis
  2. . Medium vessels: Polyarteritis nodosa
  3. Small vessels: Thromboangitis Obliterans
63
Q

Giant Cell Arteritis

A

Headaches with decreased temporal pulses
Asc with Polymyalgia rheumatica ( stiffness of the shoulders and neck)

Increases the risk of irreversible vision loss and aortic aneurys.

64
Q

What are the drug that induce LE ?

A

My two Hips

Minocyline/ Methyldopa
TNF-alpha (infliximab and adalimumab)
Hydralazine with Mono-nitrates
Isoniazid
penicillamine/ procainamide
Sulfa-drugs

Related to Abs (similar to Lupus) increased on the background of medicat

65
Q

What are the causes of Gout ?

A

Increased Urate production:
Myeloproliferative disorders
Tumor lysis syndrome

Decreased Urate excretion:
Chronic Kidney disease
Thiazide/ loop diuretics

66
Q

What is Fibromyalgia

A

Wide sprain chronic pain, that woresens with exercise.
Fatigue and impaired concentration
Tenderness at triger zones ( Midtrapezius, Chostochondral jt).

67
Q

In what population is Fibromyalgia MC in ?

A

young- middle aged females

68
Q

What is Polymyalgia Rheumatica

A

Inflammatory disease ( elevated esr, crp) that involves stifness in shoulders, Hip girdle and neck

Asc with Giant cell Arteritis

Difficulty getting out of chair and lifting arms above head

69
Q

RF of Gout ?

A

Meat and alcohol
age > 40 y.o
obesity
male

70
Q

What is Gout ?

A

Inf. arthritis with cardinal signs of inflammation, mainly affects the first metatarsophalangeal joint (podagra), caused by deposition of crystal ( urate crystals)

Monoarthritis (assymetrical)

high CRP and ESR

71
Q

What type of crystals are there

A

Gout: mono sodium urate
Pseudogout: CPPD ( calcium pyrophosphate dihydrate crystals)
hydroxyapetite arthropath: hydroxyapatite crystals

72
Q

Management of Acute Gout

A

NSAID ( Indomethecin, celexocib), Colchicine ( if multiple joints are involved) and steroids

73
Q

Management of Chronic Gout

A

Increase excretion.
Allopurinol: xanthine oxidase inhibitor and Feuxostat
probenecid and uricase ( rasburicase and Pegloticase).

74
Q

What is the main Joint affected in Pseudogout ?

A

Knee

75
Q

What is Pseudogout associated with ?

A

Hemochromatosis
Primary Hyperparathyroidism

76
Q

What happens if you give Allopurinol with Azathioprin or 6-MP

A

Those drugs are metabolized by XO. and Allopurinol inhibits XO. which will increase the toxicity of Azathioprine and 6-MP. So we will need to decrease dose of azathioprine and 6-MP

77
Q

Name one Uricosuric agent and how it works ?

A

Probenecid: inhibits URAT1 ( uric acid transport one) and increase Uric acid excretion

78
Q

SE of probenecid ?

A

Uric acid stones

radiolucent ( cannot be seen on XRAY)

79
Q

Shall we use high or lose dose Aspirin in Gout ?

A

High dose Aspirin cause it is uricosuric.

80
Q

When does Acute Rheumatic Fever Occur ?

A

after a streptococcal infection that has not been treated (2-4 weeks)

81
Q

CF of Acute rheumatic fever

A

Major signs: Migratory arthritis, nodules, carditis (pan carditis and involves Mitral Valve), sydneham chorea, erythema mariginatum

Minor signs: Fever, arthralgia, high CRP/ESR, Prolonged PR interval

82
Q

What predisposes people for Acute Rheumatic fever ?

A

HLA-DR 7
HLA0DR 53

83
Q

Diagnosis of Acute Rheumatic Fever ?

A

Anti-Strep O Ab
Anti DNase Ab.

84
Q

Rx of Rhematic fever ? and for how long

A

Penicillin G/ V, if no valvular damage for 10 years or until age of 21.

85
Q

MC pathogen causign septic arthritis of prosthetic joint ?

A

Staph aureus. ( less 3 months or more than 12 months of infection)
Staph epidermidis b/w 3 and 12 months

86
Q

Strep Pyogenes that causes pharyngitis will also cause ?

A

Acute Rheumatic fever and PSGN

87
Q

Strep pyogenes that causes a skin infection will affect

A

PSGN only, can’t affect the heart

88
Q

What is Sydenham Chorea ?

A

involuntary, semi-purposeful movements that affects all muscles. Worse on movement

89
Q

DD of Migratory Polyarthralgia

A

Acute Rheumatic fever
Dissiminated Gonococcal Arthritis

90
Q

What is Dermatomyositis ?

A

Is an Idiopathic inflammatory disease that affects the muscle fibers.

CF: symmetrical proximal muscle weakness, erythematous rash on the fingers (Gottron sign) and rash on the eyelid (heliotrope eruption).

91
Q

CF of Polymyositis

A

Weakness in the proximal muscle ( inability to get out of chair, inability to take the stairs)
Anti-Jo Abs. directed against skeletal muscles
Weaknes in proximal muscles ( thighs arms)

It is dermatomyositis without the dermanl symptoms.

92
Q

What is Duchenne Muscular Dystrophy ?

A

It is an X-linked recessive disorder, characterized by mutation in dystrophin protein in skeletal muscles and heart

93
Q

CF of DMD ?

A

Calf pseudohypertrophy (muscle degeneration, fibrosis and fat take over) –> elevated ck
Proximal muscle weakness ( Positive Gower Sign)
Dilated Cardiomyopathy

94
Q

What is Gower sign ?

A

when a toddler walks with his hands up his legs to compensate for proximal muscle weakness

95
Q

Felty Syndrome ?

A

A complication of RA
- RA (nodular) (positive RF and Anti-CCP)
- Neutropenia ( recurrent medications)
- Splenomegaly ( neutrophils stuck in Spleen)

Main Problem is Neutrophils binding IgG

96
Q

CF of Psoriatic Arthritis

A

Symmetrical Polyarthritis ( wrists and DIP)
Nail pitting, dactylitis and Onycholysis
Enthesitis
Psoriatic skin lesions
Seronegative Arthropathy
Arthritis mutilans ( deforming and Destructive arthritis)

looks like RA but involves joints of OA

97
Q

Xray Finding of Psoriatic Arthritis ?

A

Pencil in Cup appearance ( erosion of one bone seems like its sitting in hallow bone cup like).

98
Q

What is the Triad of Behcet Disease ?

A
  1. Oral Ulcers
  2. Genital Ulcers
  3. Uveitis

Erythema nodosum

99
Q

What is Behcet Disease ?

A

AI inflammatory disease of vessels

100
Q

Complications of Behcet

A

arterial/ Venothrombosis

101
Q

What is Sjogren Syndrome ?

A

Sjogren is an AI disease directed against exocrine glands

102
Q

What is the CF of Sjogren Syndrome

A

Dry eyes ( keratoconjunctivitis sicca)
Dry mouth (thrush, dental and peridental problems)
Arthritis

103
Q

Abs in SJogren syndrome

A

Anti SSA ( Anti-Ro) and Anti SSB ( Anti-la)

104
Q

What is the confirmatory test for Sjogren Syndrome ?

A

Lip Bx

105
Q

Sjogren and Anti-SSA/ Anti- SSB increases the risk of ?

A

Non-Hodgkins lymphoma

106
Q

What is a histologic evidence of Sjogren on Salivary gland ?

A

Lymphocytic infiltration

107
Q

CF of Sicca Syndrome ?

A

Dry eyes
Dry Mouth

108
Q

Difference between Osteogenesis Imperfecta and Ehlers Danlos Syndrome ?

A

OI: defect in collagen type 1 ( recurrent fractures)

EDS: Defect in Collagen type 4 ( no recurrent fractures)

109
Q

Patients who develop henoch Schonlein purpura are at a great risk of developing ?

A

Intussuception

110
Q

Difference between Systemic JIA and Acute Rheumatic Fever ?

A

both have fever and rash
s JIA: fixed arthritis
Acute Rheumatic fever: Migratory Arthritis

111
Q

Cyclophosphamide increases the risk of ?

A

Bladder Cancer and acute hemorrhagic cystitis

112
Q

Rx of Paget disease ?

A

Bisphosphonates ( inhibits osteoclast activity)

113
Q

Treatment of Kawasaki disease

A

IVIG and IV pred as adjunct

114
Q

CF of Kawasaki

A

Bilateral conjunctivitis without pus
Strawberry tongue/ pharyngeal erythema
Rash
Edema of palms and foot
Coronary artery aneurysm

115
Q

DILE ( drug induced lupus erythematosus)

A

Features similar to SLE (fever , arthritis, malar rash,..)
usually after starting a drug like hydralazine, procainamide, sulfadrugs, methyldopa, isoniazid and phenytoin.

positive Antihistone Abs ( ANA positive).

116
Q
A

Ortho- UWorld (2 decks)

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