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CanQB > Rheuma > Flashcards

Rheuma Flashcards

1
Q

Thiazide diuretics SE?

A

High GLUC + Low MgNak

High => Glucose, lipid, uric acid, Ca
Low=> Mg, Na, K

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2
Q

Medication cause osteoporosis?

A 
Phenytoin 
Glucocorticoid 
Cyclosporine 
Phenobarbital 
Heparin
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3
Q

Indication of raloxifene?

A

Osteoporosis in post-menopausal women.

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4
Q

Lab indications of disease activity in SLE?

A

Active SLE > high anti-dsDNA + low C3 / C4

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5
Q

Dx of osteoporosis?

A

DEXA

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6
Q

Sensitivity of X-ray in osteoporosis?

A

Not sensitive until bone density is decreased by >50%

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7
Q

Dx of ankylosing spondylitis?

A

X-ray of sacroiliac joint.

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8
Q

Instructions for alendronate (bisphosphonate)

A 
Empty stomach (food decreases absorption) 
30 min before food.

Remain upright for 30 min (prevent GERD)

With water.

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9
Q

Rx of male osteoporosis?

A

Alendronate

Recombinant parathyroid hormone

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10
Q

Contraindication to using testosterone replacement?

A

Hx of prostate Ca

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11
Q

Dx of giant cell arteritis

A

Biopsy of temporal artery

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12
Q

Food increase risk of gout?

A

Red meat
Seafood
Nuts (purine)
Beans (purine)

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13
Q

Food help in gout?

A

Milk and dairy products.

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14
Q

Gout classic?

A

Acute mono arthritis (MTP) peaks in 10 hr

Warmth, tenderness, swelling

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15
Q

Gout is associated with what Dz?

A

HTN

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16
Q

Dx of gout?

A

Joint aspirate

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17
Q

Joint aspirate in gout vs pauedogout?

A

Gout: needle shaped, negative birefringent, monosodium urate

Pseudogout: rhomboid shaped, positive birefringent, CPPD

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18
Q

WBC in joint aspirate of gout?

A

50 x 10^9 mostly neutrophils.

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19
Q

Importance of glucose level in joint aspirate of gout?

A

R/o septic arthritis

Glucose is low in SA

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20
Q

Are there specific X-ray changes in gout?

A

No

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21
Q

Role of pharmacological Rx in preserving joint in OA?

A

No role.

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22
Q

Rx of OA?

A
  • Ideal weight
  • Avoid excessive use of knees
  • acetaminophen (1st line)
  • IA HA or steroids => symptomatic relief.

No role of DMARD in OA

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23
Q

Classic X-ray changes in OA?

A

Decrease joint space
Osteophyte formation
Subchondrial sclerosis
Subchondrial cyst

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24
Q

What’s raloxifine?

What’s it used for?

A

SERM (selective estrogen modulator)

Prophylactic of osteoporosis.

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25
Q

Mechanism of action of raloxifene?

A

Estrogen agonistic effect on bone and lipids.

So lowers lipoprotein cholesterol and augment bone mineral density.

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26
Q

Raloxifene SE?

A

Hot flushes
Leg cramps
Risk of thromboembolic

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27
Q

Causes of osteoporosis in men?

A 
Obesity 
Alcohol
Hypogonadism 
Low Vit D
Low BMI
Steroid use
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28
Q

Effect of allopurinol in acute gout?

A

Worsen Sx

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29
Q

Rx of acute gout?

A
  • NSAIDs (indomethacin 1st choice)
  • Steroids
  • Colchicine

NB: combination of steroids and colchicine is not recommended.

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30
Q

Poor prognostic factors in SLE?

A 
Renal Dz
HTN
Male 
Young or elderly 
Anti-phospholipid syndrome 
Black race
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31
Q

Drugs induce lupus?

A 
Procainamide
Hydralazine
INH
Carbamazepine 
Phenytoin
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32
Q

Effect of thiazide on bone density?

A

Improves bone density

33
Q

Indication of thiazide in osteoporosis?

A

Reduce risk of osteoporosis in postmenopausal women

34
Q

Ankylosing spondylitis (age + sex)

A

> 40

Men > F

35
Q

Osteoarthritis effect in hands?

A

PIP + DIP of 2-5th fingers

CMC joint of thumb.

36
Q

Osteoporosis screen in F?

A

<65
If has > 1 risk factor (other than menopause)

> 65
Should be screened regardless of risks

37
Q

Risk factors of osteoporosis?

A 
Petite 
White
Inactive 
Nulliparity
Smoking 
High caffeine intake 
Alcohol 
Postmenopausal F
Low Ca intake
38
Q

Most serious association of polymyalgia rheumatica?

A

Temporal arteritis > Monocular visual loss

39
Q

Polymayalgia Rheumatica classic?

A
  1. Shoulder + hip pain > 1 mo (bilateral)
    Affects daily activity
  2. Morning stiffness > 1hr
  3. Age > 50 (~70)
  4. ESR >40-100
  5. Rapid response to steroids < 20mg
40
Q

Not a feature of PMR?

A

Muscle weakness

Muscle atrophy

41
Q

Abnormal labs in PMR?

A

Anemia
ESR > 40-100
CRP high

42
Q

Complication of advance osteoarthritis?

A

Meniscal tear

Rx doesn’t help.

43
Q

X-ray of osteomyelitis?

A

Periosteal thickening, cortical thickening, sclerosis

44
Q

Anaserine bursitis classic?

A

Nocturnal pain in medial knee region over upper tibia (2-3 cm below medial joint line)

Unit or bilateral.

45
Q

Dx of anserine bursitis?

A

Local tenderness confined to quarter-sized area of medial tibial plateau.

-ve valgus stress

Normal X-ray of tibia

46
Q

Area of de quervain’s tendinitis?

A

Wrist

47
Q

Medial joint line of knee pain is characteristic of what Dz?

A

Osteoarthritis.

Medial collateral ligament injury

Medial meniscal tear

Fracture of tibial plateau

48
Q

Most important factor to improve bone density in anorexia?

A

Normalizing weight.

49
Q

Effect of OCP on osteoporosis?

A

None

50
Q

Mechanism of action of alendronate?

A

Decrease bone resorption

Increase new bone formation

51
Q

Gout vs pseudogout

in age, joint

A

Gout: male + MTP joint
Pseudo: female + knee, wrist, ankle.

52
Q

Fibromyalgia classic?

A

Childbearing F
Generalized pain with multiple point tenderness
Sleep disturbance
Normal labs

53
Q

Fibromyalgia Rx?

A

Amitriptyline
Cyclopenzaprine
CBT
Aerobic exercise

54
Q

Gonococcal septic arthritis classic?

A
  1. Migratory arthritis
  2. Papular rash
  3. Multiple sexual partners
  4. +/- urogenital Sx
  5. Tenosynovitis
55
Q

Dx of septic arthritis?

A

Nucleic acid amplification

Cultures of sensitivity

56
Q

Rx of septic arthritis?

A 
IV ceftriaxone (Gonorrhea)
Doxycycline (Chlamydia)
57
Q

Rx of bite associated septic arthritis?

A

IV ampicillin-sulbactam

58
Q

Risk of gout?

A 
Renal failure 
HTN
Obesity 
Moonshine ingestion (lead)
Alcohol 
Drugs
59
Q

Drugs causing gout?

A 
Diuretics (thiazide)
Salicylates
Niacin 
Cyclosporine 
Ethambutol
Pyrazinamid
60
Q

How long does acute gout attack take to resolve?

A

2 weeks

61
Q

Does colchicine alter high uric acid or prevent tophi?

A

No

62
Q

Triad of reactive arthritis?

A

Arthritis,
Iritis + conjunctivitis
Urethritis

(+ GI sx + rash)

63
Q

Source of infection in reactive arthritis?

A

Urethral

GI

64
Q

Most effective drug to reduce fracture in osteoporosis?

A

Bisphosphonate

65
Q

Raloxifene prevents what fractures?

A

Vertebral only.

66
Q

HLA-B27 is associated with what erheumatological Dz?

A

Reactive arthritis
Psoriatic arthritis
Ankylosing spondylitis

67
Q

Myasthenia graves associate with what HLA?

A

HLA-DR3

68
Q

Pathophysiology of gout?

A

Purine metabolism defect > high uric acid.

69
Q

Risk of hip involvement in osteoarthritis?

A 
Obesity 
High bone mass 
Old age 
Female 
Weight Bearing sports 
Hypothyroid.
70
Q

Specific labs for rheumatoid arthritis?

A

RF

Anti-CCP

71
Q

Indicator of pulmonary vascular fibrosis in scleroderma

A

TLC/DLCO > 1.6

72
Q

Pulmonary fibrosis changes in DLCO?

A

Low DLCO

73
Q

Side effect of gold salts?

A

Skin discoloration (mauve + grey) over sun exposed areas.

74
Q

Minocycline SE?

A

Photosensitivity
Lupus
Blue grey skin + teeth
Diarrhea.

75
Q

SE of high dose steroids (>40)?

A

Psychiatric Sx (esp mood swings)

76
Q

Fibromyalgia trigger points location?

A

Along medial scapular borders

Posterior neck

Upper outer gluteal muscle

Medial fat bass of knees

77
Q

Myopathies associated with high CK?

A

Polymyositis
Dermatomyositis
Alcoholic myopathy
Hypothyroidism ass myopathy

78
Q

Myopathy with normal CK at all times?

A

PMR

79
Q

Is there a correlation between bone mineral density and risk of fracture in osteoporosis?

A

No

All patient with Hx of fracture should be on Rx regardless of T score.

CanQB (16 decks)

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