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Clinical Med - Musculoskeletal > Rheumatic Disorders > Flashcards

Rheumatic Disorders Flashcards

1
Q

Are men or women more likely to be effected by SLE?

What ethnicities are more commonly effected?

A

Women

African American
Hispanic
Native America

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2
Q

What are the most common causes of death in SLE patients in the USA?

A

Heart Disease and Stroke
Malignancies (Lung CA)
Infection
Renal Disease

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3
Q

Should patients with discoid lupus avoid the sun?

A

Yes!

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4
Q

What are DEFINITE medications that can cause drug induced lupus?

(Theres a lot)

A 
Procainamide
Hydralazine
Minocycline 
Diltiazem
Penicillamina
Isoniazid 
Quinidine
Anti-TNFs
Methyldopa
Chlorpromazine
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5
Q

What are the ELEVEN classifications for SLE?

How many of these are needed for a diagnosis?

A 
Malar Rash
Discoid Rash
Photosensitivity
Oral/Nasopharyngeal Ulcers
Arthritis
Serositis (Pericarditis/Pleuritis) 
Renal Involvement (Proteinuria) 
Neurologic Disorder (Seizure) 
Hematologic Involvement (Anemia, Leukopenia) 
Immunologic Disorder (+ Anti-dsDNA or SM)
Positive ANA
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6
Q

What are examples of medications approved for the treatment of SLE?

A 
Corticosteroids 
Cyclophosphamide
Methotrexate
Mycophenolate mofetil
Azathioprine
Hydroxychloroquine 
Belimumab 
Aspirin
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7
Q

Why do SLE patients taking hydroxychloroquine need eye examinations every 6-12 months?

A

Due to retinal Toxicity

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8
Q

A 23-year-old Hispanic female with no past medical history presented to the emergency department (ED) with an 8-week history of joint pain and swelling in the hands, knees, and ankles; fever; myalgias; pleuritic chest pain; weight loss; and a facial rash that worsened with sun exposure. She had been seen initially at a local clinic and treated for “cellulitis” with oral Keflex. Two days prior to this presentation, she was seen in another ED, found to have a temperature of 103F, proteinuria, and anemia; she was told it was a “viral syndrome” and discharged home.

On examination today, she has painless ulceration on the palate, erythematous malar rash, diffuse lymphadenopathy, and synovitis of the MCP/PIP joints.

Her blood work today show leukopenia and elevated protein, but is otherwise unremarkable. Her urinalysis shows proteinuria with hematuria present.

What is your suspected diagnosis and what antibodies would be present to confirm this?

A

SLE

+ ANA
+ Anti-dsDNA
+ Anti-Sm

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9
Q

This rheumatic disorder is characterized as a drying of mucus producing glands.

A

Sjogren’s Syndrome

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10
Q

Is Sjogren’s Syndrome more common in men or women?

A

Women

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11
Q

What are the ‘classic’ symptoms of Sjogren’s Syndrome?

A 
Dry Eyes
Dry Mouths
Vaginal Dryness
Dental Carries
Parotid Swelling
Arthralgias
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12
Q

What test in the eye is commonly used to diagnosis Sjogren’s Syndrome?

A

Schirmer Test

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13
Q

What laboratory tests are specific to Sjogren’s Syndrome?

A

SS-A (Ro)
SS-B (La)
Rheumatoid Factor

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14
Q

What vascular phenomenon is seen in Systemic Sclerosis (Scleroderma)?

A

Raynauds

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15
Q

How would the body hair appear on a patient with Systemic Sclerosis (Scleroderma)?

A

Loss of appendicular hair

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16
Q

What might the stomach be described as in a patient with Systemic Sclerosis (Scleroderma)?

A

Watermelon Stomach

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17
Q

What is the ‘classic’ finding in the hands of a patient with Systemic Sclerosis (Scleroderma)?

A

Thickening, Tightening, and Hardening of the skin

Loss of the ability to create folds and creases

18
Q

T/F: Raynaud’s Phenomenon can lead to necrosis?

A

True

19
Q

What composes CREST Syndrome?

A 
Calcinosis Cutis
Raynaud Phenomenon
Esophageal Dysmotilty
Sclerodactyly
Telangiectasia
20
Q

CREST Syndrome is associated with a ___________ ANA pattern.

A

Centromere

21
Q

What is the classic presentation of Polymylgia Rheumatica (PMR)?

A

Proximal Pain Without Weakness

22
Q

The pneumonic “SECRET” is often used in PMR…..

What does it stand for?

A 
Stiffness
Elderly (>50, commonly 70-80)
Constitutional Sx (also causcasian) 
Rheumatism
Elevated ESR
Temporal Arteritis
23
Q

Are imaging studies need when working up Polymyalgia Rheumatica?

A

No

24
Q

A 76 y.o. female presents 4 weeks of neck pain, bilateral shoulder pain, and a new onset of bilateral hip pain. She complains that these symptoms are worse in the morning. She has been able to ambulate fairly well, but the pain in her shoulders has effected her ROM. Prior to this, she denied any injuries and was otherwise healthy. On examination, she has slightly decreased ROM in the shoulders but she has 5/5 muscle strength throughout all extremities. Otherwise, her exam is unremarkable.

You order labs wisely, and her CBC is normal, but she has an elevated ESR. She has a negative ANA, Anti-dsDNA, and RF as well.

What is your suspected diagnosis?

A

Polymyalgia Rheumatica

25
Q

A 80 y.o. female presents to the ED with complaints of a right temporal headache. She noted the the headache has gradually worsened over the last week. She described it as a dull, throbbing, ache. Interestingly, she has recently noted a cramping pain with eating, which is new. In addition, brushing her hair on the right side is painful and bothersome. She denied any history of similar in the past. She denied any fever, chills, neck pain, or motor weakness associated with the headache. On examination, you note the the right temple is tender to palpation and the right temporal pulse is reduced. She also has the presence of carotid bruits. Her visual acuity is WNL however there is the presence of cotton wool spots on fundoscopy.

What lab would you expect to see elevated?

A

ESR

26
Q

A 80 y.o. female presents to the ED with complaints of a right temporal headache. She noted the the headache has gradually worsened over the last week. She described it as a dull, throbbing, ache. Interestingly, she has recently noted a cramping pain with eating, which is new. In addition, brushing her hair on the right side is painful and bothersome. She denied any history of similar in the past. She denied any fever, chills, neck pain, or motor weakness associated with the headache. On examination, you note the the right temple is tender to palpation and the right temporal pulse is reduced. She also has the presence of carotid bruits. Her visual acuity is WNL however there is the presence of cotton wool spots on fundoscopy.

What would be most diagnostic in this patient’s case

A

Temporal Artery Biopsy is the most definitive diagnostic study for Giant Cell Arteritis (GCA)

27
Q

A 80 y.o. female presents to the ED with complaints of a right temporal headache. She noted the the headache has gradually worsened over the last week. She described it as a dull, throbbing, ache. Interestingly, she has recently noted a cramping pain with eating, which is new. In addition, brushing her hair on the right side is painful and bothersome. She denied any history of similar in the past. She denied any fever, chills, neck pain, or motor weakness associated with the headache. On examination, you note the the right temple is tender to palpation and the right temporal pulse is reduced. She also has the presence of carotid bruits. Her visual acuity is WNL however there is the presence of cotton wool spots on fundoscopy. Temporal artery biopsy confirms GCA.

What would be the most concerning complication of this disease?

A

Vision Loss

28
Q

T/F: GCA is an ophthalmological Emergency

A

True

29
Q

How is PMR treated when compared to GCA?

A

PMR:

15 mg/day Prednisone
Up to 1-2 year taper

GCA:

60 mg/day prednisone
Long time

30
Q

______ _______ is described as a systemic necrotizing vasculitis typically affecting medium-sized muscular arteries.

A

Polyarteritis Nodosa

31
Q

What organs are typically involved in polyarteritis nodosa?

A 
Kidney
Skin
Joints
Muscles
Peripheral Nerves
GI Tract
32
Q

Polyarteritis Nodosa is typically idiopathic, but it can be associated with what diseases?

A

Hep B
Hep C
Hairy Cell Leukemia

33
Q

What are examples of skin manifestations of polyarteritis nodosa?

A

Tenderness
Erythematous Nodules
Pupura
Livedo Reticularis

34
Q

Would a patient with polyarteritis nodosa have symmetrical or asymmetrical polyneuropathy?

A

Asymmetrical

35
Q

What is a GI manifestation of polyarteritis nodosa?

A

Mesenteric Arteritis (Intestinal Angina)

36
Q

What is a cardiac manifestation of polyarteritis nodosa?

A

CAD

37
Q

Can aneurysms be present in polyarteritis nodosa?

A

Yes

38
Q

What nerve in the upper extremity can be effected in polyarteritis nodosa?

What is a clinical manifestation of this?

A

Radial Nerve

Wrist drop

39
Q

What are classic clinical manifestations of Polymyositis?

A 
Heliptropic Rash (Eye Lids) 
Periungal Abnormalities (Nails)
Gottron's Papules (Hands)
40
Q

________ is a syndrome associated with chronic-wide spread pain, fatigue, stiffness, poor sleep, and discreet tenderness.

A

Fibromyalgia

41
Q

For a diagnosis of fibromyalgia, a patient must have a total of _______ tender points for longer than __ ______ without another discernible cause of the pain.

A

> 11 tender points for longer than 3 months

42
Q

What THREE medications are FDA approved medications for fibromylagia?

A

Pregabalin (Lyrica)
Duloxetine (Cymbalta)
Milnacipran (Savella)

Clinical Med - Musculoskeletal (6 decks)

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