Rheumatologic Diseases Flashcards
1
Q
Body stores of uric acid can be due to ____ or ____
A
Low excretion* or overproduction
2
Q
Meds that can cause gout
A
Diuretics, ACEI, ARB, ASA
3
Q
How long do gout attacks last?
A
A few days - 2 wks
4
Q
Do all hyperuricemia pts develop gout?
A
NO, and some can have hyperuricemia for 15-20 yrs before 1st gout attack
5
Q
How to diagnose gout
A
Arthrocentesis and joint aspiration to see crystals
- Negative birefringence, needle shaped
6
Q
Is serum uric acid level diagnostic of gout?
A
NO
7
Q
Tophaceous gout
A
Collection of solid uric acid in soft tissue
8
Q
How to treat acute gout attack? (1st, 2nd, 3rd line)
A
#1: NSAIDs (NOT ASA) #2: Colchicine Last line: steroid injection in joint (make sure there is no infection)
9
Q
Pseudogout
A
Ca++ pyrophosphate dehydrate crystal deposition
10
Q
What can cause pseudogout?
A
Surgery, acute illness
Younger pts: underlying dz
11
Q
How is pseudogout similar to gout?
A
Acute onset
Both cause acute inflammatory arthritis
Episodes last a few days - a few wks
12
Q
How is pseudogout different from gout?
A
Less painful
13
Q
How to diagnose pseudogout
A
- Arthrocentesis CPPD crystals: rhomboid w/ [+] birefringence
- Xray: chondrocalcinosis
14
Q
How to treat pseudogout
A
Steroids
15
Q
Can be associated w/ hep B or C
A
Polyarteritis Nodosa (PAN)
16
Q
Systemic necrotizing vasculitis that affects muscular arteries
A
Polyarteritis Nodosa (PAN)
17
Q
What systems does PAN typically affect?
A
Kidneys, skin, joints, muscle, peripheral nerves, GI
18
Q
How to diagnose PAN
A
Biopsy or arteriography
19
Q
Polymyositis
A
Symmetrical painless skeletal muscle weakness
20
Q
How to diagnose polymyositis
A
Muscle bx
21
Q
Sx of polymyositis
A
- Heliotrope eruption
- Shawl sign
- Mechanic’s hands–cracked and dirty appearance
22
Q
Most common form of juvenile rheumatoid
A
Oligoarticular
23
Q
of joints affected in oligoarticular vs. polyarticular
A
Oligoarticular: 4 or fewer joints
Polyarticular: 5+ joints
24
Q
Joints most affected by osteoarthritis (3)
A
Hips
Knees
Hands
25
When does a pt w/ OA experience worsened PAIN and STIFFNESS
Pain--worse w/ movement
| Stiffness--after inactivity
26
Heberden's nodes
Bony enlargement of DIP
27
Bouchard's nodes
Bony enlargement of PIP
28
Which is more common in OA, Heberden's or Bouchard's nodes?
Heberden's nodes
29
How to diagnose OA
Clinical
30
4 C's to evaluate for in synovial fluid
Color=pale yellow
Clarity=viscous, not opaque
Crystals
Cells=inf
31
#1 med for OA
APAP
32
When do you never want to give steroid joint injection?
During infection
33
How to differentiate OA from RA
- How long does stiffness last in morning?
- Worse or better w/ rest?
- Worse or better throughout day?
```
OA:
- Morning stiffness <30 min
- Better w/ rest
- Stiffness worsens throughout the day (evening stiffness)
RA:
- Morning stiffness >30 min
- Worse w/ rest
- Stiffness improves through the day
```
34
How to differentiate OA from RA (age of onset)
OA: >65
RA: 25-55
35
How to differentiate OA from RA (bilateral vs unilateral)
OA: usually unilateral
RA: bilateral, symmetrical
36
Joints commonly affected by RA
Small joints: MCP, PIP, MTP, wrist
| Large joints: shoulder, knee, ankle
37
Which has systemic sx, OA or RA? What are they?
RA
| Wt loss, fatigue, eye sx, vasculitis
38
Categories of RA diagnostic criteria (4)
of joints
Serological abnormality
Increased acute-phase response
Sx duration
39
Features of RA hands
```
Boutonniere deformity (flexion at PIP, extension at DIP)
Swan neck deformity (extension at PIP, flexion at DIP)
Ulnar deviation
```
40
Most specific lab for RA
Anti-CCP antibodies
41
Felty's syndrome
RA + splenomegaly + low WBC/recurrent inf
42
Caplan syndrome
RA + pneumoconiosis
43
#1 med for RA
Methotrexate
| ***EARLY dx and tx is KEY
44
Reactive arthritis AKA...
Reiter Syndrome
45
Most common cause of Reiter Syndrome
Chlamydia
46
What is the phrase to describe the sx of Reiter Syndrome
"Can't see, can't pee, can't climb a tree"
| - Uveitis, urethritis, arthritis (usually asymmetric)
47
How long do sx of Reiter Syndrome typically last? Is it self-limited?
Days-wks
| Yes, self-limited
48
Is Reiter Syndrome characterized by joint inflammation or joint infection?
Joint inflammation, not infected
49
Which usually presents first, psoriatic arthritis or psoriasis?
Psoriasis
50
What sign is seen on xray of psoriatic arthritis
Pencil in cup deformity
51
Should you give oral steroids to pt w/ psoriatic arthritis?
No, can exacerbate psoriasis and not effective for this type of arthritis
52
Systemic sclerosis AKA...
Scleroderma
53
Prentation of systemic sclerosis
Sclerodactyly
Salt and pepper skin (hypo/hyperpigmentation)
Raynaud's
Watermelon stomach
54
What is sclerodactyly?
Thickened tight skin, claw hand
55
What is CREST syndrome?
```
Limited cutaneous systemic sclerosis
C=calcinosis cutis
R=Raynaud's
E=esophageal dysmotility
S=sclerodactyly
T=telangiectasia
```
56
Tx for systemic sclerosis
Methotrexate + steroids
57
Triad of Lupus sx
Joint pain + fever + malar maculopapular (butterfly) rash
58
Sx of discoid Lupus
Red patches on face/scalp, heals w/ scarring
59
Sx of systemic Lupus
CNS, CV, glomerulonephritis, retinitis, oral ulcers, alopecia
60
Criteria for SLE classification
- Malar rash
- Discoid rash
- Photosensitivity (worse w/ sun)
- Oral ulcers
- Arthritis
- Serositis
- Renal dz
- Neurologic
- Hematologic
- Immunologic
61
Best initial test for SLE (then?)
ANA (then anti-ds DNA)
62
#1 med for Lupus rash
Hydroxychloroquine
63
Is primary or secondary Sjogren's syndrome more common?
Primary
64
What is the major sx of Sjogren's syndrome?
```
SICCA sx (eyes, mouth)
(Can also have parotid gland enlargement)
```
65
What test is diagnostic for Sjogren's syndrome?
Anti-SSA and anti-SSB
66
What is the Schirmer test?
Tests tear production
67
Presentation of polymyalgia rheumatica
PAINFUL synovitis, bursitis, tenosynovitis
68
Do pts w/ polymyalgia rheumatica have muscle weakness?
NO
69
What makes up the SECRET mneumonic for polymyalgia rheumatica
```
S=Stiffness/pain
E=Elderly
C=Constitutional sx
R=Rheumatism
E=Elevated ESR
T=Temporal arteritis (closely related)
```
70
Criteria for diagnosing polymyalgia rheumatica (3)
- Morning stiffness >45 min
- High CRP and ESR
- New hip pain
71
How to confirm diagnosis of temporal arteritis
Biopsy
72
What do you worry about w/ temporal arteritis?
Vision loss
73
Risk factors for fibromyalgia (3)
- Hypothyroidism
- RA
- Sleep apnea
74
Which NT is abnormally low in pts w/ fibromyalgia?
Serotonin
75
Sx of fibromyalgia
- Widespread muscular pain, worse in mornings
- Extreme fatigue
- Stiffness
- Painful tender joints
- Poor sleep
- Memory problems
- HA
76
What makes sx of fibromyalgia worse?
Stress
| Cold
77
Do pts w/ fibromyalgia have joint inflammation?
NO
78
Criteria for diagnosing fibromyalgia (4)
Widespread pain
>3 month duration
3+ quadrants involved
No other causes of pain
79
What lifestyle changes may help pts w/ fibromyalgia?
Cardio exercise
80
#1 med for fibromyalgia
Pregabalin (Lyrica)
81
What type of people get osteoporosis?
Postmeno women
| Men w/ underlying demineralizing dz
82
What imaging study can be used to confirm diagnosis of osteoporosis?
DEXA scan
83
#1 med for osteoporosis
Bisphosphonates + Ca++ and Vit D
84
Causes of compartment syndrome
```
Trauma (long bone fx, crush injury)
Increased fluid (burn, tight cast)
```
85
6 P's of compartment syndrome
```
Pain
Pressure
Paresthesia
Pulselessness
Pallor
Paralysis
```
86
What would make you suspicious of compartment syndrome?
Pain disproportionate to severity of injury
87
Tx for compartment syndrome
Surgical emergency-- immediate fasciotomy and decompression
