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Clin Med II MSK > Rheumatologic Diseases > Flashcards

Rheumatologic Diseases Flashcards

1
Q

Body stores of uric acid can be due to ____ or ____

A

Low excretion* or overproduction

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2
Q

Meds that can cause gout

A

Diuretics, ACEI, ARB, ASA

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3
Q

How long do gout attacks last?

A

A few days - 2 wks

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4
Q

Do all hyperuricemia pts develop gout?

A

NO, and some can have hyperuricemia for 15-20 yrs before 1st gout attack

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5
Q

How to diagnose gout

A

Arthrocentesis and joint aspiration to see crystals

- Negative birefringence, needle shaped

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6
Q

Is serum uric acid level diagnostic of gout?

A

NO

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7
Q

Tophaceous gout

A

Collection of solid uric acid in soft tissue

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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)
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9
Q

Pseudogout

A

Ca++ pyrophosphate dehydrate crystal deposition

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10
Q

What can cause pseudogout?

A

Surgery, acute illness

Younger pts: underlying dz

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11
Q

How is pseudogout similar to gout?

A

Acute onset
Both cause acute inflammatory arthritis
Episodes last a few days - a few wks

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12
Q

How is pseudogout different from gout?

A

Less painful

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13
Q

How to diagnose pseudogout

A
  • Arthrocentesis CPPD crystals: rhomboid w/ [+] birefringence
  • Xray: chondrocalcinosis
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14
Q

How to treat pseudogout

A

Steroids

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15
Q

Can be associated w/ hep B or C

A

Polyarteritis Nodosa (PAN)

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16
Q

Systemic necrotizing vasculitis that affects muscular arteries

A

Polyarteritis Nodosa (PAN)

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17
Q

What systems does PAN typically affect?

A

Kidneys, skin, joints, muscle, peripheral nerves, GI

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18
Q

How to diagnose PAN

A

Biopsy or arteriography

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19
Q

Polymyositis

A

Symmetrical painless skeletal muscle weakness

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20
Q

How to diagnose polymyositis

A

Muscle bx

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21
Q

Sx of polymyositis

A
  • Heliotrope eruption
  • Shawl sign
  • Mechanic’s hands–cracked and dirty appearance
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22
Q

Most common form of juvenile rheumatoid

A

Oligoarticular

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23
Q

of joints affected in oligoarticular vs. polyarticular

A

Oligoarticular: 4 or fewer joints
Polyarticular: 5+ joints

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24
Q

Joints most affected by osteoarthritis (3)

A

Hips
Knees
Hands

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25
Q

When does a pt w/ OA experience worsened PAIN and STIFFNESS

A

Pain–worse w/ movement

Stiffness–after inactivity

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26
Q

Heberden’s nodes

A

Bony enlargement of DIP

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27
Q

Bouchard’s nodes

A

Bony enlargement of PIP

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28
Q

Which is more common in OA, Heberden’s or Bouchard’s nodes?

A

Heberden’s nodes

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29
Q

How to diagnose OA

A

Clinical

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30
Q

4 C’s to evaluate for in synovial fluid

A

Color=pale yellow
Clarity=viscous, not opaque
Crystals
Cells=inf

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31
Q

1 med for OA

A

APAP

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32
Q

When do you never want to give steroid joint injection?

A

During infection

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33
Q

How to differentiate OA from RA

  • How long does stiffness last in morning?
  • Worse or better w/ rest?
  • Worse or better throughout day?
A 
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
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34
Q

How to differentiate OA from RA (age of onset)

A

OA: >65
RA: 25-55

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35
Q

How to differentiate OA from RA (bilateral vs unilateral)

A

OA: usually unilateral
RA: bilateral, symmetrical

36
Q

Joints commonly affected by RA

A

Small joints: MCP, PIP, MTP, wrist

Large joints: shoulder, knee, ankle

37
Q

Which has systemic sx, OA or RA? What are they?

A

RA

Wt loss, fatigue, eye sx, vasculitis

38
Q

Categories of RA diagnostic criteria (4)

A

of joints
Serological abnormality
Increased acute-phase response
Sx duration

39
Q

Features of RA hands

A 
Boutonniere deformity (flexion at PIP, extension at DIP)
Swan neck deformity (extension at PIP, flexion at DIP)
Ulnar deviation
40
Q

Most specific lab for RA

A

Anti-CCP antibodies

41
Q

Felty’s syndrome

A

RA + splenomegaly + low WBC/recurrent inf

42
Q

Caplan syndrome

A

RA + pneumoconiosis

43
Q

1 med for RA

A

Methotrexate

***EARLY dx and tx is KEY

44
Q

Reactive arthritis AKA…

A

Reiter Syndrome

45
Q

Most common cause of Reiter Syndrome

A

Chlamydia

46
Q

What is the phrase to describe the sx of Reiter Syndrome

A

“Can’t see, can’t pee, can’t climb a tree”

- Uveitis, urethritis, arthritis (usually asymmetric)

47
Q

How long do sx of Reiter Syndrome typically last? Is it self-limited?

A

Days-wks

Yes, self-limited

48
Q

Is Reiter Syndrome characterized by joint inflammation or joint infection?

A

Joint inflammation, not infected

49
Q

Which usually presents first, psoriatic arthritis or psoriasis?

A

Psoriasis

50
Q

What sign is seen on xray of psoriatic arthritis

A

Pencil in cup deformity

51
Q

Should you give oral steroids to pt w/ psoriatic arthritis?

A

No, can exacerbate psoriasis and not effective for this type of arthritis

52
Q

Systemic sclerosis AKA…

A

Scleroderma

53
Q

Prentation of systemic sclerosis

A

Sclerodactyly
Salt and pepper skin (hypo/hyperpigmentation)
Raynaud’s
Watermelon stomach

54
Q

What is sclerodactyly?

A

Thickened tight skin, claw hand

55
Q

What is CREST syndrome?

A 
Limited cutaneous systemic sclerosis
C=calcinosis cutis
R=Raynaud's
E=esophageal dysmotility
S=sclerodactyly
T=telangiectasia
56
Q

Tx for systemic sclerosis

A

Methotrexate + steroids

57
Q

Triad of Lupus sx

A

Joint pain + fever + malar maculopapular (butterfly) rash

58
Q

Sx of discoid Lupus

A

Red patches on face/scalp, heals w/ scarring

59
Q

Sx of systemic Lupus

A

CNS, CV, glomerulonephritis, retinitis, oral ulcers, alopecia

60
Q

Criteria for SLE classification

A
  • Malar rash
  • Discoid rash
  • Photosensitivity (worse w/ sun)
  • Oral ulcers
  • Arthritis
  • Serositis
  • Renal dz
  • Neurologic
  • Hematologic
  • Immunologic
61
Q

Best initial test for SLE (then?)

A

ANA (then anti-ds DNA)

62
Q

1 med for Lupus rash

A

Hydroxychloroquine

63
Q

Is primary or secondary Sjogren’s syndrome more common?

A

Primary

64
Q

What is the major sx of Sjogren’s syndrome?

A 
SICCA sx (eyes, mouth)
(Can also have parotid gland enlargement)
65
Q

What test is diagnostic for Sjogren’s syndrome?

A

Anti-SSA and anti-SSB

66
Q

What is the Schirmer test?

A

Tests tear production

67
Q

Presentation of polymyalgia rheumatica

A

PAINFUL synovitis, bursitis, tenosynovitis

68
Q

Do pts w/ polymyalgia rheumatica have muscle weakness?

A

NO

69
Q

What makes up the SECRET mneumonic for polymyalgia rheumatica

A 
S=Stiffness/pain
E=Elderly
C=Constitutional sx
R=Rheumatism
E=Elevated ESR
T=Temporal arteritis (closely related)
70
Q

Criteria for diagnosing polymyalgia rheumatica (3)

A
  • Morning stiffness >45 min
  • High CRP and ESR
  • New hip pain
71
Q

How to confirm diagnosis of temporal arteritis

A

Biopsy

72
Q

What do you worry about w/ temporal arteritis?

A

Vision loss

73
Q

Risk factors for fibromyalgia (3)

A
  • Hypothyroidism
  • RA
  • Sleep apnea
74
Q

Which NT is abnormally low in pts w/ fibromyalgia?

A

Serotonin

75
Q

Sx of fibromyalgia

A
  • Widespread muscular pain, worse in mornings
  • Extreme fatigue
  • Stiffness
  • Painful tender joints
  • Poor sleep
  • Memory problems
  • HA
76
Q

What makes sx of fibromyalgia worse?

A

Stress

Cold

77
Q

Do pts w/ fibromyalgia have joint inflammation?

A

NO

78
Q

Criteria for diagnosing fibromyalgia (4)

A

Widespread pain
>3 month duration
3+ quadrants involved
No other causes of pain

79
Q

What lifestyle changes may help pts w/ fibromyalgia?

A

Cardio exercise

80
Q

1 med for fibromyalgia

A

Pregabalin (Lyrica)

81
Q

What type of people get osteoporosis?

A

Postmeno women

Men w/ underlying demineralizing dz

82
Q

What imaging study can be used to confirm diagnosis of osteoporosis?

A

DEXA scan

83
Q

1 med for osteoporosis

A

Bisphosphonates + Ca++ and Vit D

84
Q

Causes of compartment syndrome

A 
Trauma (long bone fx, crush injury)
Increased fluid (burn, tight cast)
85
Q

6 P’s of compartment syndrome

A 
Pain
Pressure
Paresthesia
Pulselessness
Pallor
Paralysis
86
Q

What would make you suspicious of compartment syndrome?

A

Pain disproportionate to severity of injury

87
Q

Tx for compartment syndrome

A

Surgical emergency– immediate fasciotomy and decompression

Clin Med II MSK (7 decks)

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