Rheumatology Flashcards
1
Q
- affects sacroiliac joints eventually causing fusion of the spine
- teen with night pain and morning stiffness relieved by exercise
- pain of large joints, leg and back pain when bending over
- low grade fevers and wt loss, uveitis, IBD
- Dx: HLA B27 + 90%, Xray bamboo spine
- ANA and FR are nml, mildly incr ESR
- Tx: NSAIDs, ASA, MTX
A
Ankylosing Spondylitis
2
Q
- aphthous stomatitis, genital ulcers, uveitis, GI ulcers, arthritis, DVTs
- ESR and CRP elevated
- Tx: systemic steroids
A
Bechet Disease
3
Q
- school aged child with heliotrope rash on the face (violaceous discoloration of the malar region)
- tight shiny skin on the extensor surfaces, interphalagenal joints (Gottron papules)
- hair loss, periungual lesions (nail fold telangectasias)
- can affect esophagus and lungs
- difficulty getting dressed, clumsy, difficulty climbing steps, voice change, difficulty swallowing
- Dx: CK
- Tx: high dose steroids, MTX, IVIG, antimalarials
- avoid sunlight and use sunscreen
A
Dermatomyositis
4
Q
- skin that stretches and hypermobile joints, poor wound healing
- easy bruisability
- normal life expectancy
A
Ehlers-Danlos Syndrome
5
Q
- hypermobile joints
- blindness, MR, hypotonia
A
Lowes Syndrome
6
Q
- generalized vasculitis of the skin, joints, GI, and kidneys
- antecedent viral or bacterial infx
- palpable purpura on the LE and butt, colicky abd pain, heme positive stools, hematuria, proteinuria
- intusussception (ileoileal)
- periarticular (pain of the soft tissues around the knees and ankles)
- nl plts
- supportive care
A
HSP
7
Q
- onset earlier than 16yo
- sx for at least 6 weeks in at least one joint
- morning stiffness, gradual loss of motion, and a rash
- large joint involvement more common
- more common in girls
- ANA is often positive
- RF only helpful in distinguishing the subtypes
- Tx: NSAIDs, steroids, immunosuppressants
- steroids if cardiac involvement
A
Juvenile Rheumatoid Arthritis
8
Q
- 5 or more joints are affected
- MC in females
- some extraarticular involvement
- older patients will be RF+
- RF+ are more serious
- younger pts tend to be ANA+ and have milder dz
A
Polyarthritis JRA
9
Q
- 4 or fewer joints are affected
- ANA + in young females
- bad chronic uveitis
- RF usually neg, if +, dz is worse
- boys are usually HLA B27+ (good prognosis)
A
Oligoarthritis JRA
10
Q
- AKA Still Disease
- extraarticular involvement is common
- moderately good prognosis
- high fevers with chills
- leukocytosis (30-50K)
- Rash: sm pale red macules with central clearing which coalesce
- HSM
- LAD
- pleuritis/pericarditis
- rarely uveitis
- ANA and RF are usually negative
A
Systemic JRA
11
Q
- 18-24 mo old with 5 days of fever
- cervical LAD
- dry/fissured lips or swollen tongue
- conjunctivitis
- polymorphous exanthem
- desquamation of the hands and feet
- sterile pyuria
- CNS Sx such as Seizures and septic meningitis
- thrombocytosis by D5
- leukocytosis by D12
- normocytic anemia
- CRP, ESR remain high for 4-6wks
- echo at time of Dx, 2-3wks, and 6-8wks
- Tx: IVIG, aspirin 80mg/kg/day for 1-2 days, then 5mg/kg/day for 2 mo
- monitor for coronary artery disease
A
Kawasaki Disease
12
Q
- borellia burgdorfei
- ixodes deer tick
- bullseye rash (erythema chronicum migrans) 75%
- flu-like symptoms, arthraligia, fatigue
- Carditis, Arthritis (pauciarticular, large joints), and CNS signs (Bells palsy)
- serum Ab undetectable until 4-6wks
- Dx: lyme Ab titer then a Western Blot to confirm
- false positives with SLE, DM, rickettsia
- Tx: Doxy x30d
A
Lyme Disease
13
Q
- child treated for Lyme Disease who develops chills, fevers, hypotension, with s sepsis like picture
- lysis of organism releases endotoxin
A
Jarisch-Herxheimer Reaction
14
Q
- Autosomal dominant connective tissue disorder
- tall stature, high arched palate, dental crowding, hyperextensible joints, pectus excavatum
- aortic or mitral valve insufficiency, spontaneous pneumothorax, aortic rupture
- ectopic lentis, anterior displacement of the eye-> serial slit lamp evals
A
Marfan Syndrome
15
Q
- non-specific arthritis several weeks after a viral or bacterial infx (Salmonella, Yersinia, Camphylobacter)
- can be post-live vaccination
- self-limited
- supportive care and analgesics
A
Post Infectious Arthritis
16
Q
- seronegative spondyloarthropathy
- HLA B27
- urethritis, iritis, arthritis (can’t see, can’t pee, can’t climb a tree)
- associated with venereal disease in teens
- can also be post-Yersinia, Shigella, or Salmonella
- h/o dysuria, injected conjunctiva, swelling of the foreskin
- benign urinalysis
- Tx: NSAIDs and Abx
- now called reactive arthritis
A
Reiter Syndrome
17
Q
- h/o pharyngitis or URI
- migratory arthritis of large joints
- new heart murmur (MR or AR)
- emotional lability + purposeless rapid movements (syndenham chorea)
- labs: incr ESR, ASO titer, CR
- Tx: PCN, ASA, steroids for carditis, haldol for chorea, digoxin for heart failure
A
Rheumatic Fever
18
Q
- Joints (polyarthritis, migratory)
- <3 Carditis (CHF, cardiomeg, murmurs)
- Nodules (subcutaneous on extensor surfaces)
- Erythema marginatum
- Syndenham Chorea
A
Major Jones Criteria
19
Q
- fever
- arthralgia
- elevated acute phase reactants
- prolonged PR interval
A
Minor Jones Criteria
20
Q
- wt loss, fatigue, hilar LAD
- MC in African Americans
- non-caseating granulomas, BL peribronchial infiltrates
- granulomas secrete a form of Vit D ->hypercalcemia, hypercalciuria, renal and eye dz
- EKG with rhythm disturbance
- negative PPD
- depression and chronic cough
A
Sarcoidosis
21
Q
- thickening and tightening of the skin
- MC in females
- localized linear: linear hyperpigemented patch, shiny with a brown border that becomes more fibrotic, MC, better outcome
- Tx: topical lubricants and phototherapy, steroids, antimalarials, and immunosuppressives
- systemic: sclerodactyly, pulmonary fibrosis, GERD
- all with Raynauds and ANA+
A
Scleroderma
22
Q
- acute onset of single joint pain
- MC pathogen is S. aureus
- consider gonorrhea in teens
- Dx: aspiration and culture
- Tx; long term IV Abx
A
Septic Arthritis
23
Q
- fever, urticaria, and arthralgia a few weeks after Ag exposure
- type III hypersensitivity reaction
- Tx: antihistamines and steroids
A
Serum Sickness
24
Q
- chronic autoimmune disorder
- dry mouth, dry eyes, photophobia, painless parotid swelling
- Shirmer Test: measures tear production from the eye
- elevated ESR, anti-SS-A and SS-B Ab
- Dx: salivary gland Bx
A
Sjogren Syndrome
25
Q
- AR inborn error in lipid metabolism
- ichthyosis at birth, spastic diplegia, delayed milestones, MR, seizures, photophobia, decreased visual acuity
- glistening spots on the retinas
- MRI: white matter disease
- Dx: measurement of fatty EtOH, NAD oxidoreductase in skin fibroblasts
- Tx: lotion and keratolytics
A
Sjogren-Larsson Syndrome
26
Q
- arthralgias, fatigue, malar rash, discoid lesions, photosensitivity, oral or nasal ulcerations, arthritis, hypercoaguability, pleuritis, pericarditis, psychosis, convulsions, cellular casts in the urine, hemolytic anemia
- Ag-Ab complexes in tissues
- MC in women and blacks
- anti-DNA, anti-SM Ab (most specific), ANA (most sensitive)
- decreased complement with renal disease
A
SLE
27
Q
- Drugs for the heart (procainamide, hydralazine, quinidine)
- Sulfonamides
- Lithium
- Epilepsy (AEDs)
- reversible
A
Drug Induced SLE
28
Q
- neonate with a rash and complete heart block
- hydrops fetalis
- thrombocytopenia
- measure anti-SSA and SSB Ab
A
Neonatal Lupus
29
Q
-pain that is bilateral, worse at night, walking with a limp, and joint pain without swelling
A
Growing Pains
30
Q
- joint pain, fevers, URI symptoms (sinuses, lungs), and renal involvement, with constitutional symptoms
- c-ANCA+
- cyclophosphamide, steroids
- significant morbidity and mortality
A
Wegener Granulomatosis
