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EOR - Internal Med > Rheumatology > Flashcards

Rheumatology Flashcards

1
Q

3 conditions associated w. fibromyalgia

A

hypothyroidism
RA
sleep apnea

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2
Q

5 sx of fibromyalgia

A

widespread muscular pain/tenderness
fatigue
HA
poor sleep
memory problems

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3
Q

dx for fibromyalgia

A

-widespread pain index > 7
-sx severity scale > 5 x 3 mos or more

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4
Q

bx findings of fibromyalgia

A

moth eaten appearance of type 1 muscle fibers

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5
Q

3 meds approved for fibromyalgia

A

duloxetine (cymbalta)
milnacipran (savella)
pregabalin (lyrica)

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6
Q

what class of drug is milnacipran

A

SNRI

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7
Q

pathophys for gout

A

altered purine metabolism -> sodium urate crystal precipitation into synovial fluid

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8
Q

common presentation for gout

A

> 30 yo
asymmetric
great toe
tophi

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9
Q

what is podagra

A

gout attack in MTP of great toe -> mc sx of gout attack

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10
Q

dx for gout

A

arthrocentesis: rod shaped, negatively birefringent crystals

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11
Q

what level of uric acid is indicative (but not diagnostic) of gout

A

> 8

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12
Q

XR finding of gout

A

small, punched out lesions

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13
Q

what 4 foods/drinks are mc associated w. gout attack

A

meats
beer
seafood
etoh

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14
Q

pharm for gout attack

A
  1. indomethacin tid
  2. steroids (injxn vs oral)
  3. colchicine
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15
Q

pharm for gout maintenance

A

allopurinol
colchicine

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16
Q

what 2 meds should be avoided in gout pt’s

A

thiazide diuretics
ASA

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17
Q

common presentation of pseudogout

A

> 60 yo
large joints
lower extremity
no tophi

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18
Q

dx for pseudogout

A

arthrocentesis: rhomboid shaped positively birefringent calcium pyrophosphate crystals

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19
Q

XR findings of pseudogout

A

fine, linear calcifications in cartilage

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20
Q

crystals associated w. gout vs pseudogout

A

gout: negatively birefringent, uric acid
pseudogout: positively birefringent, pyrophosphate

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21
Q

pharm for pseudogout: acute vs prophylaxis

A

acute: NSAIDs
prophylaxis: colchicine

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22
Q

45 yo M w. generalized malaise, fever, sore throat, muscle aches/pains, numbness/tingling, sensory disturbances, and weakness - PE shows tender lumps under the skin of thighs and lower legs - ESR/CRP are elevated

A

polyarteritis nodosa (PAN)

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23
Q

PAN is a blood vessel dz characterized by inflammation of _ arteries

A

small/medium (vasculitis)

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24
Q

PAN mc affects what pt pop

A

middle aged men - 40’s-50’s

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25
Q

what conditions are associated w. PAN

A

hep B/C

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26
Q

sequela of PAN

A

-increased microaneurysms w. rupture -> htn, hemorrhage, thrombosis, organ ischemia/infarction
-renal failure
-neuropathy
-amaurosis fugax

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27
Q

4 derm complications of PAN

A

livedo reticularis
purpura
ulcers
gangrene

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28
Q

what is this showing

A

tender lumps under the skin -> PAN

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29
Q

dx for PAN

A

1. gs: bx of affected artery: shows necrotizing arteritis
2. arteriography: shows typical aneurysms in medium sized arteries
3. renal or mesenteric angiography: shows microaneurysms w. abrupt cut-offs of small a

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30
Q

classic lab findings of PAN

A

elevated ESR/CRP
ANCA negative
+/- p-ANCA positive

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31
Q

tx for PAN

A
  1. prednisone
  2. cyclophosphamide for refractory
  3. plasmaphoresis if hep B
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32
Q

62 yo F c/o new onset AM HA, muscle pain, weakness, fatigue - can not raise her arm to brush her hair - PE shows normal grip strength, passive ROM limited in all direction, difficulty rising out of chair - ESR elevated

A

polymyalgia rheumatica (PMR)

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33
Q

pathophys of polymyalgia rheumatica

A

idiopathic inflammation of joints -> painful synovitis, bursitis, tenosynovitis

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34
Q

PMR mc affects what joints

A

proximal -> shoulder, hip, neck

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35
Q

PMR is closely associated w. what condition

A

temporal arteritis

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36
Q

2 ways that PMR is differentiated from polymyositis

A

PMR: joint pain, stiffness
polymyositis: muscle pain, weakness

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37
Q

hallmark lab finding of PMR

A

elevated ESR

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38
Q

gs dx for temporal arteritis

A

temporal a bx

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39
Q

tx for PMR

A
  1. low dose steroids (often long term)
  2. MTX
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40
Q

47 yo F, c/o weakness, fatigue, difficulty raising arms - no f/c, weight changes, or motor deficits - PE shows decreased shoulder strength - labs show elevated creatine phosphokinase, (+) ANCA, (+) anti-JO 1 abs

A

polymyositis

41
Q

idiopathic inflammatory dz of the muscle causing symmetrical, proximal, painless muscle weakness

A

polymyositis

42
Q

3 hallmark characteristics of polymyositis

A

symmetrical
proximal
painless muscle weakness

43
Q

how to differentiate polymyositis from dermatomyositis

A

dermatomyositis = muscle AND skin changes

no skin changes w. polymyositis

44
Q

how is polymyositis differentiated from PMR

A

polymyositis: painless
PMR: painful

45
Q

gs dx for polymyositis

A

muscle bx

46
Q

3 muscle enzyme elevations associated w. PM/DM

A

aldolase
creatine kinase
ESR

47
Q

3 labs associated w. PM/DM

A

anti-JO 1
anti SRP
anti-Mi-2

48
Q

what antibody is specific to dermatomyositis (DM)

A

anti-Mi-2

49
Q

muscle bx finding specific to PM

A

endomysial involvement

50
Q

tx for PM/DM

A
  1. steroids
  2. immunosuppresants (MTX/azathioprine)
51
Q

23 yo M w. conjunctivitis and discharge, pain w. urination, and knee pain/stiffness - treated for gonorrhea infxn 5 weeks ago

A

reactive arthritis

52
Q

pathophys of ractive arthritis

A

autoimmune response to infxn in another part of the body - think CT/GC

53
Q

hallmark sx of reactive arthritis

A

asymmetric inflammatory arthritis

54
Q

how to remember sx of reactive arthritis

A

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

conjunctivitis
uveitis
urethritis
arthritis

55
Q

4 infxns associated w. the development of reactive arthritis

A

CT/GC
salmonella
shigella
campylobacter

56
Q

dx for reactive arthritis

A

hx of infxn
(+) HLA-B27
clinical

57
Q

tx for reactive arthritis

A
  1. NSAIDs
  2. abx if indicated for underlying infxn
58
Q

describe pain w. RA

A

-morning joint stiffness > 30 min that improves throughout the day
-worse w. rest

59
Q

describe pain w. OA

A

-pain that worsens throughout the day
-if morning stiffness is presents, < 30 min
-improves w. rest

60
Q

prodrome associated w. RA

A

fever
fatigue
wt loss
anorexia

61
Q

RA mc affects what joints

A

small:

MCP
PIP
MTP

62
Q

4 PE findings of RA

A

boutonniere deformity
swan neck deformity
ulnar deviation at MCP
rheumatoid nodules

63
Q

what is this showing

A

flexion at PIP
hyperextension at DIP
boutonniere deformity

64
Q

what is this showing

A

flexion at DIP
hyperextension of PIP
swan neck deformity

65
Q

what is this showing

A

ulnar deviation at MCP -> RA

66
Q

what is this showing

A

rheumatoid nodules

67
Q

dx for RA

A

(+) RF
(+) anti ccp abs
elevated ESR/CRP

68
Q

most specific lab for RA

A

(+) anti CCP abs

69
Q

tx for RA

A

1. MTX
2. hydroxychloroquine (plaquenil)
3. sulfasalazine (SSZ)
4. leflunomide (LEF)
5. azathoprine, gold, cyclosporine
6. biologics: etanercept, -mabs

NSAIDs/steroids for acute

70
Q

triple therapy for RA

A

MTX
SSZ
HCQ

71
Q

55 yo F w. loss of teeth, dry mouth/eyes, and parotid gland enlargement

A

sjorgens

72
Q

sjorgen syndrome is a chronic, autoimmune condition that attacks the

A

exocrine glands

73
Q

3 glands mc affected in sjorgens

A

-salivary -> xerostomia
-lacrimal -> keratoconjunctivitis sicca
-parotid

74
Q

dx for sjorgens

A
  • (+) ANA:
    anti-SS-A (RO)
    anti-SS-B (La)
  • (+) RF
  • (+) schirmer test
75
Q

what is a positive schirmer test

A

<5 mm lacrimation in 5 min

76
Q

tx for sjorgens

A

artificial tears
pilocarpine
cevimeline

77
Q

moa for pilocarpine

A

cholinergic -> increased lacrimation/salivation

78
Q

moa for cevimeline

A

cholinergic agonist (stimulates muscarinic receptors)

79
Q

44 yo F w. intermittent joint pain in hands, wrists, feet - also c/o worsening fatigue, muscle aches, and dpn - PE shows painless oral ulcers, erythematous maculopapular lesions on face, and bilat wrist edema

A

SLE

80
Q

SLE triad

A

joint pain
fever
malar rash

81
Q

what is this showing

A

fixed, erythematous rash on cheeks and bridge of nose -> malar rash -> SLE

82
Q

the classic malar rash of SLE spares the _

A

nasolabial folds

83
Q

abs associated w. SLE

A
  1. ANA: best initial
  2. anti-double stranded DNA
    anti smith: most specific
84
Q

dx or SLE

A

4 or more of the following:
malar rash
discoid rash
photosensitivity
mucosal involvement
serositis
joint arthritis
renal d.o
neuro d.o
hematologic d.o
(+) ANA
(+) anti smith, anti-dsDNA, anti-phospholipid

85
Q

management of SLE

A

sun protection
skin lesios: hydroxychloroquine
NSAIDs vs APAP
steroids
MTX
cyclophosphamide

86
Q

41 yo F w. cold, blue hands in cold weather, progressive dysphagia to solids, and red skin spots - PE shows thickened hand skin w. calcific nodules, and multiple telangiectases of skin/face

A

systemic sclerosis (scleroderma)

87
Q

scleroderma/systemic sclerosis is a systemic connective tissue d.o that affects the (5)

A

skin (sclerodactylyl)
lungs
heart
kidneys
GIT

88
Q

what is CREST syndrome

A

limited cutaneous systemic sclerosis:

calcinosis cutis
raynaud’s
esophageal motility d.o
sclerodactylyl (claw hands)
telangiectasia

89
Q

what are mechanic’s hands

A

hyperkeratotic, cracked hands w. a dirty appearance -> PM/DM

90
Q

CREST affects what parts of the body (4)

A

face
neck
distal to elbow
knees

91
Q

diffuse cutaneous systemic sclerosis affects the (2)

A

trunk
proximal extremities

92
Q

raynaud’s syndrome is worse w. (3)

A

smoking
cold
emotional stress

93
Q

tx for raynaud’s

A

ccb

94
Q

2 labs associated w. scleroderma

A

(+) anti-centromere abs
(+) anti-scl-70 abs

95
Q

which lab is associated w. CREST and has a better prognosis

A

(+) anti centromere abs

96
Q

which lab is associated w. diffuse scleroderma and has a worse prognosis

A

(+) anti-scl-70 abs
(+) ANA

97
Q

management of scleroderma

A

MTX
steroids

98
Q

rheumatology conditions to know

A

fibromyalgia
gout/pseudogout
polyarteritis nodosa
polymyalgia rheumatica
polymyositis
reactive arthritis (reiter syndrome)
RA
OA
sjorgen’s
SLE
systemic sclerosis (scleroderma)

EOR - Internal Med (13 decks)

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