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Rheumatology Flashcards

1
Q

Labs

Anti-Jo-1 antibody?

A

Polymyositis

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2
Q

Labs

Anti-Ro/SSA antibody? (3)

A
  1. Sjogren’s syndrome
  2. SLE
  3. Neonatal SLE (maternal transfer to baby is associated with congenital heart block)
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3
Q

Labs

Anti-smooth muscle antibody?

A

Autoimmune hepatitis

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4
Q

Labs

Autoimmune hepatitis antibody association?

A

Anti-smooth muscle antibody

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5
Q

Seronegative Spondyloarthritis

Ankylosing spondylitis is associated with what cardiac abnormality?

A

Aortitis and aortic regurgitation

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6
Q

Labs

Anti-Smith antibody?

A

SLE

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7
Q

Arthritis

What disease are Heberden and Bouchard nodules found in?

A

Osteoarthritis

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8
Q

Seronegative Spondyloarthritis

What is one mnemonic for reactive arthritis syndrome?

A

Can’t see (conjunctivitis), Can’t pee (urethritis), can’t climb a tree (arthritis)

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9
Q

General Principals

What are the causes of low complement glomerulonephritis?

A

C LESS

Cryoglobulinemia/Hepatitis C
s(Lupus)e
Endocarditis
Streptococcal infections

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10
Q

Describe good-pasture disease?

A

Anti-GBM disease that also affects the lungs

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11
Q

What causes autoimmune encephalitis and what disease is this associated with?

A

Anti-NMDA receptor antibody causes autoimmune encephalitis. Associated with ovarian teratomas in > 50% of patients

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12
Q

Labs

Anti-mitochondrial antibodies?

A

Primary biliary cirrhosis

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13
Q

Labs

Anti-ds-DNA antibody?

A

SLE

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14
Q

Labs

Anti-histone antibody? (2)

A
  1. Drug induced lupus
  2. SLE
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15
Q

Labs

Anti-CPP antibody?

A

Rheumatoid arthritis

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16
Q

Crystal Deposition Arthritis

What types of crystals are seen in pseudogout? What is the treatment for pseudogout?

A

Weakly positive rhomboid shaped crystals.

Acute CPPD crystal arthritis is treated with NSAIDs/colchicine/intra-articular corticosteroid injections. No role for urate lowering therapy.

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17
Q

Labs

P-ANCA seen in what three diseases?

A
  1. Microscopic polyangiitis
  2. Churgg Strauss Vasculitis - Eosinophilic granulomatosis with polyangiitis.
  3. Anti-GBM disease
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18
Q

Crystal Deposition Arthritis

T/F - Urate lowering medications can be used in CPPD patients?

A

False - false, no role for urate lowering medications in CPPD

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19
Q

Crystal Deposition Arthritis

How is chronic CPPD crystal arthritis managed?

A

Chronic CPPD crystal arthritis is managed the same way as acute CPPD arthritis (NSAIDs/colchicine/intra-articular glucocorticoid injections)

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20
Q

Labs

Anti-Scl-70 antibody?

A

Systemic sclerosis

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21
Q

Labs

Anti-centromere antibody?

A

Limited scleroderma (CREST)

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22
Q

Labs

Anti-U1-RNP antibody?

A

Mixed connective tissue disorder

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23
Q

Less common arthropathies

How does adult-onset still disease present (two physical exam findings and one lab finding)?

What is the prognosis of adult-onset still disease? Treatment for adult-onset still disease?

A
  1. High daily spiking fevers
  2. Increased ferritin - 10X normal level
  3. Salmon colored rash that coincides with fevers

**Causes mild oligoarthritis. **

Tends to be self-limited.

Treatment - NSAIDs/Corticosteroids. Methotrexate can be used for refractory disease

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24
Q

What areas of the body are affected by Behcet disease? (4)

What ethnicities have Behcet disease?

A
  1. Oral ulcerative lesions
  2. Genital ulcerative lesions
  3. Eye or cutaneous lesions

Turkish or Middle Eastern ancestery

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25
Q

Describe one key physical exam finding of Behcet disease?

A

Pathergy - worsening skin ulceration with provocation.

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26
Q

How is Behcet disease treated?

A

Corticosteroids/Immunosuppressants

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27
Q

Drug induced Lupus

What are some antibodies that are positive in drug-induced lupus? (4)

A
  1. Anti-histone antibody
  2. ANCA (seen with minocycline and hydralazine drug induced lupus)
  3. Anti-Ro antibody
  4. ANA
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28
Q

Drug induced lupus

What are three hallmarks that distinguish drug-induced lupus from SLE?

A
  1. Normal complement levels
  2. Renal and neurological involvement with drug-induced lupus is uncommon
  3. Anti-dsDNA is typically negative
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29
Q

Crystal Deposition Arthritis

What is a complication of febuxostat?

A

Increased of heart related deaths and deaths from all causes

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30
Q

SLE

How much time prior to conception should SLE be controlled?

A

6 months prior to conception

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31
Q

SLE

T/F - Pregnancy and post-partum period is associated with more SLE flares?

A

Yes

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32
Q

SLE

What is one newborn and one maternal complication of SLE during pregnancy?

A

SLE increases risk of preclampsia

Neonatal lupus is associated with maternal transfer of Anti-Ro/SSA and Anti-La/SSB antibodies and may result in complete heart block

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33
Q

Drug induced lupus

What three drugs are the highest risk for drug induced Lupus?

A
  1. Procainamide
  2. Hydralazine
  3. Penicillamine
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34
Q

Drug induced Lupus

True/False: Drug induced lupus can develop at anytime while taking a drug; not only when starting a new drug

A

True

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35
Q

Paget’s disease

What are some features of Paget’s disease?

A
  1. Osteoarthritis
  2. Fractures, especially stress fractures
  3. High-output cardiac failure
  4. Hearing loss
  5. Spinal Cord Compression
  6. Hydrocephalus
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36
Q

Paget’s disease

First line treatment for Paget’s disease?

A

Bisphosphonates

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37
Q

DISH

True/False

DISH is rarely symptomatic

A

True

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38
Q

DISH

How is ankylosing spondylitis distinguished from DISH on X-ray? (1 - location)

A

DISH causes flowing linear calcification anterior to spinal ligaments in the thoracic spine unlike the ascending bamboo spine in the lumbar region in AS.

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39
Q

DISH

How is DISH treated?

A

Conservative treatment with NSAIDS and physical therapy

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40
Q

Seronegative Spondyloarthritis

What are seronegative spondyloarthritis negative for lab wise? (2)

What are the four seronegative spondyloarthritis?

What lab are seronegative spondyloarthritis positive for? (1)

A

Negative for ANA and RF; positive for HLA-B27

Four seronegative spondyloarthritis are:
1. Ankylosing spondylitis
2. Reactive Arthritis
3. Psoriatic arthritis
4. IBD-associated arthropathy

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41
Q

Seronegative Spondyloarthritis

What is Enthesitis?

Enthesitis on the fingers leads to what and is seen in what two disease processes?

What disease processes is this not seen in?

A

**Enthesitis (inflammation at the insertion site of a ligament, tendon, or joint capsule) **leads to the appearance of **dactylitis (sausage-shaped digits). **

**Dactylitis is seen in reactive arthritis and psoariatic arthritis. It is not common in RA. **

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42
Q

Seronegative Spondyloarthritis

What is necessary to diagnose early Ankylosing Spondylitis (AS) and why?

A

Early Ankylosing spondylitis is referred to as non-radiographic axial spondyloarthritis as abnormalities in the SI joint would be found on MRI but would not be found on X-ray.

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43
Q

Seronegative Spondyloarthritis

How does ankylosing spondylitis present?

A

Significant morning stiffness that improves with activity.

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44
Q

Seronegative Spondyloarthritis

What are some extra-articular manifestations of Ankylosing Spondylitis? (2 are important to know)

A
  1. Iritis/Uveitis (most common extra-articular manifestation)
  2. Conjunctivitis
  3. Ishcemic heart disease
  4. Aortic insufficiency/Aortitis
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45
Q

Seronegative Spondyloarthritis

If Ankylosing spondylitis is left untreated, what happens?

A

Eventual spinal and SI joint fusion resulting in radiographic “bamboo spine”

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46
Q

Seronegative Spondyloarthritis

How is Ankylosing Spondylitis (AS) diagnosed? (2)

What does MRI show in AS?

A

Pain radiographs of the SI joint. MRI is more sensitive for AS and shows bone marrow edema adjacent to the SI joints.

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47
Q

Seronegative Spondyloarthritis

Treatment for Ankylosing Spondylitis? (3)

A
  1. Physical therapy
  2. NSAIDs (first line)
  3. TNF inhibitor in patients with AS refractory to NSAIDs
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48
Q

Seronegative Spondyloarthritis

What are some causes of Reactive Arthritis?

A

Reactive arthritis is an immunologic reaction to a recent infection elsewhere **in the body typically GU or GI infections. **

**Common causes of reactive arthritis are GU infections such as Chlamydia trachomatis and GI infections due to Salmonella, Shigella, Yersinia, Campylobacter, and Clostridioides difficle.
**
Can also be caused by viral illnesses (enterovirus and HIV infection).

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49
Q

Seronegative Spondyloarthritis

How does reactive arthritis present?
(3) (1-mnemonic. 2/3-classic presentation/body parts affected)

A

Classic triad of urethritis, conjunctivitis, and assymmetric olgioarthritis is seen in less than 1/3 of patients. (Can’t see, can’t pee, can’t climb a tree)

Arthritis typically develops within 2 months after infection and may persist for months or years.

Usually presents as an asymmetric mono- or oligo-arthritis of the lower extremities. **Enthesitis is common and characteristic espiecally at the insertion points of the Achilles tendon and the plantar fascia. **

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50
Q

Seronegative spondyloarthritis

Reactive arthritis diagnosis?

A

Diagnosis is tough because inciting infection may have resolved when the arthritis presents.

Check for chlamydia and perform athrocentesis to rule out infectious joint.

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51
Q

Seronegative spondyloarthritis

Treatment of reactive arthritis?

What is not recommended?

A

NSAIDs are recommended as first line. Use systemic steroids for refractory peripheral arhritis.

Use of antibiotics is controversial for reactive arthritis. Don’t select as an answer choice.

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52
Q

Seronegative Spondyloarthritis

How is IBD-associated athritis treated?

A

Don’t use NSAIDs. Treat IBD (sulfasalizine and corticosteroids).

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53
Q

Seronegative Spondyloarthritis

How does psoariasis present?

A
  1. Silvery scale on extensor surfaces of the elbows, knees.
  2. Nail pitting and onycholysis (seperation of the nail from nail bed)
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54
Q

Seronegative spondyloarthritis

How does Psoariatic arthritis present on x-ray? How does this compare to osteoarthritis on x-ray?

A

Psoariatic arthritis presents as pencil in cup deformity. Osteoarthritis prsents as “gull wings” or “seagull wing” deformity.

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55
Q

Seronegative Spondyloarthritis

Treatment for psoriatic arthritis?

A

NSAIDs are first line

Methotrexate and lefluonamide are second line agents

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56
Q

Seronegative Spondyloarthritis

Which IBD disease is more likely to present with IBD associated arthritis?

A

Crohn’s disease

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57
Q

Labs

Anti-La/SSB antibody? (2)

A
  1. Sjogren’s syndrome
  2. SLE
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58
Q

General Principals

What is one possible complication of cyclophosamide therapy?

What are patients who have taken cyclophosphamide at risk for?

A

Hemorrhagic cystitis is one possible complication of cyclophosphamide therapy.

Patients who have taken cyclophosphamide are at increased risk for transitional cell carcinoma even after treatment with cyclophosphamide has been discontinued.

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59
Q

SLE

What is a significant complication of SLE?

A

Accelerated atherosclerosis and CAD (inflammatory nature of SLE)

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60
Q

Seronegative Spondyloarthritis

Which presents first in psoriatic arthritis? Skin or Arthritis?

A

Skin disease

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61
Q

Seronegative Spondyloarthritis

How should ankylosing spondylitis be treated if a patient has axial disease and inappropriate response to NSAIDs?

A

TNF-Alpha inhibitors

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62
Q

General Principals

Patients taking Hydroxychloroquine require what periodically?

A

Routine eye exams

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63
Q

Rheumatoid Arthritis

In a patient taking methotrexate for RA develops new onset dyspnea and infiltrates on CXR, what should you be concerned about? (2)

A

Hypersensitivity pneumonitis
Or
Opportunistic infection

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64
Q

Osteoarthritis

Label the DIP, PIP, and MCP joints of the hand.

A
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65
Q

Osteoarthritis

Involvement of which three parts of the body is very rare for Osteoarthritis?

A
  1. Ankles
  2. Wrists
  3. Elbows
66
Q

Osteoarthritis

How long does morning stiffness typically last in Osteoarthritis compared to inflammatory arthritis?

A

Osteoarthritis typically has morning stiffness that lasts < 30 minutes.

Inflammatory arthritis typically has morning stiffness that lasts more than an hour.

67
Q

Osteoarthritis

What joints are affected by the Bouchard nodes and Heberden nodes?

A

Bouchard node affects the PIP joint
Heberden node afffects the DIP joint

68
Q

Osteoarthritis

What joint of the hand is typically not affected by osteoarthritis?

A

MCP joints are not affected by osteoarthritis. MCP involvement is seen in RA.

69
Q

Osteoarthritis

Hip osteoarthritis typically causes pain where? Where does trochanteric bursitis typically cause pain?

A

Hip osteoarthritis typically causes pain localized to the groin. Trochanteric bursitis typically causes pain over the lateral hip.

70
Q

Osteoarthritis

Knee osteoarthritis causes pain where?

Pes Anserine bursitis typically causes pain where on the knee?

A

Superior to the patella or deep inside the knee joint

Pes Anserine Bursititis typcially causes pain medial and inferior to the knee joint

71
Q

Crystal deposition arthritis

True/False - Septic joint can coincide with crystal arthropathies

72
Q

Crystal deposition arthritis

How does Gout present?

A

Acutely tender and swollen joint that may awaken the patient from sleep. Pain reaches maximum intensity within 24 hours and self-resolves within several days/weeks.

73
Q

Crystal deposition arthritis

What joints are more commonly affected by gout?

What is not a common presentation of acute gout?

A
  1. Great toe (podagra)
  2. Knee

Acute polyarticular gout is not a common presentation of gout.

74
Q

Crystal deposition arthritis

What are the stages of gout disease?

A
  1. Acute gout
  2. Intercritical period between gout flares
  3. Tophaceous gout (after chronic gouty arthropathy and hyperuricemia)
75
Q

Crystal deposition arthritis

Compare WBC findings in acute gout vs septic joint?

A

Acute gout has WBC > 2000 with predomiance of neutrophils. Septic joint has WBC > 50,000.

76
Q

Cyrstal deposition arthritis

Gout cyrstals on microscopy?

A

Negatively birefringent needle shaped crystals

77
Q

Crystal deposition arthritis

What is the role of measuring uric acid in Gout?

What is gold standard for gout diagnosis?

What should be used in patients with gout and hypertension?

A

Hyperuricemia is supportive but not diagnostic.

Synovial fluid aspiration is gold standard.

Use losartan to lower serum urate in patients with gout and HTN.

78
Q

Crystal deposition arthritis

What should be given in patients with urate lowering therapy for the first time?

A

When starting urate lowering therapy for the first time, prescribe it concurrently with prophylactic low dose NSAIDs, low dose prednisone, or colchicine for 3-6 months to prevent precipitation of acute gout attacks.

79
Q

Crystal deposition arthritis

Treatment options for acute gout flare? (3)
What are contraindications for each treatment plan?

A
  1. NSAIDs - traditionally indomethacin has been the choice NSAID, but can use any NSAID including COX-2 inhibitor (celeoxib)
  2. Colchicine - DO NOT USE IN ESRD or renal impairment patients
  3. **Steroids - can use steroid injections or systemic steroids IF NO INFECTION IS PRESENT. **
80
Q

Crystal deposition arthritis

Treatment options for urate lowering therapy? Goal of urate lowering therapy?

A
  1. Allopurinol
  2. Febuxostat

Goal is reduce the serum uric acid level to < 6 mg/dL

81
Q

Crystal deposition arthritis

How does allopurinol hypersensitivity syndrome present and what ethnic groups are more prone to this?

A

Maculopapular drug rash that may progress to TEN/SJS/DRESS (drug rash with eosinophilia and systemic symptoms).

Ethnic groups that are more suspectible include Asians

82
Q

Crystal Deposition Arthritis

What are the four types of Calcium Pyrophosphate deposition disease (4)

A
  1. Chondrocalcinosis - cartilage calcification - asymptomatic with linear calcification of cartilage on x-ray
  2. Acute CCP - pseudogout
  3. Chronic CCP - joint involvement resembles RA distribution
  4. OA with CPPD - knee osteoarthritis with accelerated Osteoarthritis in non-weight bearing joints
83
Q

Rheumatoid arthritis

Typical age of onset for rheumatoid arthritis?

A

Typical age of onset is 40-50 years

84
Q

Rheumatoid arthritis

Seropositivity in RA refers to what? (2)

Seropositivity portends what?

A

Presence of Rheumatoid Factor

OR

Presence of anti-CCP

Seropositivity portends a worse prognosis with a more aggressive RA and more extra-articular manifestations

85
Q

Rheumatoid arthritis

  1. Rheumatoid arthritis causes a symmetric or asymmetric joint involvement?
  2. What is the most common single joint initially involved in RA?
  3. How long does morning stiffness last in RA and does it worsen or improve with physical activity?
A
  1. Causes symmetric joint involvement.
  2. The Knee
  3. Morning stiffness lasts > 1 hour and stiffness and pain improve with activity.
86
Q

Rheumatoid arthritis

  1. Time frame needed for RA to be diagnosed?
  2. RA is more likely to affect small joints or large joints?
  3. What joints are spared in RA?
A
  1. > 6 weeks of symptoms
  2. More likely to affect large joints
  3. RA spares the DIP joints
87
Q

Labs

C-ANCA is seen in?

A

Wegner’s granulomatosis aka Granulomatosis with Polyangiitis

aka

WeCner’s granulamatosis (pathoma)

88
Q

Rheumatoid arthritis

  1. What part of the spine is commonly affected in RA?
  2. What are the symptoms of spinal involvement in RA?
A
  1. RA affects the cervical spine and causes subluxation. Affects C1-C2 joints.
  2. Patients with cervical spine suubluxation in RA present with recurrent occipital headaches, neck pain, limited neck range of motion, weakness of the upper extremities, paresthesias of the hands and feet.
89
Q

Rheumatoid arthritis

What are some physical exam findings in RA (4)?

A
  1. Rheumatoid nodules on the extensor surfaces
  2. Ulnar deviation
  3. Swan-Neck deformities
  4. Boutonnere deformities
90
Q

Rheumatoid Arthritis

When concerned about cervical spine subluxation in RA patients what tests can help diagnose this condition? (2)

A
  1. Cervical spine x-rays with flexion and extension views
  2. MRI of the cervical spine is the most valuable test to visualize the spinal cord and potential cord compression due to RA pannus.
91
Q

Rheumatoid arthritis

What parts of the spine is typically spared in rheumatoid arthritis?

A

The thoracic, lumbar, sacral, and sacroilliac joints are spared in RA

92
Q

Rheumatoid arthritis

What is the preferred method of intubation in Rheumatoid arthritis patients and why?

A

Fiberoptic intubation is preferred over direct laryngoscopy to avoid neck extension

93
Q

Rheumatoid arthritis

Leading cause of death in RA patients?

A

Cardiovascular disease

94
Q

Rheumatoid arthritis

Two cardiac (extraarticular manifestations) of Rheumatoid arthritis?

A
  1. Pericarditis
  2. Rheumatoid nodules on heart valves
95
Q

Rheumatoid arthritis

What are three pulmonary manifestions (extraarticular) of rheumatoid arthritis?

A
  1. Interstitial lung disease
  2. Exudative effusions
  3. Intrapulmonary rheumatoid nodules
96
Q

Rheumatoid arthritis

Where do rheumatoid nodules occur in patients with RA?

A

On extensor surfaces of the skin

Also lungs and heart valves

97
Q

Rheumatoid arthritis

Triad of Felty Syndrome? Patients with Felty syndrome are suspetible to what?

A
  1. Rheumatoid arthritis
  2. Splenomegaly
  3. Neutropenia

Patients with felty syndrome are more suspetible to mortality from infectionsx

98
Q

Rheumatoid arthritis

  1. What is the preferred initial DMARD monotherapy for most patients with early active RA?
  2. What serves as a bridge in therapy while RA patients are started on DMARDs? (2)
A
  1. Methotrexate is the preferred initial DMARD monotherapy in RA patients
  2. NSAIDS and systemic glucocorticoids serve as a bridge.
99
Q

General Principals

  1. Name of selective COX-2 inhibitor in US?
  2. Selective COX-2 inhibitors decrease risks of what?
  3. All NSAIDs (including COX-2 inhibitors) increase risk of what?
A
  1. Celecoxib
  2. Decrease risk of GI irration and ulcer development
  3. All NSAIDs increase risk of adverse cardiac events such as MI, stroke, heart failure, and sudden cardiac death.
100
Q

General Principals

What vitamin should always be given with methotrexate?

101
Q

Rheumatoid Arthritis

What are the four conventional DMARDs for RA?

A
  1. Methotrexate
  2. Sulfasalazine
  3. Leflunomide
  4. Hydroxychloroquine
102
Q

Rheumatoid Arthritis

Which DMARD causes hypoglycemia and may require a reduction in dose of diabetic medications?

A

Hydroxycholoroquine

103
Q

Rheumatoid arthritis

Which DMARD causes reversible infertility in men?

A

Sulfasalazine

104
Q

Rhumatoid arthritis

Which DMARDs are safe in pregnant patients or patients who are breastfeeding with RA?

A

Hydroxychloroquine and Sulfasalazine is safe in pregnancy and in breastfeeding mothers

105
Q

Rheumatoid arthritis

Sulfasalazine requires which vitamin supplementation?

A

Folic acid

106
Q

Rheumatoid Arthritis

What DMARDs can be used alone? Which DMARDs can’t be used alone?

A

Use lefluonamide and methotrexate alone. Sulfasalazine and hydroxychloroquine can’t be used alone.

107
Q

Rheumatoid Arthritis

What should be used during RA flares?

A

NSAIDs and Steroids

108
Q

Rheumatoid arthritis

What is next step in RA treatment if 1st and second line options for controlling RA don’t work?

A

1st and 2nd line options for RA include DMARDs like methotrexate, lefluonamide, sulfasalazine, and hydroxychloroquine alone or in combination.

If that fails, use TNF-alpha inhibitors or biologics like ritiximab.

109
Q

Rheumatoid Arthritis

What lab test is specific but not sensitive for RA?

110
Q

Rheumatoid arthritis

What diseases processes can have a positive Rheumatoid Factor? (4)

A
  1. SLE
  2. Sjogren’s Syndrome
  3. Chronic Infections
  4. Rheumatoid arthritis
111
Q

Rheumatoid Arthritis

Name some TNF-alpha inhibitors

A
  1. Etanercept
  2. Infliximab
  3. Adalimumab
  4. Certolizumab
112
Q

Labs

What do titers show?

A

Titers show the dilution at which antibiodies become undetectable.

The higher the titer, the greater the likelihood of an autoimmune disease that is present.

113
Q

Labs

When is ANA titer considered positive?

A

ANA is positive if titers are > 1:80

114
Q

Labs

Do ANA titers correlate with disease activity?

115
Q

Labs

How can anti-dsDNA be helpful in SLE patients (2)?

A
  1. Marker for disease activity in some but not all patients
  2. Identifies patients with SLE at risk for significant kidney disease
116
Q

Joints

What are the 3C’s of aspirating synovial fluid?

A

After aspirating SF, send the sample for:
1. Cell count and differential
2. Crystal Analysis
3. Culture and sensitivity

117
Q

Joints

Inflammatory synovial fluid is characterized by what cell count?

A

WBC > 2000 suggests inflammatory synovial fluid. WBC < 2000 suggests non-inflammatory synovial fluid

118
Q

Joints

What differeniates septic from other types of inflammatory joints based on synovial fluid analysis (2)?

A
  1. Septic joints typically have WBC > 50,000
  2. Septic joints have positive gram stain and positive culture
119
Q

Joints

True/False

Patients can have septic joint with cyrstal induced arthritis?

120
Q

Genetic Collagen Disease

What is required annually to monitor patients with Marfan syndrome?

A

Yearly echocardiograms to monitor heart valves and aorta

121
Q

Labs

Name two diseases that consume complement during a flare?

A
  1. SLE
  2. Vasculitis
122
Q

SLE

What is the diagnostic criteria for SLE and how many of the following items need to be present?

A

SOAP BRAIN MD mneumonic. The presence of four of the following meets criteria

Serositis - pleuritis, pericarditis
Oral Ulcers - usually painless
Arthritis - non-erosive
Photosensitivity

Blood disorders - pancytopenia vs hemolytic anemia
Renal disease - proteinuria and RBC casts
ANA
Immunologic phenomena - anti-dsDNA; anti-Smith; anti-cardiolipin
Neurologic disorder - seizures or psychosis
Malar rash - spares nasolabial folds
Discoid rash - hyperpigmented edges and which may be raised with central scarring/atrophy with destruction of melanocytes and hair follicles.

123
Q

SLE

SLE causes inflammatory or non-inflammatory arthritis?

SLE causes erosive or non-erosive arthritis?

A

SLE causes inflammatory and non-erosive arthritis

124
Q

SLE

What are two common forms of lupus rashes?

A
  1. Chronic cutaneous lupus erythematosus aka discoid lupus erythematosus - hyperpigmented edges that may be raised; frequently causes central scarring/atrophy with destruction of melanocytes and hair follicles
  2. Acute cutaneous lupus erythematosus - malar rash that spares nasolabial folds; on sun-exposed areas
125
Q

SLE

True/False - SLE increases risk of MI

126
Q

SLE

What antibody is associated with the development of glomerulonephritis in lupus patients?

A

The presence of anti-dsDNA antibodies is associated with glomerulonephritis and nephrotic syndrome in SLE patients.

127
Q

SLE

What two features characterize Lupus nephritis?

A
  1. Proteinuria
  2. Microscopic hematuria
128
Q

SLE

What test is the most sensitive for SLE and if negative can effectively rule out Lupus?

A

The ANA is the most sensitive test for SLE and if negative can effectively rule out Lupus

129
Q

SLE

During a lupus flare, (some or all) patients have decreased C3 and C4 levels?

A

During a Lupus flare, SOME patients have decreased levels of C3 and C4

130
Q

SLE

If methotrexate is key treatment for RA, what is key treatment for SLE?

A

Hydroxychloroquine (Plaquenil)

131
Q

Infectious arthritides

What does synovial fluid show in a septic joint? (2)

A
  1. WBC typically > 50,000
  2. Positive gram stain and culture
132
Q

Infectious arthritides

What are two predisposing factors for disseminated gonorrhea?

A
  1. Pregnancy
  2. Menstruation
133
Q

Infectious arthritides

What is special about gonococcal arthritis on synovial fluid studies?

A

WBC can be as low as 10,000-20,000k. Joint cultures are usually sterile and blood cultures are positive in < 50 % of cases.

134
Q

Infectious arthritides

How does gonococcal arthritis present?

A

Fever, migratory arthritis, tenosynovitis, and dermatitis

135
Q

Infectious arthritides

  1. What patient population should you suspect as having gonococcal arthritis?
  2. What should be cultured in patients suspected of having gonococcal arthritis?
A
  1. Young adults and adolescents
  2. Culture all mucosal surfaces that may harbor the organisms (cervix, rectum, oropharynx, urethra)
136
Q

Infectious arthritides

Most common cause of septic joints in following patient populations?
1. Sickle cell anemia?
2. Human bites?
3. Animal bites?
4. Native joints?

A
  1. Sickle cell anemia - Salmonella and Strep pneumo
  2. Human bites - Eikenella and anaerobes
  3. Animal bites - Paseurella multocida
  4. Staph aureus and Streptococcus viridans
137
Q

Infectious arthritides

How do prosthetic joint infectious present (on physical exam)

A

Loosening of the joint on physical exam

138
Q

Infectious arthritides

How does parovirus B19 synovitis present? (2)
What kind of exposure signals Parvovirus B19 synovitis?

A
  1. Symmetric synovitis of the hands
  2. Macular rash

Exposure to children/school aged children

139
Q

Less common arthropathies

What should you be concerned about when you see a patient with hyperthrophic pulmonary osteoarthropathy?

A

Lung malignancies

140
Q

Other connective tissue diseases

What are some secondary causes of raynaud’s phneomenon?

A
  1. Secondary causes include rheumatological connective tissue disorders, prescription medications, illegal drugs
141
Q

Other connective tissue diseases

What test can be used to determine primary vs secondary raynaud’s phenomena?

A

Nail-fold capillaroscopy

142
Q

Other connective tissue diseases

What physical exam finding can distiguish between primary and secondary raynaud’s phenomena?

A

Finger tip ulcerations are only seen in secondary raynaud’s phenomena (secondary to connective tissue disorder). Not seen in primary raynaud’s phenomena.

143
Q

Other connective tissue disorders

Mixed connective tissue disorders is made up of what three diseases?

A
  1. Systemic sclerosis
  2. SLE
  3. Polymyositis
144
Q

Gout

What needs to be done in patients taking allopurniol and who have CKD?

A

In patients with CKD who are on allopurinol, need to change dosage of allopurniol dose

145
Q

Gout

What makes probenecid a second line agent in uric acid underexcretors?

A

Requires a galloon of water per day to prevent uric acid renal stones

146
Q

Other connective tissue diseases

What rash is associated with Raynaud’s phenomena?

A

Raynaud’s phenomena can cause a net-like or lacy rash known as LIVEDO RETICULARIS.

147
Q

Other connective tissue diseases

Treatment for Raynaud phenomenon?

A

1st line - calcium channel blockers.

2nd line - phosphodiesterase inhibitors (sildenafil/tadalafil)

148
Q

Other connective tissue diseases

Lung complications of mixed connective tissue disease? (2)

A
  1. Pulmonary Hypertension
  2. Interstitial Lung disease
149
Q

Antiphospholipid Syndrome

What are the features of antiphospholipid syndrome? (3)

A
  1. Vascular thrombosis
  2. Presence of at least one antiphospholipid antibody
  3. Pregnancy morbidity (miscarriage, premature baby)
150
Q

Antiphospholipid antibodies

What are some antiphospholipid antibodies? (3)

A
  1. Lupus anticogulant
  2. Anticardiolipin antibody
  3. Anti-B2-glycoprotein-1 antibody
151
Q

Sjogren Sydnrome

What are some signs and symptoms of Sjogren Syndrome?

A
  1. Dry eyes
  2. Dry mouth
  3. Partoid gland enlargement/inflammation
  4. Fibromyalgia
152
Q

Sjogren Syndrome

What are some antibodies that are positive in Sjogren Syndrome? (4)

A
  1. anti-SSB/La - 50%
  2. anti-SSA/Ro - 65%
  3. Rheumatoid Factor - 70%
  4. ANA - 80%
153
Q

Sjogren Sydnrome

Patients with Sjogren syndrome are at increased risk for what type of malginancies (2)?

A
  1. Non-Hodgkin Lymphoma
  2. MALToma (if these patient’s have concurrent H pylori infection)
154
Q

Systemic sclerosis

What part of the skin is involved in diffuse scleroderma vs limited scleroderma?

A

In diffuse scleroderma, skin is involved above the elbow and the knee (involving the torso).

155
Q

Systemic sclerosis

Face involvement in scleroderma can be seen in both diffuse and limited scleroderma?

156
Q

Systemic sclerosis

Antibody associated with sclerodermal renal crisis?

A

Anti-RNA polymerase 3

157
Q

Systemic sclerosis

What are lung manifestations of diffuse systemic sclerosis?

A

Pulmonary Hypertension
and
Interstitial Lung Disease

158
Q

Systemic sclerosis

Lung manifestation seen in limited sclerosis?

A

Pulmonary Hypertension

159
Q

Systemic sclerosis

Key features of limited scleroderma?

A

CREST

Calcinosis
Raynaud’s Phenomena
Esophageal dysmotlity
Sclerodactyly - localized scleroderma of the fingers or toes
Telangiectasias

160
Q

Systemic sclerosis

  1. What is the first indication of developing pulmonary hypertension or interstitial lung disease in scleroderma patients?
  2. How does sclerodermal renal crisis present? (2)
A
  1. Drop in DLCO
  2. Sclerodermal renal crisis presents as proteinuria/malginant hypertension/renal failure

ABIM (7 decks)

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