Rheumatology Flashcards

1
Q

What causes gout?

A

Changes in the metabolism of purine resulting in hyperuricemia, urate crystal deposits in tissues and synovium, resulting in inflammatory arthritis

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2
Q

What test to do if diagnostic uncertainity in gout

A

Synovial fluid aspiration ?urate crystals

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3
Q

Treatment for acute gout

A
  1. High dose NSAID then taper as symptoms improve (avoid in CrCl <40, CHF, PUD)
  2. Colchicine 0.6mg BID-TID 1-3 d

If NSAID and colchicine contraindicated then use corticosteroids

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4
Q

What is the treatment for urate lowering therapy

A

Allopurinol 50-100mg OD, increase q 2-4 weeks by 100mg

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5
Q

When to consider prophylactic gout therapy

A

> / tophi
radiographic evidence of gout
/2 flares per year

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6
Q

What test to do prior to starting allopurinol

A

HLA-B *5801

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7
Q

What are the risk factors for osteoporosis

A
  • Previous fx after age 40
  • Glucocorticoids (>3 months, pred 5mg)
  • Falls >/2 past year
  • Parent fractured hip
  • BMI <20
  • Current smoking
  • Alcohol >/3 drinks a day
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8
Q

Secondary causes of osteoporosis

A

Endo - acromegaly, hypercrotisolism, hyperparaT, hyperTSH, hypophosphate
GI - malabsorption, liver dz, calcium deficiency
Medications

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9
Q

How much calcium and vitamin D is recommended

A

Calcium 1200mg
Vit D 1000IU

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10
Q

Symptoms of polymyalgia rheumatica

A

Constitutional symptoms
Morning stiffness, symmetrical proximal muscles

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11
Q

What is the inclusion criteria for PMR

A

Age >50
Duration >2 weeks
Abrupt onset
Morning stiffness >45 min
Bilateral shoulder +/- pelvic pain
High ESR/CRP

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12
Q

What is the exclusion criteria for PMR

A

Malignancy
Infection
GCA
Inflammatory conditions
Drug induced (statins)

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13
Q

Management of PMR

A

Prednisone 15-20mg then taper over 2 weeks monitoring ESR
Stomach and bone protection while on steroid

Monitor q3months
- EST, CBC, lytes, glucose

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14
Q

Diagnostic criteria for rheumatoid arthritis

A

Atleast 4:
- Morning stiffness >/1 hour
- Arthritis >/3 joint areas
- Arthritis of hand joints
- Symmetric
- Rheumatoid nodulews
- Elevated RF
- Radiographic changes

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15
Q

Monitoring for methotrexate

A

Q4-8 weeks CBC, LFTs, albumin

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16
Q

What is the EULAR/ACR criteria for SLE?

A

Must have ANA >1:80, one clinical criterion and >/ 10 points

17
Q

Specific investigations for SLE

A

Anti-dsDNA
Complement levels
Anti-smith
Anti-phospholipid