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Internal Medicine > Rheumatology > Flashcards

Rheumatology Flashcards

1
Q

Human leukocyte serotype-B27 is risk for…

A
  1. Ankylosing spondylitis
  2. Psoriatic arthritis
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2
Q

Ankylosing spondylitis heart complication

A

Aortic regurgitation

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3
Q

Ankylosing spondylitis - signs

A
  1. Arthritis (sacroiliitis)
  2. Reduced spine mobility and chest expansion
  3. Enthesitis
  4. Dactylitis
  5. Uveitis
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4
Q

Granulomatosis with polyangiitis

A

Small-vessel vasculitis

Upper airway: nasal septal necrosis, destructive sinusitis
Lower airway: diffuse alveolar hemorrhage
Renal: microscopic hematuria with crescentic glomerulonephritis

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5
Q

RA cervical myelopathy (atlantoaxial joint instability) - signs

A
  1. Slowly progressive spastic quadriparesis
  2. Painless sensory deficits in hands or feet
  3. UMN signs
  4. Hoffman sign - flicking middle fingernail elicits flexion and adduction of thumb

Cord compression can occur from neck extension during intubation

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6
Q

Sarcoidosis - neurologic manifestations due to granulomatous infiltration

A
  1. Facial nerve palsy
  2. Neuroendocrine (central diabetes insipidus)
  3. Generalized seizures
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7
Q

Sarcoidosis - extrapulmonary

A
  1. Bilateral parotid gland swelling
  2. Hypercalcemia (1-alpha hydroxylase by macrophages in lung granulomas
  3. Constitutional (e.g. fevers)
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8
Q

Scleroderma renal crisis - treatment

A

Captopril - short-acting ACE inhibitor that can be rapidly uptitrated
Can be used even if creatinine is elevated

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9
Q

What medication should be avoided in systemic sclerosis?

A

Glucocorticoids - lead to salt and water retention, potentially causing scleroderma renal crisis

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10
Q

Initial treatment of dermatitis herpetiformis

A

Dapsone

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11
Q

Rapid onset psoriasis is associated with…

A
  1. HIV
  2. Strep pharyngitis (guttate psoriasis)
  3. Medications (systemic glucocorticoid withdrawal, antimalarial, lithium, beta blocker)
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12
Q

Pemphigus vulgaris vs bullous pemphigoid

A

PV: Age 40-60, anti-desmosome, flaccid bullae, mucosal involvement

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13
Q

Nail pitting is specific for…

A

Psoriatic arthritis

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14
Q

Where are Behcet syndrome ulcers?

A

Oral
Scrotum, vulva - red open sores

Pathergy test - insert 20-gauge needle obliquely and assess for >=2mm papule 24-48h later

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15
Q

What does negatively birefringent mean?

A

Yellow when parallel to polarizing light
Gout: negatively birefringent, needle-shaped

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16
Q

Giant cell arteritis - feared complications

A
  1. Sudden, irreversible, painless vision loss - due to anterior ischemic optic neuropathy
  2. Aortic aneurysm
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17
Q

Causes of amyloidosis types, effects

A
  1. AL - clonal plasma cells
  2. AA - secondary to chronic inflammation
  3. ATTR - age-related or hereditary
  4. AB2-m - dialysis-related

Nephrotic syndrome (AL & AA)
Hepatomegaly w/wo splenomegaly (AL & AA)
Restrictive cardiomyopathy (AL & ATTR)
Carpel tunnel syndrome, scapulohumeral periarthritis (AB2-m)
Peripheral/autonomic neuropathy
Periorbital purpura, waxy skin, macroglossia

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18
Q

Amyloid transthyretin leads to what clinical presentation?

A

Restrictive cardiomyopathy

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19
Q

Amyloid light chain leads to what presentation?

A

Nephrotic syndrome
Hepatomegaly w/wo splenomegaly
Restrictive cardiomyopathy

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20
Q

AA amyloidosis leads to what presentation?

A

Nephrotic syndrome
Hepatomegaly w/wo splenomegaly

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21
Q

What is a risk of SLE, particularly with long-term glucocorticoids?

A

Avascular necrosis - use MRI since X-ray in early months is insensitive

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22
Q

Violaceous, sometimes scaly lesions of elbows, knees, and MCP and PCP joints

A

Gottron sign/papule, pathognomonic for dermatomyositis

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23
Q

Behcet syndrome - symptoms

A

Recurrent, painful oral and genital ulcers
Uveitis
Erythema nodosum
Pathergy
Vasculitis and thrombosis

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24
Q

Erythema nodosum - workup

A

CBC, CMP
Antistreptolysin-O Ab
TB skin testing
Chest x-ray (evaluate for sarcoidosis)

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25
Erythema nodosum associated diseases
Strep, TB, endemic fungal (e.g. histoplasmosis) Sarcoidosis, IBD, Behcet
26
Ganglion cysts
Often in wrist, age 15-40, due to repetitive stress or inflammation
27
Ankylosing spondylitis treatment
Nonpharmacological: Exercise, PT 1st: NSAIDs, COX-2 inhibitor (celecoxib) - reduce formation of prostaglandin E2 2nd: TNF-a inhibitors, anti-IL-17 (e.g. secukinumab)
28
Which amyloidosis is more likely to have cardiac manifestation?
AL amyloidosis - restrictive cardiomyopathy
29
Pyoderma gangrenosum is associated with...
IBD, inflammatory arthritis (e.g. RA), malignancy (e.g. AML) Starts as papule/pustule/nodule --> rapidly progressive, painful ulcer with purulent base and violaceous border Nearly 30% triggered by local trauma (pathergy)
30
Pyoderma gangrenosum - treatment
Local or systemic glucocorticoids Do not use surgical debridement because of potential of inducing pathergy (local trauma exacerbates condition)
31
Pathergy is associated with what ulcer?
Pyoderma gangrenosum - associated with IBD, inflammatory arthritis (e.g. RA), malignancy (e.g. AML)
32
Pyoderma vs ecthyma gangrenosum
Ecthyma is Pseudomonas with profound neutropenia and bacteremia Hemorrhagic pustules with surrounding erythema --> necrotic ulcers
33
What medications are used for RA but not ankylosing spondylitis?
DMARDs like methotrexate, sulfasalazine
34
Immune response in RA vs ankylosing spondylitis
B cells in RA T cells in AS
35
Systemic sclerosis affects which part of esophagus?
Smooth muscle (distal 2/3) - hypomotility and incompetence of LES due to smooth muscle atrophy and fibrosis
36
Nail pitting and onycholysis can be seen in...
Psoriatic nail disease
37
Bullous pemphigoid vs pemphigus vulgaris
Bullous is tense, pruritic, rarely mucosal, affects hemidesmosomes, IgG and C3 at basement membrane, age >60 Pemphigus is flaccid, painful, often mucosal involved, affects desmisomes, age 40-60
38
IL-1R antagonists are useful in which autoimmune disease?
RA
39
GPA involvement
URI - ENT, otalgia, hearing loss LRI - interstitial lung disease, cavitary lesions Kidney - glomerulonephritis Cutaneous - leukocytoclastic angiitis (lower extremity purpura with ulceration), urticaria, livedo reticularis, and pyoderma gangrenosum (inflammatory papule/pustule -> painful, nonhealing ulcer)
40
When is urate-lowering medication indicated for gout?
Repeated attacks Tophi or X-ray suggesting chronic disease Uric acid kidney stones or renal insufficiency Decrease beer, weight, diuretics, animal protein, and organ-rich foods
41
Mycophenolate
Inhibits lymphocyte purine synthesis by inhibiting the enzyme IMPDH
42
Azathioprine
Metabolized to 6-mercaptopurine by liver; decreases purine metabolism and may also integrate into nucleic acids
43
What kind of GN with GPA?
Pauci-immune crescentic focal GN
44
Gout appearance on X-ray
Punched out erosion near (but not at) articular surface
45
What are popliteal (Baker) cysts?
From osteoarthritis - communication between synovial fluid and gastrocnemius and semimembranosus bursa
46
Diffuse vs limited cutaneous systemic sclerosis
Diffuse has scleroderma on trunk and upper extremities, not just head and distal upper Anti-Scl-70 and anti-RNA polymerase III, not anti-centromere Renal crisis, ILD, myocardial ischemia and fibrosis
47
Methotrexate requires what lab test monitoring?
Hepatic markers
48
Hydroxychloroquine requires what monitoring?
Ophthalmologic evaluation annually beginning after 5 years
49
TNF inhibitors require what monitoring?
Echocardiogram for cardiotoxicity
50
TNF-a inhibitors predispose to which infections most?
TB Endemic fungi Bacterial pneumonia Disseminated Listeria Zoster
51
Why does polyarteritis nodosa typically require tissue biopsy for diagnosis?
No ANCA Ab or ANA elevation, unlike others
52
Purpura particularly in raccoon pattern, but not trauma related
AL amyloidosis
53
Carpal tunnel could be sign of what rheumatological disorder?
Amyloidosis - compressive peripheral neuropathy Carpal tunnel particularly associated with age related ATTR amyloidosis
54
What rheum condition can cause exudative pleural effusion with very low glucose (<50)?
Rheumatoid arthritis
55
Where is arthritis most seen in sarcoidosis?
Ankles
56
When should cardiac sarcoidosis be suspected?
Young (<55) with unexplained 2nd or 3rd degree heart block
57
What autoimmune condition should be screened biennially in Turner syndrome, even if asymptomatic?
Celiac disease - can lead to impaired iron, vit D, and other absorption
58
Polyarteritis nodosa may be associated with what infection?
Hep B (or Hep C)
59
What rheum conditions cause erythema nodosum?
IBD Sarcoidosis Behcet
60
Lofgren treatment - differing from sarcoidosis
Eryhema nodosum, bilteral hilar adenopathy, migratory polyarthralgia, fever NSAIDs and supportive therapy
61
RA vs AS vs polymyositis vs scleroderma vs lupus treatment differences
Methotrexate: 1st line in RA, 2nd line in polymyositis (after steroids), used for limited scleroderma Sulfasalazine: 1st line in RA, 2nd line in AS (after NSAIDs) TNF inhibitors: 2nd line in RA, AS Azathioprine: 2nd line in polymyositis (after steroids), 2nd line in lupus Hydroxychloroquine: 1st line in RA, 2nd line in lupus Mycophenolate: 2nd line in lupus Cyclophosphamide: 2nd line in lupus
62
Drug-induced lupus medications
Hydralazine, procainamide, isoniazid
63
Neonatal SLE associated with what antibody normally with other rheum disease?
Anti-Ro - may cause heart block
64
Polymyalgia rheumatica vs fibromyalgia differences - ESR and treatment
PR has highly elevated ESR (vs normal) PR treated with low-dose steroids (vs rest, NSAIDs, antidepressants)
65
Behcet treatment
Colchicine to prevent recurrence Topical steroids for skin ulcers or uveitis
66
Drugs that cause hyperuricemia
Cyclosporine Diuretics Low-dose aspirin
67
Allopurinol and febuxostat (xanthine oxidase inhibitors) should not be used in what immune suppression drugs?
Azathioprine or mercaptopurine - decreases their metabolism
68
Probenecid is contraindicated in whom?
Uricosuric agent - contraindicated in CKD, nephrolithiasis, or presence of tophi

Internal Medicine (23 decks)

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