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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
Q

Erythema nodosum associated diseases

A

Strep, TB, endemic fungal (e.g. histoplasmosis)
Sarcoidosis, IBD, Behcet

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26
Q

Ganglion cysts

A

Often in wrist, age 15-40, due to repetitive stress or inflammation

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27
Q

Ankylosing spondylitis treatment

A

Nonpharmacological: Exercise, PT
1st: NSAIDs, COX-2 inhibitor (celecoxib) - reduce formation of prostaglandin E2
2nd: TNF-a inhibitors, anti-IL-17 (e.g. secukinumab)

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28
Q

Which amyloidosis is more likely to have cardiac manifestation?

A

AL amyloidosis - restrictive cardiomyopathy

29
Q

Pyoderma gangrenosum is associated with…

A

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
Q

Pyoderma gangrenosum - treatment

A

Local or systemic glucocorticoids

Do not use surgical debridement because of potential of inducing pathergy (local trauma exacerbates condition)

31
Q

Pathergy is associated with what ulcer?

A

Pyoderma gangrenosum - associated with IBD, inflammatory arthritis (e.g. RA), malignancy (e.g. AML)

32
Q

Pyoderma vs ecthyma gangrenosum

A

Ecthyma is Pseudomonas with profound neutropenia and bacteremia

Hemorrhagic pustules with surrounding erythema –> necrotic ulcers

33
Q

What medications are used for RA but not ankylosing spondylitis?

A

DMARDs like methotrexate, sulfasalazine

34
Q

Immune response in RA vs ankylosing spondylitis

A

B cells in RA
T cells in AS

35
Q

Systemic sclerosis affects which part of esophagus?

A

Smooth muscle (distal 2/3) - hypomotility and incompetence of LES due to smooth muscle atrophy and fibrosis

36
Q

Nail pitting and onycholysis can be seen in…

A

Psoriatic nail disease

37
Q

Bullous pemphigoid vs pemphigus vulgaris

A

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
Q

IL-1R antagonists are useful in which autoimmune disease?

A

RA

39
Q

GPA involvement

A

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
Q

When is urate-lowering medication indicated for gout?

A

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
Q

Mycophenolate

A

Inhibits lymphocyte purine synthesis by inhibiting the enzyme IMPDH

42
Q

Azathioprine

A

Metabolized to 6-mercaptopurine by liver; decreases purine metabolism and may also integrate into nucleic acids

43
Q

What kind of GN with GPA?

A

Pauci-immune crescentic focal GN

44
Q

Gout appearance on X-ray

A

Punched out erosion near (but not at) articular surface

45
Q

What are popliteal (Baker) cysts?

A

From osteoarthritis - communication between synovial fluid and gastrocnemius and semimembranosus bursa

46
Q

Diffuse vs limited cutaneous systemic sclerosis

A

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
Q

Methotrexate requires what lab test monitoring?

A

Hepatic markers

48
Q

Hydroxychloroquine requires what monitoring?

A

Ophthalmologic evaluation annually beginning after 5 years

49
Q

TNF inhibitors require what monitoring?

A

Echocardiogram for cardiotoxicity

50
Q

TNF-a inhibitors predispose to which infections most?

A

TB
Endemic fungi
Bacterial pneumonia
Disseminated Listeria
Zoster

51
Q

Why does polyarteritis nodosa typically require tissue biopsy for diagnosis?

A

No ANCA Ab or ANA elevation, unlike others

52
Q

Purpura particularly in raccoon pattern, but not trauma related

A

AL amyloidosis

53
Q

Carpal tunnel could be sign of what rheumatological disorder?

A

Amyloidosis - compressive peripheral neuropathy

Carpal tunnel particularly associated with age related ATTR amyloidosis

54
Q

What rheum condition can cause exudative pleural effusion with very low glucose (<50)?

A

Rheumatoid arthritis

55
Q

Where is arthritis most seen in sarcoidosis?

A

Ankles

56
Q

When should cardiac sarcoidosis be suspected?

A

Young (<55) with unexplained 2nd or 3rd degree heart block

57
Q

What autoimmune condition should be screened biennially in Turner syndrome, even if asymptomatic?

A

Celiac disease - can lead to impaired iron, vit D, and other absorption

58
Q

Polyarteritis nodosa may be associated with what infection?

A

Hep B (or Hep C)

59
Q

What rheum conditions cause erythema nodosum?

A

IBD
Sarcoidosis
Behcet

60
Q

Lofgren treatment - differing from sarcoidosis

A

Eryhema nodosum, bilteral hilar adenopathy, migratory polyarthralgia, fever

NSAIDs and supportive therapy

61
Q

RA vs AS vs polymyositis vs scleroderma vs lupus treatment differences

A

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
Q

Drug-induced lupus medications

A

Hydralazine, procainamide, isoniazid

63
Q

Neonatal SLE associated with what antibody normally with other rheum disease?

A

Anti-Ro - may cause heart block

64
Q

Polymyalgia rheumatica vs fibromyalgia differences - ESR and treatment

A

PR has highly elevated ESR (vs normal)
PR treated with low-dose steroids (vs rest, NSAIDs, antidepressants)

65
Q

Behcet treatment

A

Colchicine to prevent recurrence
Topical steroids for skin ulcers or uveitis

66
Q

Drugs that cause hyperuricemia

A

Cyclosporine
Diuretics
Low-dose aspirin

67
Q

Allopurinol and febuxostat (xanthine oxidase inhibitors) should not be used in what immune suppression drugs?

A

Azathioprine or mercaptopurine - decreases their metabolism

68
Q

Probenecid is contraindicated in whom?

A

Uricosuric agent - contraindicated in CKD, nephrolithiasis, or presence of tophi

Internal Medicine (23 decks)

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