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Cam's Cards > Rheumatology 2 > Flashcards

Rheumatology 2 Flashcards

1
Q

Symptoms of fibromyalgia

A

MSK pain, fatigue, disordered sleep, multiple somatic symptoms, cognitive problems, psychiatric problems.

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2
Q

Fibromyalgia is more common at what age and in what gender?

A

20-50 year old women

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3
Q

What is allodynia?

A

Experiencing normal sensations as painful

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4
Q

What is hyperalgesia?

A

Pain is more intense and lasts longer

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5
Q

What is commonly the most bothersome area in fibromyalgia?

A

Around neck, shoulders, and low back

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6
Q

What amount of pressure should be applied when examining points of tenderness?

A

4kg/cm^2

enough to whiten the nailbed

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7
Q

Where are the fibromyalgia tender points?

A 
Under sternomastoid muscle
Near the second costochondral junction
2 cm distal to Lateral epicondyle
Greater trochanter
medial fat pad of knee
Insertion of sub occipital muscle
origin of supraspinatus
upper outer quadrant of buttock
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8
Q

T/F? Fibromyalgia does not cause any lab abnormalities

A

True

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9
Q

Initial treatment for fibromyalgia?

A

Pt education, Good sleep hygiene, exercise, +/- CBT, +/- meds

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10
Q

What meds could be appropriate treatment of fibromyalgia?

A 
TCAs (amitriptyline, nortripyline, desipramine)
Cyclobenziprine
SNRIs (duloxetine, milnacipran)
SSRIs (fluoxetine- off label)
Anticonvulsants (lyrica, gabapentin)
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11
Q

Symptoms of polymyalgia rheumatica?

A

Pain and stiffness of the hips and shoulders

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12
Q

Polymyalgia rheumatica is associated with what other condition?

A

Giant cell arteritis

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13
Q

GCA and PMR are more common in what gender and what age group?

A

Females >50, Northern Europeans

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14
Q

Smoking ______ risk for GCA, while DM ______ risk for GCA

A

Increases, decreases

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15
Q

What gene is associated with PMR and GCA?

A

HLA-DR

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16
Q

What type of cells are present in joints affected by PMR?

A

Lymphocytes and monoctyes

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17
Q

What is the pathophys behind GCA?

A

Infiltration of inflammatory cells into vessels causing vasculitis

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18
Q

Classic symptoms of GCA?

A

headache, scalp tenderness, jaw claudication, visual changes (amaurosis fugax or diplopia)

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19
Q

Physical exam findings for GCA?

A

Ill appearing +/- temporal artery changes
Fundoscopic exam: +/-edema of optic disc, cotton wool patches, small hemorrhages,
CV: asymmetry of pulses in arms, aortic regurg, bruits near clavicle

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20
Q

What labs will be elevated in GCR?

A

ESR, CRP

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21
Q

What is the gold standard for diagnosis of GCA?

A

Temporal artery biopsy

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22
Q

T/F PMR is a clinical diagnosis

A

True

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23
Q

Treatment of PMR?

A

Glucocorticoid therapy
Prednisone 10-20mg PO QD
If no improvement after 7 days, increase to 30.

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24
Q

Treatment for GCA?

A

Prednisone 40-60mg PO QD

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25
Q

Takayasu Arteritis mostly affects what vessels?

A

Aorta and its main branches

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26
Q

Describe the typical TA patient.

A

Asian women between 10 and 40 years old

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27
Q

Physical exam findings in a patient with TA?

A

BP differential between arms.
Asymmetrical arterial pulses.
Bruits.

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28
Q

Treatment for TA?

A

Prednisone 45-60mg. PO Qam.

Taper when symptoms are controlled and labs improved.

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29
Q

What surgical interventions are options for patients with TA?

A

PCTA (percutaneous transluminal angioplasty)
Bypass grafting
Aortic repair

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30
Q

What is reactive arthritis?

A

Asymmetric polyarthritis that develops after a GI or GU infection.

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31
Q

What joints are commonly affected by ReA?

A

Large lower extremity joints

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32
Q

What infections can trigger ReA?

A

GI infections - Shigella, salmonella, yersinia, campylobacter, E. coli, C. diff
STIs - Chlamydia, ureaplasma urealyticum

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33
Q

What gene predisposes people to having ReA?

A

HLA-B27

34
Q

Patients with ReA may have enthesitis and/or dactylitis. What does this mean?

A

Enthesitis - swelling at tendon insertion

Dactylitis - sausage joint

35
Q

What are the extra articular manifestations of ReA?

A

General - Fever, fatigue, weight loss
Eye - Conjunctivitis, anterior uveitis
Mucocutaneous - Balanitis, stomatitis, kertoderma blennorrhagicum
Nails - mimics psoriasis

36
Q

T/F synovial fluid analysis will grow bacteria in ReA?

A

False.

37
Q

Treatment for ReA?

A

Treat underlying infection

NSAIDs (naproxen, diclofenac, or indomethacin)

38
Q

If a patients symptoms of ReA do not improve after treatment with NSAIDs, what are some other options?

A

Intraarticular glucocorticoids
PO glucocorticoids
DMARD(sulfasalazine or methotrexate)

39
Q

How long does a typical case of ReA last?

A

3-5 months

Most patients remit within 6-12?

40
Q

What is Sjogrens syndrome?

A

Autoimmune disease that effects the lacrimal and salivary glands.

41
Q

What are the symptoms of Sjogrens?

A

Xerostomia and keratoconjunctivitis sicca

42
Q

T/F? Sjogrens is always secondary to another disease.

A

False, can be primary or secondary

43
Q

Describe the typical Sjogrens patient.

A

Middle aged female

Women:men = 10:1

44
Q

What genes are involved in Sjogrens?

A

HLA-DQ, HLA-DB

45
Q

What test is used to check tear production?

A

Schirmer test

46
Q

What tests can be used to check for saliva production?

A

Saxon test

Saliometry

47
Q

What lab tests should be positive in a Sjogrens patient?

A

ANA
Anti-Ro
Anti-La
RF

48
Q

Gold standard of diagnosis for Sjogrens?

A

Salivary gland biopsy

49
Q

Treatment for oral symptoms of Sjogrens?

A

Regular dental visits with fluoride treatment
Artificial saliva
Pilocarpine or cevimeline

50
Q

Treatment for ocular symptoms of Sjogrens?

A

Artificial tears Q2-4 hours
Ocular ointment at night
Cyclosporine eye drops if artificial tears doesn’t help
Topical steroids if Cyclosporine doesn’t help
Punctal plugs

51
Q

Treatment of systemic manifestation of Sjogrens?

A

Hydroxychloroquine or methotrexate

52
Q

Is RA more common in women or men?

A

Women

53
Q

What genes are associated with RA?

A

HLA-DR MHC

54
Q

Morning stiffness lasts how long in RA?

A

> 30 minutes

55
Q

IS RA symmetric or asymmetric?

A

symmetric

56
Q

Joints commonly affected by RA?

A

PIP joints, MCP joints, wrist, elbow, shoulder, hip, knee, MTP joints, PIP joints of foot

57
Q

Joints commonly affected by OA?

A

DIP joints, 1st MCP joint, C-Spine, L-spine, hip, knee, 1st MTP joint

58
Q

Describe the hands of a patient with RA.

A

Ulnar deviation of MCP joints
Swan neck deformity
Boutonniere deformity
Z deformity

59
Q

Your patient with RA develops hard sub Q nodules on extensor surfaces of forearms. What are these called?

A

Rheumatoid nodules

60
Q

What secondary syndrome can be due to RA?

A

Secondary Sjogrens

61
Q

Felty syndrome is a complication of RA. What are the symptoms?

A 
SANTA
Splenomegaly
Anemia
Neutropenia
Thrombocytopenia
Arthritis
62
Q

What labs are likely to be positive in RA?

A

Anti-CCP
RF
Elevated ESR/CRP

63
Q

What is the most specific bloodwork for RA?

A

Anti-CCP

64
Q

What imaging modality is most specific for RA?

A

Radiographs

65
Q

What is needed to dx RA?

A

Inflammatory arthritis of > 2 joints
Positive RF and or CCP
Elevated ESR and/or CRP
Duration> 6 weeks

66
Q

What does a patient with RA need screening for before treatment is initaited?

A 
Hep B and C
Baseline CBC, Cr, LFTs, ESR, CRP
Ophthalmic screening
Latent TB screening
Baseline radiographs
67
Q

What medication helps with symptoms but not with disease course in RA?

A

NSAIDs

68
Q

What medication is good for symptoms relief and slowing rate of joint damage while bridging to a DMARD?

A

Corticosteroids 5-20mg PO QD

69
Q

What is the initial DMARD of choice in RA?

A

Methotrexate 7.5mg PO weekly

70
Q

What supplement should be prescribed to patients on methotrexate?

A

Folic acid 1mg PO QD

71
Q

What is the first choice TNF inhibitor for RA treatment?

A

Etanercept

72
Q

What is the downside to TNF inhibitors?

A

Expensive

SQ or IV

73
Q

What is PAN?

A

Polyarteritis nodosa

It is a systemic nercrotizing vasculitis

74
Q

What arteries are affected by PAN?

A

Medium or small muscular arteries

75
Q

What organ is usually spared by PAN?

A

Lungs

76
Q

PAN is associated with what infection?

A

Hepatitis B

77
Q

What are common clinical features of PAN?

A

Lower extremity ulcers
Hypertension and renal insufficiency
Abd pain
Mononeuritis multiplex

78
Q

What organ is most commonly affected by PAN?

A

Kidneys

79
Q

How does mononeuritis multiplex present?

A

Foot drop

80
Q

What are some diagnostics that can be used for PAN?

A

Biopsy of organ showing necrotizing inflammation of medium sized arteries
Angiogram

81
Q

What angiogram finding is seen in PAN?

A

Rosary sign

82
Q

PAN treatment

A

If patient has viral hepatitis, treat with antiviral
Mild disease - high dose corticosteroids
Mod-severe - high dose corticosteroids and immunosuppressant (cyclophosphamide)

Cam's Cards (103 decks)

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