rheumatology Flashcards
Positive straight leg test
disk herniation
Rx of acute back pain with no neurologic deficit(4)
NSAIDS
Early mobilisation
Mx relaxants
rx dure 4 a 6 semaines
Clue for whipple disease (3)
Joint pain
Malabsorption
PAS
Dx of Whipple(2)
Biopsy small intestine
PCR
quid of tropherima whippeli
Gram positive bacteria
xray in osteoarthritis(3)
subchondral sclerosis
joint space narrowing
ostophytes
joint hand involved in osteoarthritis
DIP
joint hand involved in RA(2)
MCP
PIP
Marker of systemic sclerosis
antitopoisomerase-I
digestive complication of systemic sclerosis(2)
GERD
esophageal dismotility
Most common cause of death in past from systemic sclerosis and why(2)
renal failure
because no ACE inbitor at this time
why people with multiple sclerosis can develop right failure
because of increase pulmonary artery pressure
risk of patient taking chemo in rhumatology
gout
prophylactic measure to prevent gout in patient taking chemo(2)
allopurinol
and
probenicid
most common presentation of goutty attack
podagra
quid of podagra
first metatarsophalangeal gouty arthritis
characteristic of urate crystals in gout induced by chemo(2)
negative birefringent
needled shaped
Wbc count in gout arthrocentesis
2000-50000
what’s allopurinol
xanthine oxydase inhibitor
Meds used to treat acute attack of gout(3)
colchicine
NSAIDS
Steroids
Triad of Bechet(3)
reccurent painful ulcers
erythema nodosum
ant uveitis
localisation of reccurrent ulcers in behcet(2)
mouth
penis
population touched by Behcet(3)
turkish
asian
Middle eastern population
clue for compression vertebral fractures
local tenderness upon percussion of vertebrae
cause of compression fractures(2)
Bone demineralisation
low bone densitiy
cause of osteomalacia(3)
low calcium
low vit D
low phosphore
clue for viral arthritis
Multiple joint pain in patient working in day care center
cause of viral arthritis
parvovirus B19
localisation of pain in hand(3)
like RA
PIP
MCP
how long pain last in viral arthritis
2 months
patient at risk of vertebral osteomyelitis(3)
IV drugs user
sickle cell diseas
immunodepression
Paraclinique of vertebral osteomyelitis
MRI
bugs causing vertebral osteomyelitis
staph aureus
clue in physical exam in vertebral osteomyelitis
tenderness to gentle percussion of spinous process
young patient with low back pain
ankylosing spondylitis
Most common extra articular manif of ankylosing spondylitis
Ant uveitis
clue for Ankylosing spondylitis(3)
Morning stiffness
improve with exercice
link HLA-B27
bone involved in in Ankylosing spondylitis(2)
sacroillitis
then the spine
clue for lumbar stenosis(2)
elder patient
sitting relieves pain
why pain is relieved in lumbar stenosis while sitting
spine flexion open intervertebral space
quid of neural claudication
joint disease
what could be a complication of RA(2)
cervical subluxation spine
cervical spinal cord compression
clue for RA and pain
morning stiffness improving with activity
Marker of RA
anti-CCP
which immunoglobulin in RA
IGM
first drug used to treat RA
methotrexate
second line regimen if failure if no improvement after 6 months of treatment of RA
TNF inhibitor
what other drug can be used in adjunction to metotrexate(2)
hydroxychloroquine
or
sulfasalasine
quid of non biologic agent in RA(DMARD)(4)
methotrexate
hydroxychloroquine
sulfasalazine
azathioprine
quid of biologic effect(3)
ethanercept
infliximab
rituximab
mechanism of action of biologic agent in RA
TNF inhibitor
before beginning DMARD what to check first(2)
Hep B et C
TB
diasease causing erythema nodosum(7)
sarcoidosis behcet cocciodomycosis TB histoplasmosis IBD strep infection
what to do in presence of erythema nodosum(2)
chest x ray
search hilar adenopathy
erythema nodosum plus hilar adenopathy
sarcoidosis
oligoarthritis plus uretritis plus conjunctivitis
reactive arthritis
clue for reactive arthritis(3)
oligoarthritis
uretritis
conjunctivitis
oligo arthritis plus uretritis plus mouth ulcers
reactive arthritis
first line rx of reactive arthritis
NSAIDS
quid of enthesitis
Pain in tendon
tendon most frequently involved in enthesitis
achilles
most commonly involved joint in reactive arthritis(2)
Knee
sacroilliac
fluid synovial examination in gonococcal arthritis
negative or sterile
side effects of methotrexate(6)
oral ulcers increase transaminase pulmonary toxicity BM suppression alopecia anemia
what the mechanism responsible of side effect in methotrexate
antimetabolite agent
patient taking prednisone develops hip pain Dx
avascular necrosis of femoral head
the best test to Dx avascular necrosi of femoral head
MRI
or
scintigraphy
shoulder pain in tennis player
subacromial bursitis
Physical exam finding of subacromial bursitis
pain during rotation and flexion of the shoulder
Neer impingement sign? meaning(2)
pain during rotation and flexion of the shoulder
subacromial bursitis
quid of sausage digit or dactylitis
diffusely swollen digit
disease causing dactilytis or sausage digit
psoriatic arthritis
rx of psoriatic arthritis(3)
NSAIDS
methotrexate
anti TNF agents
arthrocentesis finding in pseudogout
rhomboid shaped
positively birefringent crystals
Quid of CPPD
calcium pyrophosphate dihydrate
disease with CPPD
chondrocalcinosis in Pseudogout
clue for rotator cuff tear
pain not relieved by lidocaine shooting
clue for rotator cuff tendinitis
pain relieved by lidocaine shooting
best test to DX rotator cuff tear
MRI of shoulder
causes of rotator cuff tear(2)
rotator cuff tendinitis
trauma
physical exam clue of rotator cuff tear(2)
lifting the arm above the head causes pain
no possibility of abduction and external rotation
site of lesion in Myasthenia gravis
post synaptic acetylcholine receptor
site of lesion in lambert eaton syndrome
presynaptic voltage gated calcium channel
site of lesion in dermato myositis or polymyositis
MX fibers
clue for dermatomyositis(2)
gottron papules
heliotrop rash
quid of gottron papules
violaceus papules involving dorsum of fingers
In Lambert eaton how are reflexes
absent
patient of unilateral leg edema and fever(3)
DVT
cellulitis
lymphadenitis
clue for cellulitis in unilateral edema(2)
fissured web toe
macerated
clue of anserine bursitis(2)
pain in medial side of the tibia
just below the knee
meaning of valgus test
medial collateral ligament is touched
rx of anserine bursitis(2)
ice
rest
cause of anserine bursitis(3)
trauma
overuse
abnormal gait
clue of the arthritis in SLE
non deforming arthritis
quid of HLA-B27 arthropathy(4)
IBD
Ankylosing spondylitis
Reactive arthritis
psoriatic arthritis
point common of any disease with HLA b27
enthesitis
most common lieu for enthesitis
heel
finding of ankylosing spondylitis
spine limited mobility
other sites of enthesitis(2)
illiac crest
tibial tuberosities
clue for fibromyalgia
female with diffuse Mx pain
first rx for fibromyalgia
amitryptiline
alternative rx for fibromyalgia(3)
duloxetin
pregabalin
milnacipran
quid of negative birefringent needle(2)
yellow needle like crystal
when parallel to polarizing axis
blue needle like crystals when perpendicular to polarizing axis
crystals causing negative birefringent needle
monosodium urate crustal deposition
wbc in osteo arthritis
200-2000
arthrocenthesis result in inflammatory arthritis wbc
2000-100000
arthrocenthesis result in septic arthritis wbc
> 50000
how to differentiate septic arthritis from inflammatory arthritis(2)
PMN>50% inflammatory arthritis
PMN> 80% septic arthritis
risk factor for gout(3)
high meat consumption
excessive alcohol intake
drugs (diuretic)
drug causing gout
diuretic thiazide
short term rx of gout(3)
NSAIDS
colchicine
corticosteroids
long term rx of gout
allopurinol
clue for polymyositis et dermatomyositis(3)
elevated CPK
ESR high
proximal mx weakness
cause of proximal weakness(4)
drug induced myositis
hypothyroid myopathy
Mx dystrophy
Myathenia gravis
Confirmatory dx of polymyositis
Mx Biopsy
Drugs causing Myopathy(3)
statin
alcohol
antipsychotics
first line of polymyositis
corticosteroids
first line rx of fibromyalgia(2)
aerobic exercice
good sleep hygiene
second step of fibromyalgia
amitryptiline
lumbar pain during lifting heavy object
lumbar strain
what should be done to prevent further back pain
keep the back straight when lifting object
patient with back pain worse at night
metastasis cancer
first tumor to metastase in bone(5)
lung breast prostate thyroid kidney
rx for symptomatic sarcoidosis
glucocorticoid
workup for sarcoidosis and meaning (3)
chest xray
biopsy
ACE increases
chest xray for sarcoidosis
hilar adenopathy
biopsy finding for sarcoidosis
non caseiting granuloma
xray finding in paget
mosaic pattern of lameller bone
physiopatho of paget
bone remodelling
why can you have hearing loss in paget
cranial nerve entrapment
main cause of paget
osteoclast dysfunction
bone reached in paget
femoral bowing
clue for inflammatory arthritis(2)
pain worst with rest
improves with movement
first bone touched in ankylosing spondylitis
apophyse joint of axial skeleton
triad of gonococcemia(3)
thenosinovitis
polyarthritis
painless vesiculo pustular lesions
quid of thenosinovitis
pain along the tendon sheath
quid CREST(5)
calcinosis raynaud phenomenon esophageal dysmotility sclerodactily teleangiactasia
what’s the most important guide in the treatment SLE
the grade of lupus nephtitis
in front of lupus dx what’s the first step
kidney biopsy
clue for compression fractures
pain in back without trauma
patient with risk for Compression fractures
osteroporosis
quid of babinski sign
upper motor neuron problem
absent ankle reflex in elderly meaning?
It’s normal
finding xray in ankylosing spondylitis(2)
fusion of sacroiliac joint
bamboo spine
gender in Ankylosing spondylitis
Male>female
why respiratory problem in Ankylosing spondylitis(2)
chest wall motion restriction
restrictive disease
why chest wall motion restriction in ankylosing spondylitis
fusion of costovertebral joints
clue of secondary amyloidosis
nephrotic syndrome in the setting of chronic and reccurrent infection
cause of secondary amyloidosis
any chronic inflammation
other name of secondary amyloidosis
AA
causes of secondary amyloidosis(5)
infection chronique inflammatory arthritis IBD malignancy(lymphoma) vasculitis
dx of AA and finding(2)
fad pad aspiration biopsy
Amyloid A
rx and prevention of AA
colchicine
target organs for amyloidosis(4)
rein
foie
coeur
system nerveux autonome
two presentation of gonococcal arthritis(2)
polyarthritis with skin rash and thenosinovitis
monoarthritis
cause of CPPD(3)
hyperparathyroidism
hemochromatosis
hypomagnesemia
high calcemia plus arthritis
CPPD
complication of Paget(2)
osteosarcoma
pathologic fractures
work up for paget(4)
high ALP
High urine hydroxyproline
Normal calcium and
phosphate
urinary marker of bone resorption(4)
N telopeptide
C telopeptide
hydroxyproline
deoxypiridinoline
Long ter complication of AS
decrease bone density
consequence of reduced bone density
fracture for minimal trauma
IBD et P anca positif plus arthritis
UC
P anca positif plus arthritis
UC
extracolonic manif of UC(5)
cholangitis episcleritis erythema nodosum pyoderma gangrenosum arthritis
disease with P-ANCA positive without vasculitis(2)
UC
AS
why sjogren causes difficulty swallowing
throat dryness because of lack of saliva
consequence of lack of saliva in sjogren(3)
high incidence of caries
submandibular swelling
dysphagia
cause of lack of saliva in sjogren
lymphocytic infiltration of salivary glands
quid of keratoconjonctivitis sicca in sjogren
dry eyes
glands problem in sjogren(2)
infiltration of salivary glands
and lacrymal glands
autoantibodies in sjogren
antiRO/SSA
anti LA/SSB
dermatomyositis antibody
anti mi 2
what is often associated with Dermatomyositis
malignancy
Most common malignancy associated with dermatomyositis(3)
ovarian # 1
breast lung
female urogenital
when you dx dermatomyositis what to do?
screen for Cancer
the most important surveillance approach in patient taking hydroxychloroquine
eye examination
risk with hydroxychloroquine
retinopathy
quid of phallen sign
flexion of wrist worsens paresthesia in carpal tunnel syndrome
cause of carpal tunnel syndrome
hypothyroidism
physiopatho of carpal tunnel syndrome in hypothyroidism
accumulation of matrix substances in the endneurium and perineurium of median nerve
quid of matrix substances
it’s mucopolysaccharides
indication of cyclophosphamide in SLE(2)
severe renal impairement
CNS impairement
side effects of cyclophosphamide(4)
bladder carcinoma
hemorragic cystitis
sterility
myelosuppression
cause of bladder carcinoma and hemorragic cystitis in cyclophosphamide
bladder toxicity causes by accumulation of acrolein
quid of acrolein
metabolite of cyclophosphamide
how to avoid bladder toxicity in cyclophosphamide(2)
lot of fluids
Mesna
patient with history of gout seen with knee swollen ,what test should be done first?(2)
synovial fluid analysis
cause of neuropathic joints(6)
diabetes B12 tabes dorsalis syringomyelie peripheral nerve damage spinal cord injury
consequence of neuropathic joints in diabetes
charcot joint
quid of charcot joints
deformed foot
cause of baker cyst
inflamed synovium
cause of baker cyst(3)
rhumatoid arthritis
osteoarthritis
cartilage tears
the most readily modifiable risk factor for OA
obesity
study of choice for spiunal stenosis
MRI
pain variation in spinal stenosis
worst in standing
relieved by seating
neuropathic claudication /vascular claudication
pain persisting during rest
most common extra articular manif of AS
anterior uveitis
whtas the most common cause of back pain
lumbar strain
straight leg raise test in lumbar strain
Normal
neurologic exam in lumbar strain
normal
rx of lumbar strain(2)
NSaid
and
early mobilisation
mechanism of corticoid related osteonecrosis
disruption of bone vasculature
arthritis with no pain after 2 months
viral arthritis
cause of positive Rheumatoid factor(4)
viral arthritis
bact arthritis
malignancy
rheumatoid arthritis
ANA positive cause(4)
SLE
HIV
Hepatitis
rheumatoid arthritis
does a normal individual can have ANA positive
yes
other name of rotator cuff impingement
same rotator cuff tendinitis
mechanism of kidney damage in SLE(2)
immune complex mediated
complex antigen antibody activates complement
why C3 is decreased in immune complex mediated reaction
activation of complement system
cause of low C3
any disease caused by immune complex reaction
disease causing low C3(2)
lupus
GNA
articulation touche dans SLE(3)
MCP
PIP
it’s like Rheumatoid arthritis
blood problem in SLE(3)
anemia
low platelet
low wbc
first initial treatment in OA
acetaminophen
what the two more common site of atherobolism event secondary to cardiac catheterisation(2)
pedal arteries
renal arteries
consequence of renal arterythrombo embolism post cardiac catheterisation
high creatinine
consequence of pedal artery thrombo embolism post cardiac catheterisation
blue toe syndrome
what’s the cause of thromboembolism in post cardiac catheterisation
cholesterol embolism
why chemo causes gout
massive release of acid uric from DNA of destroyed cells
quid of acid uric
by product of DNA
back pain in OA cause(2)
osteophytes
hypertrophy of ligamentum flavum
dx of degenerative central canal stenosis
MRI
cause of Dequervain
inflammation of two muscles
Mx inflammed in Dequervain(3)
abductor pollicis longus
extensor pollicis brevis
when passing through fibrous sheath at the radial styloid process
quid of finkelstein sign
flexion of thumb into the palm elicit pain
Meaning of finkelstein sign
Dequervain
person at risk of Dequervain
mother who holds the baby with their thumb outstretched
abducted et extended
rx of polymyalgia rhumatica(PMR)
low dose of prednisone
dx criteria for PMR
age >50
Mx ache
ESR> 40
localisation of Mx ache in PMR(3)
pelvic girdle
shoulder
neck
association of PMR
giant cell arteritis
clue for OA
difficulty moving after a period of rest
predisposing factor for OA(2)
obesity
age
the most common cause of joint disease
OA
greatest risk for patient with rhumatoid arthritis
osteoporosis
how does last the morning stiffness in RA
> 1 hour
prevention of osteoporosis in rheumatoid arthritis(4)
calcium
vit D
biphosphonate
low glucorticoid use
spinal problem in degenerative joint disease
cervical spondylysis
clue for cervical spondylisis(2)
neck pain
sensory problem in forearm
xray in cervical spondylisis
bone spur over cervical vertebrae
the most common finding in cervical spondylisis
bone spur
quid of tennis elbow
lateral epicondylitis
cause of tennis elbow
degeneration of extensor carpi radialis brevis tendon
Localisation of pain in lumbar strain
perispinal
Localisation of pain in compression fracture
directly on vertebrae
quid of pain during direct palpation of vertebrae(3)
infection
compression fracture
lytic bone lesion
quid of straight leg raise test
herniated disc
3 cancer metastasis in the spine
lung
breast
prostate
spine involvement in rhumatoid arthritis
cervical spine
monoarticular arthritis in elderly with normal lab
OA
monoarticular arthritis in elderly with high acid uric and high ESR
gout
physical findings in OA
bony crepitus
criteria to dx OA(5)
at least 3 to DX OA
bony crepitus bone enlargement bone tenderness lack of warmth lack of morning stiffness ahe >50
why myeloproliferative disorder can cause gout(3)
high turnover
high catabolism of purine
so over production of acid uric
example of myeloproliferative disorder causing gout
polycythemia vera
why Polycythemia vera produces gout(2)
because of high number of circulating basophiles
histamine release
scleroderma antibody
topoisomerase -I
Monoarthritis pain(3)
crystal induced arthritis
septic arthritis
OA
predisposing factor for septic arthritis
cartilage destruction(rhumatoid arthritis)
Rx of septic arthritis(2)
drainage
IV antibio
patient with AS ,back pain after minimal trauma
rule out vertebal fracture
risk of patient with AS
vertebal fracture with minimal trauma
red flag for back pain(7)
age > 50 pain during night or sleep neurologic symptom pain > 1 month history of previous ca weight loss no response to previous rx
rx of temporal arteritis
high dose of prednisone
new headache in patient female > 50 ans
temporal arteritis
vessels involved in giant cell arteritis
aorta and its cranial branches
know to differentiate gonococcemia from toxic shock syndrome
pustules on extensor surfaces even in woman using tampon=gonococcemia
anterior knee pain in young patient(3)
patello femoral syndrome
patellar tendonitis
osgood schlatter
who’s at risk for patellar femoral syndrome
female
who’s at risk for patellar tendonitis
athletes
who’s at risk for osgood schlatter
adolescent
clue for patello femoral syndrome
pain during climbing stairs
physical exam in patello femoral syndrome(2)
extend the knee while compressing the patella
patello femoral compressing test
rx of patellofemoral syndrome
exercice to stretch and strenghten the mx
pain location in patellar tendonitis
inferior patella
pain location in osgood schlatter
tibial tubercle
cause of lumbar spinal stenosis
spinal canal narrowing
cause of neurogenic claudication
spinal canal narrowing
mx pain with normal ESR
fibromyalgia
mx pain with high ESR
PMR
most common complication of giant cell arteritis
aortic aneurism
after dx giant cells arteritis next step
serial chest xray
specificity of neurogenic claudication
pain when standing
difference between anserine bursitis and patellar tendonitis
X?
quid of tophi
urate deposition in soft tissue forming tumor
HCTZ and gout(2)
hyperuricemia
can worsen gout
biopsy in whipple(2)
PAS positive macrophages in lamina propia
nonacd fast gram positive bacilli
action allopurinol
decrease acid uric production
Parvovirus in children
slapped cheek fever
risk factor for vertebral osteomyelitis
distant infection
Median for AS
20’s-30’s
palinfilm in AS
bilateral sacroilitis
quid of trigger finger
thenosinovitis of the palms
disease with trigger finger
RA
quid of rhumatoid nodules
nontender nodulesnear the elbows over the back the forearm
spinal complication of RA(2)
cervical spine subluxation—->
spinal cord compression
limitation of glucocorticoid in rx of RA
doesn’t prevent cartilage destruction
when can you use glucocorticoid in RA
to provide short term in awaiting response of DMARD
quid erythema nodosum
painful reddish multiple on ant surface of legs
most common casue of recent infection
recent strep infection
patient on rx for RA develops cytopenia and high transminases,what drug he is on
leflunomide
quid of leflunomine
pyrimidine synthesis inhibitor
action of hydroxychloroquine and sulfasalasine
TNF
IL-1 suppresor
patient on rx for RA develops hemolytic anemia and high transminases and stomatitis,what drug he is on
sulfasalazin
TNF inhibitor(6)
adalimumab certolizumab ethanercept infliximab golumumab
DMARDS
adalimumab certolizumab ethanercept infliximab golumumab methotrexate leflunomide hydroxychloroquine sulfasalazine
how to reduce toxicity of metotrexate
folic acid
cause of avascular necrosis(3)
corticosteroids
alcoholism
hemoglobinopathies
articulation involved in psoriasis
DIP
when can occur pseudogout
after recent surgery
medical illness
what about deformity in SLE
deformity is uncommon
young patient with articular pain
AS
quid of PAget disease
osteoclast hyperfunction
hearing loss in paget why
entrapment of 8
syndrome nephrotic in a context of hepatomegaly,palpable kidneys,fourth heart sound
amyloidosis
quid of 4 heart sound
ventricular hypertrophy
tender articulation and fever in young adult sexually active
Neisseria gonorrhea
constipation plus hypercalcemia with arthritis
pseudo gout
what disease to rule out after dx pseudogout
hyperparathyroidism
CPPD
calcium pyrophosphate dihydrate
most commonly affected bone in paget
skull
cause of charcot joint(2)
complication of neuropathy
repeated joint trauma in diabetic
when baker cyst can be confused with DVT
when rupture
profession with risk of lateral epicondylitis
tennis player
screwdriver
initial work up in back pain
xray plain film
patient with RA develops swollen knee chills and fever
septic arthritis
cause of charcot joint
nerve damage
greatest risk of complication in RA
osteoporosis
pain during squatting in woman
patellofemoral syndrome
quid of Anti CCP
anti cyclic citrulinated peptide
