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Rheumatology Flashcards

1
Q

recurrent inflammatory condition of cartilage of joints, nose, ears, costal cartilage and airways that shows tracheal narrowing on XR - dx? tx?

A

Dx. relapsing polychondritis

Tx. high dose oral prednisone

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2
Q

intensely red, ulcerated and pedunculated mass that formed after minor trauma and bleeds easily - Dx? Tx?

A

Dx. pyogenic granuloma

Tx. shave and electrodessication OR excision

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3
Q

diagnostic criteria for RA (4 out of 8)

A
  1. morning stiffness > 1 hr
  2. wrist and finger (MCP, PIP)
  3. swelling of at least 3 joints
  4. symmetric involvement
  5. rheumatoid nodules
  6. XR abnormalities
  7. elevated CRP or ESP
  8. positive RF or anti-CCP
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4
Q

single most accurate test for dx. RA

A

anti-CCP (>95% specificity)

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5
Q

Felty’s syndrome

A

RA
splenomegaly
Neutropenia

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6
Q

MC involved joint in RA

A

MCP

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7
Q

Tests to order on CCS for RA

A 
XR
RF and anti-CCP level
CBC (normochromic normocytic anemia)
sedimentation rate (high)
if there is an effusion --> joint aspiration
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8
Q

what joint in spared in RA

A

sacroiliac joint

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9
Q

standard of care for pts with RA

A

NSAID + DMARD

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10
Q

stepwise management of RA

A
  1. NSAID always - doesnt matter which one
  2. add Methotrexate
  3. if MTX fails, add anti-TNF (infliximab, etanercept, adalimumab)
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11
Q

DMARDs that can be used in RA

A 
MTX
anti-TNF
hydroxychloroquine (only mild disease)
rituximab (anti-CD20)
anakinra (IL1 R antagonist)
Toclizumab (IL6 R antagonist)
Abatacept
Leflunomide (similar in effect to MTX but less toxic)
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12
Q

s/e MTX

A

BM suppression

pneumonitis

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13
Q

what needs to be monitored if pt is on hydroxychloroquine

A

regular eye exam to check for retinopathy

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14
Q

role of steroids in managing RA

A

bridge to DMARD therapy when patient is acutely ill with severe inflammation

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15
Q

CF: ankylosing spondylitis

A
  1. young male with back pain/stiffness, >3 mths, better w/ exercise; pain worse at night, relieved by leaning forward
  2. limited ROM of lumbar spine; kyphosis
  3. diminished chest wall expansion
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16
Q

assoc. conditions with ankylosing spondylitis

A

eye = acute anterior uveitis, cataracts, cystoid macular edema
aortitis; valvular dz - AR, MVP
restrictive lung disease - apical pulmonary fibrosis
varicocele
GI - nonspecific ileal and colonic mucosal ulcerations
IgA nephropathy

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17
Q

Tx. ankylosing spondylitis

A

NSAIDS
Biologic agents – infliximab, adalimumab
Sulfasalazine

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18
Q

triad of knee pain, urinary difficulties dure to genital lesions and conjunctivitis in a patient with history of chlamydia, shigella, salmonella, yersinia or campylobacter infection - dx?

A

reactive arthritis

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19
Q

skin lesion characteristic of reactive arthritis

A

keratoderma blenorrhagicum

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20
Q

which joint is characteristically involved in psoriatic arthritis

A

DIP

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21
Q

Tx. reactive arthritis

A

NSAIDs
abx for acute infection
DMARDS: sulfasalazine, MTX if sulfa ineffective
progressive exercise

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22
Q

Tx. psoriatic arthritis

A

NSAIDs
if no response to NSAIDS –> start MTX
biologic anti-TNF also effective

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23
Q

dx criteria for juvenile RA

A 
fever
salmon-colored rash
polyarthritis
LAD
myalgias
hepatosplenomegaly
elevated transaminases
elevated WBCs, high ferritin level
negative RF and ANA
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24
Q

Tx, JRA

A

NSAIDs

unresponsive cases with steroids

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25
Pt presents with diarrhea, fat malabsorption, weight loss and joint pain - Dx? Test? Tx?
Dx. Whipple's disease Test: biopsy of small bowel (PAS + org) Tx. ceftriaxone followed by TMP/SMX for a year
26
MC involved joint in osteoarthritis
DIP joints
27
Tx. osteoarthritis
acetaminophen | weight loss, exercise
28
what symptom is present in 95% of SLE patients?
fatigue
29
SLE - best initial test (1) - most specific test (2)
1. ANA level | 2. anti DS DNA or anti-Sm ab
30
best test to f/u severity of a flare in SLE
``` complement levels (decrease) anti-DS DNA (rises) ```
31
which abs are a risk factor for developing heart block in baby
anti-RO and anti-SSA ab
32
Tx. acute flare ups of SLE
steroids
33
Tx. rash and joint pain in SLE not responding to NSAIDs
hydroxychloroquine | anti-malarials
34
Tx. severe SLE relapse upon cessation of steroids
bemalimumab azathioprine cyclophosphamide
35
Tx. lupus nephritis
steroids + mycophenolate mofetil
36
Dx. criteria Osler-Weber Rendu
1. recurrent epistaxis 2. cutaneous telengiectasias 3. proven visceral AV malformations 4. first degree relative
37
CF in drug-induced lupus
1. presence of anti-histone ab or positive ANA 2. NEVER renal or CNS involvement 3. complement and anti-DS DNA normal
38
drugs that may cause lupus
``` hydralazine procainamide isoniazid penicillamine minocycline diltiazem methyldopa chlorpromazine IFNalpha ```
39
most accurate test for diagnosing Sjogren's syndrome
lip biopsy or salivary gland biopsy
40
Schirmer test
decreased wetting of paper held to eye
41
pts with sjogrens are at increased risk of what cancer
B cell NHL (polyclonal activation and infiltration of salivary glands)
42
Tx. Sjogrens
keep eyes and mouth moist Cevimeline --> more specific for oral and ocular secretions (increase Ach which increases secretions) Pilocarpine
43
ab in Scleroderma
anti-topoisomerase (anti-Scl 70)
44
Tx. scleroderma with renal involvement and HTN
ACEI
45
Tx. scleroderma with pulmonary HTN
bosentan, prostacyclin analogs, sildenafil
46
Tx. scerloderma (Raynauds)
CCBs - nifedipine, amlodipine, diltiazem (not verapamil)
47
Tx. GERD assoc. with scleroderma
PPIs
48
Tx. lung fibrosis secondary to scleroderma
cyclophosphamide
49
dx. testing CREST syndrome
anti-centromere abs
50
Pt presents with thickened skin that has a peau d'orange appearance; On labs, he has marked eosinophillia. Dx? Tx?
Dx. Eosinophilic fascitis | Tx. steroids
51
presence of anti-Jo1 ab in dermatomyositis greatly increases risk for what disaese?
interstitial lung disease
52
what tests should you order for patient with suspected dermatomyositis or polymyositis?
``` CPK, aldolase LFTs ANA EMG biopsy - single most accurate ```
53
Tx, dermatomyositis/polymyositis
steroids
54
Tx. fibromyalgia
1. exercise | 2. milnacipran, duloxetine, pregabalin - initial therapy
55
Tx. polymyalgia rheumatica
prednisone 10-20 mg/day (low dose) | if temporal arteritis involved --> 40-60 mg (high dose)
56
features of polyarteritis nodosa
vasculitis with additional findings of abdominal pain, renal involvement, testicular involvement, pericarditis, HTN, HEP B
57
best initial test for PAN
angiography of abdominal vessels
58
most accurate test for any vasculitis
biopsy!
59
Tx. PAN
prednisone | cyclophosphamide
60
lab test in Wegener's granulomatosis
c-ANCA
61
lab findings in Churg Strauss
p-ANCA anti-myeloperoxidase ab eosinophillia
62
Tx. Churg Strauss
steroids
63
young asian female + diminished pulses who presents s/p TIA
Takayasu arteritis
64
Dx. Takayasu arteritis
aortic arteriography or MRA
65
Hep C + pt presents with fatigue, malaise, skin lesions, joint pain and renal issues - dx?
cryoglobulinemia
66
Tx. hep C assoc. with cryoglobulinemia
ribavirin and interferon
67
Tx. Behcets dz
prednisone | colchicines
68
things that can exacerbate an acute gouty attack
binge drinking alcohol thiazides nicotinic acid cyclosporin
69
tests to order on CCS for gout
``` arthrocentesis (best initial) joint fluid examination: cell count, culture, protein serum uric acid level XR extremity examination for tophi ```
70
best initial therapy for acute gouty attack
NSAIDs - indomethacin, ibuprofen | - if insufficient response or C/I to NSAIDs (renal failure), use steroids
71
when is colchicine beneficial for gout
1. first 24 hours of attack 2. C/I to NSAIDs, such as renal insufficiency 3. preventive therapy
72
which drugs lower the level of uric acid
allopurinol probenicid sulfinpyrazone
73
febuxostat
xanthine oxidase inhibitor | - used in gout if pt is intolerant of allopurinol
74
s/e allopurinol
rash allergic interstitial nephritis hemolysis
75
rasburicase/pegloticase
benign drugs that breakdown uric acid | - used if allopurinol or febuxostat is not enough
76
empiric therapy for septic arthritis
IV ceftriaxone and vancomycin
77
MC organisms causing septic arthritis
staph aureus strep gram negative bacili
78
best initial test for Paget's disease
serum Ca and ALP level | - elevated ALP, normal Ca
79
most accurate test for Paget's disease
XR | bone scan is more sensitive
80
for CCS, in case of Paget's disease what tests should you order
``` ALP XR urinary hydroxyproline serum calcium level serum phosphate level bone scan ```
81
Tx. Paget's disease
NSAIDs - pain bisphosphonates - usual treatment calcitonin
82
complications of Paget's disease
``` bone fractures tumors high output heart failure hypercalcemia and nephrolithiasis compression neuropathy arthritis of adjacent bone hearing loss - 37% of pts ```
83
diagnostic testing for Baker's cyst
none - clinical diagnosis | order an USG to excluse DVT
84
Tx. Baker's cyst
NSAIDs
85
Tx. Mallet finger (extended finger is forcibly flexed)
extensor splinting for 4-5 weeks | tendinous injuries require 6-8 weeks
86
tests to order in pt with suspected fibromyalgia
CBC, ESR, TSH and muscle enzymes (CK) | if all normal, consider psych eval (30% have coexisting depression)
87
pt presenting with proximal muscle weakness and skin lesions - dx? in adults what is this related to often time
Dx. dermatomyositis | usually related to malignancy, esp in presence of RFs
88
CK levels > 10, 000 should make you think of what
rhabdomyolysis
89
CF: rhabdomyolysis
``` muscle tenderness increased muscle tone renal failure hyperkalemia hypocalcemia hyperphosphatemia ```
90
Tx. rhabdomyolysis
immediate isotonic saline hydration | alkalinization of the urine with bicarb
91
what should you suspect in pt presenting with isolated proximal muscle weakness and what test should you order?
myopathy | order - EMG
92
best initial test in pt with suspected ankylosing spondylitis
plain film XR of sacroiliac joint
93
how do you monitor disease progression in pts with ankylosing spondylitis
AP/lateral XR of lumbar spine lateral XR of cervical spine pelvic XR, incl sacroiliac joint and hips acute phase reactants i.e. ESR
94
next step in management of pt with SLE presenting with kidney involvement
kidney biopsy | - treatment is based on pattern of glomerular involvement
95
Tx. Type I and II lupus nephritis
no therapy required
96
Tx. extensive Type III and all type IV lupus nephritis
IV methylprednisolone
97
Tx. type V lupus nephritis
tx with steroids when proliferative lesions are superimposed
98
when do you use cyclophosphamide for SLE nephritis
if steroids are inadequate or pt has severe disease
99
what can be used to monitor dz activity in SLE
anti-dsDNA and complement levels
100
which ab levels in SLE have been assoc with development of lupus nephritis
anti-dsDNA ab
101
what SLE symptoms is hydroxychloroquine useful for?
arthralgias serositis cutaneous symptoms
102
young, female pt presenting with chronic knee pain that is worse with squatting. on exam, she has pain on extension of the knee with anterior patellar compression - dx?
patellofemoral syndrome
103
pain and tenderness at inferior patella; usually in "jumping" sports
patellar tendonitis
104
tx. patellofemoral pain syndrome
exercises to stretch and strengthen the thigh muscles
105
localized pain/tenderness at medial aspect of knee joint distal to the joint line; usually acute in onset
anserine bursitis
106
localized tenderness at tibial tubercle
osgood schlatter
107
anterior knee pain, acute onset, with visible swelling anterior to patella; may be secondarily infected
prepatellar bursitis
108
lateral shoulder or deltoid pain aggravated by reaching or lifting the arms up
rotator cuff tendonitis/tear - weakness + loss of strength impingement syndrome frozen shoulder - stiffness + decreased ROM
109
causes of anterior shoulder pain
acromioclavicular or glenohumeral joint OA | biceps tendonitis
110
posterior shoulder pain
usually referred from cervical spine - nerve impingement 2 to disc herniation - spinal stenosis
111
tx. of acute gout attack in pt with renal failure
intra-articular corticosteroids
112
which lab finding may be present in pt with inflammatory myositis...
elevated serum ferritin levels (acute phase reactant)
113
tx. inflammatory myositis
high dose steroids --> prednisone, 1mg/kg

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