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Step 3 > Rheumatology > Flashcards

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
Q

Pt presents with diarrhea, fat malabsorption, weight loss and joint pain - Dx? Test? Tx?

A

Dx. Whipple’s disease
Test: biopsy of small bowel (PAS + org)
Tx. ceftriaxone followed by TMP/SMX for a year

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26
Q

MC involved joint in osteoarthritis

A

DIP joints

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27
Q

Tx. osteoarthritis

A

acetaminophen

weight loss, exercise

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28
Q

what symptom is present in 95% of SLE patients?

A

fatigue

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29
Q

SLE

  • best initial test (1)
  • most specific test (2)
A
  1. ANA level

2. anti DS DNA or anti-Sm ab

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30
Q

best test to f/u severity of a flare in SLE

A 
complement levels (decrease)
anti-DS DNA (rises)
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31
Q

which abs are a risk factor for developing heart block in baby

A

anti-RO and anti-SSA ab

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32
Q

Tx. acute flare ups of SLE

A

steroids

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33
Q

Tx. rash and joint pain in SLE not responding to NSAIDs

A

hydroxychloroquine

anti-malarials

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34
Q

Tx. severe SLE relapse upon cessation of steroids

A

bemalimumab
azathioprine
cyclophosphamide

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35
Q

Tx. lupus nephritis

A

steroids + mycophenolate mofetil

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36
Q

Dx. criteria Osler-Weber Rendu

A
  1. recurrent epistaxis
  2. cutaneous telengiectasias
  3. proven visceral AV malformations
  4. first degree relative
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37
Q

CF in drug-induced lupus

A
  1. presence of anti-histone ab or positive ANA
  2. NEVER renal or CNS involvement
  3. complement and anti-DS DNA normal
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38
Q

drugs that may cause lupus

A 
hydralazine
procainamide
isoniazid
penicillamine
minocycline
diltiazem
methyldopa
chlorpromazine
IFNalpha
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39
Q

most accurate test for diagnosing Sjogren’s syndrome

A

lip biopsy or salivary gland biopsy

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40
Q

Schirmer test

A

decreased wetting of paper held to eye

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41
Q

pts with sjogrens are at increased risk of what cancer

A

B cell NHL (polyclonal activation and infiltration of salivary glands)

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42
Q

Tx. Sjogrens

A

keep eyes and mouth moist
Cevimeline –> more specific for oral and ocular secretions (increase Ach which increases secretions)
Pilocarpine

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43
Q

ab in Scleroderma

A

anti-topoisomerase (anti-Scl 70)

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44
Q

Tx. scleroderma with renal involvement and HTN

A

ACEI

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45
Q

Tx. scleroderma with pulmonary HTN

A

bosentan, prostacyclin analogs, sildenafil

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46
Q

Tx. scerloderma (Raynauds)

A

CCBs - nifedipine, amlodipine, diltiazem (not verapamil)

47
Q

Tx. GERD assoc. with scleroderma

A

PPIs

48
Q

Tx. lung fibrosis secondary to scleroderma

A

cyclophosphamide

49
Q

dx. testing CREST syndrome

A

anti-centromere abs

50
Q

Pt presents with thickened skin that has a peau d’orange appearance; On labs, he has marked eosinophillia. Dx? Tx?

A

Dx. Eosinophilic fascitis

Tx. steroids

51
Q

presence of anti-Jo1 ab in dermatomyositis greatly increases risk for what disaese?

A

interstitial lung disease

52
Q

what tests should you order for patient with suspected dermatomyositis or polymyositis?

A 
CPK, aldolase
LFTs
ANA
EMG
biopsy - single most accurate
53
Q

Tx, dermatomyositis/polymyositis

A

steroids

54
Q

Tx. fibromyalgia

A
  1. exercise

2. milnacipran, duloxetine, pregabalin - initial therapy

55
Q

Tx. polymyalgia rheumatica

A

prednisone 10-20 mg/day (low dose)

if temporal arteritis involved –> 40-60 mg (high dose)

56
Q

features of polyarteritis nodosa

A

vasculitis with additional findings of abdominal pain, renal involvement, testicular involvement, pericarditis, HTN, HEP B

57
Q

best initial test for PAN

A

angiography of abdominal vessels

58
Q

most accurate test for any vasculitis

A

biopsy!

59
Q

Tx. PAN

A

prednisone

cyclophosphamide

60
Q

lab test in Wegener’s granulomatosis

A

c-ANCA

61
Q

lab findings in Churg Strauss

A

p-ANCA
anti-myeloperoxidase ab
eosinophillia

62
Q

Tx. Churg Strauss

A

steroids

63
Q

young asian female + diminished pulses who presents s/p TIA

A

Takayasu arteritis

64
Q

Dx. Takayasu arteritis

A

aortic arteriography or MRA

65
Q

Hep C + pt presents with fatigue, malaise, skin lesions, joint pain and renal issues - dx?

A

cryoglobulinemia

66
Q

Tx. hep C assoc. with cryoglobulinemia

A

ribavirin and interferon

67
Q

Tx. Behcets dz

A

prednisone

colchicines

68
Q

things that can exacerbate an acute gouty attack

A

binge drinking alcohol
thiazides
nicotinic acid
cyclosporin

69
Q

tests to order on CCS for gout

A 
arthrocentesis (best initial)
joint fluid examination: cell count, culture, protein
serum uric acid level
XR
extremity examination for tophi
70
Q

best initial therapy for acute gouty attack

A

NSAIDs - indomethacin, ibuprofen

- if insufficient response or C/I to NSAIDs (renal failure), use steroids

71
Q

when is colchicine beneficial for gout

A
  1. first 24 hours of attack
  2. C/I to NSAIDs, such as renal insufficiency
  3. preventive therapy
72
Q

which drugs lower the level of uric acid

A

allopurinol
probenicid
sulfinpyrazone

73
Q

febuxostat

A

xanthine oxidase inhibitor

- used in gout if pt is intolerant of allopurinol

74
Q

s/e allopurinol

A

rash
allergic interstitial nephritis
hemolysis

75
Q

rasburicase/pegloticase

A

benign drugs that breakdown uric acid

- used if allopurinol or febuxostat is not enough

76
Q

empiric therapy for septic arthritis

A

IV ceftriaxone and vancomycin

77
Q

MC organisms causing septic arthritis

A

staph aureus
strep
gram negative bacili

78
Q

best initial test for Paget’s disease

A

serum Ca and ALP level

- elevated ALP, normal Ca

79
Q

most accurate test for Paget’s disease

A

XR

bone scan is more sensitive

80
Q

for CCS, in case of Paget’s disease what tests should you order

A 
ALP
XR
urinary hydroxyproline
serum calcium level
serum phosphate level
bone scan
81
Q

Tx. Paget’s disease

A

NSAIDs - pain
bisphosphonates - usual treatment
calcitonin

82
Q

complications of Paget’s disease

A 
bone fractures
tumors
high output heart failure
hypercalcemia and nephrolithiasis
compression neuropathy
arthritis of adjacent bone
hearing loss - 37% of pts
83
Q

diagnostic testing for Baker’s cyst

A

none - clinical diagnosis

order an USG to excluse DVT

84
Q

Tx. Baker’s cyst

A

NSAIDs

85
Q

Tx. Mallet finger (extended finger is forcibly flexed)

A

extensor splinting for 4-5 weeks

tendinous injuries require 6-8 weeks

86
Q

tests to order in pt with suspected fibromyalgia

A

CBC, ESR, TSH and muscle enzymes (CK)

if all normal, consider psych eval (30% have coexisting depression)

87
Q

pt presenting with proximal muscle weakness and skin lesions - dx? in adults what is this related to often time

A

Dx. dermatomyositis

usually related to malignancy, esp in presence of RFs

88
Q

CK levels > 10, 000 should make you think of what

A

rhabdomyolysis

89
Q

CF: rhabdomyolysis

A 
muscle tenderness
increased muscle tone
renal failure
hyperkalemia
hypocalcemia
hyperphosphatemia
90
Q

Tx. rhabdomyolysis

A

immediate isotonic saline hydration

alkalinization of the urine with bicarb

91
Q

what should you suspect in pt presenting with isolated proximal muscle weakness and what test should you order?

A

myopathy

order - EMG

92
Q

best initial test in pt with suspected ankylosing spondylitis

A

plain film XR of sacroiliac joint

93
Q

how do you monitor disease progression in pts with ankylosing spondylitis

A

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
Q

next step in management of pt with SLE presenting with kidney involvement

A

kidney biopsy

- treatment is based on pattern of glomerular involvement

95
Q

Tx. Type I and II lupus nephritis

A

no therapy required

96
Q

Tx. extensive Type III and all type IV lupus nephritis

A

IV methylprednisolone

97
Q

Tx. type V lupus nephritis

A

tx with steroids when proliferative lesions are superimposed

98
Q

when do you use cyclophosphamide for SLE nephritis

A

if steroids are inadequate or pt has severe disease

99
Q

what can be used to monitor dz activity in SLE

A

anti-dsDNA and complement levels

100
Q

which ab levels in SLE have been assoc with development of lupus nephritis

A

anti-dsDNA ab

101
Q

what SLE symptoms is hydroxychloroquine useful for?

A

arthralgias
serositis
cutaneous symptoms

102
Q

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?

A

patellofemoral syndrome

103
Q

pain and tenderness at inferior patella; usually in “jumping” sports

A

patellar tendonitis

104
Q

tx. patellofemoral pain syndrome

A

exercises to stretch and strengthen the thigh muscles

105
Q

localized pain/tenderness at medial aspect of knee joint distal to the joint line; usually acute in onset

A

anserine bursitis

106
Q

localized tenderness at tibial tubercle

A

osgood schlatter

107
Q

anterior knee pain, acute onset, with visible swelling anterior to patella; may be secondarily infected

A

prepatellar bursitis

108
Q

lateral shoulder or deltoid pain aggravated by reaching or lifting the arms up

A

rotator cuff tendonitis/tear - weakness + loss of strength
impingement syndrome
frozen shoulder - stiffness + decreased ROM

109
Q

causes of anterior shoulder pain

A

acromioclavicular or glenohumeral joint OA

biceps tendonitis

110
Q

posterior shoulder pain

A

usually referred from cervical spine

  • nerve impingement 2 to disc herniation
  • spinal stenosis
111
Q

tx. of acute gout attack in pt with renal failure

A

intra-articular corticosteroids

112
Q

which lab finding may be present in pt with inflammatory myositis…

A

elevated serum ferritin levels (acute phase reactant)

113
Q

tx. inflammatory myositis

A

high dose steroids –> prednisone, 1mg/kg

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