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Clin Med II - Exam 2 > Rheumatology 3 > Flashcards

Rheumatology 3 Flashcards

1
Q

juvenile idiopathic arthritis (JIA) is an umbrella term for chronic arthritides in patients __ years old or less

A

16

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2
Q

JIA must involve at least __ joint and last for
__ weeks

A

1 joint
6 weeks

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3
Q

what are the subtypes of JIA (6)

A
  1. oligoarticular 2. polyarticular (sero pos, sero neg) 3. systemic onset 4. psoriatic 5. enthesitis-related 6. undifferentiated
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4
Q

JIA is likely caused by __ increase with __ cells and formation of __

A

synovial fluid increase with inflammatory cells and formation of panes

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5
Q

what is another name for oligoarticular JIA

A

pauciarticular JRA

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6
Q

oligoarticular haș __ joint involvement and must involve fewer than __ joints

A

asymmetric 4

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7
Q

în oligoarticular JIA, ESR/CRP might be slightly elevated, but __ is positive in 60% of pt’s

A

ANA

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8
Q

oligoarticular JIA increases risk for __, so regular __ exams must be done

A

uveitis slit-lamp

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9
Q

polyarticular JIA must involve at least __ joints

A

5

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10
Q

in polyarticular JIA, CRP may be normal, but __ is usually very elevated

A

ESR

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11
Q

what does seropositive polyarticular JIA mean

A

positive RF

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12
Q

seropositive polyarticular JIA resembles adult __; seronegative polyarticular JIA will not have any __ features

A

RA extraarticular

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13
Q

systemic onset JIA (SOJI) is also called

A

Still’s Dz

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14
Q

2 common clinical manifestations of SOJIA/Still’s

A
  1. quotidian fever 2. salmon-colored evanescent macular rash
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15
Q

SOJI/Stills mc affects

A

trunk, extremities

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16
Q

what can be a fatal complication of SOJIA/Still’s

A

pericarditis or MAS (macrophage activation syndrome)

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17
Q

what might labs show for SOJIA/Stills

A

leukocytosis very high ESR elevated ferritin

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18
Q

macrophage activation syndrome (MAS) is a complication of SOJI and can cause

A

fevers coma shock DIC -> immune system going crazy -> up to 50% mortality

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19
Q

psoriatic arthritis is associated w. what 5 clinical manifestations

A

DIP synovitis dactylitis nail pitting psoriatic rash acute anterior uveitis

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20
Q

what 3 JIA conditions increase risk for uveitis

A

oligoarticular psoriatic enthesitis-related

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21
Q

psoriatic arthritis increases risk for

A

uveitis

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22
Q

enthesitis-related JIA is characterized by __ tenderness

A

sacroiliac

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23
Q

what genetic factor is associated w. enthesitis related JIA

A

HLA-B27

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24
Q

enthesitis ininflammation of the

A

tendons or ligaments -> ex kid w. swollen achilles tendon

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25
Q

enthesitis-related JIA includes pt’s w.

A

juvenile-onset spondylitis reactive arthritis IBD arthritis

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26
Q

enthesitis-related JIA is a __ diagnosis

A

clinical

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27
Q

JIA are all __ diagnosis

A

clinical

labs can be supportive

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28
Q

first step in all JIA is

A

pediatric rheum referral

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29
Q

what are the 2 mainstays of therapy in JIA

A

NSAIDS

intraarticular joint injxn

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30
Q

SOJI pt’s need __ initially for symptom control

A

steroid

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31
Q

in addition to NSAIDs and intraarticular joint injxns, __ might also be a drug used in JIA tx

A

DMARDs → MTX

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32
Q

what JIA condition needs aggressive tx w. DMARD

A

seropositive polyarticular JIA

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33
Q

which JIA has the highest mortality rate

A

SOJIA

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34
Q

what are the two forms of systemic sclerosis (scleroderma)

A

limited

diffuse

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35
Q

systemic sclerosis/scleroderma is caused by

A

fibrosis of the skin and other organs

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36
Q

CREST syndrome is a type of __ scleroderma

A

limited

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37
Q

what does CREST stand for

A

calcinosis cutis

raynaud phenomenon

eesophageal dysmotility

sclerodactylyl

telangiectasia

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37
Q

what does CREST stand for

A

calcinosis cutis

raynaud phenomenon

eesophageal dysmotility

sclerodactylyl

telangiectasia

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38
Q

what 2 groups are esp at risk for scleroderma

A

aa

choctaw Native American

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39
Q

what does this make you think of: widespread proliferative/obliterative vasculopathy of small and medium arteries and capillary refraction

A

scleroderma

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40
Q

what is the first sign of scleroderma

A

Raynaud phenomenon

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41
Q

initial skin manifestations of scleroderma

A

edema

pruritus

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42
Q

late skin manifestations of scleroderma

A

thick, hide like skin

tight skin

hyperpigmentation/depigmentation

ulcers

telangiectasis

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43
Q

what is watermelon stomach

A

GI manifestation of scleroderma

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44
Q

pulmonary manifestation of scleroderma

A

fibrosis → pHTN

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45
Q

cardiac manifestations of scleroderma

A

pericarditis

diastolic hf

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46
Q

what do calcinosis cutis and siccca syndrome make you think of

A

scleroderma

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47
Q

what is scleroderma renal crisis

A

sudden onset of malignant HTN → renal failure → death

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48
Q

up to 80% of scleroderma pt’s have

A

pericardial involvement

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49
Q

can scleroderma also cause thromboembolic dz and affect MSK, neuromuscular, and GU systems?

A

yes

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50
Q

2 GU manifestations of scleroderma

A

ED

dysperiunia in women → fibrotic vaginal opening

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51
Q

over 95% of scleroderma pt’s have (+) ANA

A
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52
Q

what (+) lab value is related to poor prognosis w. scleroderma

A

anti-SCL-70

53
Q

imaging for lung involvement in scleroderma

A

high resolution CT

baseline PFTs

54
Q

what test to order for cardiac involvement in scleroderma

55
Q

why would you order EGD in scleroderma

A

Barrett’s esophagus

56
Q

score of __ or above is diagnostic for criteria for scleroderma

57
Q

can scleroderma be dx’ed w.o the criteria

58
Q

tx for scleroderma targets

A

affected organs

59
Q

tx for skin sx in scleroderma

A

glucocorticoids, MTX, cyclophosphamide, IVIG

60
Q

tx for raunaud phenomenon in scleroderma

A

CCB → nifedipine

61
Q

__ agents are used for GI symptoms in scleroderma

A

pro kinetic agents → reglan or erythromycin

62
Q

tx for lung sx in scleroderma

A

diuretics

+/- digoxin

63
Q

tx for renal sx in scleroderma

64
Q

tx for ED in scleroderma

A

long acting Cialis (tadalafil)

65
Q

leading cause of mortality in scleroderma

A

pulmonary fibrosis

66
Q

what do you think when you see inflammatory dz w. autoabs affecting every organ

A

systemic lupus erythematosis (SLE)

67
Q

lupus incidence is highest in

A

child bearing females

68
Q

rf for SLE

A

estrogen!

smoking

69
Q

constitutional SLE sx (5)

A

fever

fatigue

anorexia

malaise

wt loss

70
Q

skin manifestations of SLE

A

acute cutaneous lupus erythematosis (ACLE)

71
Q

ACLE looks like

A

butterfly rash

72
Q

ACLE spares __

and is triggered by __

A

nasolabial folds

sun

73
Q

what do you think when you see maculopapular lesions in a photosensitive distribution on any part of the body

74
Q

what is SCLE

A

subacute cutaneous lupus erythematosis (SCLE)

75
Q

what do you think when you see scaly erythematous papule

76
Q

most photosensitive SLE rash

77
Q

what is CCLE

A

chronic cutaneous lupus erythematosis

78
Q

mc subtype of CCLE

A

discoid lupus

79
Q

what do you think when you see raise, erythematous plaques w. a scale or ring around the lesion

80
Q

what MSK sx is common in SLE

A

arthralgia

81
Q

what is renal involvement of SLE called

A

lupus glomerulonephritis

82
Q

vascular sx of SLE

A

raynaud

vasculitis

83
Q

what does palpable purple petechiae make you think of

A

vasculitis in SLE

84
Q

mc cardiac manifestation of SLE

A

pericarditis

85
Q

what does “wart-like” pericardial lesions make you think of

A

cardiac symptom of SLE

86
Q

what ocular sx is very common in SLE

A

dry eye (keratoconjunctivitis sica) → secondary Sjorgen’s

87
Q

what lab value is always positive in SLE

88
Q

besides ANA, what other lab values are associated w. SLE

A

anti-dsDNA

anti-SM

89
Q

antiphospholipid abs in SLE can cause false positive for

90
Q

what organ involvement do you not see in drug induced lupus

91
Q

T/F drug induced lupus is just in common in women as men

92
Q

name 3 drugs that are associated w drug induced lupus

A

procainamide

hydralazine

isoniazid

→ lots more

93
Q

do lab abnormalities and sx go away when drug is removed in drug-induced lupus

94
Q

tx considerations for SLE

A

exercise

smoking cessation

sun protection

healthy diet

prevention of glucocorticoid-induced osteoporosis

utd on vaccines

+/- antimalarials (hydroxychloroquine)

95
Q

tx for cutaneous lupus

A

topical corticoids

+/- systemic meds → hydroxychloriquine

96
Q

tx for MSK SLE

A

NSAIDs/Tylenol

+/- hydroxychloriquine

97
Q

tx for serositis SLE

A

NSAIDs

+/-steroids and hydroxychloriquine

98
Q

test to order before tx of renal manifestation of SLE

99
Q

4 important drugs in SLE

A

glucocorticoids

hydroxychloriquine

MTX

99
Q

4 important drugs in SLE

A

glucocorticoids

hydroxychloriquine

MTX

100
Q

what do you think of when you see ai myopathy characterized by proximal muscle weakness

A

polymyositis

101
Q

in SLE, pt’s w. __ involvement have the poorest prognosis

102
Q

polymyositis pt’s have __ abs

A

anti muscle:

MSAs

MAAs

103
Q

muscle weakness in polymyositis is __,

__,

and __

A

gradual

progressive

symmetric

104
Q

weakness in polymyositis affects __ first

105
Q

most pt’s w. polymyositis will have elevated __;

__ may also be (+)

106
Q

gold standard for polymyositis dx

107
Q

what do you think of when you see inflammatory infiltrate on muscle bx

A

polymyositis

108
Q

how can EMG be helpful in polymyositis

A

shows early muscle involvement → show you where to bx

109
Q

how can MRI be helpful in polymyositis

A

areas of muscle inflammation → help decide where to bx

110
Q

can you dx polymyositis w.o muscle bx

111
Q

what clinical symptoms can be diagnostic of polymyositis

A

proximal muscle weakness → can be more helpful/used more than enzymes

abnormal muscle enzyme labs

no better explanation

112
Q

initial tx for polymyositis

A

steroids

→ usually combined w. another immunosuppressant

113
Q

do pt’s w. polymyositis need to avoid exercise

A

no! it helps → PT recommended

114
Q

5 clinical domains of psoriatic arthritis

A

peripheral

axial

enthesitis

dactylitis

skin and nail

115
Q

psoriatic arthritis usually develops

A

after or at same time as psoriasis

116
Q

genetic component of psoriasis

117
Q

psoriatic arthritis pt’s will have morning pain/stiffness __ min

A

more than 30

118
Q

polyarhtritis can be __

or __, but

__ is mc

A

symmetric or asymmetric mc: symmetric

119
Q

4 clinical presentations of psoriatic arthritis

A

symmetric vs asymmetric

distal → DIP

arthritis mutilans

spondyloarthritis → C-spine involvement

120
Q

3 periarticular manifestations of psoriatic arthritis

A

enthesitis

tenosynovitis

dactylics

121
Q

what is dactylics

A

sausage digit

122
Q

in psoriatic arthritis, nails can show

A

pitting

ridging

oncholysis

123
Q

psoriasis can be __, so it is important to do through exam in pt’s you suspect psoriatic arthritis

124
Q

what do you think of when you see “pencil-in-cup”deformity

A

psoriatic arthritis → damage to DIP and PIP

125
Q

what criteria is used for psoriatic arthritis

126
Q

tx for mild psoriatic arthritis

A

NSAIDs → naproxen, Celebrex

127
Q

tx for severe/unresponseive to NSAIDs psoriatic arthritis

A

DMARDs → MTX, sulfasalazine

TNF inhibitors → Etanercept

128
Q

what do you have to screen for before prescribing immunosuppressing drugs in psoriatic arthritis (or any rheum condition)

129
Q

what drug to avoid in psoriatic arthritis

A

PO steroids → can cause flare of pustular psoriasis

Clin Med II - Exam 2 (14 decks)

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