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STEP 3 > Rheumatology > Flashcards

Rheumatology Flashcards

1
Q

Rheumatoid Arthritis is defined as?

A

Having 4 or more of the following….
morning stiffness lasting >1 hour, wrist/finger involvement, swelling of at least 3 joints, symmetric, rheumatoid nodules, x-ray abnormalities(erosions), positive anti-CCP, CRP/ESR elevated
- must last for at least 6 weeks

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2
Q

What is the single most accurate test for RA?

A

anti-CCP

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3
Q

What is the treatment for RA?

A

NSAIDs combined with DMARDs

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4
Q

What is the best initial DMARD?

A

Methotrexate (causes bone marrow supression, pneumonitis, liver disease)

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5
Q

What additional tests need to be ordered if hydroxychloroquine is started for RA?

A

Regular eye exams for retinopathy

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6
Q

What role do steroids have in RA?

A

Serve as a bridge to DMARD therapy to control acutely ill patients with severe inflammation

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7
Q

What characteristics do all of the seronegative spondyloarthropathies (AS, Reactive arthritis, Psoriatic arthritis, JRA) have in common?

A

Negative test for RH
Spine predilection
SI joint involvement
HLA-B27

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8
Q

What are the characteristics of reactive arthritis(Reiter’s syndrome)?

A

asymmetric arthritis, urethritis, GI infection, conjunctivitis
Can’t pee, see, climb tree

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9
Q

How do you treat reactive arthritis?

A

NSAIDs

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10
Q

What are the characteristics of psoriatic arthritis?

A

joint arthritis, nail pitting, DIP joint involvement, sausage shaped digits, enthesitis

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11
Q

What is the treatment for psoriatic arthritis?

A

NSAIDs

Methotrexate for resistant disease

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12
Q

What are the characteristics of JRA?

A

fever, salmon colored rash, polyarthritis, lymphadenopathy, myalgias

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13
Q

What lab tests are typical in setting of JRA?

A

high ferritin, negative ANA and RH, inceased WBC

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14
Q

What is the treatment for JRA?

A

NSAIDs

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15
Q

What should be ordered when a patient presents with osteoarthritis?

A

ANA, ESR, RH, Anti-CCP

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16
Q

What is the best initial test for SLE?

A

ANA

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17
Q

What is the most specific test for SLE?

A

Anti-DS DNA or Anti-Smith

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18
Q

What is the best way to follow severity of SLE flares?

A

Complement levels(drop in flare-ups and anti-DS DNA(rises in flare-ups)

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19
Q

What is the treatment for acute flares for SLE?

A

prednisone and other glucocorticoids

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20
Q

What are the causes of drug induced lupus?

A 
HIPP
Hydralazine
Isoniazid
Procainamide
Phenytoin
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21
Q

What are the characteristics of Sjogrens syndrome?

A

woman, dry eyes, mouth, sensation of sand under eyelids, loss of taste and smell

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22
Q

What is the most accurate test for Sjogrens?

A

lip biopsy

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23
Q

What serologic tests are positive in Sjogrens?

A

Anti-Ro/SSA and Anti-La/SSB

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24
Q

What is the treatment for Sjogren’s?

A

keep mouth/eyes moist

pilocarpine

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25
Q

How does scleroderma present?

A

woman, tight/thick/fibrous skin, Raynauds phenomenon

can have lung fibrosis(pulmonary HTN), restrictive cardiomyopathy, renal involvement with HTN

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26
Q

What is the diagnostic test for scleroderma?

A

antitopoisomerase(anti-Scl 70)

27
Q

How do you treat scleroderma?

A 
Treat the symptoms..
HTN- ACEi
Pulmonary HTN- bosentan
Raynauds- CCB
GERD- PPI
Lung fibrosis- cyclophosphamide
28
Q

How does eosinophilic fasciitis present?

A

Thickened skin that looks like scleroderma but with no hand involvement, Raynauds, heart/lung/kidney involvement

29
Q

How does polymyositis present?

A

Patient can’t get up out of seated position, proximal weakness, muscle inflammation

30
Q

How does dermatomyositis present?

A

Patient can’t get up out of a seated position, rashes, periorbital rash (Heliotrope rash), Shawl sign(shoulder and neck erythema), MCP papules (Grotton’s)

31
Q

What are the diagnostic tests for polymyositis and dermatomyositis?

A

Elevated CPK, aldolase, abmormal EMG,

Order liver function tests and ANA for CCS portion of exam

32
Q

What is the most common complication of polymyositis/dermatomyositis?

A

malignancy

33
Q

What is the treatment for PM/DM?

A

Steroids

34
Q

How does fibromyalgia present?

A

woman, muscle aches and stiffness in certain trigger points

35
Q

How to treat fibromyalgia?

A

exercise, milnacipran, duloxetine, pregabalin(best initial therapy), TCAs

36
Q

How does polymyalgia rheumatica present?

A

pain/stiff proximal muscles(shoulders/pelvis), worse in morning, localized to muscles not joints, elevated ESR

37
Q

What is the most accurate test for vasculitis?

A

biopsy

38
Q

What is the best initial therapy for vasculitides?

A

prednisone, glucocorticoids

39
Q

What is the best initial test for diagnosing polyarteritis nodosa?

A

angiography of abdominal vessels

40
Q

What is the most accurate test for diagnosing PAN?

A

biopsy (skin, muscle)

41
Q

What is the treatment for PAN?

A

prednisone and cyclophosphamide

42
Q

How does Wegener’s granulomatosis present?

A

upper and lower respiratory findings, positive c-ANCA

43
Q

What is the treatment for Wegeners granulomatosis?

A

prednisone and cyclophosphamide

44
Q

How does Churg-Strauss present?

A

Vasculitis, eosinophilia, asthma

45
Q

If a patient presents with symptoms of temporal arteritis(headache, jaw pain, vision changes, tender scalp….) what is the first step?

A

Treat with steroids, more important than diagnosis

46
Q

How does Takayasu’s arteritis present?

A

usual vasculitis picture along with possibly stroke/TIA from vascular occlusions

47
Q

How is Takayasu’s arteritis diagnosed?

A

Aortic arteriography or MRA. NOT DIAGNOSED VIA BIOPSY

48
Q

What disease is associated with cryoglobulinemia?

A

Hepatitis C, treat disease with interferon and ribavarin

49
Q

What is the best initial test for septic joints?

A

Cell count on aspiration
Normal < 2000
Inflammatory 2000-5000
Infectious > 50,000

50
Q

What is the most accurate test for gout?

A

polarized light exam (negative birefringent needles)

51
Q

Best initial test for gout?

A

arthrocentesis

52
Q

What is the best initial treatment for acute gout attack?

A

NSAIDs, if no response(or contraindicated) after NSAIDs, use steroids

53
Q

When is colchicine indicated for gout?

A

When NSAIDs are contraindicated and it is within 24 hours

54
Q

What is given for gout prevention?

A

Allopurinol- lowers UA levels
Weight loss/no booze
febuxostat- xanthine oxidase inhibitor
uricase- breaks down UA

55
Q

How does CPPD present?

A

Knee and wrist involvement, slower onset than gout

56
Q

What is seen on microscopy for CPPD?

A

positive birefringent crystals

57
Q

What is the best initial therapy for CPPD?

A

NSAIDs

58
Q

How does Paget’s disease present?

A

Often symptomatic, pain, stiff, achy joints, fractures, sarcomas in 1% of patients

59
Q

What is the best initial test for Paget’s disease?

A

Alkaline phosphatase

60
Q

What is the most accurate test for Paget’s disease?

A

Xray

61
Q

What should be ordered on the CCS portion of the exam for Paget’s disease?

A

Urine hydroxyproline, serum Ca, serum P, bone scan

62
Q

What is the treatment for Paget’s?

A

Bisphosphonates, Calcitonin

63
Q

What is the diagnostic test for Baker’s cyst?

A

US, must r/o DVT

64
Q

What is the treatment for Baker’s cyst?

A

NSAIDs

STEP 3 (8 decks)

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