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ICM II > Rheumatology > Flashcards

Rheumatology Flashcards

1
Q

What is the most common autoimmune arthritis?

A

Rheumatoid arthritis

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2
Q

What allele and what gene are associated with increased risk of RA?

A

Gene: HLA-D4

Allele: HLA-DRB1

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3
Q

Patient presents with symmetric arthritis with small joint involvement. Patient is experiencing early morning stiffness, and joints are tender and swollen. Sedimentation rate, c reactive protein, RF and anti-CCP are positive on labs. What is the likely diagnosis?

A

Rheumatoid arthritis

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4
Q

What is involved in the fluid phase of rheumatoid arthritis pathophysiology?

A
  • Overall:
    • vasodilation
    • swelling
    • pain
    • superficial cartilage damage
  • Neutrophil recruitment
  • Complement activation
  • Release of Pgs, LTs, and ROS
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5
Q

What is involved in the tissue phase of rheumatoid arthritis pathophysiology?

A
  • Overall:
    • Pannus formation that invades bone, cartilage, and ligaments
  • Mech
    • Stimulates
      • T cells: cytokines
      • B cells: RF, anti-CCP
      • Monocytes: IL-1, TNF alpha
    • Synovial cells proliferate
    • Synthesis of collagenase and metalloproteinases
      • break down cartilage and bone
    • Activation of osteoclasts
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6
Q

What is the function of metalloproteinases?

A

Break down of bone

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7
Q

What joints are most commonly affected by RA?

A

Hands

Feet

Ankles

Elbows

Large joints as well

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8
Q

What is present in the X-rays of RA?

A
  • Joint space loss
  • Erosions
  • Subluxation
  • Ulnar drift of MCPs
  • Swan neck deformities
  • Boutonniere
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9
Q

What complication can arise in the posterior popliteal fossa of RA patients?

A

Bakers cyst

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10
Q

What complication can arise in the neck of RA patients?

A

C1-C2 subluxation

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11
Q

Where are rheumatoid nodules found?

A

extensor tendons

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12
Q

What is Caplan Syndrome?

A

Multiple RA nodules in lung with pneumoconiosis

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13
Q

What is Felty’s syndrome?

A

Splenomegaly

Leukopenia

Recurrent pulm infections

(in RA patients)

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14
Q

What labs are elevated in RA?

A
  • Sedimentation rate
  • C reactive protein
  • RF
  • anti-CCP
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15
Q

RA patients are at an increased risk of what systemic disease? What neoplasm?

A

CV disease

Non-Hodgkin’s lymphoma

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16
Q

What is the most common population affected by SLE?

A

Females in reproductive years

Blacks and Hispanics

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17
Q

How does arthritis present in SLE?

A

Symmetric (like RA)

Non-erosive (unlike RA)

Causes joint laxity

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18
Q

What is the most common serious organ involvement in SLE?

A

Lupus Nephritis

Class V: diffuse membranous (nephrotic syndrome)

Class VI: diffuse proliferative

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19
Q

What are possible symptoms of Lupus Cerebritis?

A
  • Psychosis
  • Seizure
  • Coma
  • Transverse myelitis
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20
Q

How does SLE present in its mildest form?

A
  • Rash
    • Butterfly
    • Photosensitive
    • Alopecia
  • Arthritis
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21
Q

What occurs in Discoid rash of SLE?

A

Follicular plugging

Alopecia

Scarring

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22
Q

What auto-Abs are present in SLE?

A
  • ANA
    • sensitive
    • not specific
  • dsDNA and Smith
    • not sensitive
    • specific
  • SSA
  • SSB
  • Others
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23
Q

What causes increased rates of miscarriage in SLE patients?

A

Antiphospholipid Ab Syndrome

(clotting of placental vessels)

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24
Q

What is Rhupus?

A

erosive arthritis

evidence of RA and SLE

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25
Q

What is Mixed Connective Tissue Disease?

A

SLE

Myositis

Scleroderma

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26
Q

Which drugs can cause SLE as a side effect?

A

Procainamide

Hydralazine

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27
Q

How is Neonatal Lupus acquired?

A

Passive transfer of Ab to child thru placenta

Will resolve in time after birth

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28
Q

Which Ab is associated with complete heart block in neonatal lupus?

A

SSA

This complicatino is permanent

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29
Q

What are the signs and symptoms of Antiphospholipid Ab Syndrome?

A

Recurrent arterial or venous thrombosis

Recurrent spontaneous abortions

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30
Q

What causes gout?

A

Deposits of uric acid (end product of purine metabolism) around joints = tophi

Can form renal calculi

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31
Q

What population is most affected by gout?

A

Men

Post-menopausal women

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32
Q

How and where does gout typically present?

A
  • Presentation
    • Painful
    • Red
    • Swollen
    • Single joint
  • Location:
    • 1st MTP
    • Cooler temperature promotes deposition
      • most common in lower extremities
33
Q

What is the gold standard for diagnosis of gout?

A

Synovial fluid examination

Looks like toothpaste (white)

34
Q

What is seen on polarized light microscopy in gout?

A

Strongly negatively birefringent crystals

35
Q

What are the characteristics of pseudogout?

  • Joints affected
  • Population
  • Material Deposited
  • X-ray appearance
  • Polarized light microscopy appearance
A
  • Joints
    • large joint involvement
  • Population
    • aging pop
  • Deposition of:
    • Calcium Pyrophosphate dihydrate crystals
  • X-ray
    • Chondrocalcinosis
  • Polarized light microscopy
    • Rhomboid crystals
    • Weakly positive
36
Q

What is the difference in distribution of Diffuse Scleroderma vs CREST syndrome?

A
  • Diffuse
    • Trunk, face, proximal extremities
  • Limited
    • Face, fingers, toes
37
Q

What are the symptoms of CREST?

A
  • Calcinosis
  • Raynauds
  • Esophageal hypomotility
  • Scleroderma
  • Telangectasia
38
Q

What autoantibodies are present in Systemic Sclerosis?

A

ANA family

  • anti-topoisomerase I (scl-70)
    • more common in diffuse
  • Anti-centromere
    • more common in limited
39
Q

What common symptom affecting tendons is found in diffuse sclerosis?

A

Tendon Friction Rub

40
Q

Secondary Raynaud’s is found in which rheumatic diseases?

A
  • Scleroderma
  • SLE
  • RA
41
Q

How are vessels affected by Systeic sclerosis?

A

Endothelial and smooth muscle cell proliferation

Obliteration of vessel

42
Q

Anti-topoisomerase is most associated with which form of systemic sclerosis? What complications are more likely to result?

A

Diffuse Sclerosis

Increased risk of renal and lung involvement

43
Q

Anti-centromere is most associated with which form of systemic sclerosis? What complications are more likely to result?

A

Limited Sclerosis

Increased risk of Pulm HTN

44
Q

What is Scleroderma sine scleroderma?

A

Findings of vascular and visceral involvement without skin findings

45
Q

What is Morphea?

A

Inflamed skin, fibrosis, and atrophy (even down to the bone) w/o Raynaud’s or other scleroderma features

46
Q

What Auto-Ab is present in spondyloarthropathies?

A

None!

Trick Question!

47
Q

Which Spondyloarthropathises are related to HLA B27?

A

Ankylosing Spondylitis

Reactive arthritis

Psoriatic arthritis

Enteropathic arthritis

Uveitis

(arthritic diseases with spinal involvement)

48
Q

What are the causes of Reactive Arthritis?

A

Chlamydia trachomatis

Shigella

Salmonella

Campylobacter

Yersinia

Klebsiella pneumonia

49
Q

What are the symptoms of Reactive Arthritis?

A

Conjunctivitis

Urethritis

Arthritis

(Can’t see, can’t pee, can’t climb a tree)

Skin (including palms)

Oral ulcers

Nail thickening

50
Q

Enteropathic Arthritis

  • Path
  • Common location
  • Associated diseases
A
  • Path
    • Non-erosive
  • Common location
    • Lwr Extremities
  • Associated diseases
    • Crohns
    • Ulcerative colitis
51
Q

What is the treatment for Spondyloarthropathy affecting the spine?

A

Physical therapy

Daily exercise

52
Q

What auto-Ab is present in inflammatory myopathies?

A

Anti-Jo

(antisynthetase)

53
Q

Inclusion Body Myositis

  • Population affected
  • Symptoms
A
  • Population affected
    • >50
  • Symptoms
    • DIstal muscle weakness
    • Problems with balance and falls
54
Q

Dermatomyositis

  • Symptoms
  • Lab results
  • Auto-Ab
  • Testing
A
  • Symptoms
    • Slowly progressive, symmetrical, proximal weakness
    • Minimal pain
    • Shawl (v-shaped) rash
    • Gottron’s Lesions
  • Lab results
    • increased muscle enzymes
  • Auto-Ab
    • Anti-Jo
  • Testing
    • muscle biopsy
      • quadriceps
55
Q

What is the cancer risk in dermatomyositis?

A

2X increase

56
Q

What extra-dermal symptoms are often present in dermatomyositis?

A

Pulm involvement

57
Q

What type of crystals are found in osteoarthritis?

A

Calcium pyrophosphate crystals

Apatite crystals

58
Q

Which joint disease has cysts and osteophytes?

A

Osteoarthritis

59
Q

What is the most common cause of Septic Bursitis?

A

S. aureus

60
Q

Where is pain localized in subacromial bursitis?

A

Deltoid area

Pain on abduction or external rotation

61
Q

What are the characteristics of Hypertrophic osteoarthropathy? It is associated with which type of cancer?

A
  • Characteristics
    • Clubbing
    • Periostitis (long bones)
  • Cancer
    • Lung cancer (90%)
62
Q

What rheumatic manifestation presents in Leukemia and Lymphoma?

A

Arthritis

63
Q

What rheumatic manifestation presents in Hemophilia?

A

Hemarthrosis

Aspirate only if spetic joint is considered!!

64
Q

What rheumatic manifestation presents in Sickle cell and thalassemia?

A

Bone pain

Fractures

Osteonecrosis

65
Q

What rheumatic manifestation presents in Multiple Myeloma and amyloidosis?

A

Bone pain

Osteoporosis

Enlarged tongue

66
Q

What is seen in tissue biopsy in amyloidosis?

A

_Apple gree_n birefringent fluorescence with congo red stain

67
Q

What rheumatic manifestation presents in Hemochromatosis?

A

Pseudogoat

Symmetric arthropathy of 2,3 MCP

OA

68
Q

What rheumatic manifestation presents in Whipple disease?

A

Arthritis

69
Q

What rheumatic manifestation presents in Primary Biliary Chirrhosis?

A

Osteoporosis

Pruritis

Assoc. w/ other autoimmune disorders

70
Q

What is diabetic hand syndrome?

A

Thickening of joint capsules, tendons, skin

71
Q

What rheumatic manifestation presents with hyperparathyroidism?

A

Joint symptoms

Pseudogout

72
Q

What rheumatic manifestation presents in sarcoidosis?

A

Arthritis

73
Q

What is Lofgren’s Syndrome?

A

Acute Sarcoidosis

Hilar adenopathy

Erythema nodosum

Arthritis of ankles

74
Q

Polymyalgia Rheumatica

  • Symptoms
  • Associated disorder
  • Labs
A
  • Symptoms
    • proximal mm pain and stiffness
  • Associated disorder
    • Giant Cell Arteritis
  • Labs
    • Increased ESR
75
Q

Polyarteritis Nodosa

  • Size of artery affected
  • Most common arteries affected
  • Diagnosis
A
  • Size of artery affected
    • Medium
  • Most common arteries affected
    • Renal
    • Mesenteric
  • Diagnosis
    • Angiogram
    • ANCA
76
Q

Churg Strauss Syndrome

  • Size of vessel affected
  • Population
A
  • Size of vessel affected
    • Small to medium
  • Population
    • Middle aged
    • Chronic Asthma
77
Q

Where are pseudotumors found in Wegener’s Granulomatosis?

A

Lung

Retro-orbital

78
Q

What is Leukocytoclasstic Vasculitis?

A

Palpable purpura

Seen w/ any vasculitis of small / medium vessels

ICM II (12 decks)

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