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MKSAP - Internal > Rheumatology > Flashcards

Rheumatology Flashcards

1
Q

“tennis elbow”

A

lateral epicondylitis; MCC of elbow pain

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2
Q

sx. of tennis elbow

A

tenderness over lateral epicondyle

pain on resisted wrist extension and hand gripping

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3
Q

“golfers elbow”

A

medial epicondylitis

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4
Q

sx. of golfers elbow

A

tenderness over medial epicondyle

pain on wrist flexion

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5
Q

cubital tunnel syndrome

A

ulnar nerve entrapment

  • pain and sensory/motor loss in ulnar region
  • paresthesias in ulnar aspect of arm/hand
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6
Q

carpet layers elbow

A

olecranon bursitis

- extremely tender to palpation but does NOT cause restriction or pain with ROM of elbow

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7
Q

how can you diagnose trochanteric bursitis?

A

hip pain that pts can point to with one finger on lateral hip; pain worsened with actively resisted abduction

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8
Q

Tx. trochanteric bursitis

A

corticosteroid injection

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9
Q

what type of pain is consistent with hip joint pathology?

A

pain localized to groin and restricted ROM in hip

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10
Q

what kind of injury should make you suspect a meniscal tear?

A

twisting injury of foot in weight bearing position, in which a popping or tearing sensation is felt, followed by severe pain and swelling over several hours

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11
Q

sx. experienced by pts with meniscal tears

A

clicking or locking of knee secondary to loose cartilage; but usually pain only on walking, esp stairs

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12
Q

sensitive and specific tests to dx. meniscal tears

A

pain along joint line - sensitive

audible pop or snap in McMurray’s test - specific

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13
Q

pain and tenderness over anteromedial aspect of lower leg just below the joint line of the knee; focal tenderness on the upper, inner tibia about 5 cm distal to medial articular line of the knee

A

anserine bursitis

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14
Q

young woman complains of pain in knee when going down steps and development of knee stiffness/pain at rest when knee is flexed for prolonged period of time

A

dx. patellofemoral pain syndrome

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15
Q

pt presents with pain when reaching overhead and when lying on their shoulder - dx?

A

rotator cuff tendinitis

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16
Q

rotator cuff tendinitis

A

inflammation of the supraspinatus and/or infraspinatus tendons as well as the subacromial bursa

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17
Q

adhesive capsulitis

A

frozen shoulder - decrease range of shoulder motion due to stiffness (not pain or weakness)

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18
Q

bicipital tendinitis

A

anterior shoulder pain is elicited with resisted forearm supination or elbow flexion

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19
Q

pt comes in with arm weakness, esp during abduction and/or external rotation

A

rotator cuff tear

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20
Q

how can you diagnose a rotator cuff tear?

A

positive drop-arm test (inability to smoothly lower affected arm from full abduction)

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21
Q

what is the next step in management of someone with referred shoulder pain?

A

CXR - helps identify underlying intrathoracic process (apical lung tumor, effusion,PTX)

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22
Q

how do you treat a pt with polymyalgia rheumatica who is having flares on steroid tapering?

A

give min. dose of steroids that prevents symptoms and add steroid-sparing agent such as Methotrexate

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23
Q

empiric therapy of choice for community acquired septic arthritis w/ synovial fluid positive for gram positive cocci

A

Vancomycin - increase in MRSA strains

- may switch to oxacillin or cefazolin once culture results are present

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24
Q

what is MRI of joints useful for?

A

detecting avascular necrosis
soft tissue masses
collections of fluid not visualized by other modalities

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25
Q

gold standard for diagnosing prosthetic joint infection

A

arthrocentesis with culture

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26
Q

CF in prosthetic joint infection

A

mostly pain
fever, leukocytosis absent
elevated ESR

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27
Q

pt who had arthroplasty many years ago presents with pain in proximal and medial aspect of the thigh that is worse with weight bearing

A

aseptic loosening

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28
Q

radiograph finding in aseptic loosening

A

osteolysis

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29
Q

what drugs can you use in an acute gout attack

A

NSAIDs - first line
corticosteroids
colchicine

30
Q

when is colchicine most effective in tx. gout

A

pts with monoarticular involvement

when used w/in first 24 hours of attack can abort the attack

31
Q

when can you begin uric-acid lowering therapy in gout pts?

A

when pt has atleast 2 documented cases of gout; never during an acute attack

32
Q

what is the target serum uric acid level in gout therapy?

A

< 6.0 mg/dl - at this conc, monosodium urate crystals are resorbed

33
Q

what else should you give a pt before initiating allopurinol?

A

prophylactic colchicine OR
low dose steroids OR
NSAIDs
- atleast for 1 week before

34
Q

chronic apatite deposition disease

A

large, minimally inflammatory effusions that develop in shoulder or knee; destruction of associated tendon structures and chronic pain

35
Q

first line management option for pts with OA of the knee

A

physical therapy - esp. quadriceps muscle training

36
Q

chronic pain at the base of the thumb suggests..

A

OA of first carpometacarpal joint

37
Q

“grind test”

A

movement of thumb in circular direction elicits pain in OA

38
Q

finkelstein test

A

flexing thumb into palm, closing fingers over thumb and bending wrist elicits pain in De Quervain tenosynovitis

39
Q

pt presents with pain on palpation of the distal aspect of the radial styloid

A

de Quervain tenosynovitis

40
Q

which tests can be used to test for Carpal tunnel syndrme?

A

Tinel sign - tapping flexor retinaculum

Phalen sign - flexing the wrists against each other

41
Q

next best step in pt with OA that acetaminophen isnt helping?

A

NSAIDs, ie. ibuprofen

42
Q

next pharmacologic intervention in pt with OA in whom NSAIDs are not helping

A

intra-articular corticosteroids or hyaluronan injections

43
Q

radiograph showing marginal joint erosions would support a diagnosis of..

A

rheumatoid arthritis

44
Q

what chronic infection can RF be positive in?

A

chronic hepatitis C

45
Q

in which RA patient is methotrexate not warranted as first line DMARD therapy?

A

those who consume alcohol regularly -> increases risk of hepatotoxicity

46
Q

what DMARD is warranted in a patient with early, mild and nonerosive RA?

A

hydroxychloroquine

- esp if pt has contraindications to methotrexate

47
Q

what should you suspect in pts with explosive onset, widespread psoriasis along with DIP joint involvement, asymmetric joint involvement and symptoms of enthesitis or joint ankylosis?

A

untreated HIV infection

48
Q

presence of acute oligoarticular arthritis involving the lower extremities in a patient with inflammatory diarrheal illness suggests…

A

enteropathic arthritis

49
Q

patient has pain in the eye, sensitivity to light and blurred vision - dx?

A

acute anterior uveitis

50
Q

acute anterior uveitis (unilateral) is strongly associated with..

A

HLA-B27 arthropathies, esp, ankylosing spondylitis

51
Q

MC diagnosed systemic illnesses associated with anterior uveitis (3)

A

ankylosing spondylitis
reactive arthritis
sarcoidosis

52
Q

definitive test to diagnose ankylosing spondylitis

A

MRI (with gadolinium enhancement )of sacroiliac joints

53
Q

young pt presents with persistent pain and morning stiffness involving the lower back that is alleviated with activity; there is accompanying tenderness of the pelvis

A

consider a diagnosis of ankylosing spondylitis

54
Q

what tests can be done to confirm presence of SLE?

A
  1. anti-dsDNA ab

2. measure complement C3, C4 and CH50 levels

55
Q

which antibody is associated with development of interstitial lung disease in scleroderma?

A

anti-Scl70

56
Q

antihypertensive drugs of choice in SLE?

A

ACEi - help control proteinuria as well

57
Q

what is initial tx. when you suspect lupus nephritis in pt?

A

high dose prednisone

58
Q

skin condition characterized by central telengiectasias, flushing and acneiform papules/pustules

A

rosacea

59
Q

the classic malar rash typically spares what area of the face?

A

nasolabial folds - relatively protected from the sun

60
Q

most appropriate tx. for Raynaud’s phenomenon in systemic sclerosis

A

dihydropyridine CCB i.e. amlodipine

61
Q

young female presents with diffuse pain on both sides of the body, above and below the waist as well as axial skeletal pain - dx?

A

fibromyalgia

62
Q

lab findings frequently present in pts. with Sjogren’s syndrome

A

Ro/SSA and La/SSB abs
ANA
RF
hypergammaglobulinemia

63
Q

MC organ involved in PAN

A

kidney - causes HTN, kidney insufficiency and renal vasculitis

64
Q

diagnosis of PAN (2)

A
  1. sural nerve biopsy

2. kidney angiography

65
Q

angiographic findings in pts with PAN

A

microaneurysms or a beaded pattern with areas of arterial narrowing and dilation

66
Q

Tx. of suspected PAN

A

immunosuppressive therapy - steroids, cyclophosphamide (if severe)

67
Q

what should you consider in a pt with upper and lower airway manifestations, renal involvement and inflammatory arthritis

A

Wegener’s granulomatosis

68
Q

ab’s that are specific for Wegeners

A

c-ANCA

anti-proteinase 3 ab

69
Q

what do you do next if you suspect giant cell temporal arteritis in a patient?

A

IV steroids (methylprednisone) - initiate treatment before doing any diagnostic test

70
Q

gold standard for dx. of temporal arteritis

A

temporal artery biopsy

71
Q

patient presents with pain in the shoulder and hip girdle accompanied by significant elevation in ESR

A

suspect polymyalgia rheumatica

MKSAP - Internal (11 decks)

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