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Step2 CK > Rheumatology > Flashcards

Rheumatology Flashcards

1
Q

How is osteoarthritis differentiated from rheumatoid arthritis?

A

In OA there is no inflammation, usually weight-bearing joints are involved (but if hand involvement then in DIP and PIP). Crepitations may been seen on exam and a short

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2
Q

How is OA treated?

A

Primary: weight loss and exercise. TYLENOL, best initial analgesic
Secondary: NSAIDS (if refractory to Tylenol; more SE)
Tertiary: intraarticular steroid/hyaluronin, topical capsaicin
Last resort is joint replacement

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3
Q

What are some circumstance/conditions in where gout is more common?

A

Gout is a problem of excess uric acid; this can be due to over production or under excretion. Over production may been see in increased cell turn over (cancer, hemolysis), enzyme deficiency (lesch-Nyah’s syndrome and glycogen storage disease); under excretion may be due to renal insufficiency, lactic acidosis/Ketoscidosis, medications like thiazides, aspirin and niacin.

Gout is mostly seen in MEN (90%)

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4
Q

What is the best initial test in a suspected acute gouty attack?

A

Arthocentesis because septic joint must be ruled out.
On polarized light there should be needle shaped negatively bifringent crystals.
WBC Predominant neutrophils; 2000-50,000

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5
Q

How is the treatment for acute gout different than chronic gout?

A

Acute gout: NSAIDS>steroids>colchicine (if NSAIDS/steroids cannot be used)

Chronic gout: lifestyle changes (wt loss, decrease meat and alcohol), stop medications that decrease excretion of uric acid (thiazides). Colchicine bridge to allopurinol/ febuxostat. Pegloticase, probe acid.

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6
Q

What treatment can be used for gout in a patient with renal failure?

A

Allopurinol

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7
Q

What are the common side effects with allopurinol?

A

Hypersensitivity reactions, TEN/SJS

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8
Q

What common side effect of colchicine?

A

WBC suppression

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9
Q

What is the best anti-hypertensive to use in a patient with gout?

A

Losartan

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10
Q

What cause pseudogout?

A

Calcium pyro phosphate crystals that come from calcium-containing salt deposits in the articular cartilage.

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11
Q

What are the risk factors for pseudogout?

A

Hemochromatosis, Hyperparathyroidism

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12
Q

What is seen on xray in pseudogout?

A

Calcification of cartilaginous structures of the joint and degenerative joint disease (as in osteoarthritis).

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13
Q

What is the most accurate tests to diagnose pseudogout?

A

Arthrocentesis showing rhomboid crystals that are positively bifringent and WBC of 2000-50,000

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14
Q

Treatment for pseudogout?

A

NSAIDS, if refractory can give intraarticular steroid/colchicine.
Colchicine can be given as prophylaxis between attacks.

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15
Q

What are some differentials for lower back pain?

A

Compression of spinal cord, cauda equina, ankylosising spondylitis, herniated disc, epidural access,

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16
Q

What history and s&s would make you think lower back pain is due to cord compression?

A

History of cancer, sudden onset of focal neurological deficits, tenderness with vertebral palpation, hyperreflexia below the level of compression

17
Q

What history and s&s would make you think lower back pain is due to epidural abscess?

A

It looks a lot like cord compression: hyperreflexia below compression, vertebral tenderness with percussion, focal sensory deficits…
But will have fever and elevated ESR

18
Q

What history and s&s would make you think lower back pain is due to cauda equina?

A

Bowel and bladder incontinence, erectile dysfunction, saddle anesthesia and bilateral leg weakness

19
Q

What history and s&s would make you think lower back pain is due to disc herniation?

A

Pain/numbness of medial calf/foot, loss of knee and ankle reflexes and positive straight leg test (if this is negative then there is 95%sensitivity)

20
Q

What history and s&s would make you think lower back pain is due to ankylosing spondylitis?

A

Patient with age

21
Q

What is the best initial test for lower back pain?

A

Plain xray

22
Q

What is the most accurate test to differentiate serious causes of lower back pain and in which condition is it not necessary?

A

MRI is the most accurate test, but is not needed in a patient with exam suggestive of herniated disk (positive straight leg raise) unless there are neurological deficits.

23
Q

How is septic arthritis differentiated on arthrocentesis if many other causes like gout have elevated WBC?

A

The WBC Level in septic arthritis is well above 50,000

24
Q

In a patient with an physical exam highly suggestive of cord compression what is the next best step in management?

A

Go straight to glucocorticoids as it is urgent to decrease the risk of permanent paralysis; even before MRI

25
Q

What is the treatment for cord compression?

A

Systemic glucocorticoids, chemo for lymphoma, radiation for solid tumor, surgical decompression if none of the above help.

26
Q

What is the treatment for epidural abscess?

A

Steroids, PPX antibiotics that cover staph like vancomycin (as staph aureus is the MCC) and then switch to beta-lactams if found to be sensitive to them, add gentamicin for synergy. Surgical drainage is a large collection of infected materials.

27
Q

What is the treatment for cauda equina syndrome?

A

Cord decompression

28
Q

What is the treatment for herniated disc?

A

NSAIDS with continuation of activities (REST IS A WRONG ANSWER); steroid injection into the epidural space for those who do not improve with conservative management.

29
Q

What cause of lower back pain should be considered if it is one that is affected by position (extension/flexion) of the back?

A

Spinal cord stenosis

30
Q

What history and s&s would back you think of lumbar spinal stenosis as the cause of lower back pain?

A

Older patient >60 whose back pain is elicited when there is extension of the spinal cord as in walking downhill, with pain radiation into the legs and buttocks bilaterally. Pt may also have unsteady gait, diminished lower extremity reflexes; normal ankle-brachial index

31
Q

What initial test should be done in suspected lumbar spinal stenosis?

A

MRI is the only test

32
Q

What is the treatment for spinal stenosis?

A

Weight loss and analgesics should be first.
Steroids into epidural space can be used if refractory, and PT/exercise and put off surgery
Surgical correction to dilate the spinal canal will be needed in 75% of patients.

33
Q

How is osteoarthritis diagnosed and what is most commonly seen?

A

Xray of the affected joint is then most accurate tests.

You may see joint space narrowing, osteophytes

Step2 CK (12 decks)

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