Rheumatology

Question 1

Gout Characteristics

Answer 1

1. systemic disease of altered purine metabolism

2. more common in men until women until menopause

Question 2

Gout Clinical Features

Answer 2

1. initial attack of metatarsal phalangeal joint of greater toe
2. tophi in chronic gout form adjacent to affected joint

Question 3

Gout Diagnostic Studies

Answer 3

1. Joint fluid analysis (rod-shaped, negatively birefringent urate cystals)
2. uric acid above 8mg/dL

Question 4

Non-pharm Gout Treatment

Answer 4

1. elevation and rest

2. dietary modifications (etoh, red meats)

Question 5

Pharm Gout Treatment

Answer 5

1. NSAIDs (indomethacin)
2. colchicine
3. corticosteroid injections
4. between acute attacks: colchicine, probenacid, sulfapyrazine, allopurinol (not during acute attack), febuxostat

Question 6

Calcium pyrophosphate dihydrate (CPPD)/pseudogout general characteristics

Answer 6

affects peripheral joints, usually lower extremity, results from intra-articular deposition of calcium pyrophosphate

Question 7

Pseudogout Clinical Features

Answer 7

most common joints are knees, wrist and elbows

Question 8

Pseudogout Diagnostic Studies

Answer 8

1. Rhomboid-shaped, positively birefringement crystals

2. linear calcifications (chondrocalcinosis)

Question 9

Pseudogout Treatment

Answer 9

1. NSAIDs

2. colchicine

Question 10

SLE General Characteristics

Answer 10

1. autoimmune disorder characterized by inflammation, positive ANA, involvement of multiple organs

Question 11

Who does SLE most commonly affect?

Answer 11

1. women of child-bearing age

2. prevalance among familial and ethnic groups (most common in African Americans)

Question 12

Clinical Features of SLE

Answer 12

1. positive ANA
2. 4/11 criteria (malar rash, discoid rash, photosensitivity, oral ulcers, arthritis, serositis, renal disease, hematologic, immunologic, neurologic)

Question 13

Drug-Induced Lupus

Answer 13

1. Histone ANA

Question 14

SLE diagnostic studies

Answer 14

1. CBC, BUN, creatinine, UA, ESR, C3/C4
2. Antibodies to smith antigen, dsDNA
3. postive ANA

Question 15

SLE treatment

Answer 15

1. regular exercise
2. sun protection
3. NSAIDs for MSK pain
4. Antimalarials (hydroxyxholoquine)
5. corticosteroids
6. methotrexate

Question 16

Polymyositis Characteristics

Answer 16

1. inflammatory disease of striated muscle affected the proximal limbs, beck, pharynx

Question 17

Dermatomyositis

Answer 17

1. skin manifestation of polymyositis

2. related to underlying malignancies

Question 18

Clinical Features of Dermatomyositis

Answer 18

1. heliotrope
2. Grottens Papules (rash on knuckls)
3. Shawl sign

Question 19

Clinical Features of Polymyositis

Answer 19

painless muscle weakness

Question 20

Polymyositis Diagnostic Studies

Answer 20

1. elevated CPK/ESR
2. elevated aldolase
3. muscle biopsy with myopathic inflammatory changes

Question 21

Polymyositis Treatment

Answer 21

1. High-dose steroids

2. methotrexate/azathioprine

Question 22

Polymyalgia Rheumatica Characteristics

Answer 22

1. 50yo+

2. women more than men

Question 23

Polymyalgia Rheumatica Clinical Features

Answer 23

1. pain/stiffness in the neck, shoulder, pelvic girdles (especially morning)
2. fever, fatigue, weight loss, depression
3. MSK symptoms symmetrical, bilateral, proximal

Question 24

Giant Cell Arteritis Clinical Features

Answer 24

1. scalp tenderness
2. jaw claudication
3. temporal artery tenderness
4. BLINDNESS

Question 25

Giant Cell Arteritis Diagnostic

Answer 25

1. Temporal Artery Biopsy

Question 26

Polymylagia Rheumatica Diagnostic Study

Answer 26

1. ESR very elevated

Question 27

Polymylagia Rheumatica Treatment

Answer 27

Low dose steroids (may be required for up to 2 years)

Question 28

Polyarteritis Nodosa Characteristics

Answer 28

1. medium arteries 2. male more than females 3. 40-60yo onset 4. associated with Hep B

Question 29

Polyarteritis Nodosa Clinical Features

Answer 29

1. fever, anorexia, weight loss, abd pain, pripheral neuropathy, arthralgias, arthritis 2. palpable purapura 3. livedo reticularis 4. renal involvement (HTN, edema, oliguria, uremia)

Question 30

Polyarteritis Nodosa Diagnostic Studies

Answer 30

1. ANCA 2. vessel biopsy 3. angiography 4. elevated ESR/CRP and protein uria 5. hep B antibody possible

Question 31

Polyarteritis Nodosa Treatment

Answer 31

high dose steroids

Question 32

Scleroderma (Systemic) Characteristics

Answer 32

1. collagen deposition in skin, heart, lungs, stomach 2. females more than males 3. 30-50yo onset

Question 33

Scleroderma Clinical Features

Answer 33

1. Raynauds 2. collagen depositions 3. puffy hand stage 4. nailfold involvement 5. watermelon stomach, GI dismotility 6. pHTN

Question 34

CREST Clinical features

Answer 34

``` C- calcinosis cutitis R- Raynauds E- esophageal dysfunction S- sclerodactyly (thickening of skin on fingers) T- telanigctasia (dilated small vessels) ```

Question 35

Diagnostic Studies of CREST

Answer 35

+ANA with centromere pattern

Question 36

Diagnostic Studies of SS

Answer 36

1. +ANA (speckled pattern) | 2. anti-SCL-70

Question 37

Scleroderma monitoring

Answer 37

PFT's annually!! screening for phtn

Question 38

Scleroderma Treatment

Answer 38

``` 1. No cure Organ-specific: 2. PPI for reflux 3. ACE inhibitors for renal disease 4. Ca-channel blockers for Raynauds 5. immunosuppresives for pHTN ```

Question 39

Sjogren Characteristics

Answer 39

1. autoimmune disorder that destroys salivary and lacrimal glands 2. could be secondary to to RA, SLE, polyomyostitis, scleroderma

Question 40

Sjogren Clinical Features

Answer 40

1. xerostomia (dry mouth) 2. xerophthalmia (dry eyes) 3. swollen parotid gland

Question 41

Sjogren Diagnostic Studies

Answer 41

1. Shirmer test 2. +RF 3. + ANA 4. anti-Ro antibodies 5. anti-La antibodies 6. lower lip biopsy

Question 42

Sjogren Treatment

Answer 42

Symptomatic 1. pilocarpine (increase salia flow) 2. cyclosporine (ocular sxs)

Question 43

Fibromylagia Characteristics

Answer 43

Central pain diorder

Question 44

Fibromylagia Clinical Features

Answer 44

1. nonarticular MSK aches, pains, fatigue, sleep disturbances, multiple tender "trigger" points 2. fatigue, sleep disruption, mood changes, cognitive disturbances, anxiety, depression, HA, IBS

Question 45

Fibromylagia Diagnostic Studies

Answer 45

exclusion of other dxs

Question 46

Fibromylagia Treatment

Answer 46

1. SSRI 2. TCA 3. Pregabalin (Lyrica) 4. aerobic exercise 5. patient education! (stress reduction, sleep assistance)