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MedScape > Rheumatology > Flashcards

Rheumatology Flashcards

1
Q

What disease is the pneumonic SOAP BRAIN MD for and what does it mean

A

Lupus: serositis, oral ulcers, arthritis, photosensitivity, blood disorders, renal disease, ANA, immunologic phenomena, neurologic disorder, malar rash, discoid rash

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2
Q

An IV drug user presents with buttock area pain. What is it?

A

Infectious sacroiliitis

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3
Q

If a patient has polymyositis/dermatomyositis, what type of screening should be done?

A

cancer screening - look for underlying malignancy

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4
Q

What type of kidney disease is seen with ankylosing spondylitis?

A

IgA nephropathy

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5
Q

White middle-aged man with diarrhea, fat malabsorption/weight loss, CNS symptoms (memory loss due to progressive dementia, osculomasticatory myorhythmia, and recurring episodes of inflammatory arthritis. What is it?

A

Whipple disease - due to Tropheryma whipplei

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6
Q

Chondrocalcinosis (calcification of cartilaginous tissue) is a hint to what underlying disease?

A

CPPD

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7
Q

What joints are rarely affected by OA?

A

It’s non erosive; rarely affects ankle, wrist, and elbow or MCP’s or small bones of the feet

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8
Q

What diagnoses should you consider if you see CPPD in a patient

A

primary hyperparathyroidism, hemochromatosis, hypothyroidism, hypomagnesemia, hypophosphatemia

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9
Q

Of the three, RA, Lupus, OA, which is erosive and which is non erosive?

A

RA is erosive; Lupus is non erosive; OA is non erosive

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10
Q

What areas are rarely affected by RA?

A

thoracic, lumbar, and sacral spine and the SI joints

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11
Q

In diffuse and limited scleroderma, there are 2 auto-antibodies. What are they? What type of lung dz does each increase the risk of?

A

Diffuse - anti-Scl-70 or anti-RNA polymerase III - interstitial lung dz for first (also more likely to dvlp scleroderma renal crisis for 2nd AB)
Limited - anti-centromere - pulmonary HTN (they also have more severe digital ischemia)

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12
Q

Sausage shaped digits (dactylics) are common in the spondyloarthropathies. Name 4 diseases in this category.

A
  1. Ankylosing spondylitis 2. Reactive arthritis 3. Psoriatic arthritis 4. IBD-associated arthropathy
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13
Q

What is the classic triad of reactive arthritis?

A

urethritis, conjunctivitis, and asymmetric arthritis

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14
Q

What are common causes of erythema nodosum?

A

sarcoid
IBD
Infection - TB, strep, fungal
Drugs - OCP’s, sulfa, PCN

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15
Q

If a young person presents with arthralgia, abdominal pain, renal disease, and palpable purpura, what should you think?

A

IgA vasculitis - formerly Henoch-Schonlein purpura

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16
Q

In which disease do you see a scarlet tongue?

A

Scarlett fever

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17
Q

Buzzwords for both RA and SLE: the arthritis is _____ and ________

A
  1. symmetric

2. polyarticular

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18
Q

In RA, which joints of the hand are affected and which are spared?

A

involves the mcp and pip

spares the dip

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19
Q

Is RA and SLE joint involvement symmetric are asymmetric? What about joint involvement of hemochromatosis?

A

RA/SLE - symmetric

Hemochromatosis - asymmetric

20
Q

What is the most common single joint initially involved in RA? What is the site of the earliest radiographic changes?

A

the knee

radiographic changes - the forefoot

21
Q

What is felty syndrome?

A

RA, splenomegaly, neutropenia

22
Q

A RA patient on rituximab has new onset of CNS symptoms. What do they have?

A

PML -progressive multifocal leukencephalopathy

23
Q

What disease do you think when you see these 2 buzzwords: sausage-shaped digits (dactylitis) + pitted nails?

A

Psoriasis

24
Q

What 2 arthritis syndromes do you see sausage shaped digits?

A

reactive arthritis and psoriatic arthritis

25
Q

Describe OA changes in the hands

A

changes most often affect PIP’s and DIP’s and may have Bouchard nodes (PIP) and Heberden nodes (DIP)

26
Q

Allopurinol dosing must be decreased by 66-75% in patients taking what medications?

A

Azathioprine or mercaptopurine

27
Q

What joints does CPPD commonly affect?

A

Usually affects the knee; other joints include wrists, 2nd/3rd MCPs, shoulders, elbows, and ankles.

28
Q

What are some other diagnoses associated with CPPD?

A

hemochromatosis, hyperparathyroidism, hypothyroidism, hypomagnesemia, hypophosphatemia

29
Q

What diagnosis should you consider in an adolescent with knee pain?

A

gonococcal joint infection

30
Q

Young adult female works with school aged children presents with symmetric synovitis of the hands and a macular rash. What is it?

A

Viral arthritis from parvovirus B19; she may describe a slapped cheek rash in the kids

31
Q

What should you think about and further evaluate the patient for when you see polyarthritis, clubbing of the fingers and toes, and periostitis of the long bones?

A

Hypertrophic pulmonary osteoarthropathy and you should eval for lung cancer (usually adenocarcinoma)

32
Q

People with Sjogren syndrome are at increased risk for developing what other disease?

A

B cell lymphoma

Babies can also have congenital heart block and neonatal lupus if the mom has SSA/SSB antibodies

33
Q

What diagnosis might you want to consider in a young female who presents with acute malignant hypertension and renal failure?

A

diffuse scleroderma

34
Q

What skin findings do you see with dermatomyositis?

A

heliotrope rash - violaceous rash on the upper eyelids

gottron papules - redish to violet scaling papules on the knuckles

35
Q

Buzz word = weak handshake

A

inclusion body myositis

  • most common inflammatory myopathy in people > 50
  • can also have dysphagia
  • requires a muscle biopsy
36
Q

Polyarteritis nodosa doesn’t classically cause disease of what?

A

pulmonary arteries or glomerulonephritis (although it can involve the kidneys)

37
Q

olecranon bursitis is associated with which systemic dz?

A

RA

38
Q

If a patient has plantar fasciitis, what other disease must be considered?

A

spondyloarthropathy

39
Q

Which AB is associated with lupus nephritis?

A

anti-DS DNA

40
Q

What is the classic tetrad of hemochromatosis?

A

cirrhosis, diabetes, hyperpigmentation, cardiac issues

41
Q

Name examples of extra glandular involvement seen with Sjogrens

A

lymphocytic interstitial pneumonitis, non hodgkin lymphoma, peripheral neuropathy, RTA

42
Q

What antihypertensive medication increases uric acid levels and can cause gout? What are some other drugs that increase uric acid?

A

HCTZ

cyclosporine, niacin, ethambutol/pyrazinamide

43
Q

Men who present with fibromyalgia-like symptoms can have what?

A

Testosterone deficiency

44
Q

What is anti-Jo-1 autoantibody?

A

associated with pulmonary fibrosis in patients who have dermatomyositis or polymyositis

45
Q

Name an antibiotic used to treat MRSA that is contraindicated in patients on methotrexate

A

Bactrim

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