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Medicine Boards Jesse > Rheumatology > Flashcards

Rheumatology Flashcards

1
Q

Treatment of dermatomyocytis

A

1st line treatment is prednisone, if no response can use azathioprine or methotrexate in addition, last line is immunoglobulin

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2
Q

Modifiable risk factor for RA

A

Smoking increases the risk of RA

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3
Q

Lofgren syndrome

A

Sarcoid presenting as: fever, erythema nodosum, polyarthralgia and hilar lymphadenopathy. Do not need tissue diagnosis

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4
Q

Heerfordt syndrome

A

Sarciod presenting as: uveitis, parotid enlargement, and fever. Do not need tissue diagnosis

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5
Q

Gout or infected joint?

A

They can occur at the same time. Suspect infection if the synovial leukocyte count is >50,000

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6
Q

Treatment of RA, 2nd agent

A

If patient fails methotrexate start combination therapy by adding a TNF-alpha inhibitor.

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7
Q

Treatment of ankylosing spondylitis

A

First line treatment is routine use of NSAIDs. If not tolerated then TNF-alpha inhibitors. Nonbiologic DMARDs are NOT effective in axial disease

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8
Q

Inclusion body myositis

A

Most common form of myositis >60, men
Proximal and distal muscle weakness
CK is modestly elevated
No extramusclar manifestations

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9
Q

Polymyositis

A

Younger patients, women
Proximal muscle weakness
Extramuscular manifestations are common
Tend to have positive auto-antibodies (80% +ANA)

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10
Q

Type I cryoglobulinemic vasculitis

A 
Monoclonal immunoglobin, paraprotein
Seen in patients with Sjogrens, Waldenstrom and multiple myeloma 
Palpable purpura
Mononeuritis multiplex
Immune complex glomerulonephritis
low C3 and C4
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11
Q

Type II cryoglobulin vasculitis

A

Most commonly occurs in active hep C infection
Palpable purpura
Mononeuritis multiplex
Immune complex glomerulonephritis

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12
Q

RA developing SLE symptoms?

A

Drug induced lupus can occur with the TNF-alpha inhibitors (etnercept)

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13
Q

Mangement of SLE in pregnancy

A

Okay to use hydroxchloroquine. If have severe disease okay to have azathioprine if necessary. Prednisone for flare

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14
Q

Treatment of systemic sclerosis

A

MSK features are best treated with MTX

Alveolitis with cyclophosphamide

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15
Q

Management of arthritis associated with IBD

A

Start with sulfasalazine if NSAIDs worsen bowel symptoms.

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16
Q

Anti-UI ribonucleoprotein antibodies (RNP)

A

mixed connective tissue disease

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17
Q

Antiproteinase-3 antibodies

A

produce cANCA pattern and associated with granulomatosis with polyangiitis

18
Q

HSP

A

Small vessel vasculitis, palpable purupura, arthritis, abdominal pain and hematuria. Leukocytoclastic vasculitis with IgA deposits

19
Q

Microscopic polyangiitis

A

Small vessel vasculitis, +p-ANCA and antimyeloperoxidase antibodies , pulmonary involvement, glomuerulonephritis and purpuric skin lesions

20
Q

Polyarteritis nodosa

A

Medium vessel vasculitis, Mononeuritis multiplex, HTN, testicular, abdominal pain, look for hep B

21
Q

Granulomatosis with polyangiitis

A

Small vessel vasculitis, AKA Wegener, upper airway, mononeurititis multiplex, + c-ANCA (antiprotenase-3 antibody), pulmonary, ocular and renal disease

22
Q

Testing in myasthenia

A

most patients are acetylcholine receptor antibody +, some are MuSK +, get a chest CT to look for thymic hyperplasia or thymoma

23
Q

Reactive arthritis

A

Inflammatory arthritis that starts within 2 months of bacterial gastroenteritis or non-gonococcal urethritis/cervicitis. Can also have conjunctivitis. NSAIDS and steroids are the go to. If not effective try sulfasalazine

24
Q

Paroxysmal nocturnal hemoglobinuria

A

Unprovoked venous clots. Hemolytic anemia. Mild to moderate pancytopenia. Diagnose by flow cytometry showing that erythrocytes and lymphocytes do not have CD55 and CD59

25
Q

Dx of ankylosis spondylitis

A

MRI of sacroilliac with contrasts (appears here first before lumbar spine)

26
Q

Management of hereditary or acquired angioedema

A
  • acute episodes can give IV CI inhibitor concentrate
  • chronic use danazol and stanozol which increase hepatic synthesis of C1 esterase inhibitor
  • epinephrine is NOT effective
27
Q

Combined variable immunodeficiency, when to think about and what tests?

A
  • frequent recurrent infections, encapsulated organisms, diarrhea
  • obtain Ig levels, if low see response to tenatus (protein) and pneumococcal (polysac) vaccination
28
Q

Vitamin D supplementation

A
  • D2 and D3 are converted in the liver to 25-D3 which is then converted to active 1-25 D3 by the kidney
  • so in liver disease give 25-D3 supplementation and kidney give active calcitriol
  • if liver and kidney okay can give D2 or D3 supplementation
29
Q

Hand OA

A

effects DIP, PIP and first carpometacarpal joint, does NOT effect MCP

30
Q

Hand RA

A

effects PIP and MCP joints, does NOT effect DIP

31
Q

Arthritis of 2nd and 3rd MCP and PIP joints?

A

Think hemochromatosis

32
Q

Sjogren syndrome at risk for?

A

B cell lymphoma

33
Q

Hypertrophic osteoarthropathy

A
  • see proliferation of skin and osseous tissues at the distal extremities
  • new periosteal bone formation seen on films
  • can have swelling
  • associated with lung cancer, chronic pulmonary infections and cardiac shunts
34
Q

Systemic sclerosis antibodies

A

Diffuse: anti-scl-70
Limited: anti-centromere

35
Q

Eosinophilic fasciitis

A

Woody induration of the skin sparing the hands and feet. NO Raynaud phenomenon

36
Q

Anti–Jo-1

A

Associated with polymyocyitis and lung involvement

37
Q

Anti–Mi-2

A

associated with dermatomyocytis rash, good prognosis

38
Q

Familial Mediterranean fever

A

Fever, serosistis, arthritis and rash. Elevated inflammatory markers, positive serum amyloid A protein.
Treat with colchicine

39
Q

Anti-centromere pattern of ANA

A

CREST

40
Q

Anti-smooth muscle antibody

A

autoimmune hepatitis

41
Q

Anti-histone antibody

A

Drug induced SLE

42
Q

Hypercalcemia in sarcoid

A
  • treat with prednisone

Medicine Boards Jesse (12 decks)

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