Rheumatology Flashcards
Patient presents with an inflammatory pustule that progresses to an expanding ulcer with a purulent base and ragged violaceous borders. What underlying conditions might this patient have? Diagnosis? Treatment?
He has pyoderma gangrenosum, which can be associated with IBD, RA and myeloid leukemia. Diagnose with skin bx showing PMN infiltrate. Treat with steroids.
Sub specialist that should be tracking patients on hydroxychloroquine
Ophtho, they need to be watching out for retinopathy every 5 years
Labs to order in a patient with Raynaud’s phenomenon
UA
CBC, CMP
ANA, RF
ESR and plasma C3 & C4 levels
Lab findings in patients with lupus
Hemolytic anemia, thrombocytopenia and leukopenia
Low C3 and C4
ANA, Anti-Sm, Anti-ds DNA
UA
Felty syndrome
RA with splenomegaly and neutropenia
Triad seen in reactive arthritis? Treatment?
Arthritis, uveitis and urethritis. NSAIDs
Morning stiffness seen in OA? RA?
OA 30 min
Who gets screening for osteoporosis? What defines osteopenia?
Women > 65 years old
Osteopenia = T score of -1 to -2.5
Causes of erythema nodosum
1) Recent strep infection
Other: sarcoid, Tb, histoplasmosis and IBD
Preferred diagnostic test in evaluating a patient for suspected avascular necrosis of the femoral head?
MRI
Most common cause of isolated elevation of alk phos in the elderly? What urinary findings might you see?
Paget’s. Urinary findings include hydroxyproline, deoxypyridinoline, N-telopeptide and C-telopeptide…which are bone degradation markers.
Common extracolonic findings in UC?
Positive p-ANCA, erythema nodosum, pyoderma gangrenosum, episcleritis, arthritis and cholangitis.
Bugs that commonly cause reactive arthritis
Salmonella, shigella, campylobacter, C. difficile
Conditions associated with pseudo gout
Pseudo gout is a result of calcium pyrophosphate crystal deposition. This occurs in hyperparathyroidism, hemochromatosis and hypothyroidism.
How to diagnose fibromyalgia
Widespread pain and symptom severity index score
Deadly complication of giant cell arteritis
Aortic aneurysm
Why do patients with systemic sclerosis get GERD?
Smooth muscle atrophy and fibrosis of the lower esophagus results in LES incompetence
Plain x-ray findings in patients with advanced avascular necrosis
Subchondral lucency (crescent sign)
Gout etiologies
Increased urate production (high protein diet, trauma/surgery, volume depletion, alcohol consumption, myelo/lympho proliferative disorders, tumor lysis syndrome, HGPRT deficiency)
Decreased urate clearance (CKD, loop and thiazide diuretics)
Antibodies present in systemic sclerosis
Anti-topoisomerase I
Inflammatory symmetric polyarthritis that resolves within 2 months, but had positive RF and weakly positive ANA
Viral: parvo, hepatitis, HIV, mumps, rubella, etc.
Criteria for diagnosis of OA
Age > 50, minimal morning stiffness, no bony tenderness, bony enlargement, crepitus on active motion and no warmth of joint…need 3+ criteria for > 70% specificity.
Treatment of fibromyalgia
Good sleep hygiene and aerobic exercise. Add TCAs if they do not respond to initial conservative treatment. Pregabalin, duloxetine and milnacipran can be used as 2nd line drugs.
Why take MESNA when on cyclophosphamide
Cyclophosphamide can produce a metabolite, acrolein, which can cause hemorrhagic cystitis and bladder cancer.
First line drug therapy for patients with rheumatoid arthritis
1) Methotrexate
Add TNF inhibitors as step up therapy if there is no improvement after 6 months.
Labs to run prior to treating a patient with methotrexate for rheumatoid arthritis
HBV, HCV and Tb
What conditions are associated with Charcot join?
B12 def., DM, tertiary syphilis and other nerve injury
Sjogren’s antibodies
Anti SSA (Ro) and SSB (La) antibodies
Conditions associated with enthesitis
Spondyloarthropathies (ankylosing spondylitis, psoriatic arthritis and reactive arthritis)
Riluzole
Blocks Na channels in damaged neurons, used to slow progression of ALS
Risk factors for carpal tunnel syndrome
Obesity, diabetes, hypothyroidism and pregnancy
Auto-antibodies seen in patients with dermatomyositis
Anti-RNP, anti-Jo-1 and anti-Mi2
Malignancies with increased frequency in patients with dermatomyositis?
Ovarian, lung, colon, stomach, pancreas and non-Hodgkin lymphoma.
Next step in a patient with suspected giant cell arteritis?
Start high dose corticosteroids while awaiting temporal artery biopsy to confirm diagnosis.
