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Rheumatology Flashcards

1
Q

What are the criteria for SLE?

A

4/11

  1. Malar rash
  2. Discoid rash
  3. Photosensitivity
  4. seizures or psychosis
  5. oral ulcers
  6. pleuritis or pericarditis
  7. positive anti-ds, anti-smith, antiphospholipid
  8. positive ANA
  9. Renal
  10. hematologic disorder
  11. nonerosive arthritis
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2
Q

What endocrine problem is associated with SLE?

A

Hypo/hyperTH, Addisonian crisis

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3
Q

What neurologic problems are associated with SLE?

A

HA, memory loss, sz, psychosis, stroke, pseudotumor cerebri, cerebral venous thrombosis, aseptic meningitis, coma, chorea, global cognitive deficits, mood disorders, transverse myelitis, peripheral neuropthay

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4
Q

What pulmonary problem is associated with SLE?

A

Bleeding, HTN, interstitial lung disease

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5
Q

Morbidity for SLE occurs most often in which 2 disease systems?

A

Renal and CNS

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6
Q

What drugs typically cause drug-induced lupus?

A

diphenylhydantoin, ehtosuximide, carbamazepine

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7
Q

What are the most common lab findings in 1) drug induced lupus 2) neonatal lupus

A

1) antihistone and anti-DNA antibodies

2) Ro and La antibodies

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8
Q

What systematic problem is most common in

1) SLE
2) Neonatal lupus
3) Drug-induced

A

1) renal and CNS
2) heart block, rash, hepatitis
3) hematologic, pleural/pericardial disease

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9
Q

Pattern: rash in lower trunk and legs, appears in crops, eruptions last 3 weeks, has colicky abdominal pain, nausea, vomiting, large joint arthritis

A

HSP

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10
Q

How often is kidney involvement seen in HSP patients?

A

20-40% hematuria, proteinuria, oliguria, ARF

So measure microalbuminemia

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11
Q

What GI problems in HSP

A

intussusception, bowel infarction, bowel perforation, hydrops of the gallbladder, pancreatitis, massive GI bleeding

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12
Q

What labs must you do if you suspect HSP?

A

CBC, PT/PTT, CMP, ESR/CRP, urine for protein, stool for occult blood

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13
Q

What cardiac complications are associated with Kawasaki?

A

Tachycardia, myocarditis, pericarditis, coronary artery aneurysms

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14
Q

Which constellation of lab findings are seen with Kawasaki disease?

A

High ESR, CRP, WBC, left shift, platelets, transaminases, TG/LDL. low HDL, sterile pyuria

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15
Q

What is the treatment for Kawasaki?

A

IVIG and mega dose aspirin for 48hr, then go to 3/-5mg/kg/day. Can discontinue with all acute phase reactants return to normal

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16
Q

If cANA is high, which vasculites is it most likely to be?

A

Wegener’s; Churg-Strauss

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17
Q

If pANCA is seen, which vaculities can it be?

A

microscopic polyarteritis, Churg-Strauss, UC, sclerosing cholangitis, Crohn’s disease

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18
Q

Which labs indicate active disease in SLE?

A

Low complement and anti-ds DNA

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19
Q

Which autoantibody is sensitive and which is specific for SLE?

A

ANA-specific

Anti-dsDNA specific

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20
Q

Anti-ribosomal P is a test for what?

A

psychosis associated with autoimmune

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21
Q

How do you treat HSP?

A

supportive, Tylenol/NSAIDs for joint pain, steroids for severe abdominal pain, steroids and immunosuppression for renal involvement

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22
Q

Which of the three JIA typically has highest morbidity for uveitis?

A

oligoarticular/pauciarticular JIA

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23
Q

Which JIA has highest percentage of patient with ANA+

A

Oligo/pauci

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24
Q

What is the morbidity of most concern in polyarticular JIA?

A

unremitting arthritis

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25
Q

What is the most concerning morbidity with systemic JIA?

A

The chronic systemic involvement. Uveitis is rare.

26
Q

What complications can be seen in systemic JIA?

A

cardiac: pericarditis, myocarditis, endocarditis; hepatosplenomegaly, lymphadenopathy, pleuropulmonary disease, CNS disease, growth failure, osteoporosis

27
Q

Pattern: unremitting fever, bruising purpura, mucosal bleeding, hepatomegaly, lymphadenopathy, liver dysfunction, CNS involvement, multiple organ failure.
Labs - pancytopenia, falling ESR, liver derangement, coag abnormalities, increased ferritin, elevated TG

A

macrophage activating syndrome

28
Q

Pattern: male with hip, knee, ankle pain, HLA-B27+

A

enthesitis related arthritis

29
Q

Pattern: chronic inflammatory arthritis of axial and peripheral skeleton, frequent enthesitis, seronegative, HLA-B27, b/l sacroiliac joint inflammation

A

Juvenile ankylosing spondylitis

30
Q

What is reactive arthritis?

A

Response ton an infectious agent in another part of the body

31
Q

Postinfectious arthritis is what?

A

immune complexes containing non-viable components of an initiating infectious illness

32
Q

What degree of extension or flexioun would classify as hypermobility?

A

> 10 degrees

33
Q

Criteria and associated symptoms for fibromyalgia

A

Generalized MSK at 3 or more sites for more than 3 months, 5+ tender points, difficulty sleeping

34
Q

What is the weakness pattern for dermatomyositis?

A

Proximal muscle weakness

35
Q

Pattern: 5-14yr old female with increased fatigue, had a cold 6 weeks ago, having trouble getting on the school bus. Parents noticed eyes loo puffy and red over the eyelids.

A

Dermatomyositis

36
Q

Describe the rash of JDM

A

discoloration of the eyelids with periorbital edema; Gottron’s papules, Erythematous, scaly rash over dorsal aspects of metacarpal and proximal interphalageal joints

37
Q

What enzymes are elevated in JDM?

A

CK, AST, ALT, LDH, Aldolase

38
Q

What type of disease is JDM?

A

Vasculitis of skin and muscle

39
Q

Pattern: rash, dysphagia/dysphonia, dyspnea, GI (micro perforation), edema, joint contractures, cutaneous ulceration, calcinosis

40
Q

What is the calcinosis in JDM?

A

healing that happens with calcium deposition, can become very skeletal

41
Q

Treatment plan for JDM

A

Oral pred 2mg/kg daily until serum CK normalized, slowly taper over 24 months, hydroxychloroquine (Plaquenil), MTX, IVIG, TNF inhibitors

42
Q

What tissues can scleroderma affect?

A

Skin, bone growth, joint

43
Q

Pattern: calcinosis, Raynaud, esophageal dysmotility, sclerodactylyl, telangiectasia

A

limited cutaneous systemic scleroderma

44
Q

Pattern: sclerodactylyl and tight face

A

system diffuse cutaneous scleroderma

45
Q

What test for scleroderma?

A

ANA, Scl-70, anti-centromere Ab

46
Q

Treatment for complications of scleroderma

A

Topical Vit D, MTX, calcium channel blocker (Raynaud’s), ACE (renal)

47
Q

What organ systems do you have to worry about with scleroderma?

A

skin, lungs, heart, renal

48
Q

What gene is associated with familial sarcoidosis?

A

NOD2/CARD15 mutation

49
Q

Pattern: polyarthritis, dermatitis, uveitis

A

sarcoidosis

50
Q

What labs are useful for sarcoidosis?

A

Calcium and VitD; acute phase reactants, mild anemia, ACE

51
Q

Trio of drugs for sarcoidosis

A

steroids, TNF inhibitors, methotrexate

52
Q

Gene mutation in Ehlers Danlos

53
Q

What organ systems are affected in Ehlers Danlos?

A

osteopenia and cardiac

54
Q

Gene mutation in Margan

A

AD FBN1 (fibrillin2)

55
Q

Organ systems involved in Marfans

A

heart valves, aorta, lungs, dural sac of spine, skeleton, and eyes

56
Q

Pattern: mutation of pyrin gene, amyloidosis that causes renal disease

A

familial Mediterranean fever

57
Q

Pattern: period fever, apthathous ulcer, occurring every 28das

58
Q

Which microorganisms can cause postinfections arthritis

A

parvovirus B19, influenze, hepatitis B, rubella, Epstein-barr

59
Q

Which microorganisms can cause transient arthritis?

A

enterovirus, hepatitis B, rubella and mumps

60
Q

Cause of chest pain in patient with JIA

A

pericarditis

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