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Step 2 UWORLD > Rheumatology > Flashcards

Rheumatology Flashcards

1
Q

back pain that’s worse @ night

A

Malignancy (mets)

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2
Q

T/F: Ankylosing spondylithis, reactive arthritis, psoriac arthritis, and IBD display back pain that is better with exercise, not better with rest, and have gradual onset

A

True

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3
Q

Pain and bilateral stiffness (esp in am) in shoulders and hips + Increased ESR + Normal CK. Age >50

A

Polymyalgia rheumatica –> ass. w/Temporal Arteritis

Tx= low dose steroids

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4
Q

Rotator cuff tears: yes/no pain on active ROM, yes/no on passive ROM

A

yes on active

no on passive

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5
Q

Antipyretic, analgesic, but not anti-inflammatory

A

Acetaminophen

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6
Q

Antiplatelet, antipyretic, analgesic, anti-inflammatory

A

Aspirin

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7
Q

Antipyretic, analgesic, anti-inflammatory

A

NSAIDs

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8
Q

Acute monoarticular arthritis that quickly progresses to max intensity in 12-24 hours, relieved by OTC meds

A

Gout

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9
Q

What precipitates gout attack?

A
  • Meds: low-dose aspirin, diuretics
  • Surgery, Trauma, Hospitalization
  • Volume depletion
  • Diet: high protein, high fat, sweetened drinks
  • HTN/Obesity/CKD/Organ Transplant
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10
Q

What decreases risk of gout attack?

A

Dairy product intake, Vitamin C, Coffee (>6 cups/day)

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11
Q

wbc in joint aspiration of OA, RA, Septic Arthritis

A

OA: <2000
RA: 2,000 - 100,000
Septic: 50,000-150,000

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12
Q

Initial DMARD agent of choice in RA

A

Methotrexate…start as soon as possible.

–>Nsaids only give sx relief (never monotherapy)

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13
Q

Symmetric proximal mm weakness, elevated CK and aldolase (muscle enzymes)

A

Polymyositis. Dx w/muscle bx. Initial tx w/Prednisone.

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14
Q

Symmetric proximal mm weakness + erythematous rash over dorsum of fingers and/or upper eyelids

A

Dermatomyositis. (Gottron’s papules/heliotrope eruption)

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15
Q

Pt with back pain. Indications for xray vs MRI

A

Xray: Suspect malignancy; osteoporosis/compression fracture; ankylosing spondylitis

MRI: sensory/motor deficits; cauda equina syndrome; epidural abscess/infection;

–>you do bone scan if indication for MRI but can’t get MRI

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16
Q

where do rheumatoid nodules form

A

over pressure points…elbow/extensor surface of promixal ulna. Are flesh colored

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17
Q

Symmetrical progressive muscle weakness + rash (heliotrope, with periorbital edema)

A

Dermatomyositis (DONT THINK MG…ptosis/diplopia) #PEASANTRY)

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18
Q

violaceous, scaly papules overlying joints + proximal muscle weakness

A

Gottrons papules –> Dermatomyositis

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19
Q

Tx for Paget’s (mixed lytic and blastic bone lesions)

A

Bisphosphonate

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20
Q

Erythema nodosum is associated with:

A

Sarcoid
Crohns/UC
Histo/Cocci/TB/Strep

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21
Q

most common cause of asx elevated Alkaline Phosphatase in elderly

A

Paget dz (freq discovered incidentally)

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22
Q

Best way to dx polymositis/dermatomyositis

A

Muscle bx –> mononuclear infiltrate surrounding necrotic and regenerating muscle fibers

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23
Q

causes of gout (except for idiopathic which is most common)

A

Increased Urate Production:

  • Tumor Lysis Syndrome
  • Myeloproliferative disorders (i.e. PV…pruritis by hot baths, HA, hepatosplenomegaly)
  • Tumor lysis syndrome
  • HGPTT deficiency (Lesh-Nyhan…self-injurious behavor)

Decreased Uric Acid excretion

  • CKD
  • Thiazides/loops
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24
Q

features of low back pain suggesting an inflammatory cause

A
  • gradual onset
  • age <40
  • pain @ night that doesn’t improve w/rest
  • improvement w/activity or exercise
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25
Q

T/F: Obesity, female, hypothyroidism = risk factors for carpal tunnel

A

True

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26
Q

T/F: Carpal tunnel = pain and paresthesias in first 3 fingers, typically worse at night, and is confirmed by nerve conduction studies

A

True

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27
Q

How do crystals appear in Pseudogout vs Gout

A

Pseudo: Calcium pyrophosphate (RHOMBOID, + birefringence)

Gout: Monsodium (NEEDLE-shaped, - birefringence)

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28
Q

T/F: Pseudogout often occurs in the setting of surgery or illness can result in chondrocalcinosis and classically affects the knee

A

True

calcified articular cartilate, i.e meniscal calcification

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29
Q

osteoblast and clast activity in paget

A

increased osteoblast activity

osteoclast dysfunction

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30
Q

Soft tissue swelling, small tibiotalar joint, chronic calcification of the articular cartilage

A

PSEUDOGOUT…chondrocalcinosis

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31
Q

Tx for Raynauds

A

CCB…Amlodipine or Nifedipine

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32
Q

What lab should you look at if you suspect Raynauds?

A

Autoantibodies and inflammatory markers, i.e. ANA, CRP, etc (NOT THYROID F(x) studies)

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33
Q

Pain with passive wrist flexion and/or pain with resisted wrist extension

A

Lateral epicondylitis (tennis elbow)

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34
Q

Can hypothyroid patients present with Raynauds?

A

Kind of…they can have cold-induced vasospasm but do NOT have sharply demarcated color like in Raynauds and do not have tissue ischemia…so if you suspect Raynaud’s in someone you would NOT do thyroid studies (you do autoantibody and inflammatory marker instead)

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35
Q

Arthritis w/o rheumatoid factor

A

Seronegative spondyloarthropathies (PAIR = Psoriac Arthritis, Ankylosing Spondylitis, IBD, Reiters syndrome aka reactive arthritis)

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36
Q

How do you dx Ankylosing Spondylitis?

A

X-ray of the sacroiliac joint (NOT ordering HLA-B27, even though its highly associated…not specific).

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37
Q

Clinical features of ankylosing spondylitis?

A

Age <40
Chronic back pain that is relieved by w/exercise and NSAIDS but not with rest
tenderness at lumbosacral area
may have Uveitis, aortic regurg, dactylitis, IBD

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38
Q

rhomboid shaped crystals on arthrocentesis

A

Pseudogout

gout = needle shaped

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39
Q

Pain/swelling of knee in patient with constipation, kidney stones, fatigue, Ca = 11

A

Pseudogout…this patient has hypercalcemia due to Primary Hyperparathyroidism (stones groans).

Pseudogout caused by Calcium Pyrophosphate Dihydrate (CPPD), common complication of HyperPTH

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40
Q

What will xray of pseudogout show?

A

Chondrocalcinosis (calcium deposition in the joint space)

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41
Q

Features consistent with osteoarthritis of the knee

A 
Crepitus with movement
worse at end of day 
small joint effusion w/o warmth/edema
popliteal (bakers) cyst behind knee
limited ROM
arthro shows clear fluid w/few inflam cells
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42
Q

Inflammation at sites of tendon and ligament attachment to bone (i.e at the HEEL, AC joint. etc)

A

Enthesitis –> common finding in ankylosing spondylitis/seronegative spondy’s

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43
Q

Patient as pain at AC joint, heels, iliac crests, and tibial tuberosities. Low back that IMPROVES with movement

A

Enthesitis…Ankylosing spondylitis. Patient will have limited ROM spine

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44
Q

best long term tx for SLE

A

antimalarials –> Hydroxychloroquine

…need to do annual eye exams because of retinal toxicity

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45
Q

FP test for Syphilis

A

SLE (due to cardiolipin)

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46
Q

Most common causes of death in SLE

A

Renal failure, opportunisitic infections

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47
Q

Fatigue, malaise, fever, weight loss in a patient with joint pain and rash and photosensitivity

A

SLE constitutional sxs

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48
Q

T/F: A patient who develops Raynauds is unlikely to also have SLE

A

False. 20% of SLE patients develop Raynauds (exacerbated by smoking and exposure to cold)

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49
Q

Cardiac manifestations of SLE

A

Pericarditis, myocarditis, and Libman-Sacks endocarditis

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50
Q

most common pulmonary finding of SLE

A

Pleuritis

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51
Q

Do SLE patients exhibit GI sxs?

A

Yes, nausea and vomiting, dysphagia, PUD

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52
Q

Dx of SLE

A

ANA
Anti-dsDNA and anti-Sm Ab = diagnostic
Anti-ssDNA
Antihistone = drug-induced lupus

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53
Q

Lupus anticoagulant

A

Antiphospholipid syndrome

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54
Q

ESR vs CRP

A

ESR used to dx or r/o inflammtory process. Can also be up in infection/malignancy/rheum dz

CRP primary used for infection

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55
Q

Tx for SLE

A
  1. Avoid sun exposure
  2. nsaids
  3. STEROIDS for ACUTE exacerbation
  4. HYDROXYCHLOROQUINE (anti-malarial) = best long term therapy…need annual eye exams b/c retinal toxicity
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56
Q

When is hydroxychloroquine used in rheumatology?

A

This anti-malarial is the best long term therapy for SLE patients…need annual eye exams b/c retinal toxicity

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57
Q

What is the difference btwn SLE and drug-induced lupus

A

drug-induced lupus does NOT have CNS or Renal involvement…if there is, it is not drug-induced lupus. Will improve after withdrawal of drug. Antihistone antibodies +, and - for anti-dsDNA, anti-Sm

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58
Q

Drugs that caused drug-induced lupus

A 
Hydralazine
Procainamide
Isoniazid
Methyldopa
Chlorpromazine (antipsychotic like haloperidol)
Quinidine (class IA antiarrythmic)
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59
Q

What is scleroderma?

A

Triad of autoimmunity, noninflammatory vasculopathy, and collagen deposition w/fibrosis

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60
Q

What is the pathophys in scleroderma?

A

Too much collagen deposition…the collagen is normal, but there is too much (from cytokines stimulating fibroblasts)

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61
Q

Clinical features of scleroderma

A
  1. Raynauds (present in nearly all)
  2. Sclerodactyly = tightening of skin on face/extremities…can lead to contractures
  3. GI: Dysphagia/reflux b/c esophageal immbility
  4. Pulm: Most common cause of death…fibrosis/pulm HTN
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62
Q

Dx of scleroderma

A
  1. Elevated ANA
  2. Anticentromere antibody (limited form. CREST)
  3. Antitopoisomerase I (antiscleroderma-70) (diffuse)
  4. Barium swallow (esophageal dysmotility) and PFTs
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63
Q

Tx of scleroderma

A

Sx mgmt!

  • NSAIDS
  • PPI or H2 for reflux
  • CCB/avoid cold and smoking for Raynauds
  • Bosentan for pum HTN; Cyclophosphamide for pulm fibrosis
  • ACE-I
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64
Q

What is antiphospholipid syndrome?

A

hypercoagulable state commonly ass. w/ SLE

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65
Q

findings in antiphospholipid syndrome

A
  • Recurrent arterial/venous thrombosis (risk of PE)
  • Recurrent fetal loss (abortions)
  • Thrombocytopenia
  • Livedo reticularis
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66
Q

Lab findings in antiphospholipid syndrome

A

Lupus anticoagulant
Anticardiolipin (FP for syphilis)
Prolonged PTT/PT not corrected by adding normal plasma

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67
Q

What is Sjogrens?

A

Autoimmune dz commonly in women in which LYMPHOCYTES destroy Salivary/Lacrimal Glands

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68
Q

Clinical features of Sjogren?

A

-Dry eyes, dry mouth/tooth decay, swollen Parotid = KEY

  • arthralgia/arthritis, fatigue, interstitial nephritis/vasculitis may be present
  • 20% of scleroderma pts have Sjogren
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69
Q

What is the pathophysiological difference between dysphagia/reflux of Achalasia and Scleroderma (aka systemic sclerosis)?

A

Achalasia: Decreased peristalsis in distal esophagus, increased LES pressure and failure to relax (b/c no Auerbach myenteric plexus)

SS: Decreased peristalsis in distal esophagus, but decreased LES pressure/incompetence –>smooth muscle atrophy and fibrosis

both have esophageal immobility

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70
Q

If a woman comes in with dry eyes/dry mouth, what should you be evaluating for?

A

She has Sjogrens, which has increased risk of Non-hodgkin LYMPHOMA –>look for lymphadenopathy and hepatosplenomegaly

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71
Q

Lab dx for Sjogren

A

ANA+ in 95% pt
Rheumatoid Factor + in 50-75%% DONT BE A PEASANT

Anti-Ro (SS-A) and Anti-La (SS-B)

Schirmer test: filter paper inserted in eye to measure lacrimal gland output

72
Q

Tx for Sjogren

A

Pilocarpine or Cevimeline –>enhance oral/ocular secretions via ACh

73
Q

Pseudogout, Gout, Septic arthritis by wbc count

A

Pseudogout: 15000 - 30000, rhomboid shaped, + biref
Gout: <50,000, needle shaped, neg birefringence
Septic Arthritis: >50,000, visible organisms on gram stain/neutrophils

74
Q

Causes of migratory arthritis

A

Lyme
Neisseria Gonorrhea (septic arthritis)
Crohns dz
Rheumatic Fever

75
Q

Gonococcal arthritis

A

monoarthritis (septic)
or
triad of tenosynovitis, dermatitis, asymmetric migratory polyarthritis

76
Q

What conditions are Pseudogout associated with

A

Hemochromatosis (look for patient with hx/fhx Diabetes)
–>need Iron studies to dx, then risk of HCC

Hyperparathyroidism
Hypothyroidism

77
Q

Chondrocalcinosis is pathomneumonic for:

A

Pseudogout

78
Q

anti-CCP (cyclic citrullinated peptide)

79
Q

Tx strategy for gout: Lifestyle, Acute flare, Prophylaxis

A

Lifestyle: Decrease alcohol, red meat, fructose, don’t use thiazide
Acute Flare-up: Colchine or NSAIDS, steroids if desperate
Prophylaxis (against recurrent attacks): Allopurinol

–>you don’t sue allopurinol for acute flare-up

80
Q

which 3 patients are most likely to get gout ?

A
  • drink alcohol
  • CKD
  • thiazide diuretic
81
Q

tx for non-gonococcal (staph) septic arthritis (IVDU, Dialysis)

A

MSSA: Nafcillin
MRSA: Vancomycin, Linezolid (esp if theyre in a hospital setting)

82
Q

best way to dx septic joint with gonorrhea

A

NAAT (culture won’t show shit, Chocolate agar isnt a great test)

83
Q

differences between diffuse and limited scleroderma

A

Limited: gradual onset Cutaneous to face/extremities only (won’t have wrinkles). CREST syndrome. Very late visceral organ involvement, will really only see esophageal = reflux . Anti-centromere.

Diffuse: widespread cutaneous + rapid onset + visceral organ (lungs/heart/kidney), anti-topoisomerase/scl70,
–>do NOT give steroids for AKI…actually give them ACE-I (opposite of what you would normally do for AKI)

84
Q

Pt with CKD gets gadolinium contast/MRI

A

Nephrogenic Systemic Sclerosis
–>may look like sclerodactyly because pt will have loss of wrinkles/tightening of face, so dont get confused…will be in a CKD pt with Gadalonium

85
Q

Pulmonary arterial hypertension in scleroderma

A

Limited: lungs will look normal, no hypoxia
Diffuse: will occur after interstitial lung dz, will have hypoxia

86
Q

if you dx polymyositis, dermatomyositis, or inclusion body myositis, what kind of screening is necessary?

A

Age-appropriate cancer screening…theres an association with occult malignancy

87
Q

Proximal muscle weakness (can’t get out of chair/go up stairs), Heliotrope rash (purple swelling of eyes), Gottron’s papules, shawl sign (photosensitivity)

A

Dermatomyositis

polymyositis has proximal muscle weakness, not really the other signs

88
Q

Tx for poly/dermatomyositis

A

Steroids son

89
Q

Who gets hydroxychloroquine (HCQ)?

A

ALL SLE PATIENTS.

HCQ for SLE

90
Q

What do you tx RA w/?

A

Methotrexate

NOT HCQ…which is for SLE

91
Q

Tx for Lupus Nephritis

A

IV Cyclophosphamide or Oral Mycophenolate

–>Cyclo increases risk for hemorrhagic cystitis/bladder carcinoma

92
Q

how to do you tx acute SLE flare?

A

steroids, but get them off of them asap

93
Q

What 2 complications of Lupus are we most worried about?

A

Lupus Nephritis is the big scary monster.

Lupus cerebritis is also bad, will look like meningitis/encephalitis

94
Q

Anti-dsDNA

A

Lupus nephritis

95
Q

Pt has a fever, low complement levels (C3, C4)

96
Q

how to do you dx lupus nephritis?

A

BIOPSY. typically don’t do bx for renal conditions but you do for this.
Is ass with anti-dsDNA AB, but this is not how you dx

97
Q

How does RA present with joint pain?

A 
Lady >45 yo with predilection for small joints...hands and feet. symmetric. >3 joints. SPARES DIP. 
Morning stiffness (>60 min, vs OA is <30). 
Fingers may be bent.

Nodules: if bx, cholesterol

98
Q

what are you looking for on xray in RA patient?

A

Erosions

periarticular osteopenia

99
Q

Tx for mild RA

A

NSAIDS (ibuprofen, meloxicon) –>but can NEVER be monotherapy
so ALL RA patients, no matter severity, get DMARDS (METHOTREXATE ALWAYS EVERY TIME SON)

100
Q

how do you tx severe RA?

A

If severe, can add biologics = TNF alpha inhibitor = Infliximab, Rituximab, Etanercept
–>make sure theyre 1. Vaccinated 2. get TB test 3. travel to endemic Fungus area
(these ruin immune system)

101
Q

Would you ever use hydroxycholoroquine (HCQ for SLE) for RA?

A

Rarely. Basically if they are pregnant, b/c then you can’t use methotrexate or leflunomide (would use these before hcq normally)

102
Q

Morning stiffness + spine

A

Mostly Ankylosing Spondylitis.

IF involves C1,C2 cervical spine…get Xray because this is now probably RA

103
Q

Joint pain + cervical spine involvement

104
Q

wbc, rbc, platelet: which decreased in lupus

A

platelet, rbc

105
Q

SLE patient has stroke. What should you consider?

A

Antiphospholipid…hypercoag state associated with SLE. Stroke = thrombotic event

106
Q

Steroid use, joint pain/decreased ROM, normal xray

A

Osteonecrosis (avascular necrosis) –> disruption of bone vasculature

107
Q

Link between osteoporosis and RA?

A

RA increases risk for osteopenia, osteoporosis, and bone fractures

108
Q

T/F: Tx for fibromyalgia = low-dose steroids

A

FALSE AF BOY

  • ->EXERCISE = PRIMARY TX
  • ->can also use antidepressants, anti-convulsants

Low-dose steroids used for Polymyalgia rheumatica

109
Q

what is Felty’s syndrome?

A

RA + Neutropenia + Splenomegaly

–>don’t dx if RA and Spleno but not neutropenia! its rare af, low yield

110
Q

adverse effects methotrexate (anti-metabolite drug)

A

Myelosuppression (need leucovorin rescue)
Hepatotoxicity
Mucositis (oral ulcers)
Pulmonary Fibrosis

111
Q

Mgmt of acute/chronic low back pain

A

EXERCISE THERAPY

–>NOT BED REST

112
Q

Lab values in Paget

A

Normal Calcium, Phosphate, PTH

Increased ALP, urine hydroxyproline

113
Q

Why do patients with sarcoidosis have increased urination?

A

Hypercalcemia

–>granuloma = 1 alpha hydroxylase activity = increased 1, 25 vit d = increased Ca absorption

114
Q

Tx of sarcoidosis

A

Steroids son

115
Q

T/F: Patients with sciatica typically need life-long therapy

A

False, typically self-resolves. Initial tx is just NSAIDS

116
Q

Pain on hip abduction and internal rotation

A

Avascular necrosis (osteonecrosis). Steroid users, sickle cell, SLE, etc

117
Q

Symmetric arthritis in patient exposed to young children. brief, self-limited course.

A

Viral arthritis –> Parvo

118
Q

Vascular vs neurogenic claudication

A

Vascular: Relived with rest, pain with exertion
Neurogenic: Relieved by walking and leaning forward, not worse with rest

119
Q

How do labs differentiate fibromyalgia and polymyalgia rheumatica?

A

Fibromyalgia: normal
PMR: elevated CRP, ESR

120
Q

Joint pain + dactylitis (sausage fingers)

A

Psoriac Arthritis. classically involves DIP joint (which is spared in RA)

121
Q

Fatigue + stiffness/pain in neck, shoulders, lower back, and hips. Has some point tenderness. Normal CRP and ESR.

A

Diffuse pain + fatigue + normal labs = Fibromyalgia

122
Q

T/F: Initial tx for Fibromyalgia = exercise and NSAIDS

A

FALSE BITCH.
Initial: Exercise + Sleep Hygiene + TCA (AMITRYPTILINE, Imipramine). Can use SSRI/Pregabalin alternatively if not responding to TCA.

123
Q

Why do RA patients develop macrocytic anemia?

A

They take methotrexate, which inhibits dihydrofolate reductase = Folate deficiency

124
Q

Disseminated gonoccocal infection triad

A

Polyarthritis, Tenosynovitis (pain along tendon sheats), vesciopustular skin lesions

125
Q

Rapid onset pain and swelling of knee while playing sports. Bloody fluid on joint aspiration (hemarthrosis). Unable to bear weight.

A

ACL injury

126
Q

major risk factors for osteoporosis = advanced age, postmenopausal status, and obesity

A

false: advanced age, postmenopausal status, and LOW BODY WEIGHT

127
Q

genu varum and costochondral enlargement in a baby who is black and breastfed

A

worried about Rickets (rachitic rosary). increased risk w/increased pigmentation and no vit d supplementation (formula or IU)

128
Q

some features and risk factors of developmental dysplasia of the hip

A
  • limited hip abduction, dislocated hip, +Ortolani
  • Asymmetric gluteal/thigh/inguinal creases or skin folds
  • leg length discrepancy
  • RF: Breech, white, female, +FHx
129
Q

Imaging for DDH

A

<4mo: US Hip

>4mo: Xray Hip

130
Q

slow-developing back pain
+Neuro dysf(x)..loss of perianal sensation/bladder f(x)
palpable step-off at lumbosacral area on exam

A

Spondylolisthesis –>developmental disorder with forward slip of a vertebrate (usually L5 over S1). Usually manifests in young kids ( so young kid with back pain, this is high on differential. Cancer wouldn’t have chronic nature or step off; Ank spond wouldnt have neuro)

131
Q

most common elbow fracture (FOOSH)

A

supracondylar humeral fracture. watch out for brachial a injury (look for loss of pulse, not so much increase in pain)
and compartment syndrome! (increasing pain, may have pulselessness, pallor, poikolothermia)

132
Q

lytic bone lesion in kiddo, +/- skin rash, recurrent otitis media with mass involving mastoid bone. neoplastic. immature dendritic cells (no prolif) and immune cells. +S-100, birbeck granules on EM

A

Langerhans. Usually benign and self-resolves so don’t need tx! LYTIC LESION IN BONE is the most important now

133
Q

Arthritis + nail pitting/nail infection

A

Psoriac Arthritis. May look like onychomycosis or IDA.

134
Q

Adverse effects methotrexate

A
  • Pulmonary Fibrosis!
  • Liver toxicity!
  • Myelosuppression/cytopenia/megaloblastic anemia
  • mucositis/stomatitis (mouth ulcers)
135
Q

Temporal arteritis, a type of ____ _____ ____ (sxs = jaw claudication, HA, vision loss), is associated with this disease in >50 that is treated with low-dose steroids: ______

A

Giant cell arteritis

Polymyalgia Rheumatica

136
Q

what seperates limited cutaneous from diffuse scleroderma?

A

Limited cutaneous = CREST, anti-centromere. no visceral organ involvement, shit aint gonna kill you

Diffuse = anti-topoisomerase (Anti-Scl70). shit!

  • ->Interstitial Lung Disease (lungs)
  • ->Myocardial ischemia/fibrosis (heart)
  • ->Scleroderma renal crisis (kidneys). give ACE-I and get bx
137
Q

what does CREST stand for?

A 
Calcinosis (skin pitting)
Raynauds. tx w/CCB
Esophageal dysmotility (GERD)
Sclerodactyly (tense fingers/thickening)
Telangiectasias (GI bleeds/IDA)
138
Q

How do you make the dx of ank spond?

A

Xray of sacroiliac joints

139
Q

progressive low back pain and stiffness, relief with activity, reduced spinal ROM, lumbosacral tenderness, young patient

140
Q

needle shaped crystals

A

gout. neg birefringence

141
Q

T/F: seronegative spondys are more common in younger patients and present with pain at rest made better by movement

142
Q

patient with erythema nodosum and no other sxs

A

get a CXR to r/o sarcoid

143
Q

who gets the Seronegative spondys?

A

Men aged 15-35 = classic. Not gonna be someone >45. Pain is worse with rest and better with activity. Elevated CRP/ESR usually.
(vs fibromyalgia…female, pain is worse with activity, normal ESR, CRP)

144
Q

long term complications in patients with ank spond

A

Osteoporosis/penia (so vertebral frac in a younger guy)
Aortic root dilation (AR murmur)
Cauda equina

145
Q

most common extra skeletal manifestation of ank spond

A

Anterior uveitis (unilateral ocular pain/photophobia)

146
Q

step up therapy for rheumatoid arthritis (methotrexate not controlling xs after 6 mo)

A
  • add another nonbiologic (sulfasalazine, hydroxychloroquine, or alternate DMARD)
  • can add a TNF alpha inhibitor (biologic like etanercept/infliximab/adalumab) if needed
  • ->either way, continue methotrexate
147
Q

what are the DMARDS (can be used in RA)

A

Nonbiologic: Methotrexate (obvi), Rituximab, Anakinra, Leflunomide, Tociluzumab

Biologics: Etanercept/Infliximab/Adalimubab)

148
Q

multiple white nodules in the hands with a hx of arthritis in the fingers and feet

A

gout (tophi)

149
Q

__________ can be a paraneoplastic syndrome associated with heliotrope rash (upper eyelids) and gottrons papules (erythematous rash on dorsum of fingers) in a patient with symmetric proximal mm weakness

A

Dermatomyositis (also shawl sign:back/shoulders)

Polymyositis also a paraneoplastic, without the skin findings

Confirm dx w/biopsy

150
Q

some diseases that might be underlying reason for Gout

A
  • Myeloproliferative disorder: 40% ppl w/ polycythemia vera have gout
  • Lesch-Nyan
  • Tumor lysis syndrome
  • CKD
151
Q

headache, blurred vision, splenomegaly, gout, pruritis after showers

A

Polycythemia vera (myeloproliferative disorder)

152
Q

T/F: Surgery/trauma/hospitalization can be the precipitating factor for gout, and it can affect the knee or ankle as well as the toe (1st MTP)

A

TRUE AF HABIBI NIGGA

153
Q

T/F: Gout = recurrent attacks that occur overnight/in the morning and maximum intensity in 12-24 hours

154
Q

How do you dx and tx poly/dermatomyositis (proximal mm weakness and violaceous skin lesion)?

A

BIOPSY: shows mononuclear infiltrate surrounding necrotic/regenerating muscle fiber
Tx; Steroids

155
Q

primary raynauds vs secondary

A

P: Female <30, no cause or precipitating factors, neg ANA/ESR
S: Men>40, connective tissue disorders, tissue injury etc, look for underlying disorder

156
Q

What should you screen for in a patient with poly/dermatomyositis?

A

associated with Malignancy!

157
Q

most common cause of hip pain in children

A

Transient Synovitis! follows viral infection or mild trauma. Supportive care and reassurance

158
Q

Clavicular fracture (following FOOSH), patient holding the affected arm/side with the opposite, requires what kind of followup?

A

careful Neurovascular exam because brachial plexus and subclavian run right there. Do clinical exam (motor testing) of hand and arm, and angiogram for vessel.

159
Q

factors that are more likely to be non-gonococcal septic arthritis than GSI

A
  • not a young foxy lady
  • single joint (not migratory)
  • underlying joint disease (i.e. RA)
  • immune suppression (i.e. diabetes)
  • IVDU
160
Q

clinical presentatiosn of disseminated gonococcal infection

A
  • purulent monoarthritis OR

- triad of tenosynovitis, dermatitis (pustules/papules), asymmetric migratory polyarthralgias

161
Q

Carpal tunnel is caused by:

A

compression of carpal tunnel by flexor retinaculum

162
Q

T/F: patients with rheumatoid arthritis have an increased risk of osteoporosis, osteopenia, and bone fractures

163
Q

complications from Pagets dz

A

HA, frontal bossing, CN dysfx, Hearing Loss

164
Q

hip pain worse with internal rotation

A

osteoarthritis

165
Q

where do rheumatoid nodules forms?

A

elbow = classic site

166
Q

what level of spine does rheumatoid affect?

A

cervical…can lead to subluxation and spinal cord compression

167
Q

“spares the DIP joint”

A

rheumatoid arthritis

168
Q

adult with arthritis after viral infx. which virus?

169
Q

Xray vs MRI in patient with back pain:

A

xray: risk of malignancy, infection or vertebral compression
MRI: neuro deficits, cauda equina, suspected epidural abscess

170
Q

patient with Raynauds. What are some other things you’re going to be on the lookout for?

A 
GERD GERD GERD
skin thickening
arthritis 
Intersitial lung disease, nephritis, pericarditis/myocardial fibrosis/pericardial effusion
SCLERODERMA/CREST aka systemic sclerosis
171
Q

T/F: Aortic aneurysm is a well known complication of giant cell arteritis (of which one subtype is temporal)

A

true –> thats why you follow them with serial CXRs

172
Q

dysmotility in Achalasia vs systemic sclerosis

A

Achalasia: decreased peristalsis with increased LES pressure and incomplete LES relaxation due to loss of myenteric plexus

Scleroderma: decreased peristalsis and Decreased LES tone due to smooth muscle atrophy and fibrosis

173
Q

young guy with chronic back pain that is worse at night but improves throughout the day with physical activity

A

Inflammatory –> mostly likely Ankylosing Spondy/PAIR
–>common in men <40
look for Enesthesis: inflammation at site of ligament insertion

174
Q

symmetrical polyarthritis in a young woman married with kids

A

PARVO. Viral arthritis PEASANTRY (its not transient synovitis thats in a kid)

175
Q

what’s the presentation of patellofemoral syndrome?

A

woman with chronic anterior knee pain worse on extension (climbing stairs), squatting, running.
Dx: Extension of knee while compressing patella
Tx: stretch/strengthen thigh

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