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MS3 Year > Rheumatology > Flashcards

Rheumatology Flashcards

1
Q

gt 50,000 white cells on arthrocentesis, dx?

A

Septic arthritis

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2
Q

Anti-CCP antibody positive, dx?

A

Rheumatoid arthritis

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3
Q

Anti-centromere antibodies, dx?

A

Scleroderma CREST (isolated type of scleroderma)

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4
Q

Positive ANA, most correlated with?

A

lupus

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5
Q

Anti-histone antibodies, dx?

A

Drug induced lupus

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6
Q

Topoisomerase antibodies, dx?

A

Scleroderma (systemic form - they likely won’t show it as Scl-70 on the test)

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7
Q

10,000 white cells on arthrocentesis, dx?

A

Inflammatory arthritis (yellow, white in color, gt 50% polys)

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8
Q

What’s the max number of WBCs you will see in arthrocentesis of osteoarthritis? And percent polys?

A

less than 2000, less than 25%

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9
Q

Acute joint pain, name 4 causes?

A

septic (infxn), trauma, crystal, reactive

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10
Q

Chronic joint pain, name two categories?

A

Degenerative (osteoarthritis) vs Inflammatory (everything else)

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11
Q

Anti-Ro+La antibodies? Anti-Jo

A

Sjogren’s; polymyositis

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12
Q

Anti-smooth muscle antibodies?

A

autoimmune hepatitis

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13
Q

What is the most specific antibody for lupus and lupus nephritis?

A

Anti-dsDNA

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14
Q

What is the antibody seen in primary biliary cirrhosis?

A

Anti-mitochondrial

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15
Q

If gt 50,000 WBCs on tap but negative gram stain/cx, what should you think?

A

Gonorrhea! Can do NAAT or grow on chocolate agar

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16
Q

Pt has lupus and is in renal failure, what do you do next?

A

get a biopsy (lupus nephritis)

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17
Q

Name 5 drugs that can cause drug-induced lupus

A

SHIPP

Sulfonamides, hydralazine, isoniazid, phenytoin, procainamide (also alpha methyl dopa)

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18
Q

How do you diagnose antiphospholipid syndrome? What happens in mixing study? What happens to coag study?

A

Russel viper venom test; mixing study fails to correct; PTT increases, normal INR

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19
Q

Anti-histone antibodies, dx? Tx?

A

Drug-induced lupus; remove drug

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20
Q

Picture of a face with a rash that spares nasolabial folds, dx?

A

Malar rash = lupus

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21
Q

How do you treat lupus nephritis?

A

Cyclophosphamide IV (can switch to po mycophenolate mofetil)

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22
Q

Vegetation on BOTH sides of a valve, dx?

A

libman sacks endocarditis (LSE for SLE)

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23
Q

How do you treat lupus? Lupus flare?

A

hydroxychloroquine; prednisone

use NSAIDs to control symptoms; cyclophosphamide for severe or lupus nephritis

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24
Q

Name 5 of 11 symptoms of Lupus

A

MD SOAP BRAIN
Malar rash, Discoid rash, Serositis (pleuritic chest pain), Oral ulcers, Arthritis (joint pain), Photosensitivity, Blood (anemia and thrombocytopenia), Renal failure, ANA+, Immunologic (other serologic markers), Neurology (cerebritis causes psychosis or AMS)
also see libman sacks endocarditis

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25
Q

Refractory RA treatment (3)?

A

Biologics = etanercept, infliximab, or rituximab

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26
Q

RA and the spine, where is it located?

A

C1 and C2

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27
Q

XR shows erosions in joints, diagnosis?

A

rheumatoid arthritis

28
Q

Name the 3 conditions of felty syndrome?

A

1) RA; 2) neutropenia; 3) splenomegaly

29
Q

What antibodies should you order for RA? Which is sensitive and which is specific?

A 
RF = sensitive
CCP = specific
30
Q

Before you start a biologic, what do you do?

A

Screen for TB and fungus

31
Q

How do you tx rheumatoid arthritis?

A

NSAIDs (Sxs) + Methotrexate (DMARD for everyone!); if severe can use biologic, and steroids for flare

32
Q

What joint does RA spare?

A

DIP joints

33
Q

XR shows periarticular osteopenia, dx?

A

Rheumatoid arthritis (buzzword)

34
Q

Name the 7 characterisitcs of RA with the mnemonic

A

Nobody Should Have Rheumatoid Symptoms 3 X
Nodules (bx shows cholesterol); Symmetric; Hands (and feet); RF (or ccp); Stiffness; 3 or more joints spares DIP; Xray shows erosions

35
Q

Anti-topoisomerase antibody, dx?

A

Systemic sclerosis (also see anti-Scl-70)

36
Q

Dry eyes and dry mouth, dx? Tx?

A

Sjogren’s; artificial tears, artificial saliva

37
Q

How do you diagnose a myositis?

A

biopsy the muscle (will also see increased CK, and possibly anti-Mi or anti-Jo antibodies)

38
Q

How do you treat scleroderma GERD?

A

PPI

39
Q

Scleroderma renal crisis, tx?

A

Ace-inhibitor (not steroid!!!)

40
Q

Anti-centromere antibody, dx?

A

CREST

41
Q

What does CREST stand for and how do they present?

A

calcinosis (can cause HTN), raynauds, esophageal dysmotility (causes unrelenting GERD), Sclerodactyly (tense fingers), Telangiectasia (GI bleeds/Fe deficiency anemia)

42
Q

Name 3 skin presentations of dermatomyositis

A

1) heliotrope rash (purple eyelids); 2) Gottron’s papules (scaly rash on extensors of joints); 3) Shawl sign (neck shoulders)
(causes proximal muscle weakness)

43
Q

What is the underlying pathology in inclusion body myositis, polymyositis, and dermatomyositis? Which one is associated with cancer?

A

IBM and Polymyositis: T-cell
dermatomyositis: Complex deposition
Dermatomyositis (in 25% of cases - ovary, lung, GI, lymphoma)

44
Q

What tests can you order when considering myositis (5)?

A

Antibodies (anti-Mi and Jo), increased CK, increased aldolase, EMG, biopsy of muscle

45
Q

How do you treat tumor lysis after it happens?

A

Rasburicase

46
Q

How do you tx gout?

A

NSAIDs (can’t if have CKD - then use steroids)

47
Q

How do you tx gout chronically?

A

allopurinol (febuxostat also okay)

48
Q

Rhomboid shaped crystals, diagnosis?

A

pseudogout

49
Q

Septic joint and cultures are positive for gram positive cocci, diagnosis and next step?

A

Staph spetic joint; Tx with nafcillin (vanco if pt is toxic or MRSA is confirmed)

50
Q

What type of crystals do you see with gout?

A

needle shaped negatively birefringent

51
Q

Inflamed big toe, diagnosis?

A

Podagra, gout

52
Q

Septic joint but no cultures are positive, dx and next step?

A

Gonorrhea, send for pcr (NAAT)

53
Q

Positively birefringent crystals, dx?

A

pseudogout (rhomboid shaped)

54
Q

Nail pitting and arthritis: diagosis?

A

psoriatic arthritis

55
Q

How do you handle enteropathic arthritis?

A

Treat the inflammatory bowel disease (UC and Crohns) - Mild: 5-ASA; Mod: Azathioprine or 6-MP; Severe: UC = resection, Crohn’s = Anti-TNF

56
Q

Ulcerative colitis and arthritis, dx?

A

Enteropathic arthritis

57
Q

How do you treat reactive arthritis?

A

IM ceftriaxone and doxycycline

58
Q

Sexually active, cervicitis, joint pain, dx? Next step?

A

Reactive arthritis; find the STD to diagnose (swab everything)

59
Q

Vascultitis commonly associated with Hep B?

A

Polyarteritis nodosa (no lung involvement is what differentiates it from wegeners!)

60
Q

Which small vessel vasculitide is associated with palpable purpura and hepatitis C?

A

Cryoglobulinemia

61
Q

Giant cell arteritis: classic sxs (3) and first step?

A 
age gt 50, unilateral temporal headache, tender swollen temporal artery
Give steroids (then confirm)
62
Q

Which vasculitis is associated with a strawberry-like tongue?

A

Kawasaki disease

63
Q

Absent pulses in large vessels of a systemically inflamed female less than 40 yo?

A

Takayasu arteritis

64
Q

Polymyalgia rheumatica is commonly associataed with which vasculitis?

A

Giant cell arterities (large vessel)

65
Q

Vasculitis that’s usually c-ANCA positive?

A

Wegner’s

MS3 Year (18 decks)

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