rheumatology Flashcards
which is preferred first-line therapy for active RA?
methotrexate
if RA patient fails methotrexate, what is next step?
add or switch to anti-cytokine (infliximab, etanercept)
if RA patient fails methotrexate and subsequent anti-cytokine what is next step?
cyclosporine
GU infections preceding reactive arthritis
chlamydia
GI infections preceding reactive arthritis?
shigella, salmonella, yersinia, campylobacter, C diff
circinate balanitis - what is it, when does it happen?
painless penile ulcers without LAD, they appear within 1-4 weeks of chlamydia infection. I
how do you treat Paget’s disease?
bisphosphonates
disseminated gonorrhea - how present?
tenosynovitis
migratory arthritis
rash
pseudogout - what are the crystals?
positively birefringent rhomboid crystals
probenecid - what does it do?
uricosuric agent
nephrogenic diabetes insipidus - mechanism?
renal resistance to ADH
central diabetes insipidus - mechanism?
deficient excretion of ADH ( trauma, pituitary surgery, or hypoxic or ischemic encephalopathy)
Lofgren syndome - which disease is it associated with and what is it?
SLE:
- erythema nodosum
- hilar adenopathy
- migratory polyarthralgia
- fever
what is calcitriol?
1, 25-dihydroxyvitamin D
what do you send to test for SLE?
ANA, anti-dsDNA
what do you send to test for CREST variant of scleroderma?
anti-centromere ab
what do you send to test for primary biliary cirrhosis?
anti-mitochondrial ab
what is a highly specific but insensitive test for SLE?
anti-Smith ab
what do you send to test for sjogren’s?
anti-Ro/SSA ab
what do you send to test for scleroderma?
anti-centromere ab
if pt w/SLE presents w/complaint that could be flare vs something else, what can you send to tell how active disease is?
Anti-dsDNA
when do you use hydroxychloroquine in SLE?
- athralgias
- serositis
- cutaneous symptoms
when do you use cyclophosphamide in SLE?
patients w/more serious manifestations
- lupus nephritis
- CNS involvement
- vasculitis
when do you use methotrexate in SLE?
patients w/significant organ involvement who have had incomplete response to prednisone alone
why not use rituximab in SLE?
reports of PML (progressive multifocal leukoencephalopathy)
benign tumor in the proximal femur of teens
osteoid osteoma
what do you send to test for RA?
- RF
- anti-CCP
AM joint pain in SLE lasts for how long?
minutes
what are the DMARDs used in RA (5)?
- methotrexate
- hydroxychloroquine
- sulfasalazine
- lefunomide
- azathioprine
what is first-line in RA?
methotrexate
first diagnostic test for ankylosing spondylitis?
SI joint plain film
genetic mutation associated w/ankylosing spondylitis?
HLA-B27
how does anterior uveitis present?
acute onset unilateral eye pain, photophobia, and blurring of vision
extra-articular manifestations of ankylosing spondylitis?
- anterior uveitis
- aortic regurg
- apical pulm fibrosis
- IgA nephropathy
- restrictive lung dz
what do you send to test for polymyositis?
anti-Jo-1, ANA
myasthenia gravis - symptoms?
weakness that increases with repeated use
Henoch-Schonlein purpura - pathogenesis?
systemic IgA deposition
Henoch-Schonlein purpura - what is it?
vasculitis most common in kids
Henoch-Schonlein purpura - clinical characteristics?
URI (50%) then palpable purpuric rash on legs, abd pain 2/2 intussuception
TTP pentad?
- fever
- MAHA
- thrombocytopenia
- renal failure
- AMS
HUS - hallmarks?
- MAHA
- thrombocytopenia
- acute renal failure
- age <5
- s/p bloody diarrhea
HUS typically occurs after what illness?
bloody diarrheal illness
neurofibromatosis type 1 - body parts affected?
- skin (cafe au lait macules)
- eyes (optic nerve glioma, lisch nodules in iris)
- scoliosis
- axillary + inguinal freckling
- neurofibromas
- pseudoarthrosis
neurofibromatosis type 2 - how different than type 1?
- type 2 = vestibular schwannomas
- type 2 = no cafe au lait macules
cafe au lait macules, fibrous dysplasia precocious puberty - dx?
McCune Albright Syndrome
sjogren’s syndrome is associated w/which malignancy?
B-cell non-Hodgkin’s lymphoma
polymyalgia rheumatica is frequently associated with which other rheum dz?
GCA
drugs associated w/risk of lupus?
- procainamide
- hydralazine
- minocycline
- atanecept/infliximab
which autoantibody is associated w/drug inducd lupus?
anti-histone
mafan is what genetically?
autosomal dominant
marfan affects which molecule?
fibrillin - 1
eye complication of marfans?
ectopia lentis (lens subluxation)
Ehlers-danlos - what vascular complication?
berry aneurysm
marfans - what vascular complication?
aortic root dilation + dissection
what use if sarcoid is unresponsive to steroids?
- mtx
- anti-TNF
in sarcoid - tender, red nodules on skin what is this called?
erythema nodosum
what does PTH do to ca and phos?
- phos excretion
- ca reabsorption
gout - acute treatment?
- naproxen
- indomethacin
- if NSAIDS contraindicated = intraarticular or oral steroids
- – 3rd line is colchicine
