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Clinical Medicine 2 > Rheumatology > Flashcards

Rheumatology Flashcards

1
Q

What are the 5 cardinal signs of inflammation?

A
  1. Pain/Tenderness
  2. Swelling
  3. Warmth
  4. Redness
  5. Loss of function
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2
Q

WIT: Chronic, systemic inflammatory disease primarily affecting synovial joints; symmetrical; polyarthritis; extra-articular features

A

Rheumatoid Arthritis

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3
Q

What are the 3 extra-articular features of RA?

A
  1. Nodules
  2. Anemia of chronic disease
  3. Pleural effusion
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4
Q

What is the prevalence and peak onset of RA?

A

3% of ppl have RA

onset = 25-50yo

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5
Q

Inflammation of joints in RA are caused by what?

A

lymphocytic and marcrophage infiltration

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6
Q

A patient with RA will have joint pain and stiffness lasting more than 1 hr during what time of the day?

A

Morning

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7
Q

What are the 2 main hand deformities found in RA?

A

Swan neck & boutonniere deformity

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8
Q

WIT: Degenerative condition, a “wear and tear” athritis; not systemic; breakdown of cartilage

A

Osteoarthritis

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9
Q

What leukocyte antigen is the most common cause of anterior uveitis and hypopyon uveitis in patients?

A

HLA-B27

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10
Q

What are the 5 characteristics of Seronegative Spondyloarthropathies?

A
  1. chronic low back pain
  2. > 3 mo. duration
  3. Heel enthesitis
  4. Dactylitis
  5. Oligoarthritis
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11
Q

Seronegative refers to the absence of ?

A

RF = Rheumatoid Factor

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12
Q

HLA-B27 genotype is located on short arm of what chromosome?

A

chromosome 6

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13
Q

HLA-B27 is found in what 5 diseases?

A
  1. Ankylosing Spondylitis
  2. Reiter’s Syndrome
  3. Inflammatory BD
  4. Psoriatic Arth.
  5. Reactive Arthritis
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14
Q

What are the classic x-ray findings in SN SpA?

A

Sclerosis

  1. Joint widened space
  2. Erosion
  3. Changes in spine
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15
Q

What is the main finding in Axial SpA? When is the pain worse?

A

Chronic low back pain for at least 3 months

- worse at night

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16
Q

Inflammatory back pain is found in what % of Axial SpA pts?

A

70-80%

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17
Q

How can Axial SpA back pain be improved?

A
  1. Exercise
  2. NSAIDs
  3. NOT REST
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18
Q

Peripheral Arthritis SpA is acute pain of what part of the body?

A

Lower extremities

  1. Knees
  2. Ankles
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19
Q

In peripheral arthritis SpA, the arthritis usually presents in what type of pattern?

A

Assymmetrical

- RA is symmetrical

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20
Q

What percentage of Ankylosing Spondylitis patients are HLA B27 positive?

A

90%

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21
Q

What is the most common extra-articular complication of AS? What % of pts does this occur in?

A

Unilateral Uveitis

- occurs in 25-40% of patients

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22
Q

Aortitis and PUlmonary apical fibrosis is found in what % of AS pts?

A

5%

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23
Q

AS is found in more males or females?

A

Males

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24
Q

What is the classic triad of Reiter Syndrome?

A
  1. Non-specific Urethritis
  2. Polyarthritis; assymetrical
  3. Conjunctivitis + Iritis
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25
Reiter Syndrome may be triggered by what infeciton preceding the arthritis?
GI/Urogenital infection
26
What % of psoriatic arthritis pts have psoriasis as well?
70%
27
Bamboo spine is found in what disease?
AS
28
What are the 2 main findings in the hands from Psoriatic Arthritis?
1. Nail lesions,pits 2. Separation of nail from nail bed 2. DIP joints inflamed
29
What percentage of Psoriatic patients develop conjunctivitis and uveitis?
Conj: 20% Uveitis: 7%
30
Arthritis occurs in what % of ppl with IBD?
6-46%
31
Type 1 arthropathy is an acute attack w/ IBD flares. What bone is most commonly effected? What leukocyte antigen is it associated with?
1. Knee is most common | 2. HLA B27
32
Type 2 arthropathy is a chronic attack w/o IBD flares. What joint is mostly affected? Is HLA B27 associated with it?
1. MCP | 2. no
33
What treatment is good for SpA?
1. NSAIDS (not for IBD) | 2. DMARDS (Methotrexate/Humira)
34
What are the 4 types of CT disease?
1. SLE 2. Sarcoidosis 3. Sjrogrens 4. Antiphospholipid
35
WIT CTD: Chronic inflammatory disease of unknown cause that can affect virtually any organ. Primarily affects women of child-bearing age.
Systemic Lupus Erythematous (SLE)
36
What is the worst test to do for SLE? What are the 2 best tests fo SLE?
1. ANA = worst | 2. Antiphospholipid antibodies & Urine to Creatinine ratio = best
37
Ocular manifestations are found in what % of lupus patients?
50%
38
What are the 6 ocular manifestations of lupus?
1. Lesions on eyelid 2. 2' Sjrogrens (20%) 3. Neuro-ophthalmic lesions 4. Retinal vasculopathy 5. Uveitis (rare)
39
Lupus Retinopathy is characterized by what findings?
1. CWS | 2. Retinal vascular occlusive disease
40
Lupus choroidopathy is characterized by what findings?
1. CNV 2. Serous Retinal/RPE evaluation 3. Choroidal infarction
41
WIT CTD: Multisystem disorder; granulomas in affected organs; Presents w/ bilateral swollen lymphs, pulmonary infiltrates & skin/eye lesions
Sarcoidosis
42
How do you dx Sarcoidosis?
1. Biopsy of granulomas (gold standard) 2. Imaging -CXR abnormal 3. Increased specificity of +ACE and +Lysozyme labs
43
What are the ocular manifestations of sarcoidosis?
1. Conjunctival Granuloma 2. Anterior Uveitis 3. Punched out choroidal lesions 4. Iris granuloma
44
Vasculitis is a inflammatory vessel disease that encompasses what 5 diseases?
1. GCA 2. Kawasaki 3. Polyarteritis Nodosa 4. Wegner's 5. Behcet's
45
GCA is what size vessel disease?
Large
46
Kawasaki is what size vessel disease?
Medium
47
Polyarteritis Nodosa is what sie vessel disease?
Medium/Small
48
Wegner's is what size vessel disease?
Small
49
Behcet's is what size vessel disease?
Whatever size it wants
50
Systemic vasculitis is rarely associated w/ retinal vasculitis. What lab should you perform on any pt who presents w/ scleritis?
ANCA and UA
51
What is the most common presenting symptom in Polyarteritis Nodosa? What % of patients are Hep. B +?
- Mononeuritis Multiplex | - 10% are +
52
10-20% of PAN pts have ocular involvement. What are they?
1. CN palsies 2. Amaurosis Fugax 3. Optic Atrophy 4. Horner's 5. Scleritis 6. Peripheral Ulcerative Keratitis
53
Which ocular SE is a definite link the PAN?
Peripheral Ulcerative keratitis
54
What is the classic triad of Wegener Granulomatosis?
1. Granulomatous Vasculitis of resp. tract 2. Glomerulonephritis 3. Vasculitis of small vessels
55
What's the most characteristic feature of Wegener's?
Paranasal sinus involvement
56
What's the most common cause of mortality in Wegener's?
Renal involvement
57
What's the most common CNS symptom in Wegener's?
Mononeuritis Multiplex
58
What % of pts present with dermatologic involement (most commonly purpura)?
50%
59
What are the ocular manifestations of Wegener's? FYI: Retinal involvement is uncommon
1. PTC 2. Dacryocystitis 3. Scleritis 4. Uveitis
60
This disease is most commonly found in Turkey. Dx by recurrent oral ulceration, genital ulceration, eye and skin lesions
Behcet's Syndrome
61
WIT: Painful and disabling inflammatory arthritis, usually a single joint is inflamed mainly in feet and hands; caused by buildup of urate crystals
Gout
62
Juvenile Idiopathic Arthritis is a type of SN SpA dx usually at what age?
2-3 years old
63
In JIA, uveitis is found how many years after onset of joint disease? What's the ave. age of onset?
5-7 years after dx 6 yo
64
What are the frequent ocular complications of JIA?
1. Band keratopathy 2. Glaucoma 3. Cataract
65
What are the tx options for JIA?
1. NSAIDs 2. Prednisone (be careful bc can stunt a child's growth) 3. DMARDs
66
Too much prednisone is associated with what % risk of aseptic necrosis of bones?
15-20%
67
In patients with RA, long term corticosteroid use is associated with what?
Increased mortality
68
The most common SE of aathioprine (imuran) is what?
GI Upset and Alopecia
69
The most common SEs of Cyclosporine are?
1. Nephrotoxicity | 2. HTN
70
What are the SEs of Tacrolimus?
Headache Renal Impairment GI Upset hyperglycemia
71
What is the only agent FDA approved for tx of non-infectious uveitis? What's the most common SE?
Adalimumab burning at injection site

Clinical Medicine 2 (12 decks)

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