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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
Q

Reiter Syndrome may be triggered by what infeciton preceding the arthritis?

A

GI/Urogenital infection

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26
Q

What % of psoriatic arthritis pts have psoriasis as well?

A

70%

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27
Q

Bamboo spine is found in what disease?

A

AS

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28
Q

What are the 2 main findings in the hands from Psoriatic Arthritis?

A
  1. Nail lesions,pits
  2. Separation of nail from nail bed
  3. DIP joints inflamed
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29
Q

What percentage of Psoriatic patients develop conjunctivitis and uveitis?

A

Conj: 20%
Uveitis: 7%

30
Q

Arthritis occurs in what % of ppl with IBD?

A

6-46%

31
Q

Type 1 arthropathy is an acute attack w/ IBD flares. What bone is most commonly effected? What leukocyte antigen is it associated with?

A
  1. Knee is most common

2. HLA B27

32
Q

Type 2 arthropathy is a chronic attack w/o IBD flares. What joint is mostly affected? Is HLA B27 associated with it?

A
  1. MCP

2. no

33
Q

What treatment is good for SpA?

A
  1. NSAIDS (not for IBD)

2. DMARDS (Methotrexate/Humira)

34
Q

What are the 4 types of CT disease?

A
  1. SLE
  2. Sarcoidosis
  3. Sjrogrens
  4. Antiphospholipid
35
Q

WIT CTD: Chronic inflammatory disease of unknown cause that can affect virtually any organ. Primarily affects women of child-bearing age.

A

Systemic Lupus Erythematous (SLE)

36
Q

What is the worst test to do for SLE? What are the 2 best tests fo SLE?

A
  1. ANA = worst

2. Antiphospholipid antibodies & Urine to Creatinine ratio = best

37
Q

Ocular manifestations are found in what % of lupus patients?

A

50%

38
Q

What are the 6 ocular manifestations of lupus?

A
  1. Lesions on eyelid
  2. 2’ Sjrogrens (20%)
  3. Neuro-ophthalmic lesions
  4. Retinal vasculopathy
  5. Uveitis (rare)
39
Q

Lupus Retinopathy is characterized by what findings?

A
  1. CWS

2. Retinal vascular occlusive disease

40
Q

Lupus choroidopathy is characterized by what findings?

A
  1. CNV
  2. Serous Retinal/RPE evaluation
  3. Choroidal infarction
41
Q

WIT CTD: Multisystem disorder; granulomas in affected organs; Presents w/ bilateral swollen lymphs, pulmonary infiltrates & skin/eye lesions

A

Sarcoidosis

42
Q

How do you dx Sarcoidosis?

A
  1. Biopsy of granulomas (gold standard)
  2. Imaging -CXR abnormal
  3. Increased specificity of +ACE and +Lysozyme labs
43
Q

What are the ocular manifestations of sarcoidosis?

A
  1. Conjunctival Granuloma
  2. Anterior Uveitis
  3. Punched out choroidal lesions
  4. Iris granuloma
44
Q

Vasculitis is a inflammatory vessel disease that encompasses what 5 diseases?

A
  1. GCA
  2. Kawasaki
  3. Polyarteritis Nodosa
  4. Wegner’s
  5. Behcet’s
45
Q

GCA is what size vessel disease?

A

Large

46
Q

Kawasaki is what size vessel disease?

A

Medium

47
Q

Polyarteritis Nodosa is what sie vessel disease?

A

Medium/Small

48
Q

Wegner’s is what size vessel disease?

A

Small

49
Q

Behcet’s is what size vessel disease?

A

Whatever size it wants

50
Q

Systemic vasculitis is rarely associated w/ retinal vasculitis. What lab should you perform on any pt who presents w/ scleritis?

A

ANCA and UA

51
Q

What is the most common presenting symptom in Polyarteritis Nodosa? What % of patients are Hep. B +?

A
  • Mononeuritis Multiplex

- 10% are +

52
Q

10-20% of PAN pts have ocular involvement. What are they?

A
  1. CN palsies
  2. Amaurosis Fugax
  3. Optic Atrophy
  4. Horner’s
  5. Scleritis
  6. Peripheral Ulcerative Keratitis
53
Q

Which ocular SE is a definite link the PAN?

A

Peripheral Ulcerative keratitis

54
Q

What is the classic triad of Wegener Granulomatosis?

A
  1. Granulomatous Vasculitis of resp. tract
  2. Glomerulonephritis
  3. Vasculitis of small vessels
55
Q

What’s the most characteristic feature of Wegener’s?

A

Paranasal sinus involvement

56
Q

What’s the most common cause of mortality in Wegener’s?

A

Renal involvement

57
Q

What’s the most common CNS symptom in Wegener’s?

A

Mononeuritis Multiplex

58
Q

What % of pts present with dermatologic involement (most commonly purpura)?

A

50%

59
Q

What are the ocular manifestations of Wegener’s? FYI: Retinal involvement is uncommon

A
  1. PTC
  2. Dacryocystitis
  3. Scleritis
  4. Uveitis
60
Q

This disease is most commonly found in Turkey. Dx by recurrent oral ulceration, genital ulceration, eye and skin lesions

A

Behcet’s Syndrome

61
Q

WIT: Painful and disabling inflammatory arthritis, usually a single joint is inflamed mainly in feet and hands; caused by buildup of urate crystals

A

Gout

62
Q

Juvenile Idiopathic Arthritis is a type of SN SpA dx usually at what age?

A

2-3 years old

63
Q

In JIA, uveitis is found how many years after onset of joint disease? What’s the ave. age of onset?

A

5-7 years after dx

6 yo

64
Q

What are the frequent ocular complications of JIA?

A
  1. Band keratopathy
  2. Glaucoma
  3. Cataract
65
Q

What are the tx options for JIA?

A
  1. NSAIDs
  2. Prednisone (be careful bc can stunt a child’s growth)
  3. DMARDs
66
Q

Too much prednisone is associated with what % risk of aseptic necrosis of bones?

A

15-20%

67
Q

In patients with RA, long term corticosteroid use is associated with what?

A

Increased mortality

68
Q

The most common SE of aathioprine (imuran) is what?

A

GI Upset and Alopecia

69
Q

The most common SEs of Cyclosporine are?

A
  1. Nephrotoxicity

2. HTN

70
Q

What are the SEs of Tacrolimus?

A

Headache
Renal Impairment
GI Upset
hyperglycemia

71
Q

What is the only agent FDA approved for tx of non-infectious uveitis? What’s the most common SE?

A

Adalimumab

burning at injection site

Clinical Medicine 2 (12 decks)

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