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MTBs Step 2CK > Rheumatology > Flashcards

Rheumatology Flashcards

1
Q

tx for Lower back pain from lubosacral strain

A

NSAIDs

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2
Q

when do you do a MRI for back pain?

A

Positive SLR + low back pain + sensory deficits

*no sensory deficits = no MRI

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3
Q

back pain + super high ESR + fever + point tenderness dx?

A

S. aureus cord abscess

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4
Q

back pain, bowel/bladder dysfunction, bilateral leg weakness and saddle anesthesia. dx? tx?

A

cauda equina sy.

tx: steroids + surgical decompresssion

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5
Q

tx of Sciatica?

A

NSAIDs > stretches > steroids

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6
Q

Felty Syndrome

A

RA + Splenomegaly + neutropenia

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7
Q

Caplan Syndrome

A

RA + Pneumoconiosis + lung nodules

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8
Q

MCC of death in ppl with RA?

A

CAD

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9
Q

if your gonna operate on someone with RA what must you do first? why?

A

cervical XR looking for C1/C2 subluxation

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10
Q

Rheumatoid Arthritis(RA) dx criteria

A

4+ of the following:

  1. morning stiffness lasting >1hr
  2. wrist and finger involvement(MCP, PIP)
  3. swelling of at least 3 joints
  4. symmetric involvement
  5. rheumatoid nodules
  6. XR abnormalities showing erosions
  7. +RF (70% specific) or + anti-CCP(>80% sen. 95% specific)
  8. CRP or ESR elevation
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11
Q

anemia in RA? why?

A

anemia of chronic dz, normal MCV

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12
Q

whats special about RA pleural effusions?

A

lowest glucose levels of all causes

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13
Q

tx of RA

A

NSAIDs + DMARD(methotrexate > infliximab > hydroxychloroquine(check eyes often))

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14
Q

Seronegative Spondyloarthropathies

what are they? why they called that?

A

PAIR = Psoriatic Arthritis, Ankylosing Spondyylitis, Idiopathic Juvenile RA, Reactive Arthritis

*called that bc negative Rheumatoid factor

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15
Q

what are all the Seronegative Spondyloarthropathies assocaited wiht…

A

negative RF, usually involve the spine, sacroiliac joint involvement, HLA B27, Uveitis

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16
Q

Ankylosing Spondylitis

sx? tx?

A

young male <40, spin or back stiffness worse at night, relieved by leaning forward +/- arthritis, bamboo spine, uveitis(30%), restrictive lung dz(2-15% due to spinal shit)

*tx w/NSAIDs + exercise

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17
Q

Reactive Arthritis

sx?tx?

A

cant see cant pee cant climb a tree!
* urethrits, GI infection, fever, weight loss, fatigue, arthritis, conjunctivitis,

tx: NSAIDs

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18
Q

Psoriatic Arthritis

sx? tx?

A

nail pitting, DIP involvment = pencil in cup, sausage-shaped digits, enthesis(inflammation @ tendon insertion sites)

tx: NSAIDs > methotrexate

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19
Q

Idiopathic Juvenile Rheumatoid Arthritis(JRA)

sx? tx?

A

> 6wks joint pain, fever(>104), salmon-colored rash, polyarthritis, lymphadenopathy, myalgias, splenmegaly, pericardial effusions, high ferritin, anemia of chronic dz, elevated WBC, negative RF & ANA

tx: NSAIDs > steroids

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20
Q

kid with JRA what must you do for him?

A

EYE EXAM EVERY YEAR TO LOOK FOR UVEITIS

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21
Q

whipple dz

sx? tx?

A

whipple dz
Dude with joint pains, diarrhea, fat malabsorption, weight loss, bowel bx shows PAS + shit.
tx: TMP/SMX

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22
Q

Osteoarthritis(OA)

sx?

A

morning stiffness <30 min, crepitus, DIPS involved, Heberdens nodes(DIPS), Bouchards(PIPs)

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23
Q

OA dx?

A

Xray joint + low leukocytes <2k

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24
Q

tx of OA

A

acetaminophen

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25
Q

Rotator cuff tear/tendonitis/frozen sx

A 
tear = weakness
tendonitis = pain on abduction and external rotation + pt tenderness
frozen = ^ + decreased ROM
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26
Q

patellofemoral Syndrome

sx? tx?

A

imbalance of quads strength or menisal tear. due to trauma = pain in front of knee behind patell when walking up or down stairs, crepitis, joint locking, worse after moveing from sitting for awhile

tx: PT

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27
Q

Systemic Lupus Erythematousus(SLE)

dx criteria?

A

4 of:

  1. Skin: malar rash, photosensitivity, Oral ulcers, discoid rash
  2. Arthralgias
  3. blood: leukopenia, thrombocytopenia, hemolysis
  4. Renal: benign proteinuria to ESRD(membranous GN)
  5. cerebral: behavior change, stroke, seizure, meningitis
  6. Serositis: pericarditis, pleuritc chest pain, pulmonary HTN, Pneumonia, myocarditis
  7. Serology: ANA(95% sen), DS-DNA(60% sen but more specific 70%)
28
Q

How can you differentiate a SLE flare vs another illness like pneumonia?

A

complement levels drop(C3) and Anti-ds DNA rises in flares

29
Q

Antiphospholipid syndrome

PTT & PT

A

elevated PTT, normal PT and normal INR

30
Q

antiphospholipid syndrome mixing studies

A
  • mixing with APL = no change in PTT; if due to factor deficiency it would return to normal.
  • Russel Vipor Venom Test(RVVT) - prolonged and doesnt correct with mixing
31
Q

tx of antiphosphoplipid syndrome?

A

heparin then warfarin

32
Q

Sjogren’s Syndrome

sx?

A

ab to lacrimal glands and salivary glands +/- vasculitis, lung dz, pancreatitis, RTA, dysparenia(pain w/intercourse)

*dry eyes, drye mouth, sand under eyes and dental carries

33
Q

Sjogren Syndrome

dx?

A
  1. Schirmer test = paper to eye to show decreased wetting
  2. lip bx
  3. ANA +, RF +
34
Q

tx of Sjogren syndrome?

A

moisturizers, Pilocarpine for eyes & Cevimeline = increases the rate of saliva production

35
Q

ab positive with systemic scleroderma?

A

anti-topoisomerase = Scl-70

36
Q

ab positive in CREST scleroderma?

A

anti-centromere ab

37
Q

CREST Scleroderma

A

Calcinosis of fingers, Raynauds, Esophageal Dysmotitlity, Sclerodactyly, Telangiectasia

38
Q

Eosinophilic Fasciitis

sx? tx?

A

inflammation of the fasia under the skin = thick skin taht can look like scleroderma + “orange peel” appearance. will see EOSINOPHILIA(not seen in scleroderm)

  • worse with excise
    tx: steroids
39
Q

whats the same between polymyositis and dermatomyositis?

A

both: proximal M weakness(difficulty rising from chair) & muslce inflmmation(pain + tenderness)
dermato: DERM SHIT! = Gottrons papules(scales over fingers), Heliotrope rash, Shawl Sign(shoulder and neck erythema)

40
Q

dx & Tx of poly/dermatomyositis?

A

elevated CPK, elevated aldolase, abnormal electromyogram(EMG)

tx: steroids

41
Q

anti Jo-1 is associated with…

A

poly/dermatomyositis + increased risk of intersitial lung dz with both these

42
Q

what will labs look like in fibro?

A

all normal!

43
Q

sx of fibromyalgia?

A

muscle aches and stiffness with trigger points/point tenderness on palpation and nonrefreshing sleep

*depression and anxiety are common

44
Q

tx of fibro

A

exercise > SSRI, TCA(amitriptyline)

45
Q

Polymyalgia Rheumatic(PMR)

A

> 50 yoa profound pain and stiffness on the proximal muscles such as shoulders and pelvic girdle. worse in teh mroning and is localized to the muscles rather than to the joints + associated with GCTA

46
Q

Common lab finding with all vasculitisissss

A

normocytic anemai = chronic dz, elevated ESR, thrombocytosis

47
Q 
Polyarteritis Nodosa(PAN)
sx? tx?
A

fatigue, malaise, weight loss, feer, skin lesions = purpura rash, joint pain, neuropathy(mononeuritis multiplex)
+ abdomainl pain(worse with eatting), renal involvement, testicular involvment, pericarditis, HTN, lower extremeity ulcers

tx: prednisone + cyclophosphamide

48
Q

common findings with all vasculitis

list some commonvasculitis

A

fatigue, malaise, weight loss, feer, skin lesions = purpura rash, joint pain, neuropathy(mononeuritis multiplex)

-PAN, Wegners, Churg-Strauss, GCTA, Takayasu, Henoch-Sclone purpura, Cryogloulinemia, Behcet dz,

49
Q

Wegener’s granulomatosis

sx? tx?

A

C dz! = CANCA, UR+ LR findsing, + kidney + otitis

dx = bx tx: steroids + cyclo

50
Q

Churg-Strauss Syndrome

A

aka allergic angiitis = PANCA, Vasculitis, Eosinophilia & asthma

51
Q

Giant Cell Temporal Arteritis

tx?

A

fever weight loss fatigue, jaw claudication, visual sx, HA, scalp tenderness/pain when brushing hair, decrease pulses in arm, aortic regurge

tx: steroids 1st then bx

52
Q

Takayasu Arteritis

A

arteritis of the aorta = different pulses n shit

53
Q

Cryoglobulinemia

A

vasculitis + fatigue, malaise, skin lesions, joint pain & ASSOCIATED WITH HEPATITIS C = TX HEP C AND WILL GO AWAY

54
Q

Behcet Disease

sx? tx?

A

oral/genital ulcers, middle eastern ppl/asian, ocular involvment(uveitis, optic neuritis), skin lesions = pathergy = hyperreactivity to mild skin trauma, CNS disease

tx: prednisone and colchicine

55
Q

Gout birefringent?

A

negative needles

56
Q

tx of gout

A

NSAIDS, steroids then colchicine within 1st 24 hrs or as preventative

*allopurinol for prevention only do not use as acute tx

57
Q 
Calcium Pyrophosphate (Pseudogout)
birefringent? what is this associated with?
A

positive rhomboid

  • hyperparathyroidism & hemochromatosis
  • *usually effects big joints
58
Q

Carpel Tunnel Syndrome

nerve? whats the tunnel?

A

median nerve trapped under felxor retinaculum

59
Q

Tinel & Phalen sign

A 
tinel = pain when tapping median nerve
phalen = pain with wrists at 90 degrees

*carpel tunnel syndrome

60
Q

Dupuytren Contraction

A

hyperplasia of palmer fascia leading to nodule formation and contraction of 4-5th digits

61
Q

what is dupuytren contraction associated with?

A

alcohol, cirrhosis

62
Q

tx of dupuytren contraction

A

Triamcinolone > surgery

63
Q

Plantar Fasciitis vs Tarsal Tunnel Syndrome

A

PF: tenderness at insertion, sever in morning, imporves with walking, tx NSAIDs will resolve

TTS: more painful with use, like carpel tunel of foot, tx avoid high heels, may need steroids, may need surgery

64
Q

baker’s cysts

dx? tx?

A

posterior herniation of the synovium of the knee, usually seen with RA or OA; dx w/ U/S tx: NSAIDs or steroids

65
Q

Morton Neuroma

sx

A

painful burning senation in the INTERDIGITAL WEB SPACE BETWEEN THE 3rd and 4th toes, tenderness when pressure is applied, shap intermitten pain radiating nto the toes that feels better with shoes off

MTBs Step 2CK (20 decks)

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