rheumatology Flashcards
Positive straight leg test
disk herniation
Rx of acute back pain with no neurologic deficit(4)
NSAIDS
Early mobilisation
Mx relaxants
rx dure 4 a 6 semaines
Clue for whipple disease (3)
Joint pain
Malabsorption
PAS
Dx of Whipple(2)
Biopsy small intestine
PCR
quid of tropherima whippeli
Gram positive bacteria
xray in osteoarthritis(3)
subchondral sclerosis
joint space narrowing
ostophytes
joint hand involved in osteoarthritis
DIP
joint hand involved in RA(2)
MCP
PIP
Marker of systemic sclerosis
antitopoisomerase-I
digestive complication of systemic sclerosis(2)
GERD
esophageal dismotility
Most common cause of death in past from systemic sclerosis and why(2)
renal failure
because no ACE inbitor at this time
why people with multiple sclerosis can develop right failure
because of increase pulmonary artery pressure
risk of patient taking chemo in rhumatology
gout
prophylactic measure to prevent gout in patient taking chemo(2)
allopurinol
and
probenicid
most common presentation of goutty attack
podagra
quid of podagra
first metatarsophalangeal gouty arthritis
characteristic of urate crystals in gout induced by chemo(2)
negative birefringent
needled shaped
Wbc count in gout arthrocentesis
2000-50000
what’s allopurinol
xanthine oxydase inhibitor
Meds used to treat acute attack of gout(3)
colchicine
NSAIDS
Steroids
Triad of Bechet(3)
reccurent painful ulcers
erythema nodosum
ant uveitis
localisation of reccurrent ulcers in behcet(2)
mouth
penis
population touched by Behcet(3)
turkish
asian
Middle eastern population
clue for compression vertebral fractures
local tenderness upon percussion of vertebrae
cause of compression fractures(2)
Bone demineralisation
low bone densitiy
cause of osteomalacia(3)
low calcium
low vit D
low phosphore
clue for viral arthritis
Multiple joint pain in patient working in day care center
cause of viral arthritis
parvovirus B19
localisation of pain in hand(3)
like RA
PIP
MCP
how long pain last in viral arthritis
2 months
patient at risk of vertebral osteomyelitis(3)
IV drugs user
sickle cell diseas
immunodepression
Paraclinique of vertebral osteomyelitis
MRI
bugs causing vertebral osteomyelitis
staph aureus
clue in physical exam in vertebral osteomyelitis
tenderness to gentle percussion of spinous process
young patient with low back pain
ankylosing spondylitis
Most common extra articular manif of ankylosing spondylitis
Ant uveitis
clue for Ankylosing spondylitis(3)
Morning stiffness
improve with exercice
link HLA-B27
bone involved in in Ankylosing spondylitis(2)
sacroillitis
then the spine
clue for lumbar stenosis(2)
elder patient
sitting relieves pain
why pain is relieved in lumbar stenosis while sitting
spine flexion open intervertebral space
quid of neural claudication
joint disease
what could be a complication of RA(2)
cervical subluxation spine
cervical spinal cord compression
clue for RA and pain
morning stiffness improving with activity
Marker of RA
anti-CCP
which immunoglobulin in RA
IGM
first drug used to treat RA
methotrexate
second line regimen if failure if no improvement after 6 months of treatment of RA
TNF inhibitor
what other drug can be used in adjunction to metotrexate(2)
hydroxychloroquine
or
sulfasalasine
quid of non biologic agent in RA(DMARD)(4)
methotrexate
hydroxychloroquine
sulfasalazine
azathioprine
quid of biologic effect(3)
ethanercept
infliximab
rituximab
mechanism of action of biologic agent in RA
TNF inhibitor
before beginning DMARD what to check first(2)
Hep B et C
TB
diasease causing erythema nodosum(7)
sarcoidosis behcet cocciodomycosis TB histoplasmosis IBD strep infection
what to do in presence of erythema nodosum(2)
chest x ray
search hilar adenopathy
erythema nodosum plus hilar adenopathy
sarcoidosis
oligoarthritis plus uretritis plus conjunctivitis
reactive arthritis
clue for reactive arthritis(3)
oligoarthritis
uretritis
conjunctivitis
oligo arthritis plus uretritis plus mouth ulcers
reactive arthritis
first line rx of reactive arthritis
NSAIDS
quid of enthesitis
Pain in tendon
tendon most frequently involved in enthesitis
achilles
most commonly involved joint in reactive arthritis(2)
Knee
sacroilliac
fluid synovial examination in gonococcal arthritis
negative or sterile
side effects of methotrexate(6)
oral ulcers increase transaminase pulmonary toxicity BM suppression alopecia anemia
what the mechanism responsible of side effect in methotrexate
antimetabolite agent
patient taking prednisone develops hip pain Dx
avascular necrosis of femoral head
the best test to Dx avascular necrosi of femoral head
MRI
or
scintigraphy
shoulder pain in tennis player
subacromial bursitis
Physical exam finding of subacromial bursitis
pain during rotation and flexion of the shoulder
Neer impingement sign? meaning(2)
pain during rotation and flexion of the shoulder
subacromial bursitis
quid of sausage digit or dactylitis
diffusely swollen digit
disease causing dactilytis or sausage digit
psoriatic arthritis
rx of psoriatic arthritis(3)
NSAIDS
methotrexate
anti TNF agents
arthrocentesis finding in pseudogout
rhomboid shaped
positively birefringent crystals
Quid of CPPD
calcium pyrophosphate dihydrate
disease with CPPD
chondrocalcinosis in Pseudogout
clue for rotator cuff tear
pain not relieved by lidocaine shooting
clue for rotator cuff tendinitis
pain relieved by lidocaine shooting
best test to DX rotator cuff tear
MRI of shoulder
causes of rotator cuff tear(2)
rotator cuff tendinitis
trauma
physical exam clue of rotator cuff tear(2)
lifting the arm above the head causes pain
no possibility of abduction and external rotation
site of lesion in Myasthenia gravis
post synaptic acetylcholine receptor
site of lesion in lambert eaton syndrome
presynaptic voltage gated calcium channel
site of lesion in dermato myositis or polymyositis
MX fibers
clue for dermatomyositis(2)
gottron papules
heliotrop rash
quid of gottron papules
violaceus papules involving dorsum of fingers
In Lambert eaton how are reflexes
absent
patient of unilateral leg edema and fever(3)
DVT
cellulitis
lymphadenitis
clue for cellulitis in unilateral edema(2)
fissured web toe
macerated
clue of anserine bursitis(2)
pain in medial side of the tibia
just below the knee
meaning of valgus test
medial collateral ligament is touched
rx of anserine bursitis(2)
ice
rest
cause of anserine bursitis(3)
trauma
overuse
abnormal gait
clue of the arthritis in SLE
non deforming arthritis
quid of HLA-B27 arthropathy(4)
IBD
Ankylosing spondylitis
Reactive arthritis
psoriatic arthritis
point common of any disease with HLA b27
enthesitis
most common lieu for enthesitis
heel
finding of ankylosing spondylitis
spine limited mobility
other sites of enthesitis(2)
illiac crest
tibial tuberosities
clue for fibromyalgia
female with diffuse Mx pain
first rx for fibromyalgia
amitryptiline
alternative rx for fibromyalgia(3)
duloxetin
pregabalin
milnacipran
quid of negative birefringent needle(2)
yellow needle like crystal
when parallel to polarizing axis
blue needle like crystals when perpendicular to polarizing axis
crystals causing negative birefringent needle
monosodium urate crustal deposition
wbc in osteo arthritis
200-2000
arthrocenthesis result in inflammatory arthritis wbc
2000-100000
arthrocenthesis result in septic arthritis wbc
> 50000
how to differentiate septic arthritis from inflammatory arthritis(2)
PMN>50% inflammatory arthritis
PMN> 80% septic arthritis
risk factor for gout(3)
high meat consumption
excessive alcohol intake
drugs (diuretic)
drug causing gout
diuretic thiazide
short term rx of gout(3)
NSAIDS
colchicine
corticosteroids
long term rx of gout
allopurinol
clue for polymyositis et dermatomyositis(3)
elevated CPK
ESR high
proximal mx weakness
cause of proximal weakness(4)
drug induced myositis
hypothyroid myopathy
Mx dystrophy
Myathenia gravis
Confirmatory dx of polymyositis
Mx Biopsy
Drugs causing Myopathy(3)
statin
alcohol
antipsychotics
first line of polymyositis
corticosteroids
first line rx of fibromyalgia(2)
aerobic exercice
good sleep hygiene
second step of fibromyalgia
amitryptiline
lumbar pain during lifting heavy object
lumbar strain
what should be done to prevent further back pain
keep the back straight when lifting object
patient with back pain worse at night
metastasis cancer
first tumor to metastase in bone(5)
lung breast prostate thyroid kidney
rx for symptomatic sarcoidosis
glucocorticoid
workup for sarcoidosis and meaning (3)
chest xray
biopsy
ACE increases
chest xray for sarcoidosis
hilar adenopathy
biopsy finding for sarcoidosis
non caseiting granuloma
xray finding in paget
mosaic pattern of lameller bone
physiopatho of paget
bone remodelling
why can you have hearing loss in paget
cranial nerve entrapment
main cause of paget
osteoclast dysfunction
bone reached in paget
femoral bowing