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MTBs Step 3 > 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
Rotator cuff tear/tendonitis/frozen sx
``` tear = weakness tendonitis = pain on abduction and external rotation + pt tenderness frozen = ^ + decreased ROM ```
26
patellofemoral Syndrome | sx? tx?
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
27
Systemic Lupus Erythematousus(SLE) | dx criteria?
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
How can you differentiate a SLE flare vs another illness like pneumonia?
complement levels drop(C3) and Anti-ds DNA rises in flares
29
Antiphospholipid syndrome | PTT & PT
elevated PTT, normal PT and normal INR
30
antiphospholipid syndrome mixing studies
* 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
tx of antiphosphoplipid syndrome?
heparin then warfarin
32
Sjogren's Syndrome | sx?
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
Sjogren Syndrome | dx?
1. Schirmer test = paper to eye to show decreased wetting 2. lip bx 3. ANA +, RF +
34
tx of Sjogren syndrome?
moisturizers, Pilocarpine for eyes & Cevimeline = increases the rate of saliva production
35
ab positive with systemic scleroderma?
anti-topoisomerase = Scl-70
36
ab positive in CREST scleroderma?
anti-centromere ab
37
CREST Scleroderma
Calcinosis of fingers, Raynauds, Esophageal Dysmotitlity, Sclerodactyly, Telangiectasia
38
Eosinophilic Fasciitis | sx? tx?
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
whats the same between polymyositis and dermatomyositis?
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
dx & Tx of poly/dermatomyositis?
elevated CPK, elevated aldolase, abnormal electromyogram(EMG) tx: steroids
41
anti Jo-1 is associated with...
poly/dermatomyositis + increased risk of intersitial lung dz with both these
42
what will labs look like in fibro?
all normal!
43
sx of fibromyalgia?
muscle aches and stiffness with trigger points/point tenderness on palpation and nonrefreshing sleep *depression and anxiety are common
44
tx of fibro
exercise > SSRI, TCA(amitriptyline)
45
Polymyalgia Rheumatic(PMR)
>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
Common lab finding with all vasculitisissss
normocytic anemai = chronic dz, elevated ESR, thrombocytosis
47
``` Polyarteritis Nodosa(PAN) sx? tx? ```
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
common findings with all vasculitis | list some commonvasculitis
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
Wegener's granulomatosis | sx? tx?
C dz! = CANCA, UR+ LR findsing, + kidney + otitis dx = bx tx: steroids + cyclo
50
Churg-Strauss Syndrome
aka allergic angiitis = PANCA, Vasculitis, Eosinophilia & asthma
51
Giant Cell Temporal Arteritis | tx?
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
Takayasu Arteritis
arteritis of the aorta = different pulses n shit
53
Cryoglobulinemia
vasculitis + fatigue, malaise, skin lesions, joint pain & ASSOCIATED WITH HEPATITIS C = TX HEP C AND WILL GO AWAY
54
Behcet Disease | sx? tx?
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
Gout birefringent?
negative needles
56
tx of gout
NSAIDS, steroids then colchicine within 1st 24 hrs or as preventative *allopurinol for prevention only do not use as acute tx
57
``` Calcium Pyrophosphate (Pseudogout) birefringent? what is this associated with? ```
positive rhomboid * hyperparathyroidism & hemochromatosis * *usually effects big joints
58
Carpel Tunnel Syndrome | nerve? whats the tunnel?
median nerve trapped under felxor retinaculum
59
Tinel & Phalen sign
``` tinel = pain when tapping median nerve phalen = pain with wrists at 90 degrees ``` *carpel tunnel syndrome
60
Dupuytren Contraction
hyperplasia of palmer fascia leading to nodule formation and contraction of 4-5th digits
61
what is dupuytren contraction associated with?
alcohol, cirrhosis
62
tx of dupuytren contraction
Triamcinolone > surgery
63
Plantar Fasciitis vs Tarsal Tunnel Syndrome
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
baker's cysts | dx? tx?
posterior herniation of the synovium of the knee, usually seen with RA or OA; dx w/ U/S tx: NSAIDs or steroids
65
Morton Neuroma | sx
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 3 (30 decks)

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