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Step 2CK > Rheumatology > Flashcards

Rheumatology Flashcards

1
Q

Does osteoarthritis cause inflammation?

A

No

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2
Q

Which joints are usually most affected in OA?

A

DIP and PIP

“Oh yA when I DIP you PIP”

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3
Q

What are Heberden nodes?

A

DIP enlargement

“DIP down into the den”

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4
Q

What are Bouchard nodes?

A

PIP enlargement

“PB and OA”

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5
Q

Will ESR be normal in OA?

A

Yes

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6
Q

What is gout?

A

Accumulation of uric acid

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7
Q

Can gout have fever?

A

Yes

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8
Q

Which is the most often affected joint in gout?

A

MTP

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9
Q

What are “tophi” in gout?

A

Tissue deposits of urate crystals with foreign body reaction

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10
Q

What does a joint aspiration of gout show?

A

Needle-shaped crystals with negative birefringence

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11
Q

What are the predominant blood cells in gout?

A

Neutrophils

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12
Q

What do you treat acute gout attacks with?

A

NSAIDs or steroids

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13
Q

What do you treat chronic gout with?

A

Colchicine, allopurinol, or febuxostat

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14
Q

What’s the best BP drug for patients with gout?

A

Losartan (it lowers uric acid)

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15
Q

How do CPPD and gout differ?

A

CPPD is usually not in the MTP

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16
Q

What does arthrocentesis show in CPPD?

A

Positively birefringent rhomboid-shaped crystals

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17
Q

Will WBC in the joint be elevated in gout and CPPD?

A

Yes

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18
Q

What’s the best initial tx for CPPD?

A

NSAIDs, steroids

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19
Q

What medication works as a chronic CPPD treatment?

A

Colchicine

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20
Q

What does a straight leg raise test for?

A

Herniated disk

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21
Q

When should you perform an MRI for back pain?

A

When there are neurological deficits?

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22
Q

What antibiotic is best initially for an epidural abscess?

A

Vancomycin (also steroids for acute)

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23
Q

What dx presents with pain particularly when leaning back?

A

Lumbar spinal stenosis

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24
Q

What’s the best initial therapy for fibromyalgia?

A

TCAs such as amitryptyline

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25
Q

Dx: atrophy of thenar eminence?

A

Carpal tunnel

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26
Q

What’s the best test for carpal tunnel?

A

Nerve conduction & electromyography

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27
Q

If the question stem for carpal tunnel describes muscle wasting, the answer is ____ ____?

A

Surgical release

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28
Q

What dx is hyperplasia of the palmar fascia, associated with alcoholism and cirrhosis, and is treated with triamcinolone injection?

A

Dupuytren contracture

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29
Q

What’s the most accurate test for rotator cuff injury?

A

MRI

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30
Q

What dx presents with anterior knee pain secondary to trauma, imbalance of quads strength, or meniscal tear, and sx are worse when starting to walk after a prolonged period of sitting, with normal x-rays?

A

Patellofemoral syndrome

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31
Q

T/F: plantar fasciitis has point tenderness and improvement with use?

A

True

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32
Q

Is x-ray useful in plantar fasciitis?

A

No

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33
Q

Which 2 joints of fingers are most affected by RA?

A

PIPs and MCPs

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34
Q

Which joint is spared in RA?

A

DIP

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35
Q

Is Rheumatoid factor increased in all RA?

A

No, approx 70-80%

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36
Q

What disease is anti-cyclic citrullinated peptide (anti-CCP) associated with?

A

RA (more than 80% sensitive)

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37
Q

Is RA associated with anemia?

A

Yes, normocytic

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38
Q

How is RA diagnosed?

A

A point system (6 points = RA)

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39
Q

What are the criteria of the RA diagnosing system?

A
  1. Joint involvement
  2. ESR or CRP
  3. Duration for >6 weeks
  4. RF or anti-CCP
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40
Q

What is Felty Syndrome?

A

RA plus splenomegaly and neutropenia

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41
Q

What needs to happen prior to surgery in patients with RA?

A

Cervical spine x-ray (because endotracheal intubation can cause vertebral subluxation)

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42
Q

What’s the best initial disease modifying therapy for RA?

A

MTX

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43
Q

What’s the secondary treatment for RA if MTX doesn’t work?

A 
TNF inhibitors:
Infliximab
Adalimumab
Etanercept
Golimumab
Certolizumab
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44
Q

What do you need to do prior to starting a TNF inhibitor?

A

PPD screen (they can reactivate TB)

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45
Q

What’s a DMARD for mild RA that can be used instead of MTX, and is safe in pregnancy but toxic to the retina?

A

Hydroxychloroquine

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46
Q

What toxicity does hydroxychloroquine lead to?

A

Retinal

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47
Q

What toxicity does sulfasalazine have?

A

BM toxicity, hemolysis with G6PD deficiency, rash

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48
Q

What are the adverse effects of rituximab?

A

Infex

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49
Q

What are the adverse effects of gold salts?

A

Nephrotic syndrome

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50
Q

What are the adverse effects of MTX?

A

Liver, lung, marrow

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51
Q

What are the adverse effects of anti-TNF?

A

Reactivation of TB

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52
Q

What are the adverse effects of hydroxychloroquine?

53
Q

What are the adverse effects of sulfasalazine?

A

Rash, hemolysis

54
Q 
What dx presents with: 
Salmon-colored rash
Temp elevation
Ill-appearing patient
LAD
Leukocytosis
Splenomegaly
A

STILLS disease

55
Q

What lab level is markedly elevated in STILLS disease?

56
Q

How is SLE diagnosed?

A

4 out of 11 known signs

57
Q

What are some of the signs of SLE?

A 
Malar rash
Discoid rash
Photosensitivity
Oral ulcers
Arthritis
Serositis
Glomerulonephritis
Hemolytic anemia
False positive test for syphilis
58
Q

What are the antibodies associated with SLE?

A

ANA
dsDNA
anti-SM
antiphospholipid

59
Q

Which antibodies are associated with Sjogren’s but can rarely also be associated with SLE?

A

anti-SSA

anti-Ro

60
Q

In an acute lupus flare, what 1 level drops and what level rises?

A

Complement drops

anti-DS DNA rises

61
Q

How do you treat an acute lupus flare?

A

High-dose boluses of steroids

62
Q

What do young lupus patients die of?

63
Q

What do old lupus patients die of?

A

MI from accelerated atherosclerosis

64
Q

What dx is caused by IgG or IgM antibodies against phospholipids?

A

Antiphospholipid syndrome

65
Q

What dx presents with recurrent thromboses of arteries and veins and also spontaneous abortions?

A

Antiphospholipid syndrome

66
Q

What are the following values in antiphospholipid syndrome:?
aPTT
PT
INR

A

aPTT: elevated
PT: normal
INR: normal

“aPTT=antiPhosphoTipidTyndrome”

67
Q

What’s the best initial test for antiphospholipid syndrome?

A

Mixing study (patient’s plasma is mixed with normal plasma; if APL syndrome Ab is present, the aPTT won’t come back down to normal. If it does, it means it’s a clotting factor deficiency)

68
Q

Does an asymptomatic APL antibody need to be treated?

69
Q

Which widespread anticoagulant is contraindicated in pregnancy?

70
Q

What’s the treatment to prevent a recurrence of spontaneous abortion in APL syndrome?

A

Heparin and aspirin

71
Q

What does CREST syndrome stand for?

A 
Calcinosis
Raynaud
Esophageal dysmotility
Sclerodactyly
Telangiectasia
72
Q

Is CREST syndrome limited or diffuse scleroderma?

A

Limited

“We have a limited edition CREST toothpaste”

73
Q

What dx presents with a young female with fibrosis of the skin and internal organs?

A

Scleroderma

74
Q

Why does scleroderma give diarrhea?

A

Bacterial overgrowth in large diverticula

75
Q

What antibody is associated with limited scleroderma?

A

Anti Scl-70

76
Q

What antibody is associated with diffuse scleroderma?

A

Anti-centromere

77
Q

Which type of scleroderma is associated with pulmonary HTN?

78
Q

Which type of scleroderma is associated with pulmonary fibrosis?

79
Q

What’s the tx for scleroderma?

A

MTX slows the process of limited scleroderma; otherwise treat the pieces

80
Q

What dx presents with elevated ANA, CK, and ESR, and presents with rash on face (malar), scaly patches of hands, and proximal muscle weakness?

A

Dermatomyositis

81
Q

What’s the tx for poly and dermatomyositis?

82
Q

What dx presents with dry eyes, mouth, and vagina due to antibodies against these glands?

A

Sjogren Syndrome

83
Q

What’s the most dangerous complication of Sjogren?

84
Q

What’s the best initial therapy for Sjogren?

A

Water the mouth

85
Q

What’s the best medication tx for Sjogren?

A

Pilocarpine

86
Q

Which vasculitis affects small and medium size vessels, presents with kidney, neuro, and GI problems, spares the lungs, and shows renal artery “beading?”

A

Polyarteritis Nodosa

87
Q

What should you test all PAN patients for?

A

Hepatitis B & C

88
Q

What dx presents in patients >50 with pain and stiffness in shoulder and pelvic girdle muscles, difficulty combing hair and rising from a chair, elevated ESR, and NO elevation in CK or aldolase?

A

Polymyalgia Rheumatica

89
Q

What’s the tx for polymyalgia rheumatica?

90
Q

What vasculitis presents with headaches, decreased arm pulses, bruits near the clavicle, and elevated ESR and CRP?

A

Giant Cell (Temporal) Arteritis

91
Q

What’s the other name for Wegener’s Granulomatosis?

A

Granulomatosis with Polyangiitis

92
Q

What dx presents with a combo of upper and lower respiratory tract findings (sinusitis, otitis media, unresolving pneumonia) in association with renal insufficiency?

A

Granulomatosis with Polyangiitis

93
Q

Which ANCA is Wegener’s?

94
Q

Which ANCA is Churg-Strauss and microscopic polyangiitis?

95
Q

Which biopsy is better for Wegener’s?

96
Q

What 2 meds treat Wegener’s?

A

Prednisone and cyclophosphamide

97
Q

What dx is associated with asthma, eosinophilia, renal, and pulmonary issues?

A

Eosinophilic Granulomatosis with Polyangiitis (Churg-Strauss)

98
Q

What’s the most accurate test for Churg-Strauss?

99
Q

What dx presents usually in kids, and presents with GI, purpura, arthralgia, and hematuria?

100
Q

What’s the most accurate test for HSP?

101
Q

What is associated with chronic hep C and rhymes with “Myoglobulinemia?”

A

Cryoglobulinemia

102
Q

How does cryoglobulinemia present?

A

With non-blanchable purpuric-type lesions

103
Q

What is “pathergy” in Behcet Syndrome?

A

Sterile skin pustules from minor trauma like a needle stick

104
Q

What dx presents in Asian or Middle-Eastern person with painful oral and genital ulcers in association with skin lesions, ocular lesions, and MS-like sx?

A

Behcet Syndrome

105
Q

What are the 3 seronegative spondyloarthropathies?

A
  1. Ank spond
  2. Psoriatic arthritis
  3. Reactive arthritis
106
Q

What presents with uveitis, joint pain, and are often in men under age 40?

A

Seronegative spondyloarthropathies

107
Q

How does ankylosing spondylitis present?

A

Like Bret’s sx!

108
Q

What’s the best initial test for ank spond?

A

X-ray of the SI joint

109
Q

Which HLA is associated with ank spond?

110
Q

What’s the initial tx for psoriatic arthritis?

111
Q

What type of arthritis occurs from inflammatory bowel disease, GI infex, or STI, and presents with joint pain, uveitis or conjunctivis, and genital abnormalities?

A

Reactive Arthritis

112
Q

Is there a specific test for reactive arthritis?

113
Q

What’s the best tx for reactive arthritis?

114
Q

When do you treat osteoporosis with dronates?

A

When the T-score <2.5 SD’s below normal

115
Q

What’s the mechanism of Denosumab?

A

RANKL inhibitor

116
Q

What’s the mechanism of Raloxifene?

A

Estrogen substitute

117
Q

What’s the mechanism of Teriparatide?

A

PTH analogue

118
Q

What rare side effect is associated with bisphosphonates?

A

Osteonecrosis of the jaw

119
Q

What’s the best empiric therapy for septic arthritis?

A

Ceftriaxone and vancomycin

120
Q

What’s the most common organism for prosthetic joint infex?

A

Staph epidermidis

121
Q

What’s the best tx for gonococcal arthritis?

A

Ceftriaxone

122
Q

What’s the most common organism for osteomyelitis?

A

Staph aureus

123
Q

What’s the most common organism for osteomyelitis in patients with sickle cell?

A

Salmonella

124
Q

What dx might present with a purulent sinus tract in a diabetic patient with bone pain?

A

Osteomyelitis

125
Q

What’s the best initial test for osteomyelitis?

126
Q

What’s the best tx for sensitive staph osteomyelitis?

A

Ceftriaxone

127
Q

What’s the best tx for resistant staph osteomyelitis?

A

Vancomycin

128
Q

What should be used for sensitive gram negative bacillus ostoemyelitis?

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