Rheumatology Flashcards
1
Q
Does osteoarthritis cause inflammation?
A
No
2
Q
Which joints are usually most affected in OA?
A
DIP and PIP
“Oh yA when I DIP you PIP”
3
Q
What are Heberden nodes?
A
DIP enlargement
“DIP down into the den”
4
Q
What are Bouchard nodes?
A
PIP enlargement
“PB and OA”
5
Q
Will ESR be normal in OA?
A
Yes
6
Q
What is gout?
A
Accumulation of uric acid
7
Q
Can gout have fever?
A
Yes
8
Q
Which is the most often affected joint in gout?
A
MTP
9
Q
What are “tophi” in gout?
A
Tissue deposits of urate crystals with foreign body reaction
10
Q
What does a joint aspiration of gout show?
A
Needle-shaped crystals with negative birefringence
11
Q
What are the predominant blood cells in gout?
A
Neutrophils
12
Q
What do you treat acute gout attacks with?
A
NSAIDs or steroids
13
Q
What do you treat chronic gout with?
A
Colchicine, allopurinol, or febuxostat
14
Q
What’s the best BP drug for patients with gout?
A
Losartan (it lowers uric acid)
15
Q
How do CPPD and gout differ?
A
CPPD is usually not in the MTP
16
Q
What does arthrocentesis show in CPPD?
A
Positively birefringent rhomboid-shaped crystals
17
Q
Will WBC in the joint be elevated in gout and CPPD?
A
Yes
18
Q
What’s the best initial tx for CPPD?
A
NSAIDs, steroids
19
Q
What medication works as a chronic CPPD treatment?
A
Colchicine
20
Q
What does a straight leg raise test for?
A
Herniated disk
21
Q
When should you perform an MRI for back pain?
A
When there are neurological deficits?
22
Q
What antibiotic is best initially for an epidural abscess?
A
Vancomycin (also steroids for acute)
23
Q
What dx presents with pain particularly when leaning back?
A
Lumbar spinal stenosis
24
Q
What’s the best initial therapy for fibromyalgia?
A
TCAs such as amitryptyline
25
Dx: atrophy of thenar eminence?
Carpal tunnel
26
What's the best test for carpal tunnel?
Nerve conduction & electromyography
27
If the question stem for carpal tunnel describes muscle wasting, the answer is ____ ____?
Surgical release
28
What dx is hyperplasia of the palmar fascia, associated with alcoholism and cirrhosis, and is treated with triamcinolone injection?
Dupuytren contracture
29
What's the most accurate test for rotator cuff injury?
MRI
30
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?
Patellofemoral syndrome
31
T/F: plantar fasciitis has point tenderness and improvement with use?
True
32
Is x-ray useful in plantar fasciitis?
No
33
Which 2 joints of fingers are most affected by RA?
PIPs and MCPs
34
Which joint is spared in RA?
DIP
35
Is Rheumatoid factor increased in all RA?
No, approx 70-80%
36
What disease is anti-cyclic citrullinated peptide (anti-CCP) associated with?
RA (more than 80% sensitive)
37
Is RA associated with anemia?
Yes, normocytic
38
How is RA diagnosed?
A point system (6 points = RA)
39
What are the criteria of the RA diagnosing system?
1. Joint involvement
2. ESR or CRP
3. Duration for >6 weeks
4. RF or anti-CCP
40
What is Felty Syndrome?
RA plus splenomegaly and neutropenia
41
What needs to happen prior to surgery in patients with RA?
Cervical spine x-ray (because endotracheal intubation can cause vertebral subluxation)
42
What's the best initial disease modifying therapy for RA?
MTX
43
What's the secondary treatment for RA if MTX doesn't work?
```
TNF inhibitors:
Infliximab
Adalimumab
Etanercept
Golimumab
Certolizumab
```
44
What do you need to do prior to starting a TNF inhibitor?
PPD screen (they can reactivate TB)
45
What's a DMARD for mild RA that can be used instead of MTX, and is safe in pregnancy but toxic to the retina?
Hydroxychloroquine
46
What toxicity does hydroxychloroquine lead to?
Retinal
47
What toxicity does sulfasalazine have?
BM toxicity, hemolysis with G6PD deficiency, rash
48
What are the adverse effects of rituximab?
Infex
49
What are the adverse effects of gold salts?
Nephrotic syndrome
50
What are the adverse effects of MTX?
Liver, lung, marrow
51
What are the adverse effects of anti-TNF?
Reactivation of TB
52
What are the adverse effects of hydroxychloroquine?
Ocular
53
What are the adverse effects of sulfasalazine?
Rash, hemolysis
54
```
What dx presents with:
Salmon-colored rash
Temp elevation
Ill-appearing patient
LAD
Leukocytosis
Splenomegaly
```
STILLS disease
55
What lab level is markedly elevated in STILLS disease?
Ferritin
56
How is SLE diagnosed?
4 out of 11 known signs
57
What are some of the signs of SLE?
```
Malar rash
Discoid rash
Photosensitivity
Oral ulcers
Arthritis
Serositis
Glomerulonephritis
Hemolytic anemia
False positive test for syphilis
```
58
What are the antibodies associated with SLE?
ANA
dsDNA
anti-SM
antiphospholipid
59
Which antibodies are associated with Sjogren's but can rarely also be associated with SLE?
anti-SSA
| anti-Ro
60
In an acute lupus flare, what 1 level drops and what level rises?
Complement drops
| anti-DS DNA rises
61
How do you treat an acute lupus flare?
High-dose boluses of steroids
62
What do young lupus patients die of?
Infex
63
What do old lupus patients die of?
MI from accelerated atherosclerosis
64
What dx is caused by IgG or IgM antibodies against phospholipids?
Antiphospholipid syndrome
65
What dx presents with recurrent thromboses of arteries and veins and also spontaneous abortions?
Antiphospholipid syndrome
66
What are the following values in antiphospholipid syndrome:?
aPTT
PT
INR
aPTT: elevated
PT: normal
INR: normal
"aPTT=antiPhosphoTipidTyndrome"
67
What's the best initial test for antiphospholipid syndrome?
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
Does an asymptomatic APL antibody need to be treated?
No
69
Which widespread anticoagulant is contraindicated in pregnancy?
Warfarin
70
What's the treatment to prevent a recurrence of spontaneous abortion in APL syndrome?
Heparin and aspirin
71
What does CREST syndrome stand for?
```
Calcinosis
Raynaud
Esophageal dysmotility
Sclerodactyly
Telangiectasia
```
72
Is CREST syndrome limited or diffuse scleroderma?
Limited
| "We have a limited edition CREST toothpaste"
73
What dx presents with a young female with fibrosis of the skin and internal organs?
Scleroderma
74
Why does scleroderma give diarrhea?
Bacterial overgrowth in large diverticula
75
What antibody is associated with limited scleroderma?
Anti Scl-70
76
What antibody is associated with diffuse scleroderma?
Anti-centromere
77
Which type of scleroderma is associated with pulmonary HTN?
Limited
78
Which type of scleroderma is associated with pulmonary fibrosis?
Diffuse
79
What's the tx for scleroderma?
MTX slows the process of limited scleroderma; otherwise treat the pieces
80
What dx presents with elevated ANA, CK, and ESR, and presents with rash on face (malar), scaly patches of hands, and proximal muscle weakness?
Dermatomyositis
81
What's the tx for poly and dermatomyositis?
Steroids
82
What dx presents with dry eyes, mouth, and vagina due to antibodies against these glands?
Sjogren Syndrome
83
What's the most dangerous complication of Sjogren?
Lymphoma
84
What's the best initial therapy for Sjogren?
Water the mouth
85
What's the best medication tx for Sjogren?
Pilocarpine
86
Which vasculitis affects small and medium size vessels, presents with kidney, neuro, and GI problems, spares the lungs, and shows renal artery "beading?"
Polyarteritis Nodosa
87
What should you test all PAN patients for?
Hepatitis B & C
88
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?
Polymyalgia Rheumatica
89
What's the tx for polymyalgia rheumatica?
Steroids
90
What vasculitis presents with headaches, decreased arm pulses, bruits near the clavicle, and elevated ESR and CRP?
Giant Cell (Temporal) Arteritis
91
What's the other name for Wegener's Granulomatosis?
Granulomatosis with Polyangiitis
92
What dx presents with a combo of upper and lower respiratory tract findings (sinusitis, otitis media, unresolving pneumonia) in association with renal insufficiency?
Granulomatosis with Polyangiitis
93
Which ANCA is Wegener's?
WeCeners
94
Which ANCA is Churg-Strauss and microscopic polyangiitis?
P-ANCA
95
Which biopsy is better for Wegener's?
Lung
96
What 2 meds treat Wegener's?
Prednisone and cyclophosphamide
97
What dx is associated with asthma, eosinophilia, renal, and pulmonary issues?
Eosinophilic Granulomatosis with Polyangiitis (Churg-Strauss)
98
What's the most accurate test for Churg-Strauss?
Biopsy
99
What dx presents usually in kids, and presents with GI, purpura, arthralgia, and hematuria?
HSP
100
What's the most accurate test for HSP?
Biopsy
101
What is associated with chronic hep C and rhymes with "Myoglobulinemia?"
Cryoglobulinemia
102
How does cryoglobulinemia present?
With non-blanchable purpuric-type lesions
103
What is "pathergy" in Behcet Syndrome?
Sterile skin pustules from minor trauma like a needle stick
104
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?
Behcet Syndrome
105
What are the 3 seronegative spondyloarthropathies?
1. Ank spond
2. Psoriatic arthritis
3. Reactive arthritis
106
What presents with uveitis, joint pain, and are often in men under age 40?
Seronegative spondyloarthropathies
107
How does ankylosing spondylitis present?
Like Bret's sx!
108
What's the best initial test for ank spond?
X-ray of the SI joint
109
Which HLA is associated with ank spond?
HLA-B27
110
What's the initial tx for psoriatic arthritis?
NSAIDs
111
What type of arthritis occurs from inflammatory bowel disease, GI infex, or STI, and presents with joint pain, uveitis or conjunctivis, and genital abnormalities?
Reactive Arthritis
112
Is there a specific test for reactive arthritis?
No
113
What's the best tx for reactive arthritis?
NSAIDs
114
When do you treat osteoporosis with dronates?
When the T-score <2.5 SD's below normal
115
What's the mechanism of Denosumab?
RANKL inhibitor
116
What's the mechanism of Raloxifene?
Estrogen substitute
117
What's the mechanism of Teriparatide?
PTH analogue
118
What rare side effect is associated with bisphosphonates?
Osteonecrosis of the jaw
119
What's the best empiric therapy for septic arthritis?
Ceftriaxone and vancomycin
120
What's the most common organism for prosthetic joint infex?
Staph epidermidis
121
What's the best tx for gonococcal arthritis?
Ceftriaxone
122
What's the most common organism for osteomyelitis?
Staph aureus
123
What's the most common organism for osteomyelitis in patients with sickle cell?
Salmonella
124
What dx might present with a purulent sinus tract in a diabetic patient with bone pain?
Osteomyelitis
125
What's the best initial test for osteomyelitis?
X-ray
126
What's the best tx for sensitive staph osteomyelitis?
Ceftriaxone
127
What's the best tx for resistant staph osteomyelitis?
Vancomycin
128
What should be used for sensitive gram negative bacillus ostoemyelitis?
Cipro
