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Role 3 > Rheumatology > Flashcards

Rheumatology Flashcards

1
Q

Differences between Osteoarthritis and RA (Talk about OA), Onset, fast/slow progression, how are joints, morning stiffness? how movement effects joints, is it symmetrical? asymmetrical?

A

Occurs later in life, slow progression, joints achy with no swelling, begins on one side, morning stiffness which goes away with 1 hour, whole body symptoms not present

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2
Q

Differences between Osteoarthritis and RA (Talk about RA), Onset, fast/slow progression, how are joints, morning stiffness? how movement effects joints, is it symmetrical? asymmetrical?

A

occurs at anytime in life, rapid progression (weeks to months), joints are painful, red, swollen and stiff, affects small and large joints symmetrically, stiffness lasts longer than an hour, frequent fatigue, feeling ill

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3
Q

what does it mean when OA is detectable by radiograpgh?

A

joint fails, need replacement

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4
Q

what kind of test is needed in the pre-radiographic phase of OA to detect diease?

A

MRI

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5
Q

Herbeden’s nodes are seen with which disease and where are they located?

A

OA, distal (closer to fingertips)

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6
Q

Bouchard’s nodes are seen with which disease and where are they located?

A

OA, proximal (closer to wrist)

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7
Q

when is OA usually seen in women

A

after menopause

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8
Q

Hand OA diagnostic criteria (3 of the following)

A

-hard tissue enlargement of at least 2 of the following joints:
2nd and 3rd DIP
2nd and 3 PIP and/or
first MCP
-hard tissue enlargement of 2 or more DIP joints
-Fewer than 3 swollen MCP joints
-Deformity of at least 1 of the joints listed

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9
Q

Hip OA diagnostic criteria: Hip pain and 2 of the following

A

ESR<20, Osteophytes on xray, joint space narrowing on xray

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10
Q

Knee OA diagnostic criteria: Knee pain, osteophytes and 1 of the following

A

age older than 50, stiffness lasting less than 30 minutes and/or crepitus

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11
Q

are synovial fluid analysis and lab tests diagnostic for OA?

A

no

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12
Q

what does c-reactive protein show?

A

pain and stiffness

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13
Q

when do you do radiographic studies with OA?

A

when there is a change symptoms

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14
Q

when do you do ultrasound or MRI with OA?

A

we don’t usually, maybe to r/o meniscal tears or tumors

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15
Q

Drugs recommended for OA of hand, knee and hip

A

NSAIDs

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16
Q

Intraarticular glucocorticoid injection are good for which problems

A

OA of hand, knee and hip

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17
Q

when is Arthroplasty used to treat OA

A

when all other conservative treatments have failed with severe OA

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18
Q

which disease is characterized by uncontrolled proliferation of synovial tissue

A

RA

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19
Q

HLA (human leukocyte antigen) class II genotypes

A

RA genes, can make RA worse

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20
Q

can smoking make RA worse?

A

yes

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21
Q

what do CCPs (Citrulline-containing) peptides do in RA

A

they initiate RA cascade, this test is specific to RA

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22
Q

What does the RA cascade release that invades the joints

A

cytokines( interleukins)

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23
Q

Are Rheumatoid Factor-(IgG class)polyclonal antibodies specific to RA?

A

No can be present in SLE, scleroderma

24
Q

Tumor necrosis factor-alpha( TNF-a) is one of the main cytokines that trigger what?

A

proliferative rheumatoid synovium

25
Q

7 criteria for RA diagnoses

A
  1. ) Morning stiffness for at least 1 hour
  2. ) Soft tissue swelling of 3 more joints
  3. ) Hand joint involvement
  4. ) Symmetric arthritis
  5. ) Rheumatoid nodules
  6. ) Serum Rheumatoid factor positive
  7. ) Xray changes show loss of erosions or loss of density
26
Q

Boutonniere deformity

A

flexion of the PIP joints and hyperextension of the DIP joints due to rupture of extensor tendons over the fingers

27
Q

In RA, Proliferation of the synovium on the palmar aspect of the wrist may cause compression on which nerve? and what can this cause?

A

median nerve and carpal tunnel could develop

28
Q

In RA,Laxity in the cervical regions may allow compression of the vertebral artery which affects motion and could cause what?

A

HA

29
Q

Are shoulder involvement in RA an early or later stage?

A

later

30
Q

Baker cyst are found where and with what problem?

A

found behind the knee, RA

31
Q

What feet deformities are found with RA?

A

Hallux valgus, Hammer toe, Rheumatoid nodule

32
Q

why is a urinalysis important when testing for connective tissue diseases?

A

microscopic hematuria or proteinuria may be present

33
Q

Will RA increase or decrease alkaline phosphatase?

A

increase it

34
Q

RA radiology findings

A

erosions on the margins of bone, joint space narrowing, osteopenia, and eventual misalignment and subluxation of the bones

35
Q

How fast should patients be referred if RA is suspected?

A

3 months

36
Q

methotrexate, leflunomide, hydroxychloroquine, and sulfasalazine are what kind of drugs?

A

DMARDs

37
Q

RA < 6 months is considered what stage?

A

early

38
Q

RA 6-24 months is considered what stage?

A

intermediate

39
Q

RA >24 months is considered what stage?

A

late

40
Q

When a patient is on DMARDs what do you need to monitor? and which disease can’t you give these too?

A

LFTs and CBC, can’t give to liver disease patients

41
Q

steroid treatment for lupus can put patient at risk for what?

A

osteoporosis and cataracts

42
Q

ACR and CRP are used to monitor what in RA?

A

to see how well meds are working

43
Q 
CBC, CMP, ANA, U/A
Anti-dsDNA, Antiphospholipid antibodies
Anti-SM antibodies
Plain films if needed
Guided by clinical presentation

is used for diagnostic testing for?

A

Lupus

44
Q

Polyarthritis

A

multiple joint arthritis

45
Q

Vasculitis

A

inflammation of the blood vessels

46
Q

mild lupus treatment

A

NSAIDS

47
Q

treatment for Cutaneous (affecting the skin) manifestations-

A

Plaquenil (HCQ)

48
Q

lupus treatment for multiple organ involvement

A

Glucocorticoid steroids

49
Q

what are Cellcept, Imuran, Cytoxan used for?

A

lupus, immunosuppressants

50
Q

what is Benlysta used for?

A

lupus, immunosuppressant

51
Q

what does lupus put you at greater risk for

A

lymphoma, breast cancer, abnormal pap and skin cancer

52
Q

who is more at risk for a lupus flare

A

age <25, nonwhite, poor people and family/life stressors, patients with more disease complications

53
Q

an isolated lupus flare can be treated with what?

A

increased steroids

54
Q

Lab work up for RA

A 
Rheumatoid factor
Sedimentation rate (ESR) 
C-reactive protein (CRP) 
CBC (to see if anemic)
Urinalysis 
CMP
55
Q

Why is a urinalysis important to do?

A

Microscopic hematuria or proteinuria may be present in many connective tissue diseases

56
Q

What will X-rays show with RA?

A

erosions on the margins of bone, joint space narrowing, osteopenia, and eventual misalignment and subluxation of the bones

Role 3 (10 decks)

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