Rheumatology Flashcards
Pattern of AM stiffness in OA?
Lasts < 30 minutes
2 XR findings for OA?
Osteophytes, Joint narrowing
Pattern of arthritis in Hereditary Hemochromatosis?
2nd + 3rd MCP joint
XR appearance of arthritis in Hereditary Hemochromatosis?
Hook-shaped osteophytes
Best initial treatment for OA?
Scheduled acetaminophen
Only role for corticosteroids in setting of OA?
Intra-articular injection … (never systemic)
Pattern of AM stiffness in RA?
Lasts > 45 minutes
Patient with HX of RA presents with swelling in popliteal fossa – diagnosis?
Baker cyst
Diagnostic test for Baker cyst?
Need to distinguish from popliteal artery aneurysm … US
Extra-articular manifestations of RA are more common in patients with high titers of …
RF
What treatment typically worsens RA nodules?
Methotrexate
2 characteristics of RA pleural effusion?
High LDH, Low glucose (< 30)
Are RA pleural effusions exudative or transudative?
Exudative
Ocular manifestation of RA?
Episcleritis
Triad of clinical symptoms seen in Felty Syndrome?
RA, Splenomegaly, Neutropenia
3 aspects of treatment for Felty Syndrome?
Methotrexate, Corticosteroids, Splenectomy
56 yo female with HX of RA develops R knee pain; PE shows fever, R knee redness/swelling – diagnosis?
Septic arthritis
First step in management of Septic arthritis?
Joint aspiration
What is the only medication that slows the progression of joint destruction in RA?
DMARDs … Methotrexate
AE of sulfasalazine?
Reversible oligospermia
Major AE of hydroxyurea?
Retinopathy
Monthly monitoring required for patients on hydroxyurea?
Ophthalmology visits
AE of D-penicillinamine?
Bronchiolitis obliterans PNA
3 conditions that contraindicate methotrexate use?
Renal disease, ETOH abuse, Liver failure
Medication that is contraindicated with methotrexate use?
TMP-SMX
Which cytokine is a significant mediator of inflammation in RA?
TNFa
6 aspects of clinical presentation for Adult Still’s Disease?
Fever, Arthritis, Rash during febrile episodes, Sore throat, LAD, Splenomegaly
Characteristic lab finding in setting of Adult Still’s Disease?
Increased ferritin
Most common cause of death in Ehlers-Danlos Syndrome?
Aortic aneurysm rupture
Malignancy associated with Sjogren Syndrome?
Lymphoma
Diagnostic test for Sjogren Syndrome?
Lip biopsy of minor salivary glands
Appearance of biopsy in Sjogren Syndrome?
T lymphocyte infiltration
DOC for Raynaud’s phenomenon in Systemic sclerosis?
CCBs
Most common cause of death in Systemic sclerosis?
Pulmonary HTN
What accounts for development of pulmonary HTN in Systemic sclerosis?
Intimal proliferation
Patient with PMHX of scleroderma is diagnosed with acute renal failure, severe HTN, edema – diagnosis?
Scleroderma renal crisis
Best treatment for Scleroderma renal crisis?
ACEIs
Change to GI that is pathognomonic for scleroderma?
Wide-mouth diverticula
Best treatment for SIBO?
10 days of ciprofloxacin
What is most specific skin finding for dermatomyositis?
Grotton papules
Characteristic of Grotton papules?
Spares the interdigital spaces
Lab value that is always seen in Polymyalgia Rheumatica?
ESR > 50
Best test for establishing diagnosis of ankylosing spondylitis?
Pelvic XR
2 aspects of clinical presentation for ankylosing spondylitis?
Iritis, Sacroilitis
Heart murmur associated with ankylosing spondylitis?
AR
Best treatment for ankylosing spondylitis?
Anti-TNFa
Patient develops painful keratotic papules + plaques of soles, penis; Reports recent HX of urethritis, arthritis – diagnosis?
Reiter’s Syndrome
Most common pathogen responsible for Reiter’s Syndrome?
Chlamydia
3 DOC for psoriatic arthritis?
Anti-TNFa, Methotrexate, NSAIDs
MSK disorder associated with Crohn’s Disease?
SI joint arthritis
Location of pathogen in joint in reactive arthritis?
Aseptic effusion … No growth of pathogen in joint
Location of pathogen in joint in Whipple’s Disease?
Synovial tissues
What is required for definitive diagnosis of gout?
Aspiration of fluid
DOC for overproduction of uric acid causing gout?
Allopurinol
DOC for underexcretion of uric acid causing gout?
Probenecid
2 conditions associated with Pseudogout?
Hyperparathyroidism, Hemochromatosis
Which joint is most affected by Pseudogout?
Knee
XR appearance seen in setting of Pseudogout?
Chondrocalcinosis
Description of chondrocalcinosis seen in Pseudogout XR?
Linear calcification of joint cartilage
Best treatment for Pseudogout?
NSAIDs, Intra-articular corticosteroids
Most SN lab for SLE?
ANA
Most SP lab for SLE?
Anti-dsDNA
Antibody associated with Mixed Connective Tissue Disease?
Anti-U1-RNP
Which lab finding is most characteristic of Anti-Phospholipid Syndrome?
Prolonged PTT
Which antibody is needed on ELISA for diagnosis of Anti-Phospholipid Syndrome?
Anti-Cardiolipin Antibody
Characteristic of rash in vasculitis?
Palpable
2 examples of large-vessel vasculitis?
Takayasu arteritis, Giant cell arteritis
Change to vision in Giant cell arteritis?
Amaurosis fugax … transient loss of vision
Clinical presentation of Takayasu arteritis?
Raynaud’s phenomenon
Which vessels are most affected in Takayasu arteritis?
Aortic arch vessels
2 DOC for treatment of Takayasu arteritis?
Glucocorticoids, CCBs
1 example of medium-vessel vasculitis?
Polyarteritis nodosum
Pathogen associated with Polyarteritis nodosum?
Hepatitis B
Which organ system is always spared in Polyarteritis nodosum?
Lungs
Most common site of aneurysm in Polyarteritis nodosum?
SMA
Is P-ANCA or C-ANCA (+) in Polyarteritis nodosum?
Both are (-)
3 examples of small-vessel vasculitis?
Microscopic polyarteritis, Wegner’s granulomatosis, Churg-Strauss disease
Is P-ANCA or C-ANCA (+) in Microscopic polyarteritis?
P-ANCA
Renal manifestation of Microscopic polyarteritis?
Rapidly Progressive GN
Is P-ANCA or C-ANCA (+) in Churg-Strauss disease?
P-ANCA
Hallmark lab test seen in Churg-Strauss disease?
Eosinophilia
Clinical presentation of Churg-Strauss disease?
Adult-onset asthma
Is P-ANCA or C-ANCA (+) in Wegner’s granulomatosis?
C-ANCA
Alternate name for Wegner’s granulomatosis?
Granulomatosis with polyangiitis
Which 3 organ systems are most affected by Wegner’s granulomatosis?
Sinuses, Lungs, Kidneys
2 DOC for treatment of Wegner’s granulomatosis?
Corticosteroids, Cyclophosphamide
Pathogen associated with cryoglobulinemia?
Hepatitis C
Which PE finding will differentiate Rotator Cuff Tendinitis from Rotator Cuff Tear?
Tear = (+) drop arm test
Which 2 motions are limited by Biceps tendinitis?
Elbow flexion, Supination
3 aspects of treatment for De Quervain’s Tenosynovitis?
Spica splint, Steroid injection, NSAIDs
Which 2 tendons are affected by De Quervain’s Tenosynovitis?
EBP + APL
Best diagnostic test for Carpal Tunnel Syndrome?
EMG
Best initial treatment for Carpal Tunnel Syndrome?
Immobilization
Patient presents with clenched fist; Recently punched someone in mouth – pathogen responsible for symptoms?
Staph, Eikenella
Patient presents with clenched fist; Recently punched someone in mouth – best treatment?
Ampicillin-Sulbactam
Best treatment for plantar fasciitis?
Stretching
Patient presents with pain to upper medial aspect of tibia that increases with climbing stairs – diagnosis?
Anserine bursitis
2 aspects of treatment for Anserine bursitis?
Steroid injection, Quadriceps training
Best test for diagnosis of avascular necrosis?
MRI
Best treatment for trochanteric bursitis?
Stretching, Steroid injection
Best treatment for lumbar strain?
Exercise therapy, NSAIDs
MRI appearance of spinal stenosis?

3 conditions associated with Cauda Equina Syndrome?
Paget Disease, Ankylosing spondylitis, Tumors