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Internal Medicine > Rheumatology > Flashcards

Rheumatology Flashcards

1
Q

Name the muscles involved in Shoulder rotation

A 
SITS
S= Supra spinatus
I= Infra spinatus 
T= Teres minor
S= Subscapularis
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2
Q

Name the MC rotator cuff injury

A

Supra spinatus (Tendinopathy / Tear)

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3
Q

Important information

A

Rotator cuff tendinopathy/tendinitis May present with pain but weakness won’t be present in tendinitis without tear

In both conditions there is no restriction of passive ROM

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4
Q

What is impingement syndrome in rotator cuff?

A

Flexion Or Abduction decreases space b/w humeral head and acromion
Pressure on supra spinatus tendon and subacromial bursa result compression of these soft tissues

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5
Q

Name the test to assess rotator cuff impingement

A

Neer test

Empty/full can test

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6
Q

Treatment of Rotator Cuff tear

A

Acute tear is surgery with best result obtained if performed within 6wks of injury

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7
Q

Name the muscle which abduct upper arm upto 15 degrees

A

Supra spinatus innervated by supra scapular nerve

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8
Q

Name the muscle which abduct upper arm upto 100 degrees (Starr after 15 degrees)

A

Deltoid

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9
Q

Name the muscle which abduct upper arm more than 90 degree

A

Trapeziums

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10
Q

Name the muscle which abduct upper arm more than 100 degree

A

Serratus anterior

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11
Q

Name the condition which restrict movement of shoulder both actively and passively

A

Adhesive capsulitis/ frozen shoulder MCC is rotator cuff tendinopathy

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12
Q

Difference b/w posterior and anterior shoulder dislocation

A

In POSTERIOR shoulder is held in adducted and internally rotated with visible flattening of anterior aspect of the shoulder and prominence of the coracoid process

In ANTERIOR shoulder is held slightly abducted and externally rotated

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13
Q

Radiographic findings of Posterior shoulder dislocation

A

Light Bulb sign

Rim sign

Trough line sign

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14
Q

Name the risk factor for Carpal tunnel syndrome

Remember DROP H

A

D diabetes
R RA
O obesity
P Pregnancy

H Hypothyroidism

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15
Q

How to confirm carpal tunnel syndrome ?

A

Nerve conduction studies

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16
Q

Name the carpal bone which cause acute carpal tunnel syndrome

A

Lunate

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17
Q

How De Quervain Tenosynovitis presents?

A

Pain occur by direct palpation of radial side of wrist at the base of the hand

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18
Q

What is Finkelstein test?

A

Used to De Quervain Tenosynovitis

  • Passive stretching of affected tendon by grasping flexed thumb in palm with fingers result pain
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19
Q

How Trigger thumb present?

A

Pain over palmar aspect of 1st MCP and locking of thumb in flexion

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20
Q

How flexor carpi radialis tenosynovitis presents?

A

Pain with radial flexion of wrist and point tenderness of trapezium

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21
Q

How to elicited medial and lateral epicondylitis?

A

If pain occur by resisted wrist flexion and passive wrist extension then MEDIAL epicondylitis

If pain occur by passive wrist flexion and resisted wrist extension and supination then LATERAL epicondylitis

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22
Q

Name the nerve which hurt in anterior dislocation of humerus

A

Axillary nerve

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23
Q

What is the cause of injury of musculocutaneous nerve (C5-C7)?

A

Upper trunk compression

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24
Q

How to d/f proximal and distal median nerve injury?

A

If palmar sensation lost then mean proximal injury

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25
Q

How to d/f proximal and distal ulnar nerve injury?

A

Radial deviation of wrist upon flexion in proximal injury

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26
Q

Name the conditions causes pain in foot

Remember STAMP

A 
S Stress fracture
T Tarsal tunnel syndrome 
A Achilles tendinopathy
M Morton Neuroma
P Plantar fasciitis
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27
Q

Triad of Plantar fasciitis

A
  • Burning pain on PLANTAR surface of foot with 1st step in the morning
  • Prolong runners
  • Point tenderness at plantar surface of heel on examination
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28
Q

Triad of Morton Neuroma

A
  • Pain b/w 3rd & 4th toes on PLANTAR surface
  • Clicking sensation and pain that occurs when palpating this space and squeezing metatarsal joints at same time
  • Mechanically induced neuropathic degeneration of interdigital nerves
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29
Q

Triad of Tarsal Tunnel syndrome

A
  • Occur due to fracture of ankle bones
  • Compression of tibial nerves
  • Burning, numbness and aching of the distal plantar surface of the foot/toes
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30
Q

Name the tendons which make PES anserinus

A

Gracilis
sartorius
AND semitendinosus

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31
Q

Triad of ANSERINE BURSITIS/PES ANSERINUS PAIN SYNDROME (PAPS)

A
  • localized Pain at medial knee just below the knee line
  • Exacerbated by pressure from opposite knee while lying on side
  • Negative valgus test
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32
Q

Name the bursitis which is due to infection

A 
Prepatellar bursitis (Housemaid knee)
Due to S aureus
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33
Q

DIFFERENTIAL DIAGNOSIS OF ANTERIOR KNEE PAIN IN YOUNG PATIENTS
Remember POP

A

P Patellofemoral Syndrome

O Osgood Schlatter disease

P Patellar tendonitis

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34
Q

Triad of Patellofemoral Pain Syndrome

A
  • Anterior Knee pain increase on prolonged sitting (Due to flexion)
  • pain elicited by extending the knee while compressing patella into trochlear groove and reproduction of pain with squatting are highly suggestive
  • exercises to stretch and strengthen thigh muscles/quadriceps, knee extensors and hip abductors (Treatment)
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35
Q

Name the cause of anterior knee pain which occurs due to repeated knee extension Or jumping and kicking

A

Patellar tendonitis

  • pt has point tenderness over inferior pole of patella and patellar tendon
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36
Q

Triad of OSGOOD SCHLATTER DISEASE

A
  • Seen in adolescent athletes
  • Pain reproducible by extending knee against resistance
  • . Edema and tenderness over tibial tubercle
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37
Q

How Patellar dislocation occurs?

A

Occur after quick lateral movements around flexed knee

O/E flexed knee with patella displaced laterally

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38
Q

What is Unhappy triad?

A

Damage of ACL, MCL and Medial meniscus

But lateral meniscus more involved

Occur in contact sports due to lateral force applied to a planted foot

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39
Q

Triad of Meniscal Tear

A
  • Joint Line tenderness
  • Acute Popping Sensation with catching, locking and Reduced ROM
  • MRI best test to dx
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40
Q

Causes of Avascular Necrosis

D-HAIRS

A

D Decompression sickness

H Hemoglobinopathies
A Alcohol/ APLA 
I infection like bone / HIV
R Renal Transplant 
S steroid / SLE
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41
Q

Triad of Avascular Necrosis of Hip

A
  • Pain on hip abduction and Internal rotation
  • No signs of Inflammation
  • Normal Lab tests
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42
Q

Imaging of choice to dx Hip Avascular Necrosis

A

MRI visualize boundary between normal and ischemic bone, as well as zone of hypervascula

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43
Q

Why children are less prone to develop hip Avascular necrosis?

A

Due to presence of foveal artery

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44
Q

Name the nerve compress in MERALGIA PARESTHETICA

A

Lateral femoral Cutaneous nerve at Waist

  • burning pain and paresthesia at lateral thigh
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45
Q

Causes of Lower Back Pain

Mnemonic IMM

A

I inflammatory / Infectious
M musculoskeletal
M malignancy

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46
Q

What are Red flags of Lower back pain?

A

Age more than 50 yrs
Constitutional symptoms

Trauma
Infectious risk

Nighttime risk
Hx of malignancy

IV drug abusers
LBP more than 1 month

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47
Q

LBP which improves with activity but worst at rest

A

Sero negative spondylitis

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48
Q

LBP which worse with extension but improves with flexion

A

Spinal stenosis

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49
Q

What is the characteristic thing of herniated disc?

A

Pain below knee

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50
Q

How to manage acute LBP? Less than 6 wks

A

Maintain moderate activity

NSAIDS Or Acetaminophen

Consider opioids, spinal manipulation or muscle relaxants

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51
Q

How to manage chronic LBP?

A

Exercise therapy (aerobic/ stretching and strengthening)

Intermittent use of NSAIDS or Acetaminophen

Consider TCA / SSRI

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52
Q

Basic d/f b/w neurogenic and vascular claudication

A

Neurogenic.C improves with activity but worse at rest

Lumber flexion improves pain but extension increases pain
………,…………….
Vascular.C worse with activity but improves at rest

Lumber flexion worse pain but extension decreases pain

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53
Q

Important information

A

loss of DTRs is common in elderly esp. above 70yrs and not related to Vertebral compression trauma.

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54
Q

Causes of Vertebrate compression fractures

TOP IBM

A

T trauma
O osteoporosis/osteomalacia
P Paget disease

I infection
B. Bone Mets
M metabolic like hyperparathyroidism

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55
Q

Name the nerve damage in posterior hip dislocation

A

Inferior gluteal nerve

Pt complains of difficulty climbing stairs or rising from seated position

Also loss of hip extension

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56
Q

Impairment of which nerve causes fecal and urine incontinence

A

Pudendal nerve

Also decreases sensation of genital area and perineum

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57
Q

Name the nerve which gives sensory sensation to supra Pubic region and motor innervation to transverse abdominis and internal oblique

A

Iliohypogastric

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58
Q

Name the nerve responsible for cremasteric reflex

A

Gentiofemoral nerve

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59
Q

Which lower extremity nerve get damaged if wear tight clothing?

A

Lateral femoral cutaneous nerve

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60
Q

Name the nerve responsible for hip adduction

A

Obturator nerve

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61
Q

How sciatic nerve gets damaged?

A

Via Herniation Of disc Or Posterior Hip dislocation

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62
Q

Why Disc herniation always occur posteriorly?

A

Due to thin posterior longitudinal ligament

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63
Q

What Neurovascular structure hurts if axilla/lateral thorax involve?

A

Long thoracic nerve

And lateral thoracic artery

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64
Q

What Neurovascular structure hurts if surgical neck of humerus involve?

A

Axillary nerve

And posterior circumflex artery

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65
Q

What Neurovascular structure hurts if Midshaft of Humerus involve?

A

Radial nerve

And Deep brachial artery

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66
Q

What Neurovascular structure hurts if Distal humerus/cubital fossa involve?

A

Median nerve

And brachial artery

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67
Q

What Neurovascular structure hurts if popliteal fossa involve?

A

Tibial nerve

And Popliteal artery

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68
Q

What Neurovascular structure hurts if posterior to medial malleolus involve?

A

Tibial nerve

And Posterior tibial artery

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69
Q

What are the consequences of Anti SSA positive Ab in pregnant women?

A

Neonatal lupus could occur
Manifestations are ;

Congenital heart block
Periorbital/diffuse Rash
Transaminitis

And Cytopenias at birth

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70
Q

Name the antibodies formed in APS

A

Anti cardiolipin Ab

Anti beta 2 glycoprotein Ab

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71
Q

Specific test to dx APS

A

Diluted Russell viper venom test

Kaolin clotting time

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72
Q

Triad of Primary Raynaud phenomenon

A

No underlying cause

Usually occur in women under 30 yrs

With no tissue injury with Negative ANA and ESR

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73
Q

Triad of Secondary Raynaud Phenomenon

A

Presence of Underlying cause

Usually occur in men over 40 yrs

Tissue injury Or digital Ulcer

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74
Q

Triad of Systematic sclerosis

A

Autoimmune

Non inflammatory vasculopathy

Collagen deposition with fibrosis

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75
Q

Name the antibody associated with diffuse scleroderma

A

Anti SCL 70 Ab (Anti DNA Topi 1 Ab)

Anti RNA Polymerase 3

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76
Q

Name the antibody associated with limited scleroderma

A

Anti centromere Ab

77
Q

Important information of Sjogren Syndrome

A

Female of 40-60 yrs

78
Q

Name the antibody associated with Sjogren Syndrome

A

Anti Ro and Anti La Ab

79
Q

What will be seen in biopsy of Sjogren Syndrome?

A

Focal lymphocytic sialadenitis on labial salivary gland

80
Q

Sx S of myasthenia gravis

A

Remember D

Diplopia with ptosis
Dysphagia
Dyspnea

81
Q

Triad of Lambert Eaton Syndrome

A

Proximal muscle weakness

ANS Dysfunction

Absence of Deep tendon reflexes

82
Q

Triad of POLYMYALGIA RHEUMATICA

A

Proximal muscle pain and stiffness in females over 50 yrs

Increase ESR & CRP but normal CK

Associated with GCA

83
Q

Triad of Steroid Induced myopathy

A

Proximal muscle weakness & atrophy w/o pain and tenderness

Normal ESR & CK

Muscle power ↑ after discontinuation but recovery takes weeks to months

84
Q

Triad of Inflammatory myopathy

A

Proximal muscle weakness,pain and tenderness

Skin rash and Inflammatory arthritis

Increase in both CK and ESR

85
Q

Name the antibodies present in Inflammatory myopathy

A

Anti Jo Ab (histidyl trna synthetase)

Anti SRP Ab

Anti Mi 2 (Helicase) Ab

86
Q

Triad of Statin induced myopathy

A

Prominent muscle pain/tenderness with Or without weakness

Normal ESR and increase CK

Rare Rhabdomyolysis

87
Q

Important information

A

Both statin induced and Hypothyroid induced myopathy have normal ESR but increase in CK

88
Q

Condition associated with Charcot Joint

A

Vitamin B12 Deficiency
DM

Peripheral nerve damage
Spinal cord Injury

Syingomyrelia
Tabes dorsalis

89
Q

Triad of Charcot Joint

A

Arthritis with deformed joint

Lacking sensation with loss of neurologic input

Degenerative joint disease and loose bodies on joint imaging

90
Q

Name the factors which decrease the risk of gout

A

Dairy product intake

Vitamin C (≥1500mg/day)

Coffee intake more than 6 cups per day

91
Q

What will be seen in x-ray of chronic gout ?

A

Punched out erosions with an over-hanging rim of cortical bone known as a “rat bite lesion”

92
Q

Triad of Whipple disease

Cause by Trophyrema whippelii

A

Migratory Arthritis non deforming

Malabsorptive Diarrhea

Lymphadenopathy

93
Q

How Paget disease present?

A

Seen in old age with complains of headache, deafness and bone pain

Sometimes neurological Sx if involved spinal cord

94
Q

How Paget diseases increase the chances of heart failure?

A

Due to formation of AV shunt

95
Q

Laboratory values in Paget disease

A

Increase ALP and Increase born turnover markers like PINP and urine hydroxyproline

Whereas Sr calcium and Sr Phosphate are in normal range

96
Q

MCC of isolated, asymptomatic elevation of alkaline phosphatase in an elderly patient?

A

Most common cause of isolated, asymptomatic elevation of alkaline phosphatase in an elderly patient is Paget Disease Of Bone(osteitis deformans)

97
Q

What’s the pattern of bone in Paget disease?

A

Mosaic pattern of woven and lamellar bone

osteocytes within lacunae in chaotic juxtaposition

98
Q

Triad of Systematic juvenile idiopathic arthritis

A

Arthritis

Salmon shaped pink colour macular rash

Daily spiking fever

99
Q

CBC picture in Systematic juvenile idiopathic arthritis

A

Increase in WBC and platelets count

And anemia

100
Q

Triad of Gonococcal arthritis

A

Pain in multiple Migratory joints without purulent

Dermatitis

Tenosynovitis
…………………….

But stimes purulent arthritis occur

101
Q

Triad of Osteoid osteoma

A

Bone pain worse esp at night

Decreases with NSAIDs and no association with physical activity

X rays shows typical small, round, lucency with sclerotic margins and sometimes central ossification.

102
Q

Bone tumor associated with Gardner syndrome

A

Osteoma

103
Q

How to d/f osteoblastoma from Osteoid osteoma?

A

In osteoblastoma, the size is more than 2cm and pain doesn’t decrease with NSAIDs.

104
Q

Imaging findings of Giant cell tumor

A

X rays shows Soap bubble appearance/ Expansile and eccentric lytic areas

MRI shows both hemorrhagic and cystic regions

105
Q

Predisposing risk factors for osteosarcoma

A

Paget disease of bone
Bone infarct

Radiation
Familial retinoblastoma

Li fraumeni syndrome

106
Q

Triad of Ewing sarcoma

A

Bony pain in children with constitutional symptoms

Imaging shows lamellated appearance or “onion skin” periosteal reaction—usually lytic, central and accompanied by endosteal scalloping followed with moth-eaten or mottled appearance and extension into soft tissue

±lymphadenopathy

107
Q

Name the bony conditions which have normal lab values Viz Serum(Calcium, ALP, Phosphate and PTH)
Remember triple O

A

O osteoporosis
O osteopetrosis
O osteitis deformans

108
Q

Important information

A

1-2.5 SD below mean (ie T-score -1 to -2.5) Osteopenia

109
Q

Define Mixed CT disease?

A

Autoimmune disease with a features of SLE, systematic sclerosis and polymyositis

110
Q

Name the antibody detected in Mixed CT disease

A

Anti U1-Ribonucleoprotein

111
Q

D/F b/w X ray findings of RA and OA

A

RA—-> Periarticular erosion

OA—> Narrow joint space with Osteophytes

112
Q

How to t/m Ankylosing spondylitis?

A

1) Non Pharma
2) if Pharma give NASIDs Or Celecoxib
3) if fail or disease prgress give TNF alpha inhibitor / Anti IL17 Ab viz secukinumab

113
Q

What is the pathognomonic feature of DUPUYTREN contracture?

A

Thickening of palm fascia and Decrease extension of digit

Discrete Nodules along flexor tendon near the distal plamar crease

114
Q

Name the condition showed this–>Discrete Nodules along flexor tendon near the distal plamar crease

A

DUPUYTREN contracture which dx clinically

115
Q

Name the Reflex and movement impaired if L2-L4 affected

A

Patellar reflex

Hip adduction and flexion
Knee extension

116
Q

Name the movement and sensation impaired if L5 affected

Foot DIE

A

Foot dorsiflexion, Inversion and Eversion
Toe extension

Loss of sensation of lateral shin and dorsum of foot

117
Q

Name the Reflex and movement impaired if S1 affected

A

Think of ankle and plantar

Loss of ankle reflex

Hip extension
Foot plantar flexion

118
Q

What weakness occur due to S2-S4 lesion?

A

Incontinence of fecal and urine
Sexual dysfunction

Loss of perineum sensation

119
Q

How to d/f Sjogren syndrome and

Age related sicca syndrome ?

A

Both have somehow same sxs but sjogren occur in middle age and SICCA occurs in very old age

SICCA due to decrease exocrine output from salivary and lacrimal gland

120
Q

How to dx and manage planter fasciitis?

A

Dx clinically unless secondary pathology
Activity modification and soft heel insert
Stretching exercises

Heat pads / orthotics
Surgery in refractory cases.

121
Q

What are the risk Factors of Achilles tendinopathy?

A

Meds like Steroid or Quinolones
Athletic activity

Sys disorder like psoriasis or ankylosing spondylitis

122
Q

What are the examination findings of Achilles tendinopathy?

A

Swelling and tenderness 2-6cm proximal to tendon rupture

And

Positive Thompson test means no planter flexion

123
Q

How to manage Achilles tendinopathy?

A

In Acute give NASIDS or activity modification ± icing

In chronic Eccentric resistance exercise

124
Q

How to manage Pes Anesrine

A

Bursitis
NASIDS

Quadriceps and Hamstring muscles exercise

125
Q

What are the risk Factors of Osteoarthritis?

A 
Non modifiable::
Being female with advance age 
Fx hx 
Prior joint trauma 
Abnormal joint alignment

Modifiable
Obesity with DM
Occupational joint loading
Sedentary lifestyle

126
Q

How to Approach Scoliosis?

A

1)) If it is idiopathic—-> X ray to determine the degree of curvature and assess skeletal maturity Or if show neurological sxs DO MRI

127
Q

How to manage Scoliosis?

A

If it is mild (10-30 degree) monitor and reassess after every 6 months

If above 30 degree—> apply thoracolumbarsacral spine brace

If ≥40 degree —->Spinal fixation

128
Q

What are the complications of shoulder dislocation?

A

Recurrence of condition
Fracture
Rotator cuff injury

129
Q

When to take X ray in ankle injury?

Ottawa ankle rules 1

A

If pain in either malleolus zone esp posterior or tip of it

If unable to walk or bear weight

130
Q

When to take X ray in foot injury?

Ottawa ankle rules part 2

A

Pain at the mid zone of foot with::

1) tender at the navicular zone or
2) tender at the base of the 5th meta tarsal or

3) unable to unable to walk or bear weight

131
Q

Important point of Burst vertebral fracture

A

Typically occur at L1 with positive finding on imaging

132
Q

How facet dislocation present?

A

Typically occur in cervical region due to forward flexion

Affects C5/C6 and C6/C7 region

It shows U/L sxs of radiculopathy

133
Q

How to prevent future attacks of Gout?

A

Drop Weight with BMI less than 25
Consume low fat, Red meat and sea food

Avoid alcohol, diuretics and organic rich food
Get protein from vegetables or low fat dairy food

134
Q

Important point of Gout

A

Smoking and coffee both lower the risk of Gout

135
Q

Name the cause of foot pain occur if foot is dorsiflex-eversion and planterflex-inversion
Or
Percussing at the posterior medial malleolus area

A

Tarsal tunnel syndrome t/m via steroids

136
Q

How to d/f Ewing sarcoma and fibrosarcoma on the basis of age and image ?

A

Both show lytic bone lesion and moth eaten margin

But in Ewing sarcoma—>lytic lesion surrounded by concentric layers ±Codman triangle

Fibrosarcoma occur after 30 yrs and Ewing occur in adolescence

137
Q

Triad of TAKAYASU Arteritis

A

Mid age Female with BP discrepancies due to aterio occulsive in upper extremity

Pain in muscle and joint

Pulse deficit with arterial bruit on examination

138
Q

What are the lab and image findings of Takayasu Arteritis?

A

Elevate inflammatory markers

CT / MRI shows narrow lumen with wall thickening

CXR shows aortic dilation with wide mediastinum

139
Q

How to treat GONOCOCCAL ARTHRITIS?

A

1g IV ceftriaxone for 7-14 days followed by PO cefixime when stable

Azomax or doxycycline for Concomitant chlamydia infection

Treat sexual partner too!
How

140
Q

How toe deformity occurs?

A

Due to imbalance in strength and flexibility b/w the flexor and extensor muscle group

Seen in DM patient

141
Q

Name the type of toe deformity which shows this dorsiflexion at MTP joint and planter flexion at PIP and DIP joint

A

Claw toe

142
Q

Name the type of toe deformity which shows this dorsiflexion at MTP DIP joint and Planter flexion at PIP joint

A

Hammer toe

143
Q

How osteoarthritis present at foot?

A

It involves mid foot and the first MTP joint

No involvement of lesser toes

144
Q

Name the condition which shows Pain occur by direct palpation of radial side of wrist at the base of the hand

A

De Quervain Tenosynovitis

145
Q

Passive stretching of affected tendon by grasping flexed thumb in palm with fingers result pain
Name the condition and test

A

Finkelstein test and De Quervain Tenosynovitis

146
Q

Name the condition which shows Pain over palmar aspect of 1st MCP and locking of thumb in flexion

A

Trigger thumb

147
Q

Which condition show this; Pain with radial flexion of wrist and point tenderness of trapezium

A

flexor carpi radialis tenosynovitis

148
Q

Name the condition which pain on flexing pt’s long finger while pt actively extends fingers and wrist (elbow pain)

A

RADIALTUNEL SYNDROME

149
Q

How to approach Shoulder pain?

A

If Movement restrict Both on active and passive—-> ADHESIVE CAPSULITIS and Glenohumeral arthritis

If movement restrict only active—->rotator cuff

150
Q

How to d/f ADHESIVE CAPSULITIS and Glenohumeral arthritis as both condition show disruption active and passive

A

All shoulder movements disrupt—-> ADHESIVE CAPSULITIS

Only abduction and ext-rotation only—> Glenohumeral arthritis

151
Q

Triad of Panner diseases

A

Osteochondrosis of capitellum

Occurs in sports sports that involve throwing

crepitation with loss of supination and pronation in elbow

152
Q

What are the risk factors of Septic arthritis?

A

Age above 80

Pre existing joint like OA, RA, Gout and Prosthetic joint

DM, IV drug abuser Or alcohol
Steroid injection in joint

153
Q

Name the Abx for septic arthritis

A

Vanco—> Gram positive cocci

3rd generation cephalosporins—>Gram -ve rod

Vanco + cephalosporins -> if negative microscopy and in immunocompromised

154
Q

How to approach acute lower back pain if patient shows cord compression SxS?

A

Stat MRI

155
Q

How to approach acute lower back pain if patient shows sciatica Or red flag?

A

X Ray And ESR—> normal—>conservative t/m—->no improvement-» MRI

If not normal—>MRI

156
Q

Name the complications of ANKYLOSING SPONDYLITIS

A

Osteoporosis
Vertebral fractures

Cauda equina
Aortic regurgitation

Uveitis

157
Q

Important point

A

Episcleritis—most strongly associated with RA and IBD

158
Q

How to manage RHEUMATOID ARTHRITIS ?

A

Start with methotrexate

If SxS persists after 6 months—->add non biological or Biological therapy

Still persist—> switch to alternate biological therapy

159
Q

Triad of Felty syndrome

A

RA

Neutropenia (less than 1500 ANC)

With or without splenomegaly

160
Q

How to manage OA?

NI—-> No improvement

A

Non pharma—> NI —>NASID—>NI

Topical NASIDS/Capsaicin or IA steroid/hyaluronic acid —->NI—>surgery Or palliative management

161
Q

How thrombocytopenia and leukopenia Occur in SLE?

A

thrombocytopenia due to Immune mediated destruction

leukopenia due to autoimmune mediated destruction

162
Q

What are the mechanisms of anemia in SLE?

A

Anemia of chronic diseases
Iron deficiency anemia due to GIT loss

Autoimmune hemolytic anemia
SLE nephritis

163
Q

Important point of pancytopenia due to SLE

A

Due to immune mediated destruction (Not due to bone marrow suppression)

164
Q

What is the MOA and S.E of TNF inhibitors?

A

MOA is anti cytokines agent

S.E are Infection and Malignancy
CHF and demyelination

165
Q

What is the MOA and S.E of hydroxchloroquine and sulfasalazine?

A

Both inhibit TNF and IL-1

hydroxchloroquine cause retinopathy

sulfasalazine causes hepatotoxcity, stomatitis and hemolytic anemia

166
Q

What are the s.e of MTX and leflunomide?

A

Both cause hepatotoxicity and cytopenias

MTX also causes stomatitis
How

167
Q

How to manage FIBROMYALGIA?

A

Conservative managed like exercise —->NI—>TCA—-> NI—->SSRI/SNRI

Still NI—-> combination drug therapy, referral for supervised rehabilitation, pain management consultation or cognitive behavioral therapy.

168
Q

Name the condition associated with POLYMYOSITIS /DERMATOMYOSITIS

A

Malignancy
Myocarditis

Interstitial Lung disease
Dysphagia

169
Q

What is the bx finding of POLYMYOSITIS?

A

Patchy necrosis

Endomysial mono nuclear infiltrate

170
Q

How to manage SECONDARY AMYLOIDOSIS ?

A

T/m underlying causes

Colchicine for prevention and treatment

171
Q

Important point of HEREDITARY HEMOCHROMATOSIS and AUTOIMMUNE HEPATITIS

A

AUTOIMMUNE HEPATITIS
Associated with type 1 DM and (not type 2)

HEMOCHROMATOSIS
Associated with type 2 DM and (not type 1)

172
Q

Triad of OSTEITIS FIBROSA CYSTICA (Von Recklinghausen disease of bone)

A

Bone pain due to excessive osteoclastic resorption of bone

fibrous tissue (brown tumors)

Seen in primary and secondary/tertiary (advanced renal disease) hyperparathyroidism.

173
Q

Define Brodie abscess

A

central lytic bone defect with surrounding sclerosis termed as Brodie’s abscess

174
Q

How to treat GIANT CELL ARTERITIS ?

A

GCA with vision loss—-> High dose steroid that’s pulse therapy for 3 days

GCA only —-> I/m to high oral steroid 40-60mg

PMR only —-> low dose oral steroid 10-20mg

175
Q

Triad of FIBROSARCOMA

A

Malignant spindle cell neoplasm

Seen in 30-60yrs

Image shows osteolytic lesion whose margins are well-defined or ragged and moth-eaten

176
Q

Triad of CHONDROSARCOMA

A

Occurs in fifth or sixth decade of life

multiple endochondromas and hemangiomas at high risk to develop this

X Ray shows fusiform defect with scalloping

177
Q

Name the organism causing EARLY ONSET PROSTHETIC JOINT INFECTION (less than 3 months)

A

S.aureus

Gram negative rod

Anaerobes

178
Q

Name the organism causing DELAYED ONSET PROSTHETIC JOINT INFECTION (3-12 months)

A

Coagulase negative staphylococci (epidermis)

Enterococci
Propionibacterium species

Typical sxs like No fever or increase WBC but implant loosening or sinus tract formation

179
Q

Name the organism causing LATE ONSET PROSTHETIC JOINT INFECTION ( >12 months)

Patient had Infection at distant site then bacteria infects joints via blood

A

S.aureus

Gram negative rod
B-Hemolytic strep

180
Q

How to d/f Femoral neck fracture and posterior hip dislocation?

Remember fracture disown leg whereas dislocation still own leg

A

In Neck fracture, leg is short, abducted and Ext-rotated

Whereas post- Hip dislocation, leg is adducted and Internal rotate

181
Q

Difference b/w Osteosarcoma and Unicameral Bone cyst

A

Both have lytic bone lesion

Unincameral has well define borders Whereas Osteosarcoma has irregular borders

182
Q

Difference between Langerhans cell histiocytosis and Osteosarcoma

A

Both have lytic lesions

but osteosarcoma Occur in adult and elderly patient whereas other diseases occur in less than 4 years kids

183
Q

What are the causes of Cervical Radiculopathy and How does it present?
(Sxs depend on nerve involvement)

A

Causes are disk herniation Or spondylosis

Sxs are loss of upper limb reflexes with pain and paresthesia

184
Q

Name the test which is Dx and therapeutic for cervical Radiculopathy

A

Shoulder abduction relief test

Abduction relief the tension on impinged nerve root and improve radicular pain when hand is placed on the top of hand

185
Q

What are the CNS, CVS and Pulmonary complications of RA?

A

CNS:
Depression and neuropathy

CVS viz Atherosclerosis and Vasculitis

Pulmonary
Pleural effusion and Pul-HTN
Fibrotic lung disease and lung nodules

186
Q

What are the Blood, skin, MSK, eye and other complications of RA?

A

Blood—>anemia

Skin—->RA nodules

MSK—-> Osteoporosis and Osteopenia

Eye—-> Scleritis and epiScleritis

Other—> Sjogren syndrome, Raynaud phenomenon

187
Q

Triad of Osler weber rendu syndrome

Autosomal dominant

A

Recurrent nasal bleeding and clubbing

Ruby colored papules blanch with pressure (telangiectasia)

AV malformation with reactive polycythemia

188
Q

D/f b/w Type 1 and Mixed (type 2 and 3) cryoglobulinemia

A

> > Type 1:
• Associated with lymphoproliferative or hematologic like Mulitple myeloma

• Normal complement level

> > Mixed
• Associated with HCV, HIV and SLE
• low C4

Internal Medicine (14 decks)

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