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Medicine Boards > Rheumatology > Flashcards

Rheumatology Flashcards

1
Q

Which medication is a huge risk factor in causing scleroderma renal crisis?

A

glucocorticoids – do NOT use them to treat scleroderma

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2
Q

how do you treat scleroderma renal crisis vs. Lupus nephritis?

A
  1. ACE-i, no matter degree of AKI (captopril)

2. Myophenolate mofetil&raquo_space; cyclophosphamide

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3
Q

In what condition are anti-U1 RNP antibodies positive? what defines this disease? what causes mortality?

A

MCTD (mixed connective tissue disease)

Includes features of at least 2 of the following - SLE/SSc/Polymyositis in the presence of antiU1 RNP

Mortality largely attributable to PH

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4
Q

What 3 medications are FDA approved for fibromyalgia?

A

Pregabalin
Duloxetine
Milnacipran (SNRI)

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5
Q

which antihypertensive should you use vs. NOT use in gout?

A

Use – Losartan (modest uricosuric effect)

NOT - HCTZ (common gout trigger)

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6
Q

What can you use for chronic refractory gout, when standard urate therapy is not working? whats MOA?

A

IV pegloticase

enzymatically converts urate to more soluble compound (allantoin)

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7
Q

Which medication is contraindicated with the use of allopurinol or febuxostat?

A

Azathioprine

because combination will raise azathioprine levels!

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8
Q

what are the 4 clinical presentations of CPPD? (Calcium Pyrophosphate Deposition) Describe the crystals

A
  1. Chondrocalcinosis - asymptomatic cartilage calcification - ie. traingualr fibrocartilage of wrist joing, menisci of knee (line in cartilage), symphysis pubis
  2. pseudogout - acute CPP crystal arthritis
  3. chronic CPP crystal inflammatory arthritis (resenbles RA)
  4. OA with CPPD

rhomboid shaped positively birefringent crystals (blue)

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9
Q

IF someone is <50yo and has CPPD, what 4 things should you screen them for?

A
  1. hemochromatosis
  2. hypomagnesemia
  3. hyperparathyroidism
  4. hypothyroidism
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10
Q

How do you treat CPPD?

A
  • intra-articular glucocortioids if one or two joints
  • NSAIDs (initial)
  • Colchicine if doesn’t respond to NSAIDS or contraindicated
  • systemic glucocorticoids if unable to take colchicine or NSAIDs
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11
Q

How do you diagnose Tuberculous arthritis?

A

Synovial biopsy

gram stain and culture will be negative, TST may not be positive

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12
Q

What is antisynthetase syndrome? in what patient population is it seen? What antibody?

A

ILD + inflammatory polyarthritis + fever + Raynaud’s + “mechanics hands” (dry, rough, scaly, cracked) –> increased risk of sudden death

seen in patients with polymyositis or dermatomyositis but NOT with inclusion body myositis

anti aminoacyl-transfer (t)RNA synthetase enzymes (e.g. anti-Jo-1 antibodies)

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13
Q

What are the 3-4 types of inflammatory myopathies?

A

proximal muscle weakness (gradual, painless) + pharyngeal and respiratory muscle weakness, 80% positive ANA –> (1)polymyositis . and.. (2)dermatomyositis

proximal AND distal muscle weakness, asymmetric, usu quads, wrists, finger flexers, 20% +ANA –> (3) inclusion body myositis

(4) toxic myopathy 2/2 meds (glucocorticoids, statins) or alcohol

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14
Q

Name 3 large vessel vasculitis, how to treat?

A

Giant Cell Arteritis (GCA)
Polymyalgia Rheumatica (PMR)
Takayasu Arteritis

Tx– GCA - high dose glucocorticoids or tocilizumab (steroid sparing) + baby ASA
PMR + Takayasu - prednisone

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15
Q

Name 2 medium vessel vasculitis, how do you treat them?

A 
Polyarteritis Nodosa (PAN) 
Primary angiitis of the CNS (PACNS)

tx – prednisone + cyclophosphamide

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16
Q

Name as many small vessel vasculitis as you can (7)

Name the one with C-ANCA and the two with P-ANCA

A
  1. GPA (wegners) – C- ANCA/anti PR3
  2. MPA (microscopic polyangitis) - P-ANCA/anti MPO
  3. Eosinophilic Granulomatosis with Polyangitis (churg strauss) - P-ANCA/anti MPO
  4. HSP
  5. hypersensitivity vasculitis (leukoclatic vasulitis)
  6. Cryoglobulinemic vasculitis
  7. Bechets syndrome
17
Q

Name some conditions in which you can see saddle nose deformity

A 
Relapsing Polychondritis 
Granulomatosis with Polyangitis (GPA) 
syphilis
cocaine use
leprosy
18
Q

How do you treat relapsing polychondritis?

A

minor - NSAIDs, colchicine, or dapsone

severe - glucocorticoids and steroid sparing agents

19
Q

Familial Mediterranean Fever

  1. symptoms
  2. lab findings
  3. treatment
A
  1. recurrent, self limited fever and serositis (abdominal or pleuritic pain), arthritis, rashes lasting 3-4 days
  2. elev ESR, CRP, +AA protein (amyloid A), proteinuria, MEFV gene
  3. colchicine – prevents symptomatic attacks + development of AA amyloidosis
20
Q

Treatment for adult onset stills disease

A

1st line - NSAIDs
Refractory - glucocorticoids
Refractory - MTX, TNF-a inhibigtor, or anakinra (IL-1 inhibitor)

21
Q

In unclear cases what is the Gold Standard to diagnose Sjogren syndrome?

A

lip biopsy - of minor salivary gland

22
Q

Dx?

2nd +/- 3rd MCP and PIP joint arthritis + hook like osteophytes (not RA)

A

hemochromatosis

23
Q

What is DISH?

A

Diffuse idiopathic skeletal hyperostosis is a noninflammatory condition that involves ossification of spinal ligaments and entheses and usually presents as back pain and stiffness; characteristic radiographic changes include confluent ossification of at least four contiguous vertebral levels, usually on the right side of the spine. THORACIC most often involved.

24
Q

Side effects of colchicine + drug interactions

A

diarrhea
colchicine + CYP3A4 inhibitors (clarithromycin or fluconazole) –> potentially fatal colchicine toxicity with kidney failure, rhabdomyolysis, and bone marrow suppression may occur.

25
Q

what is the gold standard test to diagnose microscopic polyangitis? what does it show?

A

biopsy (skin ulcer)

nongranulomatous necrotizing pauci-immune vasculitis of small vessels OR pauci-immune necrotizing crescentic glomerulonephritis in the kidney

26
Q

Criteria for inflammatory back pain to help diagnose ankylosing spondylitis

A
  • onset before 45yo
  • duration >3 months
  • insidious onset
  • morning stiffness >30min
  • improvement with exercise, no improvement with pain
  • awakening from pain with improvement on rising
  • alternating buttock pain
27
Q

Criteria for inflammatory back pain to help diagnose ankylosing spondylitis

A
  • onset before 45yo
  • duration >3 months
  • insidious onset
  • morning stiffness >30min
  • improvement with exercise, no improvement with pain
  • awakening from pain with improvement on rising
  • alternating buttock pain
28
Q

What is the usual cause of diarrhea in systemic sclerosis?`

A

SIBO- small intestinal bacterial overgrowth –> chronic diarrhea and malabsorption. More than 70% have GI involvement (dysmotility –> SIBO).

Dx with glucsoe hydrogen breath testing or jejunal aspirate cultures

29
Q

What is Felty Syndrome? What does it put you at risk for?

A

TRIAD - long standing aggressive RA + neutropenia + splenomegaly

Risk for serious infections, LE ulcers, lymphoma, vasculitis

Tx – more aggressive RA therapy

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