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Rheumatology Flashcards

1
Q

approach to joint: single joint

A

septic

crystals

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2
Q

approach to joint: multiple joints

A 
osteoarthritis
lupus
rheumatoid 
scleroderm
myositis
seronegatives
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3
Q

approach to joint pain: chronic

A

osteoarthritis, lupus, rheumatoid, scleroderma, myositis, seronegatives

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4
Q

approach to joint pain: acute

A

septic, trauma, crystal, reactive

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5
Q

approach to joint pain: isolated

A

septic, crystal

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6
Q

approach to joint pain: systemic manifestations

A

seronegative (IBD)
lupus (face, CNS, renal, heart, lung)
rheumatoid (nodules, serositis)
reactive (oral + genital ulcer)

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7
Q

approach to joint pain: degenerative

A

osteoarthritis

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8
Q

approach to joint pain: inflammatory

A

everything else

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9
Q

normal joint serology

A

clear
<2% wbcs
<25% polys
no gram/cx/dx

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10
Q

non-inflammatory joint serology

A 
clear
<2% wbcs
<25% polys
no gram/cx
dz osteoarthritis
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11
Q

inflammatory joint serology

A 
yellow, white
>2, <50 wbcs
>/= 50% polys
no gram/cx
dz everything but OA/infection
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12
Q

sepsis joint serology

A 
opaque
>50 wbcs
>/= 75% polys
\+ gram/cx
dz infection
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13
Q

antinuclear antibodies

A

sensitive lupus

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14
Q

anti-histone antibodies

A

specific drug-induced lupus

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15
Q

anti-ds-DNA antibodies

A

specific lupus + renal involvement

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16
Q

anti-smooth muscle antibodies

A

autoimmune hepatitis

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17
Q

anti-mitochondrial antibodies

A

primary biliary cirrhosis

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18
Q

anti-centromere antibodies

A

scleroderma (CREST)

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19
Q

anti-Ro+La antibodies

A

sjogren’s

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20
Q

anti-CCP antibodies

A

rheumatoid arthritis

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21
Q

anti-RF antibodies

A

rheumatoid arthritis

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22
Q

anti-Jo antibodies

A

polymyositis

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23
Q

anti-topoisomerase antibodies

A

systemic scleroderma

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24
Q

lupus path

A

autoimmune, complex formation

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25
lupus pt
women > men | blacks > whites
26
lupus pt
``` MD SOAP BRAIN Malar rash Discoid rash Serositis Oral ulcers Arthritis Photosensitivity Blood Renal failure ANA Immunologic Neurology ```
27
lupus dx
1st: ANA then: ds-DNA - anti-smith - anti-histone (drug induced) lupus nephritis - U/A -> bx kidney flare - complement levels decrease in flare - complement levels increase in infection
28
lupus tx
``` reduce flares: hydroxychloroquine control symptoms: NSAIDs flare: prednisone severe: mycophenolate mofetil nephritis: IV cyclophosphamide ```
29
drug-induced lupus path
drugs procainamide α-methyldopa hydralazine
30
drug-induced lupus pt
NO visceral involvement | skin and joints only
31
drug-induced lupus dx
anti-histone
32
drug-induced lupus tx
remove drug
33
antiphospholipid antibody (APLA) syndrome path
lupus "anticoagulant" (in the lab) actually causes coagulation (in the body) anti-cardiolipin antibodies
34
anti-cardiolipin antibodies
antiphospholipid antibody (APLA) syndrome
35
antiphospholipid antibody (APLA) syndrome pt
arterial AND venous clots lupus false + RPR ... negative FTA-abs
36
antiphospholipid antibody (APLA) syndrome dx
increase PTT, normal INR mixing study fails to correct Russell Viper Venom tests
37
antiphospholipid antibody (APLA) syndrome tx
warfarin + aspirin
38
rheumatoid arthritis path
autoimmune disease women > men age > 40 panes formation -> joint destruction
39
RA pt
``` Nobody Should Have Rheumatoid Symptoms 3 times (x) N: nodules S: symmetric H: hands R: RF or CCP S: stiffness 3: 3 or more joints, spares DIP X: xray shows erosions ```
40
RA dx
1st RF or CCP
41
RF tx
``` DMARDs (everyone and early) biologics (severe) ... NSAIDs (sxs) steroids (flare) ``` ``` DMARD = methotrexate NSAID = ibuprofen/meloxicam biologics = etanercept, infliximab ```
42
RF f/u
screen for TB and fungus before biologics spine involvement = C1 and C2 bilateral carpal tunnel syndrome could be early RA Felty syndrome = RA + neutropenia + splenomegaly
43
Giant cell Arteritis path
multinucleated giant cells in large vessels like the temporal artery
44
GCA pt
age > 50 unitemporal head pain tender jaw claudication vision loss
45
GCA dx
biopsy (skip, treat first)
46
GCA tx
give steroids before biopsy
47
GCA f/u
elevated ESR, CRP, low-grade possible findings
48
polymyalgia rheumatica path
similar pathology to GCA, large-vessel vasculitis
49
polymyalgia rheumatic pt
symmetric pain and stiffness of neck, shoulder, and hip girdle proximal muscle weakness but normal CK (idiopathic inflam myop)
50
polymyalgia rheumatica dx
clinical (normal CK, high ESR)
51
polymyalgia rheumatica tx
steroids
52
polymyalgia rheumatica f/u
angiogram rules out other diseases
53
takayasu arteritis path
giant-cell arteritis of the aorta, subclavian, or axillary arteries
54
takayasu arteritis pt
asymmetric pulselessness, discordant BPs left to right arm pulseless disease < 40
55
takayasu arteritis dx
angiogram (CT, MRI, direct)
56
takayasu arteritis tx
high-dose prednisone
57
polyarteritis nodosa path
medium-vessel vasculitis | HepB-related, maybe
58
polyarteritis nodosa pt
infarction of multiple organs without common vascular distribution purpura, mesenteric ischemia, non-glomerulonephritis, renal failure
59
polyarteritis nodosa dx
angiogram = micro aneurysms and stenosis
60
polyarteritis nodosa tx
high-dose steroids and cyclophosphamide
61
Kawasaki disease path
medium-vessel vasculitis
62
kawasaki pt
asian child, strawberry tongue, truncal rash, palmar erythema, desquamation
63
kawasaki dx
clinical
64
kawasaki tx
IVIG and ASA
65
cryoglobulinemia path
HepC, cryoglobulins | small vessel, complex deposition
66
cryglobulinemia pt
palpable purpura, decreased complement, elevated RF
67
cryoglobulinemia dx
clinical
68
cryoglobulinemia tx
steroids, plasmapheresis
69
IgA vasculitis path
small vessel, IgA deposition | Henoch-Schonlein Purpura
70
IgA vasculitis pt
palpable purpura, abdominal pain, abdominal bleeding
71
IgA vasculitis dx
biopsy = leukocytoclastic vasculitis with immune complexes
72
IgA vasculitis tx
steroids
73
ganulomatosis with polyangiitis path
c-ANCA positive, small vessel | necrotizing vascuitis
74
ganulomatosis with polyangiitis pt
hematuria, hemoptysis, sinuses
75
ganulomatosis with polyangiitis dx
biopsy
76
ganulomatosis with polyangiitis tx
steroids and cyclophosphamide
77
ganulomatosis with polyangiitis f/u
'eosinophilic' if p-ANCA, asthma, allergies, and similar presentation polyangiitis if p-ANCA and no granulomas with similar presentation
78
scleroderma path
collagen deposition disease replaces smooth muscle and skin
79
scleroderma pt
diffuse cutaneous systemic sclerosis: face, hands, feet - above elbow and knee visceral inolvement - kidney and interstitial lung disease
80
scleroderma dx
anti-topoisomerase = anti-Scl-70
81
scleroderma tx
no tx available | NO steroids = harmful!
82
scleroderma f/u
renal crisis = ACE-I reflux = PPIs Raynaud's = CCB ILD = cyclophosphamide
83
CREST path
same as scleroderma
84
CREST pt
``` limited cutaneous systemic sclerosis C: calcinosis R: Raynaud's E: Esophagus S: Sclerodactyly T: Telangiectasia ```
85
CREST dx
anti-centromere antibodies
86
CREST tx
no treatment available
87
CREST f/u
pulmonary HTN without parenchymal disease
88
Sjogren's path
lymphocytic infiltrates of exocrine glands
89
Sjogren's pt
dry eyes dry mouth parotid swelling, dental caries
90
Sjogren's dx
anti-Ro, anti-La | Schirmer test
91
Sjogren's tx
artificial tears | artificial saliva
92
idiopathic inflammatory myopathy path
dermatomyositis = inflammation epimysium, skin findings polymyositis = inflammation perimysium, central necrosis inclusion body myositis = vacuoles
93
idiopathic inflammatory myopathy pt
skin findings = Gottron's papule, heliotrope rash, shawl sign proximal muscle weakness (myo-pathy) AND painful tender muscles (myo-sitis)
94
idiopathic inflammatory myopathy dx
1st: elevated serum CK, adolase then: EMG best: biopsy of muscle
95
idiopathic inflammatory myopathy f/u
anti-Mi, anti-Jo, associated antibodies
96
monoarticular arhtropathies
``` gout gonorrhea septic joint pseudogout tumor lysis syndrome staph septic joint ```
97
gout path
monosodium urate crystales increased production -> allopurinol decreased elimination -> probenecid
98
gout pt
podagra | single hot swollen painful joint
99
gout dx
arthrocentesis negatively birefringent needle-shaped crystal
100
gout tx: acute
``` flare mild = < 4 joints, digits only - NSAIDs (if not bleeding, CKD) - colchicine (not if chronic ppx) - steroids (last choice of three) mod = >/= 4 joints, or any non-digit joint - dual therapy: -- NSAIDs + colchicine (preferred) -- steroids + colchicine (ok) severe = same as moderate ```
101
gout tx: chronic induction
xanthine-oxidase inhibitor if: - > 2 attacks/yr, goal uric acid < 6 colchicine-px until urate < 6 (NSAIDs ok)
102
gout tx: chronic stable
d/c colchicine ppx after urate < 6 | do not stop allopurinol in flare
103
gout f/u
diet: decrease fructose, EtOH, red meat/seafood (purines) xanthine-oxidase inhibitors: febuxostate = allopurinol but $$$ urate lowering agents: probenecid (rarely useful) intra-articular glucocorticoids when in acute flare but unsafe for all else
104
gonorrhea septic joint path
STD -> hematogenous | intracellular organism
105
gonorrhea septic joint pt
STDs, lots of sex, no protection | urethritis, cervicitis
106
gonorrhea septic joint dx
arthrocentesis without organisms | NAAT to confirm
107
gonorrhea septic joint tx
ceftriaxone AND (azithro or doxy)
108
pseudogout path
calcium pyrophosphate
109
pseudo gout pt
single swollen joint
110
pseudo gout dx
positively birefringent | rhomboid shaped crystals
111
pseudo gout tx
NSAIDs (first) colchicine (better as ppx) steroids (CKD)
112
tumor lysis syndrome path
large tumor burden, cell turnover | blood cancers
113
tumor lysis syndrome pt
cancer getting chemo
114
tumor lysis syndrome dx
renal failure, lots of stones
115
tumor lysis syndrome tx
rasburicase
116
tumor lysis syndrome ppx
IVF and allopurinol
117
staph septic joint path
``` direct inoculation (wound) hematogenous spread ```
118
staph septic joint pt
penetrating trauma | IVDA, endocarditis
119
staph septic joint dx
arthrocentesis with organisms
120
staph septic joint tx
nafcillin...vancomycin
121
seronegative arthropathies
ankylosing spondylitis psoriatic arthritis reactive arthritis (Reiter's) IBD-related, enteropathic arthritis
122
ankylosing spondylitis path
sacroiliitis
123
ankylosing spondylitis pt
low back pain morning stiffness better with exercise, worse with rest
124
ankylosing spondylitis dx
lumbar lateral xray | 'bamboo spine'
125
ankylosing spondylitis tx
NSAIDs (first line) methotrexate (peripheral skeleton) intra-articular glucocorticoids (pain) TNF-α inhibitors (severe or refractory)
126
psoriatic arthritis path
autoimmune
127
psoriatic arthritis pt
40-50 men psoriasis + arthritis 'nail pitting' 'sausage digits' an arthritis question with a picture of a fingernail is psoriatic .... a picture of a deformity is RA
128
psoriatic arthritis dx
clinical
129
psoriatic arthritis tx
NSAIDs (mild arthritis) methotrexate (moderate arthritis) TNF-α inbhibitors (MTX failure)
130
psoriatic arthritis f/u
mild: < 4 joints, no erosion mod: >/= 4 joints, no erosion sev: any erosion, MTX fails
131
reactive arthritis
Reiter's
132
reactive arthritis path
STD, non-gonococcal urethritis
133
reactive arthritis pt
cervicitis + arthritis urethritis + arthritis urethritis + arthritis + conjunctivitis
134
reactive arthritis dx
finding the STD | - swab everywhere semen can go
135
reactive arthritis tx
``` doxy OR azithro (chlamydia) IM ceftriaxone (gonorrhea) ```
136
IBD-related, enteropathic arthritis path
inflammatory, idiopathic
137
IBD-related, enteropathic arthritis pt
men = women | IBD (Crohn's or UC) + arthritis
138
IBD-related, enteropathic arthritis dx
clinical
139
IBD-related, enteropathic arthritis tx
``` treat the enteropathy, treat the arthritis mild: 5-ASA mod: azathioprine or 6-MP severe: - UC = resection - Crohn's = anti-TNF ```

Online Med Ed (18 decks)

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