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Rheumatology Flashcards

1
Q

Features of prosthetic joint infection

A

Immunosuppressed + Elevated ESR + pain, warmth, effusion, fever

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2
Q

Imaging finding for prosthetic joint infection

A

Periprosthetic lucency on radiograph

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3
Q

Biopsy of microscopic polyangiitis (MPA)

A
  • Nongranulomatous *necrotizing

* Pauci immune

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4
Q

Clinical features of microscopic polyangiitis

A

*kidney involvement + palpable purpura

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5
Q

Labs for microscopic polyangitis

A

Positive p-ANCA

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6
Q

labs for GPA + biopsy

A

c-ANCA + granulomatous

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7
Q

IgA vasculitis (HSP) biopsy

A

immune complexes identified on biopsy

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8
Q

Thromboangiitis obliterans clinical features

A

Inflammation of vessels in upper and lower limbs, leading to reduced pulses and gangrenous ulcers + smoker

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9
Q

Diffuse idiopathic skeletal hyperostosis on imaging

A

Bridging ossification of spinal ligaments

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10
Q

Workup after radiologic diagnosis of AS

A

Don’t test for HLA-B27 antigen, low specificity and diagnosis is clinical + radiographic

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11
Q

WBC count in septic arthritis

A

> 50K

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12
Q

Treatment of severe tophaceous gout not responding to febuxostat

A

Pegloticase

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13
Q

Workup of reactive arthritis

A

Chlamydia urine NAAT (most common agent causing urethritis)

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14
Q

Ankylosing spondylitis diagnosis

A
  • clinical + radiographic (inflammatory back pain + sacroillitis on imaging)
  • Not HLA-B27
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15
Q

Gastric antral vascular ectasia (GAVE) clinical features

A
  • proliferation of blood vessels typically in antrum of stomach
  • looks like watermelon stripes on endoscopy
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16
Q

What is a dielafoy lesion?

A

Submucosal arterioles that protrude through the mucosa and cause hemorrhage

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17
Q

Treatment of acute gout refractory to steroids

A

Il-1 inhibitors (Anakinra or canakinumab)

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18
Q

Antisynthetase syndrome clinical features

A

ILD + Dermatomyositis or polymyositis
Raynaud’s
Inflammatory arthritis

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19
Q

Positive antibody in anti-synthetase syndrome

A

anti-Jo-1 (an anti synthetase antibody)

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20
Q

Cause of GI involvement in patients with systemic sclerosis

A

Small intestinal bacterial overgrowth (SIBO0

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21
Q

Felty syndrome clinical features

A

long standing RA + neutropenia + splenomegaly

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22
Q

Lyme arthritis clinical features

A

Large effusion + stiffness + minimal pain

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23
Q

IgG4-related disease clinical features

A
  • Organomegaly
  • diffuse fibrosis
  • Multiorgan failure
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24
Q

Germ cell tumor presentation

A
  • Bulky RP or mediastinal lymphadenopathy

- testicular mass may not always be present

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25
Q

Management of knee OA in patients with RA

A
  • topical NSAIDs
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26
Q

Management of GCA

A
  • high-dose prednisone BEFORE biopsy
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27
Q

Inclusion body myositis clinical features

A
  • inflammatory myopathy involving proximal and distal muscles + symmetric + insidious onset
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28
Q

Initial management of sjogren syndrome

A
  • artificial tears + sugar free candies
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29
Q

disseminated gonorrhea features

A

Tenosynovitis + dermatitis + polyarthralgia + fever/chills

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30
Q

Antibodies positive in GPA

A

Proteinase 3

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31
Q

Treatment of relapsed GPA

A

Rituximab

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32
Q

IMPT side effects to know with lyrica

A
  • peripheral edema
  • dizziness
  • weight gain
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33
Q

Treatment of primary angiitis of the CNS

A

Cyclophosphamide

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34
Q

Primary angiitis clinical features

A

Vasculitis of CNS + granulomas

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35
Q

joint involvement in RA

A

symmetric involving small joints of hands and feet

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36
Q

Management of OA in patients with NSAID contraindications

A

Duloxetine

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37
Q

When topical NSAIDs are beneficial

A

patients with isolated joint involvement

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38
Q

Adult-onset Still disease clinical features

A
  • spiking fever
  • evanescent salmon-colored rash on the trunk and extremities
  • arthritis
  • lymphadenopathy
  • HSM with elevated liver enzymes
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39
Q

Lab feature of adult still disease

A

Extremely high ferritin level

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40
Q

Long term treatment of IBD-associated arthritis

A

Adalimumab

Infliximab

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41
Q

psoriatic arthritis clinical features

A
  • psoriatic rash

- nailbed pitting

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42
Q

antibody used to diagnose an SLE flare

A

dsDNA (also elevated ESR + low complement support)

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43
Q

Antibody associated with immune-mediated necrotizing myopathy

A

Anti-HMG Co-A reductase antibodies

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44
Q

Workup of suspected sjogren syndrome if serology is negative

A

Lip biopsy

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45
Q

Evaluation of acute monoarthritis

A

Always joint aspiration

46
Q

When bisphosphonates need to be started for patients on chronic steroids

A

Moderate or high 10-year fracture risk according to FRAX calculator + at least 2.5 mg of prednisone daily for 3 months or more

47
Q

relapsing polychondritis clinical features

A
  • inflammation and damage of cartilaginous tissue (middle ear, nose, tracheobronchial tree, joints)
48
Q

medications safe to use in pregnancy for RA patients

A
  • plaquenil safe

- MTX, leflunomide contraindicated

49
Q

Gouty cellulitis clinical features

A

presents just like cellulitis during acute gout flair

50
Q

Treatment of gouty cellulitis

A

prednisone

51
Q

Second line for fibromyalgia

A

Duloxetine + lyrica

52
Q

Treatment of ILD associated with systemic sclerosis

A

Mycophenolate

53
Q

Most common side effect of topical NSAIDS

A
  • skin irritation and rash
54
Q

Acute calcium pyrophosphate crystal arthritis clinical features

A
  • attacks longer than gout (weeks to months) (as opposed to gout attacks, which resolve with 1-2 weeks, typically)
  • knees and wrists
  • elderly patients
55
Q

Pulmonary manifestation of RA

A

Rheumatoid pleuritis

56
Q

Takayasu arteritis clinical features

A

young woman
granulomatous
aortic involvment

57
Q

Medication patients on long term MTX need

A

Folic acid (reduces SE’s of MTX) (MTX blocks cellular utilization of folic acid)

58
Q

Lofgren syndrome clinical features

A

Acute arthritis + bilateral hilar lymphadenopathy + erythema nodosum
(Lofgren is a rheumatologic manifestation of sarcoidosis)

59
Q

IgA vasculitis diagnosis

A

Skin biopsy with immunofluorescence (leukocytoclastic vasculitis with predominance of IgA deposits on immunoflueroscence)

60
Q

How to evaluate for allopurinol hypersensitivity

A

HLA-B5801 allele testing

61
Q

When to work patients up for allopurinol hypersensitivity

A
  • Thai, Han Chinese, Korean
  • CKD
  • Diuretic use
62
Q

Treatment of class V lupus nephritis

A

mycophenolate

63
Q

First-line for ankylosing spondylitis

64
Q

Additional ankylosing spondylitis clinical features

A
  • strong hereditary predilection
  • highly correlated to HLA-B27
  • male predominance
  • may not show radiographic evidence early in course of disease
65
Q

Acute cutaneous lupus erythematosus clinical features

A
  • describes cutaneous manifestation of LSE

- bright erythematous patches over both cheeks and the nasal bridge

66
Q

Rosacea clinical features

A
  • inflammatory papules, pstules, telangiectasias + involves nasolabial fodls
67
Q

erysipelas clinical features

A

(superficial cellulitis involving the lymphatics)

  • well demarcated plaque
  • systemic symptoms (fever, malaise)
68
Q

Kawasaki disease presentation

A
  • fever, rash, cervical LAD, promoninent nonexudative conjunctivitis
69
Q

Strongest modifiable RF for OA

70
Q

Management of scleroderma renal crisis

A

Captopril (ACEi) (mitigates interstitial fibrosis and vascular dysfunction in glomerular arterial bed)

71
Q

Features of scleroderma renal crisis

A 
hypertensive emergency
headache
MAHA
thrombocytopenia
AKI
proteinuria
72
Q

Initial evaluation of steroid-induced necrosis

A

Plain film

73
Q

Management of inadequately controlled tophaceous gout

A

uptitrate allopurinol

74
Q

Description of tophaceous gouts

A
  • palpable masses, white nodules on joints
75
Q

leading cause of mortality in mixed connective tissue disease

A

pulmonary arterial hypertension + ILD

76
Q

rheum disorder I stored in TIm’s basement

77
Q

MCTD overlap of what

A

SLE
systemic sclerosis
polymyositis

78
Q

Management of refractory SLE

79
Q

Diffuse idiopathic skeletal hyperostosis (DISH) clinical features

A
  • similar to AS in radiography , don’t confuse (*no SI joint involvement)
  • noninflammatory condition involving ossification of spinal ligaments and entheses
  • ossification of spinal ligaments (typically on right side) and enthesis
80
Q

Colchicine toxicity

A

marrow suppression + kidney failure + rhabdo

81
Q

Subacute cutaneous lupus erythematosus presentation

A
  • annular rash with central clearing and plaques + scaling + SLE symptoms
82
Q

Discoid lupus erythematosus (DLE) presentation

A
  • scalp and face involvement
  • hypo and/or hyperpigemented
  • patches or plaques
83
Q

Management of gout patient starting urate-lowering therapy

A
  • should also receive prophylaxis
84
Q

prophylactic agents for gout

A

colchicine
low dose steroids
low dose NSAIDS

85
Q

meds to hold before testing for a pheo

A

TCAs (falsely elevates catecholamines or metanephrines)
SNRIs
Amphetamines
Decongestants

86
Q

Duration of oral bisphosphonate therapy for osteoporotic women

A

5 years then stop

Unless high risk (T less than negative 2.5), then 10 years

87
Q

Evaluation of pituitary tumors

A
  • evaluate for hypersecretion by measuring prolaction, IGF-1, cortisol, TSH/T4, FSH, testosterone
  • evaluate for mass effect
88
Q

management of patient prior to adrenalectomy for pheo

A

start phenoxybenzamine or another alpha-blocker (surgery can cause catecholaine release)

89
Q

Initial workup of secondary amenorrhea

A
  • rule out pregnancy

- measure FSH, TSH, prolactin

90
Q

Definition of secondary amenorrhea

A

Absence of menses for 3 or more months in patient who previously had normal cycle

91
Q

primary amenorrhea definition

A

absence of menses by age 16 + normal sexual hair pattern and breast development

92
Q

inpatient management of hyperglycemia in non-diabetic patient per boards

A
  • basal insulin + sliding scale
93
Q

Complications to be aware of following pituitary surgery

94
Q

Management of hyperprolactinemia causing hypogonadism

A

dopamine agonist therapy

95
Q

most common pituitary abnormality in empty sella syndrome

A

hyperprolactinemia

96
Q

MEN1 involves

A

pituitary
parathyroid
pancreas

97
Q

What is vitamin D-dependent hypercalcemia

A

in granulomatous disease (sarcoidosis), macrophages convert 25-hydroxyvitamin D to 1,25-dihydroxyvitamin D without PTH regulation or renal conversion

98
Q

vitamin D-dependent hypercalcemia lab features

A

high 1,25 dihydroxyvitamin D + suppressed PTH + high phosphorus (due to high vitamin D)

99
Q

Tumors most commonly associated with hypercalcemia of malignancy

A
  • Squamous cell carcinomas
  • breast cancers
  • renal cell carcinomas
100
Q

mechanism of hypercalcemia in Hodgkin’s and NHL

A

increased production of 1,25-dihydroxyvitamin D

101
Q

Management of severe sjogren’s

102
Q

Morphea clinical features

A
  • category of cutaneous sclerosis
  • only skin involvement, no systemic sclerosis
  • one or more discrete plaques
103
Q

Morphea vs. limited cutaneous systemic sclerosis

A

Morphea = isolated skin lesions
limited cutaneous systemic sclerosis = skin disease that doesn’t progress proximal to elbows or knees but may include face and neck and has extracutaneous involvement (limited just means limited areas of skin involvement)

104
Q

Treatment of oral and genital ulcers in Behcet syndrome

A

Topical steroids

105
Q

Behcet syndrome clinical features

A
  • recurrent painful oral ulcers
  • recurrent painful genital ulcers
  • uveitis/eye involvement
  • skin involvement (acneiform lesions)
  • pathergy
106
Q

What is pathergy?

A

Development of a pustule following a needle stick.

107
Q

Maintenance therapy in Behcet’s syndrome to prevent recurrent mucocutaneous lesions

A

Colchicine

108
Q

Initial step in the management of recurrent tophaceous gout

A 
Uptitrate allopurinol (even in stage 3 CKD) to a max of 800 mg/d in 100 mg increments
- (treating to a specific serum urate level is controversial, but you should still uptitrate)
109
Q

Biggest risk allopurinol poses

A

DRESS syndrome

110
Q

Use of pegloticase

A

Severe, refractory gout

111
Q

Mechanism + Use of febuxostat

A
  • lowers serum rate, similar to allopurinol

- patients who are unresponsive to or can’t tolerate allopurinol

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