Rheumatology and Orthopedics Flashcards
1
Q
RA step up tx
A
MTX for 6 months
- persistent sx - add sulfalazine/plaquenil or step up
- step up = add biologic - TNF inhibitor
2
Q
before start TNF inhibitor - check?
A
TB, hep C, hep B
3
Q
target uric acid when treating gout
A
less than 6
4
Q
4SKIN RASH NIANA
A
Lupus manifestations:
- 4 rashes - malar, discoid, photosensitive, oral ulcers
- RASH - renal, arthritis, serositis, hematologic
- NIANA - neurologic, immunologic, ANA
5
Q
rash that spares nasolabial folds
A
malar rash
6
Q
diagnosis of fibro requires
A
symptoms more than 3 months
normal inflammatory markers
7
Q
tx giant cell arteritis
A
high dose pred
8
Q
tx PMR
A
low dose pred
9
Q
pseudogout crystals?
A
calcium pyrophosphate
10
Q
DIP arthritis and arthritis mutilans
A
psoriatic arthritis
- also - pencil in cup deformity
11
Q
prognostic factors for erosive RA
A
anti-CCP and RF early development affecting multi joints radiographic erosions lower SES and education elevated ESR and CRP functional limitations
12
Q
arthritis at base of thumb
A
OA
13
Q
5% risk of developing this in sjogrens - commonly in parotid gland
A
non-hodgkin lymphoma
14
Q
risk fx for developing lymphoma in sjogrens
A
anti Ro/SSA and La/SSB Abs RF Ab cryo hypocomplement lymphopenia
15
Q
negative ANCA and concern for GPA?
A
does NOT rule it out
16
Q
pain and paresthesias sole of foot, distal foot, toes
A
tarsal tunnel syndrome
17
Q
locking of knee with extension
A
meniscal tear
18
Q
ottawa ankle rules
A
X-ray ankle if:
- pain at malleolar zone
- tender tip medial malleolus
- tender tip of lateral malleolus
- unable to bear weight
X-ray foot if:
- pain midfoot zone
- tender at navicular
- tender base 5th metatarsal
- unable bear weight
19
Q
synovial fluid in septic arthritis
A
WBC typically 50-150k
gram stain - negative in 20-30% of cases
20
Q
primary raynauds work up
A
normal nailfold capillaroscopy
normal ANA and ESR
tx - CCBs
21
Q
erythema infectiousum
A
fifth disease - parvo b19
22
Q
parvo b19 in sickle cell
A
aplastic crisis
23
Q
diagnosis parvo b19
A
acute - B19 IgM in immunocompetent or NAAT for DNA in immunocompromised
prior - B19 IgG
reactivation - NAAT for DNA
24
Q
progressive osteoporosis management
A
first = oral bispho
if BMD loss less 5% continue and DXA 2 years
if BMD loss more 5% - consider IV bispho, teriparatide, denosumab
25
severe osteoporosis T score
less than -3.5
26
screen if progressive osteoporisis
hyperT, hyperPTH, MM, malabsorption, liver disease, CKD
27
triad of feltys
neutropenia, RA, splenomegaly
in 1% of patients with seropositive advanced RA
28
extra-articular manifestations of feltys
mononeuritis multiplex, necrotizing skin lesions, pleuropericarditis, LAD, episcleritis
29
sweets syndrome
neutrophilic dermatosis associated with malignancy and autoimmune disease
- erythematous plaques with pseudo blistering and pustules - face, necks, chest, extremities
30
tx of PMR
15-20mg / d prednisone
31
tx of reactive arthritis
NSAIDS (abx don't work)
32
associations with marfans
AO root dilation and dissection
ectopia lentis
mitral valve prolapse
PTX
33
PAN association
hep B
34
vessels involved in PAN
typically - mesenteric and renal vessels (spares pulmonary)
35
tx PAN
pred and cyclophosphamide
| ACEI for HTN
36
essential mixed cryo association
hep C
| - will see low complement
37
MAP presentation
inflammation of small blood vessels
| - GN and pulm findings (hemoptysis, DAH, pulm fibrosis)
38
chondrocalcinosis
pseudogout
39
osteitis fibrosa cystica
complication of severe primary hyperPTH
- brown tumors of long bones
- tapering distal clavicles
- salt and pepper of skull
- subperiosteal bone resorption
40
dermatomyositis symptoms
gottrons papules
shawl sign
periorbital heliotrope rash
41
increased risk of what in dermatomyositis
cancer - need routine screening
42
milwaukee shoulder
basic Ca phosphate deposition
hemorrhagic synovial fluid
crystals = hydroxyapatite
43
tx mild RA
plaquenil or sulfasalazine
44
tx mod-severe RA
MTX is initial drug of choice
45
tx fibro
TCA, pregabaline, duloxetine, milnacipran
46
diagnosis of GCA (criteria)
need 3 of 5 for 94% SN and 91% SP
- age greater 50 (greatest risk fx)
- new onset HA with fever, visual changes
- ESR over 50
- tender temporal artery
- bx with necrotizing arteritis
47
anti-histone Abs
drug induced lupus
48
fever, high ferritin, arthritis, salmon colored rash
drug induced lupus
49
patient with lupus and has concern for kidney?
biopsy it
| - if proteinuria greater 500mg/d, elevated Cr, active urine sediment
50
MTX toxicity
stomatitis
| megaloblastic anemia
51
supp while taking MTX
folic acid - 1mg/d (cain increase to 5)
52
prognostic factors for erosive RA
anti-CCP
| erosions on XR = marginal erosions
53
LE symptoms - worse walking down hill and better rest and bending forward
spinal stenosis
aka = pseudoclaudication
diagnosis - MRI
54
young patient with thrombocytopenia, stroke, prolonged PTT
test for antiphospholipid syndrome
55
diagnosis of antiphospholipid
1 clinical and 1 lab criteria
- lab - lupus anticoag, anticardiolipin Ab, anti beta-2 glycoprotein
- clinical - vascular thrombosis or pregnancy issue
56
chronic accumulation of colchicine
in CKD patients
- neuromyopathy
- resolves with d/c of drug
57
colchicine accumulation on muscle bx finding
cytoplasmic vacuolization
58
screening for GCA
osteoporosis
| yearly - CXR for thoracic aortic aneurysm
59
complex regional pain syndrome types
```
1 = without definable nerve lesion
2 = associated with known peripheral lesion
```
60
hook osteophytes 2nd and 3rd MCPs
hemochromatosis
| elevated serum transferrin saturation
61
rhomboid, positive birefringent, calcium pyrophosphate
pseudogout
62
risk of recurrent aspiration PNA
dermatomyositis
- weak oropharyngeal and upper 3rd esophagus
- can develop ILD
63
target for urate lowering treatment in gout
uric acid less than 6
64
symptomatic vertebral compression fracture treatment
NSAID, tylenol, opioids
| - if this fails - intranasal calcitonin 2-4 weeks
65
hypertrophic osteoarthropathy and associations
clubbing and periosteal inflammation
- common - non small cell lung ca
- also - CF, chronic lung infection, cyanotic heart disease, cardiac shunts
66
risk of cervical region in RA
C1-2 subluxation
67
radiograph with lytic and sclerotic lesions, elevated bone alk phos
pagets
68
tx pagets
bisphos
69
cANCA and anti-PR3
GPA - CdefG
| - sinus, pulmonary, renal, systemic sx
70
pANCA and anti-MPO
MPA - MnoP
71
septic bursitis WBC
WBC greater 3k
| non-septic - less 1.5k
72
anti topoisomerase
scl-70 - systemic sclerosis
73
anti-mitochondrial Ab
PBC
74
anti Jo1 and antisynthetase
myositis
75
lofgrens syndrome and tx
sarcoid variant
- erythema nodosum, ankle arthritis, hilar adenopathy
- tx - NSAIDs
76
palpable purpura, arthralgias, MPGN, low serum complement, neuropathy
essential mixed cryo - hep C
tx hep C - may reduce the cryoglobulins
77
tx adult onset stills
NSAIDs, if bad may need steroids
78
HSP
leukocytoclastic vasculitis
| IgA
79
presenting skin symptoms of HIV
psoriasis
80
CREST variant of what type SSc
limited cutaneous
81
risk for CREST with lungs
pHTN
82
risk of diffuse SSc with lungs
ILD
83
risk fx for avascular necrosis hips
chronic steroid, alcohol, sickle cell, SLE
XR - crescent sign - late sign - MRI better
84
synovial WBC if septic arthritis
greater 100k WBC and 80-90% PMNs
85
recurrent oral and genital ulcers
behcets disease
86
point tenderness along medial knee
pes anserine pain syndrome
87
pathergy test
2mm papule after inserting needle 5mm into skin
for behcets disease
88
renal manifestations sjogrens
chronic interstitial nephritis
89
vertebral compression fracture and activity
resume ASAP
- avoid bed rest
- if 6 weeks pain - kyphoplasty/vertebroplasty
90
need bisphos in men for prevention ostoeporosis
greater 7.5mg/d for greater 3 month of prednisone
91
anti-RNP Abs
mixed CTD
| - increased mortality and risk pHTN
