Rheumatology, Orthopedics and Sports I Flashcards
Adverse hematologic effects associated with methotrexate use include […] and pancytopenia.
Adverse hematologic effects associated with methotrexate use include macrocytic anemia and pancytopenia.
macrocytic anemia likely secondary to folate depletion
All patients with polymyositis/dermatomyositis should be screened for […].
All patients with polymyositis/dermatomyositis should be screened for occult malignancy.
most commonly ovarian, lung, pancreatic, stomach, or colorectal cancers, or non-Hodgkin lymphoma
![](https://s3.amazonaws.com/brainscape-prod/system/cm/376/519/133/a_image_thumb.png?1647112758)
Common causes of lumbar stenosis include vertebral […], degenerative disk disease, and thickening of the ligamentum flavum.
Common causes of lumbar stenosis include vertebral osteoarthritis, degenerative disk disease, and thickening of the ligamentum flavum.
![](https://s3.amazonaws.com/brainscape-prod/system/cm/376/519/412/a_image_thumb.png?1647112812)
How do the following laboratory values change in patients with osteoporosis?
Serum calcium: […]
Serum phosphorus: […]
Alkaline phosphatase: […]
Urine hydroxyproline: […]
How do the following laboratory values change in patients with osteoporosis?
Serum calcium: No change
Serum phosphorus: No change
Alkaline phosphatase: No change
Urine hydroxyproline: No change
How do the following laboratory values change in patients with Paget disease of bone?
Serum calcium: […]
Serum phosphorus: […]
Alkaline phosphatase: […]
Urine hydroxyproline: […]
How do the following laboratory values change in patients with Paget disease of bone?
Serum calcium: No change
Serum phosphorus: No change
Alkaline phosphatase: Increase
Urine hydroxyproline: Increase
most common cause of asymptomatic alkaline phosphatase elevation in older patients
Hydroxyproline is a major component of the protein collagen, comprising roughly 13.5% of mammalian collagen. Hydroxyproline and proline play key roles for collagen stability. They permit the sharp twisting of the collagen helix.
![](https://s3.amazonaws.com/brainscape-prod/system/cm/376/519/536/a_image_thumb.png?1647112879)
Osteoporosis is defined with a DEXA scan T-score […].
Osteoporosis is defined with a DEXA scan T-score -2.5.
i.e. > 2.5 standard deviations below the mean for a young adult at peak bone density
Routine monitoring of which organ is necessary for patient’s being treated with long-term hydroxychloroquine?
Eyes
patient’s should have a baseline ophthalmologic evaluation with annual reassessment after 5 years of treatment
Sclerosis of what organ is the most common cause of death in scleroderma?
Lungs
causes interstitial fibrosis and pulmonary hypertension; second most common cause is kidney involvement (sclerodermal renal crisis)
Spondyloarthropathies associated with HLA-B27 may be remembered with mnemonic “PAIR”:
P: […]
A: […]
I: […]
R: […]
Spondyloarthropathies associated with HLA-B27 may be remembered with mnemonic “PAIR”:
P: Psoriasis
A: Ankylosing spondylitis
I: Inflammatory bowel disease
R: Reactive arthritis
Spondyloarthropathies often result in inflammation at sites of […], leading to gradual onset of low back pain and progressive stiffness.
Spondyloarthropathies often result in inflammation at sites of tendon/ligament insertion (enthesitis), leading to gradual onset of low back pain and progressive stiffness.
pain classically improves with activity or exercise
![](https://s3.amazonaws.com/brainscape-prod/system/cm/376/520/097/a_image_thumb.png?1647113007)
Synovial fluid analysis in patients with gout is characterized by […]-shaped crystals made of monosodium urate, that are […]-birefringent.
Synovial fluid analysis in patients with gout is characterized by needle-shaped crystals made of monosodium urate, that are negatively-birefringent.
i.e. yellow when lying parallel to polarized light
![](https://s3.amazonaws.com/brainscape-prod/system/cm/376/520/378/a_image_thumb.png?1647113046)
Synovial fluid analysis in patients with gout is characterized by needle-shaped crystals made of […], that are negatively-birefringent.
Synovial fluid analysis in patients with gout is characterized by needle-shaped crystals made of monosodium urate, that are negatively-birefringent.
i.e. yellow when lying parallel to polarized light
![](https://s3.amazonaws.com/brainscape-prod/system/cm/376/520/716/a_image_thumb.png?1647113084)
Synovial fluid analysis in patients with pseudogout is characterized by […]-shaped crystals made of calcium pyrophosphate dihydrate, that are […]-birefringent.
Synovial fluid analysis in patients with pseudogout is characterized by rhomboid-shaped crystals made of calcium pyrophosphate dihydrate, that are weakly positively-birefringent
i.e. blue when lying parallel to polarized light.
![](https://s3.amazonaws.com/brainscape-prod/system/cm/376/520/777/a_image_thumb.png?1647113117)
Synovial fluid analysis in patients with pseudogout is characterized by rhomboid-shaped crystals made of […], that are weakly positively-birefringent.
Synovial fluid analysis in patients with pseudogout is characterized by rhomboid-shaped crystals made of calcium pyrophosphate dihydrate, that are weakly positively-birefringent.
i.e. blue when lying parallel to polarized light
![](https://s3.amazonaws.com/brainscape-prod/system/cm/376/520/836/a_image_thumb.png?1647113144)
Systemic sclerosis is often characterized by […] peristalsis and […] tone in the lower esophageal sphincter on manometry.
Systemic sclerosis is often characterized by decreased peristalsis and decreased tone in the lower esophageal sphincter on manometry.
due to atrophy/fibrosis of smooth muscle in the lower esophagus; decreased sphincter tone helps differentiate achalasia from SSc
![](https://s3.amazonaws.com/brainscape-prod/system/cm/376/520/879/a_image_thumb.png?1647113195)
Takayasu arteritis is associated with a […] pulse in the upper extremity.
Takayasu arteritis is associated with a weak or absent pulse in the upper extremity.
may be more pronounced in one extremity, resulting in pulse and/or blood pressure discrepancies
![](https://s3.amazonaws.com/brainscape-prod/system/cm/376/520/952/a_image_thumb.png?1647113226)
Takayasu arteritis may present with pain in the upper extremities that is […] with activity.
Takayasu arteritis may present with pain in the upper extremities that is worse with activity.
e.g. claudication; may be worse in one extremity than the other
![](https://s3.amazonaws.com/brainscape-prod/system/cm/376/520/986/a_image_thumb.png?1647113251)
Takayasu arteritis may present with pain in the […] extremities that is worse with activity.
Takayasu arteritis may present with pain in the upper extremities that is worse with activity.
e.g. claudication; may be worse in one extremity than the other
![](https://s3.amazonaws.com/brainscape-prod/system/cm/376/521/043/a_image_thumb.png?1647113283)
The initial management for patients with fibromyalgia includes a […], patient education, and good sleep hygeine.
The initial management for patients with fibromyalgia includes a regular exercise program, patient education, and good sleep hygeine.
medications (e.g. duloxetine, TCAs) are reserved for patients who fail initial measures
What antibodies are useful for confirming the diagnosis of Sjogren syndrome?
anti-SSA (Ro) or anti-SSB (La) antibodies
diagnosis requires evidence of dry mouth/eyes and evidence of the aforementioned antibodies or histologic evidence of lymphocytic sialoadenitis
![](https://s3.amazonaws.com/brainscape-prod/system/cm/376/521/134/a_image_thumb.png?1647113323)
What aortic complication is associated with giant cell (temporal) arteritis?
Aortic aneurysm
patients should be followed with serial chest X-rays
![](https://s3.amazonaws.com/brainscape-prod/system/cm/376/521/160/a_image_thumb.png?1647113342)
What arthritic disorder is associated with hematologic malignancies (e.g. polycythemia vera)?
Gout
due to increased cell turnover
![](https://s3.amazonaws.com/brainscape-prod/system/cm/376/521/186/a_image_thumb.png?1647113366)
What bladder complications are associated with long-term use of cyclophosphamide?
acute hemorrhagic cystitis and bladder carcinoma
increased fluid intake and MESNA are helpful in preventing complications
What demographic is classically affected by Takayasu arteritis?
young Asian females (< 40)
![](https://s3.amazonaws.com/brainscape-prod/system/cm/376/521/221/a_image_thumb.png?1647113416)
What imaging modality is initially used to diagnose ankylosing spondylitis?
X-ray (of sacroiliac joints)
classically shows narrowing of the sacroiliac joint space; another classic finding is fusion of vertebral bodies with ossification of intervertebral discs (bamboo spine)
![](https://s3.amazonaws.com/brainscape-prod/system/cm/376/521/287/a_image_thumb.png?1647113441)
What imaging modality is used to confirm the diagnosis of rotator cuff tear?
MRI
![](https://s3.amazonaws.com/brainscape-prod/system/cm/376/521/315/a_image_thumb.png?1647113458)