rheumatology UWorld Flashcards
pt with facial swelling, bilateral extremity edema, proteinuria, recurrent bronchiectasis, psoriasis
dx?
amyloidosis
dx confirmed by amyloid on abdominal fat pad biopsy
congo red amorphous hyaline material
painful oral aphthous ulcers, uveitis, hyper pigmented skin lesions and tender indurated areas on legs
dx?
Behcets
painless, nonpruritic non-blanching purple lesions on legs, progressive fatigue, joint pain in knees and elbows.
elevated LFT’s, low C3 and C4, RH factor +, UA 3+ blood and protein
what to do next?
dx?
obtain viral hepatitis serology
mixed cryoglobulinemia
immunoglobulins that precipitate at <37C
d/t hepatitis or igA vasculitis(if not hep c) or SLE, hep b, HIV
72F headaches, fatigue, muscle stiffness, tender cord palpated in right temporal area
dx?
complication?
giant cell arteritis (temporal arteritis)
aortic aneurysm, anterior ischemic optic neuropathy (vision loss)
polymyalgia rheumatica – morning stiffness shoulders/hips
38F swelling/pain b/l hands
xray shows: joint space narrowing, chonedrocalcinosis, osteophyte formation at metacarpal heads
dx?
tx?
arthropathy of hereditary hemochromatosis
phlebotomy
arthritis with chondrocalcinosis
pseodogout – should be screened for hemochromatosis
sacroilitis - lower back butt pain improves with activity, and diarrhea
inflammatory bowel disease
SLE + Scleroderma + Rheumatoid Arthritis + polymyositis
Mixed connective tissue disease
anti-U1RNP
tx: glucocorticoids and methotrexate
78F with pain stiffness in shoulders and hips, rapid response with oral glucocorticoids
polymalgia rheumatica
muscle weakness, erythematous patches and violaceous papules involving the dorsal of the fingers
muscle fiber injury (immune mediated)
Dermatomyositis – myositis specific antibodies anti-Jo1
gottron sign - fingers or heliotrope eruption - upper eyelids
dermatomyositis (cd4 mediated) vs polymyositis (cd8)
difficulty rising from seating position and climbing stairs, erythematous rash on chest with violaceous periorbital edema, symmetrical proximal muscle weakness in legs
increased risk for?
malignancy – adenocarcinomas
dermatomyositis
anti-Mi2 ( helicase
anti- Jo-1 (anti-synthetase antibody mostly in polymyositis)
polymyositis dx:
muscle biopsy : endomysial infiltrate patchy necrosis
sausage digits and nail pitting
psoriatic arthritis
rheumatoid arthritis managment
methotrexate adverse effect
hepatotoxicity
oral ulcers/ stomatitis
hydroxychloroquine adverse effect
retinopathy
**check eyes yearly
first test to order with SLE
anti-Nuclear Antibody ANA
arthralgia, fever, pleuritic chest pain, pleural rub and pt takes hydralazine
drug-induced lupus
multiple tender reddish nodules below the knee, and pain in ankles, next best step?
sarcoidosis
erythema nodosum
do a Chest xray
83F with dry eyes sensation of dust ors add in eyes
age related dry eye syndrome – exocrine gland atrophy
difficulty swallowing foods, dry mouth, dry eyes, prominent dental caries, b/l firm submandibular nodules
what is needed to confirm dx?
sjorgen syndrome
antibodies to Ro/SSA and La/SSB
esophageal dysmotility, fibrotic lung disease, arthralgia
dx
d/t
systemic sclerosis
smooth muscle atrophy and fibrosis
systemic sclerosis now with lung findings
interstitial lung disease
Takayasu dx
CT-A or MR-A : thickening of large artery walls and narrowing of arterial lumen
mononuclear infiltrates and granulomatous inflammation of the vascular media, leading to arterial wall thickening with stenosis, occlusion, or aneyrsmal dilation
sacroilitis, tenderness at heals, limited spine mobility, swelling of fingers and toes, uveitis
dx?
ankylosing spondylitis
23F low back pain and stiffness, better with physical activity
next best step?
xray of sacroiliac joint : fusion vertebral bodies with ossification of intervertebral discs (bamboo spine)
ankylosing spondylitis
25M with ankylosing spondylitis, no longer relieved with naproxen
what next?
TNF-alpha inhibitors (etanercerpt, infliximab)
Anti-IL-17 antibodies (secukinumab)
ankylosing spondylitis – 42M back pain s/p fall, tenderness over upper lumbar region
d/t ?
complications associated with AS?
vertebral fracture
osteoporosis
aortic regurgitation
hyperkyphosis
sexually active with multiple partners, purulent arthritis at wrist
next step?
NAAT testing
tx: 3rd gen cephalosporin
migratory polyarthralgia, sexually active, pain with active and passive range of motion of the left wrist, right elbow, right ankle
TRIAD:
tensonyvoitis : pain along tendon sheaths – pain with passive motion
dermatitis : pustular vesiculopustular lesions on distal extremities that look like pimples/furuncles
migratory polyarthralgia
tophacious gout
negatively birefringent – gout monosodium rate crystals
severe pain in right big toe aspiration shows negative birefringent crystals, also has headaches with pruritic after hot bath,
what is cause?
myeloproliferative disorder
polycythemia vera – prurititis with hot shower
increases uric acid production
65F with worsening right knee pain, obese, knee exam shows tenderness over medial tibial condyle and small joint effusion, range of motion of knee elicits bony crepitus
what is it ?
osteoarthritis
tenderness at palmar and dorsal aspect of thumb, associated with hard enlargement at carp metacarpal junction
mild to moderate pain worse when working with hand tools in garden
osteoarthritis
worse when working with hand tools or opening food jars
tx?
topical NSAIDS diclofenac
osteoarthritis risk factor:
prior joint trauma or injury or surgery
55F with joint pains in both hands, works at day care center
right knee pain, with rhomboid shaped crystals
what is associated with this ?
meniscal calcification – chondrocalcinosis
pseudo gout
31M two months ago had urethral discharge and treated, now has stolen right knee, tender and warm to touch, tenderness over Achilles tendon and sacroiliac joint, mouth ulcers
tx?
reactive arthritis
tx: NSAIDs (antibiotics won’t tx arthritis sxms)
