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Skin Muscle and Bone > SMB Week 4 > Flashcards

SMB Week 4 Flashcards

1
Q

Things to ask in a history for arthritic pain, in addition to LOCATES questions:

A
  • Swelling, heat, redness, trauma

- Morning stiffness

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2
Q

Sources of joint pain that are not “true arthritis”:

A
  • referred pain: visceral, neurologic
  • non-articular: muscle bone
  • periarticular: muscle, tendon, tenosynovium, bursa, enthuses, bursa, ligament
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3
Q

Signs of true arthritis:

A
  • swelling/tenderness of entire joint line
  • limited ROM in all directions
  • pain with AROM = PROM
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4
Q

Signs of periarticular pain:

A
  • swelling/tenderness in area around joint
  • limited ROM in some directions
  • pain with AROM > PROM
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5
Q

What factor reliably distinguishes inflammatory vs. non-inflammatory arthritis?

A

Synovial fluid analysis

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6
Q

What do you look for in a synovial fluid analysis?

A
  • volume/appearance/viscosity
  • cell count/differential
  • crystal examination
  • stains/cultures
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7
Q

WBC seen in inflammatory arthritis

A
  • Inflammatory:
    2000 - 75000/mL
    % PMN > 75%
  • Septic:
    > 50000/mL
    % PMN > 90%
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8
Q

Crystals in gout and pseudo gout :

A
  • Yellow “needles” parallel to polarization, blue needles perpendicular = GOUT
  • “rhomboid” blue crystals parallel to polarization, yellow perpendicular = PSEUDO GOUT
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9
Q

What is the most common spondyloarthritis?

A

Ankylosing spondylitis

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10
Q

Which joints are commonly affected in RA?

A
  • MCPs and PIPs

- DIPs not usually affected

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11
Q

Which joints are commonly affected in osteoarthritis of the hands?

A
  • DIPs and PIPs

- MCPs not usually affected

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12
Q

How sensitive and specific is an RF test for RA?

A
  • sensitivity 70 - 85%

- specificity 48 - 92%

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13
Q

“Bamboo spine”

A
  • Ossification of outer fibrous ring of intervertebral disks, seen in severe cases of ankylosing spondylitis
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14
Q

Radiographic findings with advanced gout:

A
  • extra-articular erosions
  • sclerosis
  • “overhanging edge”
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15
Q

Rheumatoid factor:

A
  • Antibody against the Fc portion of IgG antibodies.

- RF/IgG complexes lead to disease

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16
Q

True or false: both rheumatic and non-rheumatic diseases (other than RA) can cause a positive RF test

A

True: numerous infections and non-rheumatic diseases, as well as SLE, Sjogrens and other connective tissue diseases can cause a + RF test.

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17
Q

True or false: a + ANA test is specific to SLE

A

False: although 99% of SLE pts will have a + ANA, many other rheumatic and non-rheumatic diseases will cause it (i.e., it’s sensitive but not specific).

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18
Q

Two tests used with ANA to rule in SLE:

A
  • anti-ds DNA

- anti-Sm

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19
Q

What is HLAB27 used for?

A

Used to help rule out ankylosing spondylitis

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20
Q

How sensitive is the HLAB27 test?

A

95%

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21
Q

True or false: SLE occurs more commonly in Caucasians than in Blacks, hispanics and asians.

A

False

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22
Q

Mnemonic for clinical features of lupus:

A

MD SOAP BRAIN

Malar rash, Discoid rash, Serositis, Oral ulcers, Arthritis, Photosensitivity, Blood Dyscrasias, Renal, ANA +, Immunologic, Neurologic

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23
Q

Musculoskeletal manifestations of SLE:

A
  • Polyarthralgias/polyarthritis
  • Soft tissue pain
  • Myositis
  • Osteonecrosis
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24
Q

What % of SLE patients have renal involvement?

A
  • 100% on biopsy

- 50-65% clinically

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25
Q

Manifestations of SLE serositis:

A
  • Pericarditis
  • Pleurisy, effusions
  • Peritonitis
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26
Q

Which antibody is seen in almost 100% of patients with drug-induced lupus?

A

Anti-histone antibody

27
Q

What are the 3 phases of scleroderma?

A
  • Inflammatory edematous phase (few months: non-pitting edema, mistaken for RA)
  • Fibrotic phase (few years: tightening/thickening/salt & pepper skin, lower oil, sweat production)
  • Atrophic phase (skin thinning, contractures)
28
Q

Leading cause of death in scleroderma:

A

Pulmonary hypertension

29
Q

GI Sx in scleroderma:

A
  • esophageal hypomotility (reflux, dysphagia)
  • bloating, diarrhea & constipation
  • malabsorption, weight loss
  • GI bleed due to telangiectasias
30
Q

Another name for GAVE (gastric antral vascular ectasia):

A

Watermelon stomach

31
Q

Treatment for renal disease in scleroderma:

A

ACE inhibitors

32
Q

Tx for pulmonary hypertension in patients with scleroderma:

A
  • Parenteral epoprostanol
  • Bosanten
  • Iloprost
  • Sildenafil
33
Q

CREST Syndrome in scleroderma:

A 
C: calcinosis
R: Raynaud's phenomenon
E: Esophageal dysmotility
S: Sclerodactyly
T: Telangiectasias
34
Q

Sjogren’s syndrome:

A
  • Inflammatory d/o of the exocrine glands
  • Lymphocytic infiltration of salivary and lacrimal glands
  • progressive glandular destruction
35
Q

Antibodies seen in Sjogren’s syndrome:

A

SSA and SSB

36
Q

Acute vs. chronic arthritis:

A
37
Q

Mono vs. oligo vs. polyarthritis:

A
  • Mono = 1 joint
  • Oligo = 2 - 4 joints
  • Poly = > 4 joints
38
Q

Polymyalgia rheumatica:

A
  • Proximal muscles (shoulders, hips, neck, thighs)
  • fever, weight loss, malaise
  • profound morning stiffness
  • almost exclusively in whites > 50
  • ESR > 50 mm/hr.
39
Q

Treatment for polymyalgia rheumatica:

A
  • Prednisone 7.5 - 20 mg/day
  • Start low, increase dose until Sx controlled, then maintain 2 - 4 weeks
  • Reduce dose 10% q 2 - 4 weeks
  • Once below 10 mg/day, reduce max 1%/month
  • May use MTX as well
40
Q

What serologic test is used for vasculitis, especially small vessel vasculitis?

A

ANCA

41
Q

Clinical features suggesting vasculitis:

A

General:

  • multiple organ dysfunction
  • constitutional Sx
  • high ESR
  • Ischemia

Organ Specific:

  • Rapidly progressing organ dysfunction
  • Skin: palpable purpura/hemorrhage
  • Neurologic change: foot drop, mono neuritis multiplex
  • ENT/lung: chronic inflammation
42
Q

Manifestations of AAV:

A
  • constitutional Sx
  • migratory arthritis/arthralgia
  • GI: bowel infarction, bleeding, perforation
  • skin: leukocytoclastic vasculitis et al.
  • neurologic: mononeuritis multiplex
  • glomulonephritis
  • granulomatous inflammation of respiratory tract
  • ocular Sx
43
Q

Mononeuritis multiplex:

A

Loss of both sensory and motor function in a major nerve/plexus/root.

44
Q

Tests suggesting immune complex formation/deposition:

A
  • RF
  • ANA
  • Low C3, C4
45
Q

Tests suggesting vasculitis without immune complex deposition:

A

ANCA

  • c-ANCA: Granulomatosis with polyangitis, AKA Wegener’s
  • p-ANCA: Churg-Strauss and microscopic polyangitis
46
Q

Tests suggesting systemic inflammation:

A
  • CRP

- ESR

47
Q

True or false: most patients with clinical signs and symptoms of vasculitis DO NOT have vasculitis

A

True: vasculitis is rare

48
Q

Red flags suggesting vasculitis mimics:

A
  • heart murmur
  • lower extremity digit necrosis
  • splinter hemorrhages
  • liver dysfunction
  • sexual activity/drug use
  • high fevers
  • prior cancer Hx
49
Q

Viral infections that mimic rheumatic and vasculitic syndromes:

A
  • HCV: cryoglobulinemia
  • HBV: polyarteritis nodosa
  • HIV: seronegative rheumatic syndromes
50
Q

Drugs that can cause hyperuricemia:

A
  • Thiazide diuretics
  • Ethambutol (TB)
  • Nicotinic acid (niacin)
  • alcohol
  • others (salicylates, cyclosporines, et al.)
51
Q

Clinical diagnosis of gout:

A

Combination of crystals, tophi and/or 6 or more criteria.

52
Q

1st line treatment for gout:

A
  • NSAIDS
  • Systemic corticosteroids
  • Colchicine
53
Q

When is colchicine the 1st line Tx for gout?

A
  • Onset no greater than 36 hours prior to treatment

- Unable to take NSAIDS

54
Q

MOA for colchicine:

A
  • decreases leukocytes mobility

- reduces deposition of uric acid crystals

55
Q

Side effects of colchicine:

A
  • NVD very common (50 - 80%)
  • bone marrow toxicity
  • contraindicated in patients with: hepatobiliary dysfunction, hemodialysis, blood dyscrasias
56
Q

Drug interactions with colchicine:

A
  • CYP3A4 inhibitors
  • clarithromycin
  • cyclosporine
  • statins
  • others
57
Q

Which combination treatment should you NOT use for gout?

A

NSAIDS + systemic corticosteroids

58
Q

1st line treatment for prophylaxis of gout:

A

allopurinol

59
Q

MOA of allopurinol:

A
  • xanthine oxidase inhibitor

- blocks last 2 steps of uric acid synthesis

60
Q

Axial vs. peripheral spondyloarthritis

A

Axial:
- predominantly involves the spine +/- peripheral joints
Peripheral:
- predominantly involves the peripheral large joints

61
Q

5 diseases of spondyloarthritis:

A
  • ankylosing spondylitis (spine is a must, often peripheral as well)
  • psoriatic arthritis (mostly peripheral)
  • reactive arthritis (mostly peripheral)
  • IBD related arthritis (mostly peripheral)
  • uveitis related arthritis (mostly peripheral)
62
Q

Spondyloarthritis is defined by the inflammation of which joints?

A

Sacroiliac

63
Q

What is the hallmark of spondyloarthritis?

A

Enthesitis/tendinitis

64
Q

What is radionuclide scintigraphy used for?

A
  • Detecting inflammatory or metabolic alterations in bone or periarticular soft tissue structures.
  • Works by using radioactive molecules, which are preferentially taken up by certain inflammatory or pathological cells.

Skin Muscle and Bone (7 decks)

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