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Rhumatology > R2 > Flashcards

R2 Flashcards

1
Q

dermatomyositis myopathy?

A

Proximal myopathy
UE=LE
Elevated CK >10x
Elevated LDH

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2
Q

Skin finding in DM?

A

1-Gottron papules: flat-topped, erythematous to violaceous papules and plaques found over bony prominences, particularly the MPJ,PIP and DIP
2- Photo distributed facial erythema
3-heliotrope [violaceous] edema of the eyelids
4–darkening and thickening of fingertips and sides resulting in irregular, “dirty”-appearing marks.

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3
Q

Extramuscular finding?

A

ILD
Dysphagia
Myocarditis

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4
Q

Diagnosis?

A

Nonspecific: ⊕ ANA, 
Specific: ⊕ anti-Jo-1 (histidyl-tRNA synthetase), ⊕ anti-SRP (signal recognition particle), ⊕ anti-Mi-2 (helicase).
EMG?Biopsy in uncertain condition

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5
Q

TX?

A

High dose GC and GC sparing agent

Screen for malignanacy

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6
Q

Joint inflamation cause differentiation?

A

BSE
Apearance
WBC
PMN

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7
Q

Apearance?

A

Normal and Non Inf.(OA)–Clear
Inflam(Ra,Crystal.)–Translucent/opaque
Septic:Opaque

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8
Q

WBC?

A

N:<200
NI:200-2000
I:2000-100,000
S:50,000-150,000

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9
Q

PMN:

A

N:<25%
Ni-25%
I>50%
S>80-90%

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10
Q

OA x-ray feauture?

A

Narowing of joint space
Joint space osteophyte
subchondral sclrosis/cyst

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11
Q

Complication of temporal artheritis?

A

Proximal myophaty
Acute visual loss
Aortic anurythm

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12
Q

Pain CXS in Carpal tunell syndrome?

A

Pain along latteral 3 fingers
not relieved by rest
shaking may inprove it
rep.hand movt can exacerbate it

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13
Q

diagosis?

A

Tinel test
Phalen test
Nerve conduction test if above non conclusive

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14
Q

Drug induced lupus CM?

A

Cons.Sx(fever,myalase)
Artheralgia
Serositis(pluritis,pericarditis)
les rash

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15
Q

Risk?

A

High dose
Prolonged use
slow acetytlator

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16
Q

LAB?

A

Antihistone

ANA

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17
Q

MC implicated drugs?

A 
Procainamide
Penicillamine
Hydralazine
TNF inhibitors
Minocycline 
Isoniazid
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18
Q

Managment?

A

stope causative drug

NSAID

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19
Q

IBD and arthritis?

A 
Occur in 45% of patients
Spondyloarthritis feature
MC sacroiliac but rare knee involvement
Using NSAID may worse diarrhea
Sulfasalazine treat both
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20
Q

Achilles tendinophaty cause?

A

Floroquinolol

Age >60,Femmale,CS use and organ transplant

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21
Q

Managment

A

stop drug
avoid exercise use that tendon
if continue use–can cause tendone rapture

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22
Q

Complex regional pain syndrome?

A 
sever/burning/regional(not dermatomal pain)
allodynia
edema and abnormal sweating
vasomotor change:alterd Temprature
tropic skin, nail, and hair change
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23
Q

Triggers?

A

Trauma
#
Sprain
Surgery

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24
Q

Diagnosis?

A

Primary clinical
X-Ray–patchy demineralization
Bone scintigraphy: Increase uptake in the affected limb

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25
Q

Managment?

A

Physical and occupational therapy
exercise
NSAID
TCA/Pregabaline

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26
Q

Polymyositis CM?

A

Similar to dermatomyositis w/o skin finding
Pharyngeal muscle involvement can lead to dysphagia
Endomysial infn.unlike dermatomyositis (periimycial)

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27
Q

Mixed CT disease triads?

A

SLE
Systemic sclerosis
Polymyositis

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28
Q

Lab finding?

A 
Anti-U1 ribonucleoprotein
ANA
RF,anti-CCP
Elevated CK
Anemia/Cytopinia
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29
Q

Lumbosacral strain cause?

A

The strain of paraspinal tendon, muscle, and IV ligament
Sudden unbalanced muscle contraction
RF:Obesity,S.deformity/degeneration,muscle weakness

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30
Q

CM?

A

Back pain that may radiate to thighs, hip, or buttock
Paraspinal tenderness
No neurologic deficit and negative straight leg test

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31
Q

managment?

A

M.activity
NSAID
Non benzodiazepine muscle relaxant

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32
Q

wrist splinting used for?

A

carpal tunnel syndrome

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33
Q

Diabetic foot deformity Pathogenesis?

A

Atrophy of intrinsic foot muscle
Nerve degeneration
Dec.Pain and Prop.
Concurrent orthopedic and vasculr formation

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34
Q

Manifestation?

A

Hammertoe(MTJ dorsiflexed, PITJ plantarflexed, and DIT joint dorsiflexion).
Clawfoot (Dorsiflexion at MTJ and plantar flexion at P & DIJ.

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35
Q

Psoriatic arthritis clinical features?

A

Asymmetric oligoartherophaty
DIP involvement
Symmetric arthropathy
Arthritis mutilans (deforming and destructive arthritis)
Spondyloartherophaty(sacroiliitis and spondylitis)

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36
Q

Soft tissue and nail involvement?

A

Ententhitis
Dactylitis
Onychomycosis
Swelling of hand and feet(pitting)

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37
Q

Skin finding?

A

Absent in 15%

Can be preceded by arthritis

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38
Q

Managment?

A

NSAID
Methotrexate
TNF alpha inhibitor

39
Q

Etiology for avascular necrosis?

A 
Steroid
Alcohol
SLE
Anti-Phospholipid syndrome
Hemoglinophaty(SCD)
Infection(osteomyelitis,HIV)
Renal transplantation
Decompression sickness
40
Q

CM?

A

Groin pain on standing
Pain on abduction and IR
No erythema,tendernes,s or swelling

41
Q

Lab?

A

Normal ESR and CRP

Normal WBC

42
Q

Radiographic sign?

A 
Cresent sign(subchondral) and deformity in X-Ray
MRI is most sensitive--determine zone of ischemia
43
Q

Cause of gout?

A 
Increase production(Primary,MPD,TLS and HGPRT deficiency)
Decreae clerance(Renal disease,Tiazide diuretic)
44
Q

Exocrine feature of Sjogren syndrome?

A

Keratoconjunctivitis sicca
Dry mouth
Xerosis
Salivary hypertrophy

45
Q

Extragladular feature?

A 
Raynaud's phenomena
Cutaneous vasculitis
arteritis/arthralgia
ILD
NHL
46
Q

Diagnosis?

A

Schirmer test (Dec.lacrimation)
anti-ro(SSA) and Anti-La(SSB)
Focal lymphocytic siaalinoadinitis in SG biopsy

47
Q

Disease-associated with psoriasis?

A

ILD
Raynauds
Esophagial dysmotility

48
Q

D/T gonococcal from non-gonococcal septic arthritis?

A

GA: Usually in young sexually active/may be migratory
NGA: Usually one joint inv. and non-migratory, occur patient with risk for SA

49
Q

DMARD used in patients with CNS or renal disease?

A

Cyclophosphamide

50
Q

S/E?

A

Hemorrhagic cystitis
Bladder Ca
Sterility
Myelosuppression

51
Q

Fibromyalgia?

A 
Widespread pain
Tenderness at the trigger point
Impaired concentration
Normal Lab.
Pain exacerbated by vigrous exercise
52
Q

Cause of lumbar spinal stenosis?

A

Osteoarthritis
Spondylosis
Degenerative disk disease
Thickening of ligamentum flavum

53
Q

CM?

A 
Back pain
Exacerbated by a back extension(walking)
Relived by leaning forward
LE tingling and numbness
LE weakness
54
Q

What triads are associated with female stress #?

A

Oligomenorrhea
low-calorie intake(low BMI)
Osteoporosis

55
Q

CM of stress #

A

Forefoot pain
Localized pain to surface of bone usually 2nd,3rd & 4th MT
Area palpation increase pain
Common in athletes
A sudden increase in exercise intensity increases the risk

56
Q

Forefoot pain other cause?

A 
Arthritis(MT-P joint tenderness)
Bursitis--Tenderness b/n metatarsal head(the poor fitting shoe is a risk)
Morton Neuroma(Pain in 3rd and 4th  toe), clicking sensation while palpating the space and simultaneous MTP joint squeezing)
57
Q

MTX toxicity?

A 
Cytopinia
Hepatitis
Stomatitis
Fever
Alopecia
ILD
Rash
58
Q

CNS Sx of SLE?

A 
Cognitive dysfunction 
Seizure
TE disease(IS,TIA)
Transverse mylitis
Vasculitis
59
Q

DEXA scan score interpration?

A

1) -1 and above — normal once over 50.
2) -1 and -2.5 —-osteopenia
3) lower than -2.5 —- osteoporosis.

60
Q

Osteoporosis risk factor?

A

Age > 65
Menopausal status
Smoking history
Family history

61
Q

Managment of osteoporosis?

A

Weight-bearing exercise
Alcohol and smoking sesassion
Adequate Ca And Vit D intake(supplemental)
Drugs

62
Q

Drug indication?

A

indication

1) -1 and -2.5 (osteopenia) with high ostoporetic # risk
2) TS, lower than -2.5
3) Osteoporetic #

63
Q

1st line drug and C/I?

A

first-line are Biposphonate (alendronate, risedronate)
Not recommended in RF patient
Prolonged use is a risk for atypical #

64
Q

alternative?

A

Denozimab
Anabolic agent(teripartide)
Nasal calcitonin
SERM(raloxifine)

65
Q

Unexplained only elevated ALP in an asymptomatic old patient?

A

Paget disease

66
Q

Viral arteritis feature?

A 
Polyarticular
symmetric
Wrist, hand, knee, and foot inv.
Usually self-limited resolve with 1-2 month
commonly due to parvovirus
Tx with NSAID
67
Q

Screening for bladder ca?

A

Not recommended b/c
No sensitive test
False survival prediction

68
Q

Scleroderma renal crisis pathophysiology?

A

Collagen deposition in renal vessel–RAAS activation

69
Q

CM?

A 
Hypertensive emergency
Renal failure
Maybe early symptom
Proteinuria(MC:normal )
Thrombocytopenia
Microangiphatic HA
Manage with ACE inhibitor irrespective of RFT(captopril more preferd due to rapid onset)
70
Q

The first test to do in SLE suspects?

A

ANA

71
Q

scleroderma Ab?

A

Anti topoisomerase—diffuse

Anti centromere–loccalize

72
Q

Morton neuroma?

A

Misnomer
Due to interdigital nerve injury
Common in athletes
Diagnose clinically by (Mulder sign)–lateral compression of 3rd and 4th MT then touching middle case reproduce pain)
For foot pain may radiate to the plantar surface
The pain worsened by walking hard surface, high heel, and tight shoo.

73
Q

Managment?

A

Make pad/slap in the metatarsal head

Surgery for failed conservative Tx

74
Q

Drug cause complication in scleroderma?

A

BB_increase Rynauds risk

CS–Increase SRC risk

75
Q

Plantar fasciitis?

A

pain in plantar area of rearfoot
pin worse in the morning then decrease after first activity and worsen back at end of day
Point tenderness at the plantar heel area

76
Q

DEXA scan indication?

A

women Age >65

Age < 65 with ostoporesis equivalent risk(FRAX calculation)

77
Q

Non BZD muscle relaxant usage?

A

Acute back pain due to benign cause I.e muscle strain does not respond to NSAID
Cyclopenzaprine and tinazidine(may have anti cholinergic S/E)

78
Q

an avascular disease that can cause asymmetric UE claudcation?

A

Takayasu arteritis

79
Q

Toxicity of hydroxychloroquine?

A

Retinal toxicity
Irreversible blindness
Commonly occur after 5-7 years of there[y
Anual and baseline test

80
Q

Factor decrease gout?

A

Dairy product
High Vit C level
Increase coffee intake

81
Q

Acute gout attack onset?

A

Develop to high-intensity pain within 12-24 Hr

82
Q

A drug used for gout that can cause rhabdomyolysis

A

Cholchicine

83
Q

A chronic complication of Enthesitis?

A

Fibrosis
calcification
End up in the difficulty of joint movt

84
Q

Initial managment of fibromyalgia?

A

Pt education(about its benign and good prognosis)
Exercise(aerobic, stretching, and strength training)
Sleep hygiene

85
Q

Behcet syndrome CM?

A 
Young adult
Recurrent painful oral ulcer
Genital Ulcer
Eye lesion(uveitis)
Skin (erythema nodusum,achneiform lesion)
Thrombosis
86
Q

Evaluation of BS?

A

Pathergy

Non-specific vasculitis in d/t vessel

87
Q

A complication of AS?

A 
Osteoporosis/osteopenia
Vertebral #
AR
Cauda equina
Kyphosis
Extrinsic restrictive lung disease
88
Q

ANA and systemic sclerosis?

A

almost all patients will have positive result

89
Q

MRI indication in Lumbosacral radiculopathy?

A

sever/progressive bilateral neuropathy
Malignancy sucpection
Epidural abscess sucpection

90
Q

pesanserinous pain syndrome?

A

due to bursa of pesanserinous tendons(formed by conjoint tendons of sartorius,grasilious and semitendinosus)
Not have thru bursitis

91
Q

CM?

A

Localize pain on AM tibia
No inflammation sign
Minimal tenderness on medial tibia

92
Q

Managment?

A

X-ray to r/o other cause
NSAID
Quadriceps strengthening exercise

93
Q

What about patellofemoral syndrome?

A

pain occurs in the medial tibia

Rhumatology (4 decks)

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