Rheumatology Flashcards
1
Q
- affects sacroiliac joints eventually causing fusion of the spine
- teen with night pain and morning stiffness relieved by exercise
- pain of large joints, leg and back pain when bending over
- low grade fevers and wt loss, uveitis, IBD
- Dx: HLA B27 + 90%, Xray bamboo spine
- ANA and FR are nml, mildly incr ESR
- Tx: NSAIDs, ASA, MTX
A
Ankylosing Spondylitis
2
Q
- aphthous stomatitis, genital ulcers, uveitis, GI ulcers, arthritis, DVTs
- ESR and CRP elevated
- Tx: systemic steroids
A
Bechet Disease
3
Q
- school aged child with heliotrope rash on the face (violaceous discoloration of the malar region)
- tight shiny skin on the extensor surfaces, interphalagenal joints (Gottron papules)
- hair loss, periungual lesions (nail fold telangectasias)
- can affect esophagus and lungs
- difficulty getting dressed, clumsy, difficulty climbing steps, voice change, difficulty swallowing
- Dx: CK
- Tx: high dose steroids, MTX, IVIG, antimalarials
- avoid sunlight and use sunscreen
A
Dermatomyositis
4
Q
- skin that stretches and hypermobile joints, poor wound healing
- easy bruisability
- normal life expectancy
A
Ehlers-Danlos Syndrome
5
Q
- hypermobile joints
- blindness, MR, hypotonia
A
Lowes Syndrome
6
Q
- generalized vasculitis of the skin, joints, GI, and kidneys
- antecedent viral or bacterial infx
- palpable purpura on the LE and butt, colicky abd pain, heme positive stools, hematuria, proteinuria
- intusussception (ileoileal)
- periarticular (pain of the soft tissues around the knees and ankles)
- nl plts
- supportive care
A
HSP
7
Q
- onset earlier than 16yo
- sx for at least 6 weeks in at least one joint
- morning stiffness, gradual loss of motion, and a rash
- large joint involvement more common
- more common in girls
- ANA is often positive
- RF only helpful in distinguishing the subtypes
- Tx: NSAIDs, steroids, immunosuppressants
- steroids if cardiac involvement
A
Juvenile Rheumatoid Arthritis
8
Q
- 5 or more joints are affected
- MC in females
- some extraarticular involvement
- older patients will be RF+
- RF+ are more serious
- younger pts tend to be ANA+ and have milder dz
A
Polyarthritis JRA
9
Q
- 4 or fewer joints are affected
- ANA + in young females
- bad chronic uveitis
- RF usually neg, if +, dz is worse
- boys are usually HLA B27+ (good prognosis)
A
Oligoarthritis JRA
10
Q
- AKA Still Disease
- extraarticular involvement is common
- moderately good prognosis
- high fevers with chills
- leukocytosis (30-50K)
- Rash: sm pale red macules with central clearing which coalesce
- HSM
- LAD
- pleuritis/pericarditis
- rarely uveitis
- ANA and RF are usually negative
A
Systemic JRA
11
Q
- 18-24 mo old with 5 days of fever
- cervical LAD
- dry/fissured lips or swollen tongue
- conjunctivitis
- polymorphous exanthem
- desquamation of the hands and feet
- sterile pyuria
- CNS Sx such as Seizures and septic meningitis
- thrombocytosis by D5
- leukocytosis by D12
- normocytic anemia
- CRP, ESR remain high for 4-6wks
- echo at time of Dx, 2-3wks, and 6-8wks
- Tx: IVIG, aspirin 80mg/kg/day for 1-2 days, then 5mg/kg/day for 2 mo
- monitor for coronary artery disease
A
Kawasaki Disease
12
Q
- borellia burgdorfei
- ixodes deer tick
- bullseye rash (erythema chronicum migrans) 75%
- flu-like symptoms, arthraligia, fatigue
- Carditis, Arthritis (pauciarticular, large joints), and CNS signs (Bells palsy)
- serum Ab undetectable until 4-6wks
- Dx: lyme Ab titer then a Western Blot to confirm
- false positives with SLE, DM, rickettsia
- Tx: Doxy x30d
A
Lyme Disease
13
Q
- child treated for Lyme Disease who develops chills, fevers, hypotension, with s sepsis like picture
- lysis of organism releases endotoxin
A
Jarisch-Herxheimer Reaction
14
Q
- Autosomal dominant connective tissue disorder
- tall stature, high arched palate, dental crowding, hyperextensible joints, pectus excavatum
- aortic or mitral valve insufficiency, spontaneous pneumothorax, aortic rupture
- ectopic lentis, anterior displacement of the eye-> serial slit lamp evals
A
Marfan Syndrome
15
Q
- non-specific arthritis several weeks after a viral or bacterial infx (Salmonella, Yersinia, Camphylobacter)
- can be post-live vaccination
- self-limited
- supportive care and analgesics
A
Post Infectious Arthritis
