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3rd Year (Step 2) > Rheumatology > Flashcards

Rheumatology Flashcards

1
Q

3 mechanisms of under excretion that can cause Gout?

A
  • Renal insufficiency
  • Ketoacidosis or Lactic acidosis
  • Thiazides & aspirin
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2
Q

Lab tests in Osteoarthritis?

A

Normal

x-rays are where to find the pathology

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3
Q

OA - Tx?

A
  1. Weight loss & moderate exercise
  2. Acetaminophen

(NSAIDS are secondary to acetaminophen b/c of side effects – GI bleeding)

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4
Q

What to look for in Synovial fluid of Acute Gout attack?

A

Elevated:

  • Uric acid levels
  • ESR
  • WBCs
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5
Q

Gout – x-ray findings?

A

Normal in early disease, erosions of cortical bone appear later on

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6
Q

Gout – best initial Tx in acute attacks?

A
  1. NSAIDS
  2. Corticosteroid injection IF no response or contraindication to NSAIDS
  3. Colchicine (only if cannot use NSAIDs or Steroids)
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7
Q

Gout – chronic Tx?

A
  1. Lifestyle mods (no alc, weight loss, decrease high purine foods like meat & seafood)
  2. Stop Thiazides, aspirin, & niacin. Use Losartan for HTN
  3. Colchicine
  4. Allopurinol (dec’s prod of uric acid)
    - - Febuxostat if allopurinol is c/i’d (XO inhibitor)
  5. Pegloticase (dissolves uric acid)
  6. Probenecid & Sulfinpyrazone (increase excretion of uric acid in kidney – rarely used)
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8
Q

Safe drug used to treat Gout if pt has Renal injury?

A

Allopurinol

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9
Q

Allopurinol isn’t used for acute gout attacks.

If patient is already taking it, do you stop or continue its use during acute attacks?

A

Continue

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10
Q

Best drug to treat HTN in patient w/ Gout?

A

Losartan

lowers uric acid

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11
Q

Calcium Pyrophosphate Deposition Disease – most common risk factors?

A

Hemochromatosis & Hyperparathyroidism

also ass’d w/ Diabetes, Hypothyroidism, & Wilson Disease

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12
Q

Gout vs. CPPD – joints involved?

A

Gout – big toe MCP

CPPD – knee & wrist
also CPPD differs from OA in that DIP & PIP are not involved

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13
Q

CPPD – best diagnostic test?

A

Arthrocentesis – cannot confirm CPPD Dx w/out joint aspiration

(positively birefringent rhomboid-shaped crystals)

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14
Q

Joint disease Synovial fluid w/ < 200 WBCs?

A

DJD

also x-ray w/ osteophytes, joint space narrowing, subchondral calcification, & bone cysts

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15
Q

Joint disease w/ Synovial fluid WBCs btwn 2,000 - 5,000?

A
  • Gout (negatively birefringent crystals)
  • CPPD (positively birefringent crystals)
  • Rheumatoid arthritis (anti-cyclic citrullinated peptide)
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16
Q

Joint disease w/ Synovial fluid WBCs > 50,000?

A

Septic Arthritis

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17
Q

CPPD – best initial Tx?

A
  1. NSAIDS

2. Intraarticular steroids – Triamcinolone or Colchicine (only if NSAIDS aren’t effective)

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18
Q

CPPD – prophylactic Tx between attacks?

A

Colchicine

helps prevent subsequent attacks

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19
Q

Point tenderness at spine w/ percussion of vertebra is highly suggestive of what?

A

Cord compression

i.e. malignancy, epidural abscess

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20
Q

Epidural abscess – most common organism?

A

Staph aureus

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21
Q

Epidural abscess presentation vs. Cord compression from malignancy?

A

Same, except Epidural abscess has high fever & markedly elevated ESR

22
Q

How to exclude Sciatica (disc herniation) on diff. Dx?

A

Straight leg raise – above 60 degrees, causes pain going into buttock & BELOW the knee

  • 50% specificity & 95% sensitivity (helps RULE OUT sciatica)
23
Q

L4 – motor deficit, reflex affected, & sensory area affected?

A

M - Dorsiflexion of foot
R - Knee jerk
S - Inner calf

24
Q

L5 – motor deficit, reflex affected, & sensory area affected?

A

M - Dorsiflexion of toe
R - None
S - Inner forefoot

25
Q

S1 – motor deficit, reflex affected, & sensory area affected?

A

M - Eversion of foot
R - Ankle jerk
S - Outer foot

26
Q

Low back pain w/ positive SLR – is MRI indicated?

A

No MRI

only indicated if severe or progressive neuro deficits are described, such as paralysis, weakness, etc.

27
Q

Cancer w/ compression - best initial test?

Most accurate

A

Best initial = X-ray

Most accurate = MRI
CT if MRI contraindicated

28
Q

Ankylosing spondylitis – Best initial test? Most accurate?

A

Best initial = X-ray

Most accurate = MRI
CT if MRI contraindicated

29
Q

Cauda Equina Syndrome – Best initial test? Most accurate?

A

Best initial = X-ray

Most accurate = MRI
CT if MRI contraindicated

30
Q

Cord compression – Tx while waiting for MRI results?

A

Glucocorticoids (to relieve compression)

31
Q

Most likely Dx?

Back pain + pain/numbness of medial calf or foot

A

Disk herniation (Sciatica)

PE findings:

  • Loss of knee & ankle reflexes
  • Positive straight leg raise

(95% of disk herniations are at L4/L5 or L5/S1)

32
Q

Most likely Dx?

Back pain + Hx of cancer

A

Cord compression (malignancy)

PE findings: Vertebral tenderness, sensory level, hyperreflexia

33
Q

Most likely Dx?

Back pain + Fever & high ESR

A

Epidural abscess

PE Findings: Vertebral tenderness, sensory level, hyperreflexia

34
Q

Most likely Dx?

30 yr old patient w/ back pain that’s better w/ activity & worse w/ rest

A

Ankylosing Spondylitis (pt < 40yrs.)

PE findings: Decreased chest motility

35
Q

Most likely Dx?

Back pain + Bowel & bladder incontinence + Erectile dysfunction

A

Cauda Equina

PE Findings:

  • Bilateral leg weakness
  • Saddle area anesthesia
36
Q

Cord Compression – Tx?

A
  1. Systemic glucocorticoids
  2. Chemotherapy (for lymphoma) or Radiation (for solid tumors)
  3. Surgical decompression (if 1 & 2 are ineffective)
37
Q

Epidural Abscess – Tx?

Which condition has same Tx?

A
  1. Steroids to control acute neuro deficits
  2. Anti-Staph ABX (Vancomycin or Linezolid) given until sensitivity of organism is known
    - Β-lactam ABX more effective if sensitive-staph is found (Oxacillin, Nafcillin, Cefazolin)
    - add Gentamicin for synergy w/ Staph
  3. Surgical drainage for larger collections of fluid
38
Q

Cauda Equina – Tx?

A

Surgical Decompression

39
Q

Disk Herniation (Sciatica) – Tx?

A
  1. NSAIDs & continue normal daily activity
  2. Yoga/PT
  3. Steroid injection for rapid & dramatic benefit if 1 & 2 ineffective
  4. Surgery is rarely needed (only needed if focal neuro deficits develop or progress)
40
Q

Spinal cord compression – most important first step?

A

Steroids urgently to decrease pressure on cord (i.e. Dexamethasone) & prevent paralysis

41
Q

Lumbar Spinal Stenosis – back position that causes pain?

A

Extension (cord presses backward against ligamentum flavum)

42
Q

Spinal stenosis – vascular study results?

A

Normal

SS can simulate Peripheral Artery Disease, but this distinguishes them

43
Q

Lumbar Spinal Stenosis – Dx test?

A

MRI (only test)

44
Q

Lumbar Spinal Stenosis – Tx?

A
  1. Weight loss & pain meds (NSAIDs, Opiates, Aspirin) are first
  2. Steroid injections
  3. PT & exercise
  4. Surgical correction to dilate spinal canal is needed in 75% of patients
45
Q

Fibromyalgia – presentation?

A

Young woman chronic MSK pain & tenderness w/ trigger points of focal tenderness @ trapezius, medial fat pad of knee, & lateral epicondyle

46
Q

Fibromyalgia – Tx?

A

Best initial = Amitriptyline

Others:

  • Milnacipran (5HT/NE reuptake inhibitor)
  • Pregabalin
  • Trigger point injections w/ anesthetics
47
Q

Carpal Tunnel pain is worse when?

A

At night

also: sensory Sx occur before motor

48
Q

Carpal Tunnel – most accurate diagnostic test?

A

Electromyography & Nerve Conduction studies

49
Q

Carpal Tunnel – best initial Tx?

A
  1. Wrist splint to immobilize & NSAIDS
  2. Steroids
  3. Surgery (cut open flexor retinaculum to relieve pressure)
50
Q

What is Dupuytren Contracture?

A

Hyperplasia of Palmar Fascia leading to nodule formation & contracture of fourth

3rd Year (Step 2) (44 decks)

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