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3rd Year (Step 2) > Rheumatology 2 > Flashcards

Rheumatology 2 Flashcards

1
Q

Clinical keys to diagnosis of Rheumatoid Arthritis?

A

Morning stiffness of multiple small, inflamed joints

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2
Q

Specific lab dx test for Rheumatoid Arthritis?

A

Anti-Cyclic Citrullinated Protein (anti-CCP)

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3
Q

What is Sicca Syndrome? What’s it found in?

A

Dry eyes, mouth, & other mucous membrane

Found in Rheumatoid Arthritis

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4
Q

Rheumatoid Arthritis – type of anemia?

A

Normocytic

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5
Q

Rheumatoid Arthritis – Dx criteria?

A

Need 6 or more points:

  • Joint involvement (up to 5 points)
  • ESR or CRP (1 point)
  • Duration for longer than 6 wks (1 point)
  • RF or anti-CCP (1 point)
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6
Q

Rheumatoid Arthritis – most common cause of death?

A

Coronary Artery Disease

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7
Q

When do RA patients need Disease-Modifying Anti-Rheumatic Drugs (DMARDs)?

A

If Erosive disease is present. Includes:

  • Joint space narrowing
  • Physical deformity of joints
  • X-ray abnormalities

(NSAIDs & steroids great for Sx, but do NOT stop progression of RA. Stopping progression is most important issue, start w/ Methotrexate)

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8
Q

Methotrexate – AEs?

A
  • Liver toxicity
  • Bone Marrow suppression
  • Pulmonary toxicity
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9
Q

anti-TNF drugs?

A

Infliximab, Adalimumab, Etanercept

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10
Q

anti-TNF drugs – AEs?

A
  • Reactivation of TB (screen w/ PPD prior to use)

- Infection

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11
Q

Hydroxychloroquine – AEs?

A

Retina toxicity (do a dilated eye exam)

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12
Q

Sulfasalazine – AEs?

A
  • Rash

- Hemolysis

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13
Q

Rituximab – AEs?

A

Infection

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14
Q

Dx?

High, spiking fever (>104C) along w/ chest/abdomen rash in a young person w/ no identifiable cause

A

Juvenile Rheumatoid Arthritis – or “Adult Still Disease”

Rash: Often only w/ fever spikes, “salmon” colored, on chest & abdomen
Other features: Splenomegaly, Pericardial effusion, mild joint symptoms

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15
Q

JRA – Tx?

A
  1. NSAIDS
  2. Steroids
  3. TNF drugs
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16
Q

SLE symptom that’s present in 90% of cases?

A

Arthritis (often first symptom)

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17
Q

SLE – most specific lab finding?

A

anti-Smith antibodies

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18
Q

SLE – most specific lab findings in acute flare?

A
  • Complement levels drop

- anti-DS DNA levels rise

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19
Q

How to determine severity of lupus nephritis?

A

Kidney biopsy (used to decide Tx based on severity)

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20
Q

SLE – Most common cause of death?

A

Young patients = Infection

Older patients = MI (2/2 accelerated atherosclerosis)

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21
Q

SLE – Tx?

A
  • Steroids during flares
  • Hydroxychloroquine controls mildly chronic disease contained to skin & joints
  • Belimumab controls progression of diseae
22
Q

Antiphospholipid Syndrome – 2 main types of antibodies & their ass’d effects?

A

Lupus anticoagulant – elevated aPTT

Anticardiolipin antibodies – spontaneous abortion

23
Q

APL Syndrome – presentation?

A

Thromboses of both arteries & veins + spontaneous abortions

    • elevated aPTT w/ normal INR & PT
    • False positive VDRL or RPR (b/c reacts w/ cardiolipin)

(path = IgG or IgM antibodies against negatively charged phospholipids)

24
Q

APL Syndrome – best initial test? Most specific?

A

Best initial = Mixing study

Most specific = Russell Viper Venom Test (RVVT)

25
Q

Asymptomatic patient w/ APL Syndrome – Tx?

A

No Tx necessary

  • Treat thromboses w/ heparin & warfarin
26
Q

How to prevent recurrent spontaneous abortion in APL syndrome?

A

Heparin & Aspirin

note: Warfarin is a teratogen

27
Q

Scleroderma – Most specific test?

A

SCL-70 (anti-topoisomerase)

28
Q

CREST syndrome – most specific test?

A

Anticentromere antibodies

  • extremely specific
  • only ~50% sensitive
29
Q

Scleroderma – Tx?

A

Methotrexate – slows underlying disease process

Renal crisis -- ACE inhibitors
Esoph Dysmotility -- PPIs for GERD
Raynaud -- Ca-channel blockers
Pulmonary Fibrosis -- Cyclophosphamide
Pulmonary HTN -- Bosentan, Sildenafil, Prostacyclin analogs
30
Q

Most likely Dx?

Young woman 20s-40s w/ fibrosis of skin & internal organs such as lung, kidney, & GI tract

A

Scleroderma

31
Q

Dermatomyositis – presentation?

A

Proximal muscle weakness

  • Dysphagia
  • Shawl sign
  • Heliotrope rash
  • Gottron papule
32
Q

Dermatomyositis – Best initial test? Most accurate?

A

Best initial = CPK & Aldolase

Most accurate = Muscle biopsy

33
Q

ANA is frequently + in Dermatomyositis. What are anti-Jo antibodies ass’d w/?

A

Pulmonary Fibrosis

34
Q

Dermatomyositis – Tx?

A

Steroids

- if unresponsive/tolerant, use Methotrexate, Azathioprine, IVIG, or Mycophenolate

35
Q

Dermatomyositis – Tx of skin lesions?

A

Hydroxychloroquine

36
Q

Sjogren Syndrome – Best initial test? Most accurate?

Best initial test on blood?

A

Best initial = Schirmer test (piece of filter paper against eye looking for tears)

Most accurate = Lip or Parotid gland biopsy

Best initial on blood = SS-A & SS-B (“Ro” & “La”)

37
Q

Sjogren Syndrome – Tx?

A
  1. Water to mouth, sugar-free gum, & Fluoride
  2. Pilocarpine & Cevimeline to inc Acetylcholine
    (Cevimeline inc’s saliva production)
38
Q

All vasculitides give what 4 Sx?

A
  • Fever
  • Malaise/fatigue
  • Weight loss
  • Arthralgia/myalgia
39
Q

Polyarteritis Nodosa – presentation?

A
  • Disease of small & medium-sized arteries
  • Spares the lungs
  • Ass’d w/ Hep B & C
40
Q

PAN – Tx?

A

Prednisone & Cyclophosphamide

  • Treat hepatitis when found
41
Q

Polymyalgia Rheumatica – presentation?

A

Pain & stiffness in shoulder & pelvic girdle muscles

  • Difficulty combing hair & rising from chair
  • Elevated ESR (normal CK & aldolase)
  • Normochromic, normocytic anemia
42
Q

Polymyalgia Rheumatica – Tx?

A

Steroids, low-dose has rapid response

43
Q

Giant Cell Arteritis – Tx?

A

High-dose steroids ASAP (prevent blindness)

44
Q

Wegener’s – best initial test? Most accurate?

A

Best initial = C-ANCA (anti-proteinase 3)

Most accurate = Biopsy (Lung > renal > sinus)

45
Q

Wegener’s – Tx?

A

Prednisone & Cyclophosphamide

46
Q

Churg-Strauss Syndrome – presentation?

A

Pulmonary-Renal Syndrome w/:

  • Asthma
  • Eosinophilia

(Tx same as others Pred & Cyclophos, biopsy is most accurate test)

47
Q

Dx?

Biopsy shows “Leukocytoclastic vasculitis”

A

Henoch-Schonlein Purpura

usually clinical dx, but biopsy is most accurate test

48
Q

Cryoglobulinemia is ass’d w/ what?

A

Chronic Hep C infection

49
Q

Dx?

Middle Eastern person w/ painful oral & genital ulcers in assoc w/ erythema nodosum-like lesions of skin.

A

Behcet Syndrome

also w/:

  • Ocular lesions leading to uveitis & blindness
  • Arthritis
  • CNS lesions mimicking MS
50
Q

What is “Pathergy”? What Dx is it ass’d w/?

A

Pathergy = sterile skin pustules from minor trauma like a needle stick

Assoc’d w/ Behcet Syndrome

51
Q

What are the non-biologic Disease Modifying Agents?

A

Methotrexate, Hydroxychloroquine, Sulfasalazine, Leflunomide, Azathioprine

52
Q

What are the biologic Disease Modifying Agents?

A

Etanercept, Infliximab, Adalimumab, Tocilizumab, Rituximab

3rd Year (Step 2) (44 decks)

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