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Internal medicine > Rheumatology > Flashcards

Rheumatology Flashcards

0
Q

Fibromyalgia treatment

A

Best initial- amitryptyline
Other treatments- milnacipran (serotonin and norepinephrine uptake
inhibitor), pregabalin

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1
Q

Fibromyalgia diagnosis

A

Clinical

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2
Q

Causes of carpal tunnel syndrome

A 
Pregnancy
Diabetes
RA
Acromegaly
Amyloidosis
Hypothyroidism
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3
Q

Nerve involved in carpal tunnel syndrome

A

Most commonly median nerve

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4
Q

Diagnosis of carpal tunnel syndrome

A

Mostly clinical to confirm
-Tinel sign: pain with tapping of median nerve
-Phalen sign: pain with flex ion of wrist to 90 degrees
Most accurate test: electromyography and nerve conduction testing.

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5
Q

Carpal tunnel treatment

A

Best initial: wrist splints
First line medical therapy: NSAIDs

If no response to NSAIDs, use STEROID injections
LAST RESORT: surgery

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6
Q

What is Dupuytren contracture?

A

Nodule formation and contracture of the forth and fifth fingers.
Associated with alcoholism and cirrhosis
Patients lose ability to extend their fingers

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7
Q

Dupuytren contracture treatment

A

Triamcinolone
Lidocaine
Collagenase injections- helpful in early stages

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8
Q

Rotator cuff injury diagnosis

A

Mostly clinical-inability to flex or abduct shoulder

Most accurate: MRI- tear of primal end of long head of bicep tendon

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9
Q

Treatment of rotator cuff injury

A

Best initial: NSAIDs, rest and PT.

If above fails: STEROID injections

SURGERY for complete tears and those not responding to the above

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10
Q

Patellofemoral syndrome

A

Anterior knee pain secondary to trauma, imbalance of quadriceps strength, or meniscus tear.
Pain is in front of the knee and under the patella
Symptoms worse walking just after having been seated for a long time
PE: crepitus, joint locking, instability

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11
Q

Diagnosis and treatment of patella femoral syndrome

A

DX: X-ray are normal

Tx: physical therapy, strength training with cycling

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12
Q

Diagnostic tests for RA

A 
Rheumatoid factor ( nonspecific)
Anti-CCP - most specific
Radiographs: erosive joints, osteopenia
Diagnosis is based on point system: 6 or more points needed
  -joint involvement (up to 5 points)
  -ESR or CRP (1 point)
  -duration longer than 6 weeks (1 point)
  -RF or anti-CCP (1 point)
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13
Q

What is the most common cause of death in RA patients?

A

Coronary artery disease

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14
Q 
A patient with long standing RA is having a coronary bypass surgery. Which of the following is the most important prior to surgery?
A. Cervical spine X-ray
B. Rheumatoid factor
C. Extra dose of methotrexate
D. ESR
E. Pneumococcal vaccination
A

A. Cervical spine X-ray

RA is associated with C1/C2 subluxation. Cervical spine imaging to detect possible instability of thr vertebra is essential prior to the hyperextension of the neck that typically occurs with endotracheal intubation.

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15
Q

RA treatment

A

Best initial DMARD: methotrexate
Tumor necrosis factor inhibitors -1st line if no response to MTX
- infliximab, adalimumab, etanercept
Rituximab (removes CD20 positive lymphocytes from circulation)
- used in combination with MTX if no response to TNF agents
Hydroxychloroquine- mild disease. Used in combination with MTX
Sulfasalazine, leflunomide, abatacept- combined with MTX
Symptomatic and pain control: NSAIDs and steroids

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16
Q

Methotrexate- folate antagonist

Toxicity?

A

Liver toxicity
Bone marrow suppression
Pulmonary toxicity

Folic acid supplements required

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17
Q

TNF alpha toxicity

A

Reactivation of TB: screen with a PPD prior to their use

Infection

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18
Q

Hydroxychloroquine toxicity

A

Retinal toxicity

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19
Q

Sulfasalazine toxicity

A

Bone marrow toxicity
Hemolysis with G6PD deficiency
Rash

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20
Q

Juvenile rheumatoid arthritis treatment

A

Best initial: aspirin or NSAIDs
If no response to either, STEROIDS
If fails: TNF drugs

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21
Q

What 2 changes are seen in acute lupus flare?

A

Complement levels drop and anti-DS DNA levels rise

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22
Q

Treatment of acute lupus flare

A

Bolus of STEROIDS

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23
Q

When is kidney biopsy recommended in lupus patients?

A

If patients present with anti double-stranded DNA

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24
Q

Lupus treatment mostly recommended for skin and joint manifestations

A

Hydroxychloroquine

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25
Q

Drug that controls progression of lupus

A

Belimumab

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26
Q

Treatment of lupus NEPHRITIS

A

Steroids + Cyclophosphamide/mycophenolate

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27
Q

Hydroxychloroquine toxicity

A

Retinal toxicity therefore need eye exams every 6 months

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28
Q

Most common cause of death in elderly SLE patients

A

MI due to accelerated atherosclerosis

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29
Q

Coagulation studied in Antiphospholipid syndrome

A

Elevated PTT

Normal: PT and INR

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30
Q

Is VDRL positive or negative in antiphospholipid syndrome

A

Usually false positive VDRL or RPR seen with normal FTA (distinguishes APS from syphillis)

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31
Q

Antibodies responsible for spontaneous abortions in antiphospholipid syndrome

A

Anticardiolipin antibody

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32
Q

Best initial test for antiphospholipid syndrome

A

mixing study-to distinguish between clotting factor deficiency and APL.

Patients plasma is mixed with an equal amount of normal plasma. In clotting factor deficiency, PTT will normalize after mixing study.
In APL, antibody present in the patients plasma will keep PTT elevated.

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33
Q

The mot specific test Lupus anticoagulant in APL

A

Russell viper venom test- prolonged with APL antibodies

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34
Q

Treatment of asymptomatic Antiphospholipid antibody syndrome

A

asymptomatic disease does not need to be treated

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35
Q

treatment of first thrombotic episode of APL syndorme

A

wrfarin and heparin with INR target of 2-3

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36
Q

treatment of recurrent thrombotic episdes

A

LIFELONG treatment of warfarin

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37
Q

treatment of recurrent spontaneous abortions due to APL syndrome

A

heparin and Aspirin

avoid warfarin and steroids!!!!

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38
Q

treatment of scleroderma that slows the process

A

methotrexate

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39
Q

scleroderma treatment

  • renal crisis
  • esophageal dysmotility
  • raynauds
  • pulmonary fibrosis
  • pulmonary hypertension
A

-renal crisis:ACE inhibitor
-esophageal dysmotility: PPI
-Raynauds: CCB
-Pulmonary fibrosis: Cyclophosphamide- improves dyspnea and PFTs
-pulm HTN: Bosertan ambrisentan (endothelin antagonist), sildenafil,
postacyclin analog (ilopost, treprostinil, epoprostenol)

40
Q

cancers associated with dermatomyositis

A

ovary
lung
GI
Lymphoma

41
Q

best initial test of polymyositis and dermatomyositis

A

CPK and aldolase

42
Q

most accurate test for polymyositis and dermatomyositis

A

muscle biopsy–> mononclear infiltrate surrounding necrotic and degenerating muscle fibers

43
Q

antibodies associated with lung fibrosis in polymyositis and dermatomyositis

A

Anti- Jo antibodies

44
Q

Labs associated with polymyositis and dermatomyositis

A

increase ESR/CRP/RF

45
Q

treatment of polymyositis and dermatomyositis

A 
STEROIDS
-if unresponsive or intolerant:
  Methotrexate
  Azathioprine
  IVIG
  Mycophenolate
 Hydroxychloroquine- helps with skin lesions
46
Q

most dangerous complication of sjogren syndome

A

Lymphoma

47
Q

sjogren syndrome: best initial test

A

Schirmer test (measures the amount of tears)

48
Q

sjogren syndrome: most accurate test

A

Lip or parotid gland biopsy ( lymphoid infiltration in the salivary gland)

49
Q

sjogren syndrome: best initial blood test

A

SS-A and SS-B (Ro and La)

50
Q

What disease is Rose bengal stain used to diagnose

A

Sjogren syndrome

  • it shows abnormal corneal epithelium
51
Q

Sjogren syndrome: treatment

A

drinking lots of water, use sugar free gum, and fluoride treatment.
Use artificial tears
Pilocarpine and cevimeline increases acetylcholine :
stimulates production of saliva

52
Q

common presentation of all vasculitis

A

fever
malaise/fatigue
weight loss
arthralgia/myalgia

53
Q

Polyarteritis Nodosa includes all organ systems EXCEPT

A

Lungs

54
Q

PAN is associated with

A

Hepatitis B and C

55
Q

2 neurologic features associated with PAN

A
  • peroneal neuropathy leading to foot drop

- stroke in a young person

56
Q

PAN: most accurate test

A

biopsy of a symptomatic site

57
Q

What does angiography of a patient with PAN show

A

abnormal dilation or beading

58
Q

PAN treatment

A

STEROIDS and CYCLOPHOSPHAMIDE

59
Q

Polymyalgia rheumatica treatment

A

LOW dose STEROIDS

60
Q

complication of temporal arteritis

A

Irreversible Blindness

61
Q

Temporal arteritis: Labs

A

elevated ESR and CRP

62
Q

Temporal arteritis: most accurate test

A

Temporal artery biopsy

63
Q

Temporal arteritis: treatment

A

Steroids ( should be stated right away instead of waiting for biopsy confirmation)

64
Q

Wegener Granulomatosis: best initial test

A

C-ANCA

65
Q

wegener granulomatosis: most accurate test

A

Biopsy (most commonly lung)

66
Q

Wegener granulamatosis: treatment

A

Steroids and Cyclophosphamide

67
Q

Churg-stauss syndrome buzz words

A

Asthma and eosinophilia

68
Q

Diagnosis and treatment of Churg-Stauss Syndrome

A

Dx: most accurate- Biopsy

Tx: steroids and cyclophosphamide

69
Q

Henoch-Schonlein Purpura diagnosis and treatment

A

Dx: most accurate- biopsy (leukocytoclastic vasculitis)

Tx: Can resolve spontaneously
- Steroids for abdominal pain or progressive renal insufficiency

70
Q

Cryglobulinemia is associated with what diseases

A

Most commonly with :Chronic Hepatitis C

Other diseases: endocarditis and Sjogren syndrome

71
Q

cryglobulinemia treatment

A

Interferon
Ribavirin
Telaprevir
Boceprevir

72
Q

Presentation of Behcet syndome

A 
Painful oral and genital ulcers + skin lesions
can also present with:
-ocular finding
-arthritis
-CNS lesions
73
Q

Behcet syndrome: “Pathergy”

A

Sterile skin pustules from minor trauma like a needle stick

74
Q

Bachet syndrome treatment

A

STEROIDS

-to wean patients off of steroids, use:
Azathioprine
Cyclophosphamide
Colchicine
Thalidomide
75
Q

Ankylosing spondylitis diagnosis: best initial and most accurate

A

Best initial test: X-ray of the sacroiliac joint.
Most accurate: MRI

Elevated ESR is seen in 85%

76
Q

Ankylosing spondylitis treatment

A

Best initial: exercise and NSAIDs
If no response to above:
anti-TNF drugs (etanercept, adalimumab, infliximab)

77
Q

Psoriatic arthritis diagnosis: best initial

A

best initial: X-ray (pencil in a cup)

Uric acid level is elevated form increased skin turnover!!!

78
Q

Psoriatic arthritis treatment: best initial

A

Best initial: NSAIDs
No response to NSAIDs: Methotrexate
If no response to MTX: Anti-TNF agents are used

79
Q

Skin lesion unique to reactive arthritis

A

Keratoderma blennorhagicum (looks like pustular psoriasis)

80
Q

Reactive arthritis diagnosis

A 
Mainly clinical (can't see, can't pee, can't climb a tree)
-if hot swollen joint is present--> needs to tap to R/O septic joint
81
Q

reactive arthritis treament

A

NSAIDs
If no response to NAIDS: Sulfasalazine

Steroid injections into the joint help!!!

82
Q

Osteoporosis diagosis

A

Most accurate: DEXA scanning

Normal levels of: Calcium, phoshpate, PTH hormones

83
Q

Osteoporosis treatment

A

Vitamin D and Calcium
Bisphophonates
Estrogen replacement (if postmenopausal)
Raloxifene (substitute for estrogen in posmenopausal)
Teriparatide (PTH analogue- stimulates new bone matrix formation)
Calcitonin nasal spray- decreases risk of vertebral fractures

84
Q

Septic arthritis risk factors

A

Usually affects previously damaged joints: DJD, RA

Increased risk in endocarditis patients and IV drug users

85
Q

Most common organism causing septic arthritis

A

STAPH

followed by strep and gram negative rods

86
Q

Septic Arthritis diagnosis

A

Best initial and most accurate: aspiration of the joint

X-ray, CT and MRI are not useful

87
Q

Joint fluid analysis in septic arthritis: Leukocytosis level

A

More than 50,000 to 100, 000

predominantly NEUTROPHILS

88
Q

Septic arthritis treatment

A

Best initial: Ceftriaxone and vancomycin
Gram - bacilli: Quinolones, Aztreonam, Cefotaxime, Piperacillin,
Aminoglycosides
Sensitive Gram +: Ox/nafcillin, Cefazolin, Piperacillin + tazobactam
resistant Gram +: Linezolid, Daptomycin, Tigecycline, Ceftaroline

89
Q

most common organism recently placed prosthetic joint

A

Staph Epidermidis

90
Q

Management of prosthetic joint infection

A

Remove joint–> treat with antibiotics for 6-8 weeks–> replace joint

91
Q

Presentation of Gonococcal Arthritis

A

Polyarticular involvement
tenosynovitis (inflammation of tendon sheaths)
petechial rash

92
Q

Gonococcal arthritis diagnosis leukocytosis count

A

between 30,000-50,000

Gram stain and culture are not too sensitive

93
Q

Gonococcal treatment

A

Ceftriaxone, cefotaxime, ceftizoxime

94
Q

If recurrent gonorrhea infection occurs in a patient, what should be tested

A

Complement C5-C9 levels

95
Q

osteomeylitis diagnosis: best initial and most accurate

A

Best initial test: X-ray (shows periosteal new bone formation)
Most accurate test: Biopsy

96
Q

If X-ray is normal in osteomyelitis, the most appropriate next step in management is:

A

MRI

Bone scan is done if MRI is contraindicated

97
Q

To follow response to therapy for osteomyelitis, check:

A

ESR level

98
Q

Osteomyelitis treament

A

Check sensitivity after biopsy results return

sensitive Staph: Ox/nafcillin, cefazolin, ceftriaxone
resistant staph: vancomycin r linezolid
Gram - bacilli (E.coli)- Qinolones(cipro)

Internal medicine (8 decks)

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