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Step 2 > Rheumatology > Flashcards

Rheumatology Flashcards

1
Q

Gout: acute and chronic management

A

Acute

1) NSAIDs
2. Corticosteroid injection (use when no response to NSAIDS or can’t use 2/2 renal insufficiency)
3) Colchicine (SE: Bone marrow suppression, diarrhea)

Chronic

1) Diet: exercise, no alcohol, no meat/seafood
2) Stop thiazides, lasix, asprin, Anti-TB (PE), niacin (use losartan first for HTN)
3) Colchicine: prevents your 2nd attack
4) Allopurinol: decreases uric acid production. If C/I use Febuxostat (both are xanthine oxidase inhibitors)
5) Pegloticase: dissolves uric acid, increases uric acid metabolism
6) Probenecid and sulfinpyrazone: increase excretion in kidney (uricosuric)

note: for renal injury avoid NSAID, probenecid, sulfinpyrazone. Allopurinol is safe in renal injury

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2
Q

“Pseudogout”: Risk Factors and Associated with

A

Risk Factors:
Hemochromatosis
Hyperparathyroidism

Associated with:
Diabetes
Hypothyroidism
Wilson Disease

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3
Q

“Pseudogout”: what joints get hit first

A

large joints: knee or wrist

DIP and PIP are NOT affected

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4
Q

“Pseudogout”: treatment

A

1) NSAIDs
2) Corticosteroid injection (use when no response to NSAIDS or can’t use 2/2 renal insufficiency)
3) Colchicine prevents next attack (SE: Bone marrow suppression, diarrhea)

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5
Q

Epidural Abscess: treatment for MRSA, MSSA, Acute neurologic defects

A

MRSA: Vanc, Linezolid
MSSA: Oxacillin, Nafcillin, Cefazolin
Acute Neuro Defects: Systemic glucocorticoids

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6
Q

Motor Deficit, reflex lost, sensory lost
L4
L5
S1

A

L4: dorsiflexion foot, knee jerk, inner calf
L5: dorsiflexion toe, none, inner foot
S1: eversion of foot, ankle jerk, outer foot

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7
Q

systemic signs A/W: Sjogren

A 
dry eyes (sicca)
parotid enlargement
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8
Q

Polyarticular symmetric:

A

RA
SLE
Viral: EBV, HepB, Parvo B19

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9
Q

Monoarticular

A

OA
Septic Arthritis
Gout

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10
Q

Migratory

A

Lyme
GC
Rheumatic Fever

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11
Q

Oligoarticular Asymmetric

A

Spondyloarthropathies

  • Ankylosing spondylitis: bamboo spine, uveitis, aortiis –> aortic regurg
  • Reiter syndrome
  • Psoriatic Arthritis

OA

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12
Q

Contraindications to Joint Aspiration

A
  • Cellulitis (overlying)

- Bleeding Diathesis: patient has a high INR, on warfarin, etc.

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13
Q

Diseases with +RF

A

RA
Subacute Endocarditis
TB
Osteomyelitis

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14
Q

p-ANCA

A

PAN
Churg-Strauss
IBD

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15
Q

c-ANCA

A

Wegener’s

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16
Q

Antiphospholipid Abs: findings

A
  • lupus anticoagulant
  • Anticardiolipin Abs
  • Increased PTT (lab phenomenon)
  • false +VDRL
  • Hypercoagulable: presents with arterial and venous thrombosis
  • spontaneous abortions
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17
Q

4H’s of Pseudogout

A

MC elderly >50yo, pre-existing joint damage

  • hemochromatosis
  • hyperparathyroidsim
  • hypophosphatasia
  • hypomagnesemia
18
Q

RA: diagnostic criteria

A
  1. Morning stiffness >1hr for 6wks
  2. swelling wrists, MCP, PIP for 6wks
  3. Swelling 3 joints for 6 weeks
  4. Symmetric joint swelling for 6 weeks
  5. Joint erosions on X-Rays
  6. RF+
  7. Rheumatoid nodules
19
Q

Felty Syndrome

A

RA
Splenomegaly
Neutropenia

20
Q

Caplan Syndrome

A

RA
Pneumoconiosis (coal miners lung)
Lung Nodules

21
Q

MC cause of death in RA

A

Coronary Artery Disease (CAD)

22
Q

MTX: S/E

A
  • Liver Toxicity
  • Bone Marrow suppression
  • Pulmonary toxicity

need CBC and Liver panel every 3mo for 1st year

23
Q

R/A DMARDs Treatment and S/E

A

1) MTX (lung, liver, BM)
2) TNFi (TB, PPD)
3) Rituximab (CD20+, infections)
4) Hydroxychloroquine (monotherapy, retinal toxicity
5) Sulfasalazine (Rash, hemolysis G6PD, BM)

24
Q

Specific Ab’s for lupus

A

Anti-DS DNA

Anti-SM

25
Q

Dx a SLE flare by finding

A

C3, C4 decreased

DS DNA elevated

26
Q

Scleroderma vs. CREST (say abbreviation)

A 
CREST: 
Calcinosis
Raynaud
Esophageal dysmotility
Sclerodactyly
Telangiectasia

Scleroderma: also involves lungs, heart, kidney (sudden hypertensive crisis)

27
Q

Scleroderma: Most-specific test

A

SCL-70 (anti-topoisomerase)

28
Q

Scleroderma: treatment

A

MTX
Renal crisis: ACE inhibitor (even if high Cr)
Esophageal dysmotility: PPI for GERD
Raynaud: CCB
Pulm Fibrosis: Cyclophosphamide
Pulm HTN: bosentan, sildenafil, prostacyclin analogs

29
Q

Polymyositis/Dermatomyositis:

  • Best initial Test:
  • Most accurate:
A
  • Best initial Test: CPK, aldolase
  • Most accurate: muscle biopsy

Note: Anti-Jo Ab a/w lung fibrosis

30
Q

Polymyositis/Dermatomyositis: Tx

A

Steroids, but if steroids don’t work

  • MTX
  • Azathioprine
  • IVIG
  • Mycophenolate
  • Hydroxychloroquine helps skin lesions
31
Q

Polymyositis/Dermatomyositis: Presentation

A
  • proximal muscle weakness: difficulty getting up from seated position or walking up stairs
  • Malar
  • Shawl sign
  • Heliotrope rash
  • Gottron papules: PIP and MCP
  • CA: ovary, lung, GI, lymphoma
32
Q

Sjogren Syndrome:

  • best initial test:
  • best initial blood test:
  • most accurate test:
  • best initial therapy:
A

Sjogren Syndrome:

  • best initial test: Schrimer test
  • best initial blood test: SS-A and SS-B
  • most accurate test: lip or parotid biopsy
  • best initial therapy: water the mouth

need to evaluate for lymphoma

33
Q

Behcet Syndrome

-What is “pathergy”:

A

-sterile skin pustules from minor trauma like needle stick

34
Q

Behcet Syndrome:
presentation
treatment

A

Presentation:

  • Asian or middle-eastern person
  • painful oral and genital ulcers
  • erythema nodosum-like skin lesions
  • ocular lesions –> uveitis, blindness
  • Arthritis
  • CNS lesions mimicking MS

tx: steroids

35
Q

Cryoglobuliinemia

  • presentation
  • a/w
  • treatment
A
  • presentation: palpable purpura, proteinuria, hematuria, arthralgia, hepatosplenomegaly, hypocomplementemia
  • A/W: Hep C –> decreased C4
  • Tx: Interferon, ribavirin, telaprevir or boceprevir

steroids are NOT effective
Lab tests: +RF, cold precipitable immune complexes

36
Q

Churg-Strauss:

  • presentation
  • most accurate test
  • treatment:
A
  • presentation: asthma, eosinophilia
  • most accurate test: biopsy
  • treatment: prednisone, cyclophosphamide
37
Q

Anklyosing Spondlyitis:

  • best initial test:
  • Most accurate test:
  • Treatment
A
  • best initial test: X-Ray sacroiliac joint
  • Most accurate test: MRI
  • Treatment: NSAIDs, exercise –> anti-TNF drugs
38
Q

Psoriatic Arthritis

  • best initial test
  • treatment
A
  • best initial test: X-ray of joint, pencil-in-cup
  • Tx: NSAIDs –> MTX –> Anti-TNF

STEROIDS ARE WRONG

39
Q

Reactive Arthritis

  • Cause
  • Test:
  • Treatment:
A
  • Cause: IBD, STD, GI infection (Yersinia, Salmonella, Camp)
  • Test: none, tap joint to r/o septic joint
  • Treatment: NSAIDs –> Sulfasalazine
40
Q

Osteoporosis

  • Most accurate
  • T-score
  • Treatment
A
  • Most accurate: DEXA
  • T-score: +2.5 SD
  • Treatment: Vit D, Ca, Bisphosphonates, ERT, Raloxifene, Teriparatide,Calcitonin
41
Q

Septic Arthritis

  • best initial and most accurate test:
  • best initial empiric therapy:
  • treatment for prosthetic joint:
A
  • best initial and most accurate test: arthrocentesis
  • best initial empiric therapy: Ceftriaxone, Vanc
  • treatment for prosthetic joint: remove joint, Rx ABX 6wks, replace joint

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