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ICM Exam 2 Rheumatology (MC) > ICM - Rheum 1 > Flashcards

ICM - Rheum 1 Flashcards

1
Q

uric acid level for hyperuricemia (doesn’t always lead to gout…most asymptomatic)

A

>6.8 mg/dL

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2
Q

uric acid is end product of this process

A

purine metabolism

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3
Q

these dietary excesses increase risk for gout

A

meat, seafood, alcohol

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4
Q

cytokine that is important in pathogenesis of acute gout flare (after crystals released into joint/bursae)

A

IL-1

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5
Q

normal urine uric acid excretion amount in 24 hours

A

250-75 mg

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6
Q

these can cause primary overproduction of uric acid

A

deficient HGPRT (salvage pathway), overactive PRPP, G6PD deficiency, F1P aldolase deficiency

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7
Q

normal amount of filtered load of uric acid that is excreted

A

10%

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8
Q

primary causes of renal underexcretion

A

deficiency in urate exporter, medullary cystic kidney disease (kids)

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9
Q

normal time it takes for acute gouty arthritis to resolve

A

3-10 days

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10
Q

80% of initial acute gouty arthritis attacks will be this

A

monoarticular

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11
Q

crystal in gout joint aspiration

A

monosodium urate monohydrate

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12
Q

crystal in pseudogout joint aspiration

A

calcium pyrophosphate dihydrate

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13
Q

perdiod after 1st gout attack…additional acute attacks (usually within 2 years), shorter asymptomatic periods, sever, prolonged polyarticular flares

A

intercritical gout

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14
Q

solid urate deposits in chronic gout

A

tophi

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15
Q

to prevent gout progression, want to lower serum urate to below this level (deplete total body urate pool)

A

6 mg/dL

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16
Q

typical drug of choice to treat gout

A

NSAIDs

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17
Q

alternative to NSAID treatment for gout, but has more side effects (*diarrhea*)

A

colchicine

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18
Q

typical length of corticosteroid treatment for gout

A

5-7 days

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19
Q

allopurinol inhibits this enzyme in purine metabolism (to reduce uric acid levels)

A

xanthine oxidase

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20
Q

this is overproduced in CPPD

A

cartilage pyrophosphate

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21
Q

where cartilage pyrophosphate crystals deposit

A

joint articular cartilage (hyaline), fibrocartilage, ligaments

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22
Q

x-ray showing calcification of cartilage and fibrocartilage

A

chondrocalcinosis

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23
Q

where are gout crystals mostly located?

A

synovium (versus CPPD in cartilage)

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24
Q

recessive renal tubular disorder –> older child/adult with hypokalemia, metabolic alklaosis, hypomagnesium, hypocalcuria, leg/arm cramps, weakness, polyuria, nocturia, chondrocalciosis

A

Gitelman syndrome

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25
Q

acute CPP crystal arthritis –> lasts 1-3 weeks, flares after parathyroidectomy, mono or oligo-articular arthritis

A

pseudogout

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26
Q

where CPP crystal arthritis most commonly affects

A

knee (50%), wrist, shoulder, ankle

27
Q

chronic CPP crystal inflammatory arthritis –> CPPD crystals demonstrable in joint fluid of RA clinical joints, radiographic changes like OA

A

pseduo-RA

28
Q

possible treatments for BCP crystal deposition arthropathy

A

NSAIDs, COX-2 inhibitors, steroid injection, irrigation (ultrasound to degrade and lowering serum phosphate also)

29
Q

stain for calcium oxalate crystal test (appear bipyramidal)

A

alizarin red

30
Q

where are calcium oxalate depositions found? (crystals can break off, causing acute synovitis stimulating synovial cell proliferation and enzyme release–> articular destruction)

A

bone, articular cartilage, synovium, periarticular tissue

31
Q

bone that is lost in osteoporosis

A

trabecular (cortical also in type II)

32
Q

common fractures in type I osteoporosis (postmenopausal women mostly, lost of trabecular bone)

A

compression fractures and Colles fracture

33
Q

most common fractures in type II osteoporosis

A

femoral neck, proximal humerus, pelvis

34
Q

risk factors for osteoporosis

A

female, estrogen depletion, Ca/VitD deficiency, low peak bone mass, decreased physical activity, hypogonadism, hyperthyroidism, smoking, corticosteroids

35
Q

most common clinical finding of osteoporosis

A

vertebral body compression factors

36
Q

gold standard for diagnosis of osteoporosis (measures bone density and compares to young adult)

A

DEXA

37
Q

DEXA score in this range is osteopenia

A

1-2.5 below

38
Q

DEXA score in this range is osteoporosis

A

less than 2.5

39
Q

who should get DEXA screening?

A

women>65, postmenopausal50 with fracture

40
Q

first line pharmacologic treatment for osteoporosis; how do these work?

A

bisphosphonates; inhibit osteoclast function

41
Q

osteoporosis therapy that helps build bone –> must limit treatment for 2 years due to increased risk of osteosarcoma

A

PTH

42
Q

possible treatment for osteoporosis….can decrease pain of vertebral fractures (not used as much anymore)

A

calcitonin

43
Q

formation of new bone at joint surfaces

A

eburnation

44
Q

formation of new bone in periarticular tissues

A

osteophyte formation

45
Q

greatest modifiable risk factor for OA

A

obesity

46
Q

gene that may be mutated to increase risk of OA

A

COL2A1

47
Q

radiographic evidence of OA

A

joint space narrowing, osteophytes, subchondral cysts and sclerosis

48
Q

nodal generalized OA has predisposition to affect these joints

A

knee, hip and spine

49
Q

first line pharmacological treatment for OA; what is just as effective but has possible GI side effect?

A

acetaminophen; NSAIDs

50
Q

DDX for OA

A

Ca pyrophosphate deposition disease, RA, infectious monoarticular disease, psoriatic arthritis

51
Q

chronic inflammatory arthritis that affects the *synovium*

A

RA

52
Q

how do joints feel in RA?

A

soft and squishy (warm, boggy)

53
Q

cardiac manifestations of RA

A

pericarditis, myocarditis, CVD

54
Q

pulmonary manifestations of RA

A

pleural effusion (low glucose and low complement), interstitial fibrosis

55
Q

ocular manifestations of RA

A

Sjogrens, corneal inflammation, scleritis

56
Q

these are pathognomonic for RA

A

rheumatoid nodules

57
Q

seropositive RA, neutropenia, splenomegaly, occasional leg ulcers (hematological manifesation of RA)

A

Felty’s syndrome

58
Q

these titer levels are good for prognosis of RA (higher=more severe)

A

RF

59
Q

very specific test for RA (96%) –> helpful in diagnosis and prognosis

A

ACCP

60
Q

anemia seen in RA

A

normocytic normochromic

61
Q

diagnostic criteria for RA (from step up)

A

inflammatory arthritis more than 3 joints, >6 weeks, elevated CRP/ESR, + RF/ACPA, radiographic changes

62
Q

drug of choice for pain control in RA

A

NSAIDs

63
Q

best initial DMARD for RA

A

methotrexate

64
Q

first line agent DMARDS for RA

A

methotrexate, leflunomide, hydroxychloroquine, sulfasalazine

ICM Exam 2 Rheumatology (MC) (5 decks)

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