Rheum Flashcards
(108 cards)
1
Q
causes of acute joint pain (typically just 1 joint)
A
trauma
infection
crystal
reactive
2
Q
athrocentesis of OA
A
serous
<2000 WBCs, 25% PMNs
no crystals
3
Q
athrocentesis of septic joint
A
pus opaque white fluid
>50,000 WBCs
+ gram stain and culture - if no staph check for gonorrhea
4
Q
arthrocentesis of inflammatory joint
A
cloudy
>2000 - <50,00 WBCs (10,000)
>50% PMNs
+/- crystals
5
Q
+ ANA =
A
SLE
6
Q
+ RF
A
RA
7
Q
+ anti citrullinated c peptide
A
RA
8
Q
+ ds DNA ab
A
SLE and lupus nephritis
9
Q
+ Anti histone ab
A
drug induced lupus
10
Q
+ anti centromere
A
scleroderma
CREST
11
Q
+ topoisomerase (Scl 70)
A
systemic scleroderma
12
Q
+ smooth muscle ab
A
autoimmune hepatitis
13
Q
anti Ro
anti La
A
sjogrens
14
Q
anti Jo ab
A
polymyositis
dermatomysositis
15
Q
anti mitochondrial ab
A
Primary biliary sclerosis
16
Q
SLE path
A
autoimmune complex
F > M
Black > white
17
Q
SLE presentation
4/11
A
Malar rash - butterfly - (spares nasolabial folds) Discoid rash Serositis (pleuritic CP) Oral ulcers Arthritis (large joints) Photosensitivity (sunburn) Blood (amenia, thrombocytopenia) Renal failure (nephritis) ANA + Immunologic Neuro (cerebritis, psychosis, AMS)
18
Q
complications of SLE
A
endocarditis - vegetations on both sides of the valve
ESRD
Miscarriages
19
Q
dx of SLE
A
1st - ANA (sensitive but not specific)
2nd - ds DNA (nephritis), anti smith, antihistone (drug induced)
ESR and CRP
complement levels - low C3 and low C4
20
Q
tx of SLE
A
hydroxychloroquine - ADR - retinopathy
steroids (flare)
nephritis - IV cyclophospamide –> oral mycophenolate
21
Q
drug induced lupus
path and pt presentation
A
path - antihistone
presentation - rash and pain after taking a medication
22
Q
dx and tx of drug induced lupus
A
- medication reconciliation
- antihistone ab
tx - remove offending agent
23
Q
medications that cause drug induced lupus
A
hydralazine
procainamide
methyldopa
24
Q
lupus nephritis
path and pt presentation
A
path - ds DNA abs
pt - asx - U/A micro –> proteinuria
or
pt - HTN, massive proteinuria, hematuria
25
dx and tx of lupus nephritis
dx - biopsy
tx - IV cyclophosphamide --> oral mycophenolate
26
path of RA
autoimmune (F>M) [45 years old]
| pannus grows --> erosions of joint
27
Dx criteria for RA
```
joints
morning stiffness >60min
nodules
imaging
blood - CCP>Rf
```
28
joints in RA
small joints affected - hands and feet
swanneck deformities
crooked bent fingers
>3 joints = symmetric
NO DIP involvement
29
nodules in RA
late finding in dz
| biopsy --> cholesterol
30
imaging in RA
morning stiffness + C1 and C2 pain --> c spine x-ray
erosions, periarticular osteopenia
31
tx of RA
NSAIDs (ibu, meloxicam) - (never monotherapy)
+
DMARDs - 1) MTX, 2) leflunomide, 3) hydroxycholoroquine 4) sulfasalizine
- combine DMARDS before you go to biologics
- pregnant use (3) or if no erosion present
32
tx of Severe RA
NSAIDS + DMARDs + Biologics (TNF alpha inhibitors) - inflixumab, rituximab, etanerept)
before giving biologics - vaccinate, test for tb, fungal exposure?
+/- steroids if flare (prednisone)
33
FELTY syndrome
splenomegaly
RA
Neutropenia
34
scleroderma path
collagen deposition
anti centromere - CREST
anti topisomerase - scl 70
35
scleroderma CREST
C - calcinosis - HTN
R - raynauds
E - esophageal dysmotility - unrelenting GERD
S - sclerodactyl - no wrinkles, tense,
T - telengiectasias - gi bleed/iron def anemia
36
complications of scleroderma
Pulmonary arterial HTN
Constrictive pericarditis
Slceroderma renal crisis - tx = ACE -I
37
tx of scleroderma renal crisis
ACE-I
38
diffuse cutaneous systemic sclerosis
CREST + visceral involvement
39
tx of CREST ISSUES
Raynauds --> CCV
esophageal dismotility ---> PPI
Sclerodactyl --> Penicillamine
40
Nephrogenic systemic sclerosis
occurs after receiving Gallidinium and MRI
41
sjogrens path
lymphoplasmocytic infiltration of the exocrine glands
42
pt presentation of sjogrens
dry eyes - keratoconjuctivitis - SICA
dry mouth - Xerostomia
parotid swelling
43
sjogren dx
1st - ANA
2nd - Ro and La abs
3rd schimer test --> can they make tears
44
tx of sjogrens syndrome
artificial tears
| artificial saliva
45
path behind dermatomyositis and polymyositis
dermatomyositis --> complex deposition dz - risk of malignancy
polymyositis --> T cell dz
46
presentation of polymositis and dermatomyositis
proximal muscle weakness
heliotrope rash - face
gottrons papules
47
dx of polymyositis and dermatomysotis
increased CK --> EMG --> biopsy (best)
abs - anti Mi and anti Jo
48
things that increase uric acid
etoh
red meat/ seafood
fructose
49
pseudogout
(+) birefringent
rhomboid shape
costocalcinosis
calcium pyrophosphate
50
tx of pseudogout
colchicine
NSAIDs
Steroids
51
gout
(-) birefringent
needle shaped
monosodium urate
- decreased elimination - tx - propenecid
- increased production - tx - rasbirucase
52
tumor lysis syndrome can lead to
increased production of uric acid
prophylaxis with IVF and allopurinol
53
management of Gout
lifestyle modifications
allopurinol or febuxostat
colchicine (#1), NSAIDs, steroids
54
things that lead to gout
Tumor lysis syndrome
CKD
alcohol
thiazide diuretics
55
management of staph infected septic arthritis
naficillin
| - unless MRSA --> vanco or linezolid
56
what type of joints does SLE have a predilection for
large joints
57
ankylosing spondylitis
M > F
sacroilitis - low back pain - gets better with use - morning stiffness
dx - lumbar spine - bamboo spine
tx - NSAIDs, local steroids, TNF alpha I
58
psoriatic
psoriasis and arthritis
M > F
nail pitting
tx - NSAIDs, local steroids, DMARDs, TNF alpha I
59
Reactive
M > F
STD hx
urethretis + arthritis
tendon pain
if conjuctivitis present = reiters syndrome
60
tx of reactive arthritis
if infectious - azithro or doxy + ceftriaxone
if not infectious - NSAIDs + time
61
IBD related arthritis
hx of crohns or UC + arthritis
tx - treat the IBD arthritis gets better
62
giant cell arthritis
path - large vessel dz
Arteries : external carotid, ophthalmic, temporal
Women >50 y/o
jaw claudication, vision changes (amarosis fugax) , temporal tenderness
63
dx and tx of giant cell arthritis
dx - biopsy granulomas but dont wait for this begin tx
tx - steroids
64
takaysu arteritis
<40 y/o, also large vessel
aorta and its branches - femoral, subclavian
pulselessness
dx - angiogram
tx - steroids
65
Polyarteritis nodusa (PAN)
medium vessels, gut renal skin
ASSOCIATED WITH HEP B
mesenteric ichemia, renal failure, purpura or painful nodules
66
dx and tx of PAN
dx - angiogram -> aneurysms of medium vessels
tx- steroids + cyclophosphamide
67
mononeuritic multiplex
associated with PAN
painful asymmetric peripheral nerve pain
68
cryoglobulinemia
| small vessel
ASSOCIATED WITH HEP C
palpable purpura
dx --> cryoglobulins, decreased complement
tx - plasmophoresis if severe
steroids and cyclophosphamide
69
Wegeners
small vessel
ANCA associated
Hemoptysis, hematuria, nose issues
dx -C-ANCA, biopsy --> lung
tx - steroids + cyclophosphamide
70
Henoch Schloein Purpura
palpable purpura, GI symptoms
dx - biopsy - leukocytoclastic vasculitis
tx - steroids
71
neonatal lupus
```
skin lesions
cardiac abnormalities (av block, transposition of great vessels)
valvular and septal defects
```
72
SLE valve issues
libman sacks endocarditis
| vegetations on both sides of the valve
73
C-ANCA
wegeners granulomatosis
74
P-ANCA
polyarteritis nodusa
75
lupus anticoagulant
antiphospholipid syndrome
76
ADR of hydroxchloroquine
retinal toxicity
77
the most common cause of death in SLE pts
opportunistic infections and renal failure
78
diffuse scleroderma
rapid onset
widespread skin involvement - more skin involved worse prognosis
antitopoisomerase (scl 70) ab
79
antiphospholipid syndrome
```
hypercoagulable states
recurrent venous thrombosis
recurrent arterial thrombosis
recurrent fetal loss
thrombocytopenia
```
80
anticentromere antibody
limited CREST scleroderma
81
most common cause of death in scleroderma
pulmonary involvment
82
complication of scleroderma
occult malignancy
| increased risk for NHL
83
deformities in RA
```
boutonnier deformities (PIP)
swan neck
```
C1-C2 subluxation and instability
84
felty syndrome
```
S- splenomegaly
A- arthritis (RA)
N- neutropenia
T- thrombocytopenia
A- anemia
```
85
ADR of MTX
bone marrow suppression
elevated LFTs - hepatocellular injury
GI upset, ulcers, stomatitis
mild alopecia
86
precipitants of acute gouty attack
```
decreased temperature
stress
dehydration
starvation
excessive alcohol intake
```
87
features of OA
heberdens nodes
brouchard nodes
88
radiograph of gout
punched out erosions with an overhanging rim of cortical bone in advanced disease
89
complications of gout
nephrolithiasis
| degenerative athritis
90
medications to avoid in gout
aspirin - can aggravate it
tynelol no anti inflammatory properties
91
uricosuric drugs
probenecid
sulfinpyrazone
indicated if <800mg/day uric acid
92
xanthine oxidase inhibitor
allopurinol
>800mg/day
93
dx of pseudogout
joint aspirate - weakly positively birefringet, rod shaped and rhamboid crystals in synovial fluid
calcium pyrophosphate
94
radiographs of pseudogout
chondrocalcionosis
| cartilage calcification
95
muscles affected in both polymyositis and dermatomyositis
proximal muscle
neck flexors
shoulder girdle
pelvic girdle muscles
96
unique features of dermatomyositis
heliotrope rash - face - on nasal bridge
gottrons papules - scaly lesions over the knuckles
97
dermatomyositis has an increased risk for
malignancy
98
muscle biopsy of polymyositis
endomysial
99
muscle biopsy of dermatomyositis
perivascular and perimysial
100
tx of fibromyalgia
exercise low intensity
TCS (amitryptilline)
101
Most common extra articular manifestations in ankylosing spondylitis
anterior uveitis
cardiac (AV heart block and aortic insufficiency)
102
complications of ankylosing spondylitis
```
restrictive lung dz
cauda equina syndrome
spine fracture with cord injury
osteoporisis
spondylodisetis
```
103
reiter syndrome
athritis
conjuctivitis
urethritis
104
signs of psoriatic arthritis
sausage digits
nail pitting
105
churg strauss syndrome
vasculitis of multile organts
prominent resp tract findgins (asthma)
eosinophilia
p-ANCA
106
wegeners granulomatosis
renal dz - mcc of death
vasculitis predmoninantly involving kidneys and upper and lower resp tract
sinusitis
glomerulonehpritis
ESR high and C-ANCA
107
behcet syndrome
autoimmune
painful sterile oral and genital ulcerations
eye involvment
108
bergers diz
smoker
phlebitis
autoamputationa and gangrene risk
