Arthritis/Rheumatologic Conditions (MSK 10%) Flashcards Preview

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Flashcards in Arthritis/Rheumatologic Conditions (MSK 10%) Deck (106):
1

RA or OA:
Morning stiffness lasting at least 60 min

RA

2

RA or OA:
Worse after effort, evening stiffness

OA

3

RA or OA:
Symmetric joint narrowing

RA

4

RA or OA:
Soft, warm boggy, tender joints

RA

5

Joints affected in RA:
Joints affected in OA:

Joints affected in RA: Wrists, MCP, PIP
Joints affected in OA: DIP, PIP thumb (CMC)

6

Boutonniere deformity =
Seen in ___

flexion @ PIP, hyperextension @ DIP
Seen in RA

7

Swan neck deformity =
Seen in ___

flexion @ DIP, hyperextension @ PIP
Seen in RA

8

Felty's Syndrome =

RA + splenomegaly + decreased WBC/repeated infection

9

Caplan Syndrome =

Pneumoconiosis + RA

10

Best initial test for RA

Rheumatoid factor (sensitive, NOT specific)

11

Most specific test for RA

Anti-citrullinated peptide antibodies

12

Tx of OA

1st line: Acetaminophen --> if fail, NSAID
Total joint replacement

13

Pannus =

Hyperplastic synovial tissue that erode cartilage, subchondral bone, articular capsule, tendons, ligaments in RHEUMATOID ARTHRITIS

14

Heberden nodes =

palpable osteophytes @ DIP in OSTEOARTHRITIS

15

Bouchard's node =

osteophytes @ PIP in OSTEOARTHRTIS

16

RA or OA:
Osteophytes on xray

OA

17

Tx of RA

Prompt initiation of DMARD (methotrexate, sulfasalazine, hydroxychloroquine)
NSAID for pain control

18

Progressive loss of articular cartilage w/ reactive changes in bone --> pain and destruction of joint

Osteoarthritis

19

Synovitis affecting multiple symmetric joints w/ bone erosion, cartilage destruction and joint structure loss d/t destruction by pannus

Rheumatoid arthritis

20

Juvenile idiopathic arthritis (JIA) defined as: (3)

1. < 16 y/o
2. >6 weeks duration of disease
3. One of 3 subtypes: Systemic (Still disease), Pauciarticular, Polyarticular

21

What type of JIA?
Spiking fever
Salmon-pink maculopapular rash
Koebner phenomenon
Minimal articular findings (What other findings? (5))

Systemic (Still disease)

Koebner phenomenon = skin lesions appearing on lines of trauma from scratching

Other findings: Hepatosplenomegaly, lymphadenopathy, leukocytosis, pericarditis, myocarditis

22

What type of JIA?
Risk of developing iridocyclitis (anterior uveitis)

Pauciarticular: Involvement of <4 medium-large joints
AND
Polyarticular: symmetric involvement of >5 small/large joints

23

Tx of JIA

NSAID, PT/OT
2nd line: methotrexate, leflunomide

24

T/F: 80% of JIA patients progress to disabling arthritis into adulthood.

False. 80% of JIA patients remit w/o serious disability

25

Definitive dx of Septic Arthritis

Arthrocentesis: WBC >50,000, mostly PMNs

26

Tx of septic arthritis for gram + cocci

Nafcillin
Vancomycin if suspect MRSA
PCN allergy: Vancomycin, Clindamycin

27

Tx of septic arthritis for gram - cocci

Ceftriaxone
PCN allergy: Ciprofloxacin
Gonococcal usually don't need arthrotomy

28

Tx of septic arthritis for gram - rods

Ceftriaxone (3rd gen cephalosporin) + gentamicin (anti-pseudomonal AG)

29

Tx of septic arthritis if no organism seen

Nafcillin
OR
Vancomycin + ceftriaxone (+/- anti-pseudomonas)

30

"Pencil in cup" deformity

Psoriatic arthritis

31

(Symmetric/asymmetric) arthritis dactylitis ("sausage" digits)

Asymmetric
Psoriatic arthritis
BUT can also be symmetric DIP joints (like in RA)

32

+ HLA-B27 seen in (3)

Reactive arthritis
Psoriatic arthritis
Ankylosing spondylitis

33

Reactive arthritis MC seen in ___

Chlamydia

34

Keratoderma blennnorrhagica =
Seen in ___.
Other clinical manifestations (4)

= hyperkeratotic lesions on palms/soles

Seen in Reactive Arthritis

Other manifestations: conjuctivitis, urethritis, arthritis, mucosal ulcers (balanitis, stomatitis)

35

Tx of Reactive Arthritis

NSAIDs

36

T/F: Synovial fluid in Reatice Arthritis shows WBC 10,000-50,000 and positive bacterial culture.

False: WBC 1,000-8,000
NEGATIVE bacterial culture (aseptic)

37

Tx of ACUTE gout

NSAID (Indomethacin) = 1st line
Colchicine = 2nd line

38

Tx of CHRONIC gout

Allopurinol (inhibit xanthine oxidase --> reduce uric acid production)
Colchicine (only med that can be used for ACUTE and CHRONIC management)

39

Gout
Joint fluid analysis:
Serum uric acid level:
X ray:

-Rod/needle-shaped, negatively birefringent urate crystals
-Serum uric acid > 8
-"Mouse/rat bite" "punched-out" erosions

40

MC joint in:
Gout =
Pseudogout =

Gout = 1st MTP joint
Pseudogout = Knee

41

Pseudogout
X-ray:
Joint fluid analysis:

X-ray: Chondrocalcinosis (cartilage calcification)--> linear radiodensities
Joint fluid analysis: positively birefringent, rhomboid-shaped CPP crystals

42

Tx of Pseudogout

Corticosteroids = 1st line
NSAIDs, Colchinine (prophylaxis)

43

Triad of manifestation of SLE

Joint pain (90%)
Fever
Malar "butterfly" rash

44

Mnemonic for SLE symptoms

"SOAP BRAIN MD"
S=serositis (pericarditis, pleuritis)
O=oral ulcers
A=arthritis
P=photosensitivity, pulmonary fibrosis
B=blood cells (hemolytic anemia, leukopenia, thrombocytopenia)
R=renal, Raynauds
A=ANA
I=immunologic (anti-Sm, anti-dsDNA)
N=neuropsych
M=malar rash
D=discoid rash

45

Best initial test for SLE:
Most specific test(s) for SLE:

Best initial test for SLE: Anti-nuclear Ab (sensitive)

Most specific test(s) for SLE: Anti-dsDNA and Anti-Smith ab (100% specific, not sensitive)

46

Drugs that induce SLE (7)

What will these drug induced SLE patients be positive for?

Procainamide
Hydralazine
INH
Quinidine
Phenytoin
Etanercept
Sulfa-drugs

+ Anti-histone bodies

47

Tx of SLE

Regular exercise, sun protection
NSAIDs: msk complaints
Antimalarials (hydroxychloroquine, quinacrine): msk and cutaneous
Corticosteroids: disease flares
Methotrexate: arthritis, rashes, serositis, constitutional symptoms

48

Idiopathic inflammatory muscle disease of proximal limbs, neck, pharynx =
When skin is affected =

Polymyositis
Dermatomyositis

49

Pathognomonic for Dermatomyositis (2)

Heliotrope (blue-purple) upper eyelid discoloration

Gottron's papules = raised violaceous scaly eruptions on knuckles

50

Ab specific for dermatomyositis

Ab specific for polymyositis (2)

Ab specific for dermatomyositis: Anti-Mi-2 Ab

Ab specific for polymyositis:
- Anti-Jo 1 Ab --> associated w/ interstitial lung fibrosis, "mechanic hands"
- Anti-SRP Ab

51

Elevated ___ & ___ seen in polymyositis and dermatomyositis.
Dx w/:

Aldolase*
Creatine kinase

Muscle bx: myopathic inflammatory changes

52

Tx of polymyositis, dermatomyositis

1st line: corticosteroids
Methotrexate, azathioprine, IV Immune globulin

53

Idiopathic inflammatory condition causing synovitis, bursitis, tenosynovitis --> aching/stiffness of proximal joints (shoulder hip, neck) in pts ____ y/o

Closely related to ____

Polymyalgia Rheumatica
>50 y/o

Related to Giant Cell Arteritis

54

Clinical manifestation of Polymyalgia Rheumatica:
(Unilateral/bilateral) (proximal/distal) joint pain/STIFFNESS in the (morning/evening) lasting ____ in ____areas.

BILATERAL PROXIMAL joint pain/STIFFNESS in the MORNING lasting > 30 MINUTES in PELVIC and SHOULDER GIRDLE areas.

(difficulty combing hair, putting on coat, getting out of chair)

55

Tx of Polymyalgia Rheumatica

low dose corticosteroids

56

Systemic vasculitis of medium/small arteries --> necrotizing inflammatory lesions
Type ___ hypersensitivity

Associated with ____

Polyarteritis nodosa (PAN)
Type III hypersensitivity

Associated with Hepatitis B** and C

57

Dx of Polyarteritis Nodosa

Tx?

Vessel/muscle biopsy
Renal/Mesenteric Angiography: microaneurysms w/ abrupt cut-off of small arteries

Tx: Steroids
Plasmapharesis in pts w/ HBV

58

T/F: Polyarteritis Nodosa is ANCA positive.

False. ANCA negative. (<20% are P-ANCA +)

59

Symptoms of Polyarteritis Nodosa

HTN, Renal failure
Fever, myalgia, arthritis
Neuropathy, Mononeuritis complex
Livedo reticularis

60

Systemic connective tissue d/o: deposition of collagen in skin --> skin thickening (sclerodactyl), lung, heart, kidney, GI tract

Sceroderma (systemic sclerosis)

61

CREST Syndrome =
Associated w/ ___

Calcinosis cutis
Raynaud's phenomenon
Esophageal motility d/o
Scerodactyly (claw hand) **
Telangectasia

LIMITED Cutaneous Systemic Sclerosis

62

1. Ab associated with Limited Sclerosis/CREST Syndrome:

2. Ab associated w/ Diffuse Systemic Sclerosis:

1. Anti-Centromere Ab
2. Anti-SCL-70 Ab

63

T/F: Scleroderma is cured w/ high dose corticosteroids.

False. NO cure. Tx towards organ specific symptoms

64

Sjogren's Syndrome is associated w/ increased incidence of ____

lymphoma (Non-Hodgkin's lymphoma)

65

Schirmer test

Test for decreased tear production
Used in dx of Sjogren's SYndrome

66

Sjogren's Syndrome: Ab+ ___, ___ and ____

AntiSS-A (Ro)
AntiSS-B (La)
RF

67

Tx of Sjogren's Syndrome

Artificial Tears
Pilocarpine (cholinergic drug) --> increase lacrimation, salivation
Cevimeline --> stimulate muscarinic chlinergic receptors

68

Widespread muscular pain, fatigue, muscle tenderness, headaches, sleep/memory problems

Fibromyalgia

*extreme fatigue, Sleep disturbances

69

Dx of Fibromyalgia

Diffuse pain in 11/18 trigger points for > 3 months

Biopsy: "moth-eaten" appearance type 1 muscle fibers, injury to muscle

70

FDA approved tx of Fibromyalgia

Other txs

Pregabalin (Lyrica)

TCA*, Cymbalta, SSRIs, Neurontin, Swimming

71

MC mechanism of injury of an ankle sprain

Inversion and plantar flexion

72

Name the level of disc herniation:
Weakness in ankle dorsiflexion

L4 (between L3-L4)

73

Name the level of disc herniation:
Sensory loss on plantar surface of foot

S1 (between L5-S1)

74

Name the level of disc herniation:
Dorsum of foot, especially between 1st and 2nd toe

L5 (between L4-L5)

75

Name the level of disc herniation:
Weakness in big toe extension

L5 (between L4-L5)

76

Name the level of disc herniation:
Plantar flexion

S1 (between L5-S1)

77

Name the level of disc herniation:
Loss of knee jerk

L4 (between L3-L4)

78

Name the level of disc herniation:
Loss of ankle jerk

S1 (between L5-S1)

79

Name the level of disc herniation:
Sensory loss of anterior thigh

L4 (between L3-L4)

80

Name the level of disc herniation:
Sensory loss of lateral thigh/leg, hip, groin

L5 (between L4-L5)

81

Name the level of disc herniation:
No diminished reflexes

L5 (between L4-L5)

82

Name the level of disc herniation:
Walking on heel more difficult than walking on toes

L5 (between L4-L5)

83

Elbow/shoulder flexed @ 90 degrees w/ sharp anterior shoulder pain on passive internal rotation of humerus =

Tests for ____

+ Hawkins test

Impingement of subscapular nerve/supraspinatus b/w acromial process and humeral head

84

Arm fully pronated (thumb's down) w/ pain during forward flexion =

Tests for ____

+ Neer test

Impingement of subscapular nerve/supraspinatus b/w acromial process and humeral head

85

Posterior hip dislocation presents ___, (abducted/adducted), (externally/internally) rotated.

shortened, adducted, internally rotated

86

Anterior hip dislocation presents (flexed/extended), (abducted/adducted), (externally/internally) rotated.

flexed, abducted, externally rotated

87

Fractured femoral neck presents ___.

shortened, externally rotated

88

What cervical level?
Pain in neck, shoulder, lateral arm, radial forearm

C6

89

What cervical level?
Biceps and wrist extensors/pollicis longus weakness

C6

90

What cervical level?
DTR changes in biceps reflex

C5

91

What cervical level?
DTR changes in biceps and brachioradialis reflex

C6

92

What cervical level?
Pain in neck, shoulder, medial border of scapula, lateral aspect of arm, dorsum of hand

C7

93

What cervical level?
Sensory changes in dorslateral aspect of thumb and index finger

C6

94

What cervical level?
Sensory changes in middle finger and dorsum of hand

C7

95

What cervical level?
Triceps and finger extensors weakness

C7

96

What cervical level?
Sensory changes in deltoid region

C5

97

What cervical level?
Pain in neck, shoulder, anterolateral aspect of arm

C5

98

What cervical level?
Biceps and deltoid weakness/atrophy

C5

99

Forced flexion and circumduction of knee joint =

Tests for ____

McMurray test

Medial meniscus tear

100

Pain after being seated for prolonged period =

Associated with ____
Tx:

Theatre sign

Patellofemoral syndrome
Tx: PT to strengthen quadriceps

101

TNF inhibitors for tx of RA that does not respond to initial therapy should be screened for ____.

Tuberculosis w/ PPD test d/t increased risk of developing opportunistic infection

102

HLA-DR4 associated with ____

Rheumatoid arthritis

103

Ottawa ankle rules=

Used for ___

1. Bony tenderness along posterior edge of lateral or medial malleolus
2. Bony tenderness over navicular

Determines if ankle x-ray should be obtained

104

Inflammatory causes of POLYarthritis (2)

SLE
Rheumatoid arthritis

105

Inflammatory causes of OLIGOarthritis (2)

Reactive arthritis
Psoriatic arthritis

106

Recommended calcium intake for postmenopausal women =

1,500 mg