Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

Rheumatology > Clin Med2 Final > Flashcards

Clin Med2 Final Flashcards

(61 cards)

Start Studying
1
Q

What rheum disorders are more common in MEN than women?

A 
GOUT *(until menopause)
Ankylosing Spondylitis (2:1)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What dz do men = women?

A

Psoriatic Arthritis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Presentation of Fibromyalgia?

A

CHRONIC, DIFFUSE MSK pain w/o obvious pathological cause
Tenter points in ALL 4 quadrants of body (inc. axial skeleton)
Sleep disturbances
Severe fatigue/ exercise intolerance
depression, anxiety

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Can an event trigger Fibromyalgia?

A

Usually no, but sometimes from trauma, emotional trauma, flu/illness, or withdrawl from steroids

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What are the Historical requirements of fibromyalgia

A

Widespread body pain involving at least 3 quadrants
At least 3 mo duration
no other pain cause

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What are the cardinal features of fibromyalgia

A

Chronic widespread pain greater than 3 months

tender points on exam

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

How do you dx fibromyalgia?

A

Pain at least 3 months of the:
R AND L sides
Axial skeleton (11/18 tender ponts)
pain at 4 kg

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What are inflammatory syndromes?

A

Gout (MC)
Pseudogout
RA
Spondyloarthropathies

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Non Inflamm syndromes

A

Osteoarthritis (MC)

Fibromyalgia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Tx of fibromyalgia

A

DO NOT USE SYSTEMIC STEROIDS
non drug tx: exercise, sleep, tx psych stress bc “mind-body” illness
drugs: anti-depressants (duloxetine, cyclobenzaprine)
Pregablin- anti-epileptic
Tramadol- mu-opiod receptor ligand
opioids are rare for pain tx

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What diseases are worse with exercise/ as the day goes on?

A

Fibromyalgia and osteoarthritis
(hey, these are the non-inflamm ones too)
they can have am stiffness less than 30 mins

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Worst upon awakening?

A

RA

PMR

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Joint pain in OA?

A

early- worse w/ exercise

late- pain at rest

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Timeframe for inflame am stiffness?

A

am stiffness greater than 30 minutes

and symptoms improve with activity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What is the #1 drug in the world that tx RA

A

Methotrexate

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What are x-ray findings in RA of the hands and wrists?

A 
symmetrical joint space loss
PIP
MCP
corner erosions (mouse bites) @ small joints
may see soft tissue swell
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Serologic testing for RA

A

+ RF plus + anti CCP + characteristic sx (swell, stiff)

means 98% likelihood the pt has RA

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Real estate of RA

A

MCP and PIPs (NOT DIPS)
common in 2nd and 3rd digits, wrist and feet
usually b/L involvement

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Real estate of OA

A

common at base of thumb, DIP and PIP (NOT MCP)
hand (70%), knee, hip and spine
usually unilateral joint involvement

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Fibromyalgia associations (not part of dz though)

A 
Dizzy, HA
cognitive dysfxn
insomnia, severe fatigue
autonomic dysfxn
exercise intolerance
patesthesia
depression, anxiety
restless legs
irritable bladder
irritable bowel
endocrine imbalance
multiple sensitivities
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Tx Temporal Arteritis

A

IMMEDIATELY give HIGH dose of PO corticosteroid (60mg prednisone) to reduce inflamm (before blindness)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

PMR presentation

A 
symmetric shoulder girdle pain  (MC)
neck + pelvic + upper arm + thigh pain 
no pain during physical exam from palpating
wt loss, fever, malaise, difficulty standing + grooming
joint ROM: normal, MSK strength: nml
soft tissue swelling- knee, wrist, MCP
LE edema
carpal tunnel
Labs: ELEVATED ESR and CRP
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Age group PMR

A

Onset is OVER 50.
Mean age 73
whites females mc too

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Lupus Criteria

A 
Malar rash (butterfly)
Discoid rash- mild form (arm+ears)
Photosensitivity
Oral Ulcers
Arthritis
Serositis
Renal d/o
Neuro d/o
Hematologic d/o
immunologic d/o
antinuclear antibody

(** you need 4/11 criteria to have SLE, don’t have to be at once**)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
DDX malar rash
``` rosacea dermatitis glucocorticoid-induced atrophy cholasma/melasma bengin flushing ```
26
explain the malar rash
(butterfly)- fixed erythema, flat or raised over malaria eminences (cheekbone) ***SPARES NASOLABIAL FOLD*** (vs rosacea- don't spare it)
27
Initial screening for inflamm autoimmune d/o
ANA is the FIRST STEP w/ reflex!! | if + then you get other tests
28
Patterns
Spekled *SLE Homogenous/diffuse =MC non specific tho Rim/peripheral nucleolar
29
What are other tests for immunology d/o
``` anti dsDNA (+ inc. lupus dx) anti Sm antiphospholipid ab (lupus anticoagulant) anti Ro (heart block in SLE pt) ```
30
What are lupus clusters?
Cutaneous, articular and renal manifestations (MC) or CNS, thrombotic and muscular sx (lesser extent)
31
Myosisitis labs | muscle and liver enzyme vs liver only
elevated levels of serum muscle enzymes bc skeletal muscle inflammation muscle: CPK, aldolase muscle and liver: AST LDH Liver only: ALT
32
Sjogren's
chronic systemic autoimmune inflammatory d/o characterize by lympocytic infiltration of endocrine glands
33
Sjrogens presents
F> M 35-50yo primary = xerostomia, keratoconjunctivitis sicca, hyposalivation secondary= primary plus RA, SLE, scleroderma
34
Target organ of Sjrogens
salivary and lacrimal glands
35
S/Sx OA
``` PAIN with increased use stiffness less than 15 to 30 minutes swelling crepitus limited ROM ```
36
OA complaints by gender
F: knee and hand M: hip
37
Enthesitis
inflammation at insertion of tendon or bone
38
Synovitis
inflammation of the synovial lining
39
Disease progression over time non inflamm is ___ vs autoimmune is ____
progression over decades (slow) | autoimmune occur in a year or two
40
Red Flags of back pain (14)
``` Age greater than 50 significant trauma neuro deficit unexplained wt loss substance abuse ankylosing spondylitis night pain malignancy hx systemic seroids fever (over 100) persistant pain compensation issues increase pain when recumbent bowel and bladder dysfxn ```
41
MC cause of LBP?
Idiopathic
42
Best way to tx LBP?
AVOID BED REST!!! -old recommendation but NOT anymore do symptomatic treatment exercise helps prevent it!
43
Pharm tx LBP?
``` anti inflamm tramadol opioids muscle relaxants (methocarbamol) epidural steroid injxn ```
44
LBP categories
acute less than 4 wks (pain control) subacute 4-12 wks (pain control + activity) chronic greater 3 mo (multidisciplinary)
45
DDX LBP
``` Mechanic Rheumatologic Endocrine Neuro/Psych Neoplastic Reffered ```
46
Spondyloarthritis is
seronegative (RF -) inflamm arthritis of the spine
47
what if you untx spondyloarthritis
entire spine can be involved it may fuse (bamboo) = increase risk spine deformity, fx, and disability limited flexibility, "squaring" of lumbar and thoracic vertebrae, osteopenia, ossification
48
what is involved in severe spondy?
HIPS! | may need b/l replacement
49
Inflamm BP explain
stiffness, worse in morning, improves with exercise not relieved by rest
50
Non inflamm BP explain
worse as day progresses, worsens with exercise
51
Spondyloarthritis extra articular
``` acute anterior uveitis (MC) IBD prostatitis (men) aortic regurgitation arrhythmias, conduction defects or complete heart block ```
52
Synovial fluid crystal eval in gout:
monosodium urate- needle shape, acute attack = intracellular btwn/late attack = extracellular
53
Synovial fluid crystal eval in pseudogout:
crystal - calcium pyrophosphate- rhomboid or rectangular shape, dominant cell is neutrophils
54
Hyperuricemia presents as disclaimer: word vomit.
Purines come from same sources, same amounts as gout. When there is renal compromise, the total body uric acid pool is altered. The miscible urate pool is expanded and "flows over" into an insoluble compromise and slightly more eliminated in the intestines to try to compensate with uric acid overload, 2 outcomes ** 3/4 people have Asx hyperuricemia ** 1/4 people have GOUT
55
Characteristic X ray finiding in pseudogout
Punctate linear deposits of CPPD crystals in the menisci and cartilage : CHONDROCALCINOSIS (knee + wrist) pseuo = acute mono-arthritis
56
Case present Older woman- what can she have? Could be: basic calcium phosphate hydroxyapatite deposition disease
MC in older women "Milwaukee shoulder"- large non-inflame effusion with glenohumeral instability (deposits of crystals in cartilage + tendons) tx with NSAIDS, intra-articular steoids
57
Temporal arteritis/giant cell arteritis:
MC systemic vasculitis -vessels above the heart (primary branch of aorta, carotids) age >50 jaw pain, tongue pain, amarosis fugax lead to visual loss (ischemic optic neuropathy)
58
Temporal arteritis gold std test
Temporal artery bx
59
Henoch-schoenlin purpura
MC children TRIAD: palpable purpura, abd pain, glomerulonephritis self limiting
60
Polyarteritis nodosa (PAN)
VERY rare!! necrotize medium-small arteries ONLY associated with HBV multiple organs but SPARES: lung and glomerulus! ANCA negative tissue bx is best for dx
61
Takayasu's Arteritis
``` "pulseless' dz in one wrist- not in other (asymmetrical BP too) renovascular HTN limb claudication MC young females HLA-class 1 MC @ aorta + branches dx with Angiogram!! ```

Rheumatology (1 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions