DIT Flashcards
(111 cards)
1
Q
hematologic manifestations SLE
A
PANcytopenia
anemia (hemolytic), thrombocytopenia, leukopenia
2
Q
SOAP BRAIN MD
A
serositis (pericardial, pleuritis, pleural effusion)
oral ulcers
arthralgia
photosensitivity
blood (pancytopenia)
renal (proteinuria, renal failure, glomeruloneph)
ANA
immunologic (anti dsDNA, anti Smith, antiphospholipid)
neurologic (personality change, seizures, psychosis, neuropathy)
malar rash
discoid rash
3
Q
rheum markers for SLE
A
anti dsDNA, anti Smith, antiphos
ANA
4
Q
anti histone
A
drug induced lupus
“SHIPP”
sulfonamides, hydra lazine, isoniazid, procainamide, phenytoin)
5
Q
drugs that cause drug induced lupus (anti histone)
A
SHIPP sulfonamides hydralazine isoniazid procainamide phenytoin
6
Q
patient with headaches, jaw claudication has shoulder and hip pain
A
Polymyalgia rheumatica
7
Q
rheum markers for PMR
A
NONE!!!!!
check for elevated ESR
8
Q
anti Jo 1 abs
A
polymotsitis/dermatomyositis
9
Q
patient can’t comb hair, get out of chair, climb stairs, elevated aldolase, CK, AST, ALT
A
polymyositis
10
Q
low fecal elastase
A
chronic pancreatitis (most sensitive test)
11
Q
elevated lab markers for polymyositis/dermatomyositis
A
ALDOLASE
CK, AST, ALT, anti Jo 1 (antisynthetase)
12
Q
complication polymer/dermatomyositis
A
increased malignancy risk
13
Q
rx polymyositis/dermato
A
steroids
methotrexate, azothioprine
14
Q
rx SLE
A
hydroxycholorquine
NSAIDS, steroids
avoid direct sunlight
15
Q
lab/rheum markers for fibromyalgia
A
NOTHING!!!!!!!!
only pain points, no lab or pathologic cause
16
Q
anti-scl 70/anti RNA polymerase
A
diffuse cutaneous systemic sclerosis
17
Q
anti centromere`
A
limited cutaneous systemic sclerosis
18
Q
limited cutaneous systemic sclerosis a/w what?
A
CREST syndrome Calcinosis (deep layers skin, fingers) Raynaud phenomenon Esophageal dysmotility sclerodactyli (tight fingers, no dactylitis/sausage) Telangiectasia (lips/hands/face)
19
Q
patient with conjunctivitis, sand in eyes, dysphagia, dental caries
A
Srogen syndrome
20
Q
Anti SSb
Anti SSA abs
A
aka Anti-Ro, Anti LA
SJROGEN
21
Q
anti u1 RNP antibodies
A
mixed connective tissue disorder
overlap of SLE, polymyositis, systemic sclerosis)
22
Q
joint pain worsens with use, DIP (heberden) PIP Bouchards
A
OA
23
Q
risk factors OA
A
aging
obesity
previous joint injury
24
Q
X-ray finding OA
A
osteophytes, joint space narrowing
25
rx OA
NSAIDs, celecoxib, acetominophen
steroid/hyaluronic acid joint injection
joint replacement
WEIGHT LOSS/REST
26
RF what kind of hypersensitivity
type III
27
swan neck deformities, ulnar deviation
RA
28
morning stiffness, improves with use
RA
29
lab and rheum marker RA (3)
anti IgG/rheumatoid factor
anti citrullinated protein antibodies (ACPA)
elevated ESR/CRP
30
ESR in OA
normal
31
ACPA (anti citrullinated protein antibodies)
RA
32
rx RA (4)
hydroxychloroquine
methotrexate
TNFa inhibitors (-zumabs, ertanercept)
leuflonomide
33
name some TNFa inhibitors
adalimumab
golimumab
infliximab
etanercept
34
rheum markers psoriatic arthritis
ANA and RF NEGATIVE
| HLA-B27 positive
35
pencil in cup deformities of finger
psoriatic arthritis
36
common eye finding for all HLA-B27
anterior uveitis
37
joints involved ankylosing spondylitis
spine and SACROILIAC JOINTS
38
low back pain worse with inactivity, better with exercise
ankylosing spondylitis
39
bamboo spine
ankylosing spondylitis
40
rx ankylosing spondylitis (2 pharm, 2 conservative)
PT/exercise
NSAID/ celecoxib
TNFa inhibitors
41
HLA B 27 seronegative spondylarthropathies
```
"PAIR"
psoriatic arthritis
ankylosing spondylitis
IBD arthritis
reactive arthritis (uveitis, urethritis, arthritis)
```
42
medications that lead to decreased uric acid excretion
loop diuretics
| thiazides
43
synovial fluid of gout vs pseudogout
gout - YELLOW, NEEDLE, NEGATIVELY birefringent
| pseudo gout - BLUE, RHOMBOID, POSITIVELY birefringent
44
rx acute gout
NSAIDs
glucocorticoids
colchicine
45
rx chronic gout
allopurinol (inhibits uric acid production; xanthine oxidase inhibitor)
probenecid (prevents uric acid reabsorption)
46
risk factors pseudogout
hypercalcemia, hyperparathyroidism
47
Most common affected joint in gout vs pseudogout
gout - first big toe (podagra)
| pseudo gout - KNEE, elbow, feet
48
MCC septic arthritis overall
staph aureus
49
young, sexually active patient with septic arthritis, pustules/papules on skin
gonococcus
50
lab findings septic arthritis
elevated ESR CRP
synovial fluid >50,000 WBC
luekocytosis
51
rx septic arthritis
immediate surgical drainage/irrigaiton
| culture and empiric antibiotics (vanc, ceftriaxone)
52
How long does tick need to stay on skin to transmit Lyme dx
2-3 days
53
early localized lyme disease (1-2 weeks)
erythema migrans
| constitutional symptoms
54
early disseminated Lyme disease (weeks to months)
facial nerve/BELLS PALSY
lymphocytic meningitis
peripheral neuropathy/radiculopathy
carditis (AV heart block, myocarditis)
55
late Lyme disease (months to years)
arthritis
| mild encephalopathy
56
1st line rx lyme disease
doxy
DO NOT GIVE TO PREGNANT PATIENT
57
rx Lyme disease pregnant patient
amoxicillin
| cefuroxime
58
x-ray finding pseudogout
calcification of articular cartilage (chonedrocalcinosis)
VERY HIGH YIELD
59
pseudo gout involves deposition of what...
calcium pyrophosphate dihydrate crystals
60
Ca, PTH, phosphate, alk phos value in osteoporosis
NORMAL
61
T score values for dx osteoporosis
>-1 normal
-1 - -2.5 osteopenia
< - 2.5 osteoporosis
62
pharm rx for osteoporosis
bisphosphonates
denosumab (RANKL inhibitor)
teriparatide (recombinant PTH, stimulates osteoblasts)
63
pancytopenia (increased infections), hearing loss, fractures, increased skull circumference, normal bone labs, flared ends Xrays
osteopetrosis (impaired osteoclasts, abnormally dense bone)
genetic, rare
64
patient arthritis, bored tibias, hearing loss, can't fit hats, normal bone labs except alk phos
Paget disease (osteoclast overactivity -> osteoblast overactivity, unorganized bone)
65
how to dx paget's
```
bone labs (elevated alk phos), osteolytic lesions on xray
hot spots on radio bone scan
```
66
paget's increases risk for....
osteosarcoma (lots of unorganized bone metabolism)
67
osteomyelitis in sickle cell patient
salmonella
68
osteomyelitis in IV drug user
pseudomonas
69
osteomyelitis in person with prostheses
staph epidermidis
70
MCC osteomyelitis
staph aureus
71
osteomyelitis in diabetic foot ulcer
pseudomonas
72
most helpful tests for osteomyelitis
MRI
also do bone biopsy and culture
can also see elevated ESR/CRP, bone erosion on Xray
73
what cancers like to met to bone?
```
"Permanently Relocated Tumors Like Bones"
prostate
renal
testicular/thyroid
lung
breast
```
74
Rb gene mutation
osteosarcoma
75
11;22 translocation, young boy, bone tumor
Ewing
76
"soap bubble" bone appearance
giant cell tumor
77
painless bone mass, benign, male <25, "chunk" of bone with cartilage cap
osteochondroma
78
multinucleate giant cells, distal femur, proximal tibia, benign but destructive
giant cell tumor
79
elevation of periosteum on bone xray
| sunburst pattern
osteosarcoma
80
onion skin appearance of bone on xray
Ewing
"wings and onion rings"
81
60 year old man, bowed out legs kyphosis, hearing loss, hat can't fit
Paget's disease
more common than osteopetrosis
82
carpal tunnel syndrome is injury of what nerve
median
numbness in palmar 1,2,3rd and half of ring finger
83
patient has blow to extended arm, arm is in external rotation and slight abduction
anterior shoulder dislocation
| AXILLARY NERVE commonly affected
84
patient with seizure/electrocuted comes in with shoulder internally rotated and adducted, cannot externally rotate
posterior shoulder dislocaiton
| rare
85
patient has hyperextension of 4'th and 5th MCPs, and flexed IPs, apparent when patient tries to extend fingers
ulnar claw (ulnar nerve injury)
86
patient can't flex first and 2nd digits when asked to make fist
median nerve injury farther up arm
87
patient has thenar muscle atrophy and cannot abduct thumb
median nerve injury at elbow
88
patient develops wrist drop and cannot extend wrist
radial nerve injury
89
radical nerve compression against spiral groove of humerus
Saturday night palsy
90
scapular winging
long thoracic nerve
91
unable to wipe bottom
thoracodorsal
92
loss of shoulder abduction
axillary nerve
93
loss of elbow flexion and forearm supination
musculocutaneous
94
trouble initiating shoulder abduction
suprascapular
95
trouble abducting arm beyond 10 degrees
axillary
96
unable to raise arm above horizontal
long thoracic, spinal accessory
97
fracture of shaft of humerus
radial nerve
98
fracture of surgical neck of humerus
axillary
99
supracondylar humerus fracture
median nerve
100
fracture of medial epicondyle
ulnar nerve
101
fall on outstretched hand, fracture of distal radius, posterior displaced
dx and rx
colle's fracture
| long arm cast
102
fall on a flexed wrist, distal radius fracture, anterior displaced (more rare)
smith fracture
| casting
103
fall on outstretched hand, tenderness at anatomical snuff box
rx and mangement
scaphoid fracture
| thumb spica and serial imaging (initial imaging may be negative)
104
complication scaphoid fracture (2)
nonunion
| avascular necrosis
105
patient gets into a fight, fractures neck of 5th metacarpal
| rx and potential complication
boxer's fracture
| watch out for infection from bite
106
complication of femur fracture
fat embolus
107
elderly woman after fall with shortened and external rotated leg
hip fracture (watch out for femoral neck avascular necrosis)
108
rx carpal tunnel conservative
wrist splinting
| activity mofidifaciton
109
pharm treatment for carpal of conservative fails
NSAIDs
glucocorticoids (injected or PO)
surgial decompression
110
how does ankylosing spond pain change throughout day
improves with exercise
| worse in the morning
111
younger patient symmetric polyarticular arthritis self limited course
viral arthritis usually due to parvovirus b19
