ICM - Rheum 4

Question 1

what anatomic site does gout (microcrystalline arthritis) affect?

Answer 1

joint space

Question 2

cardiovascular exercise is important treatment/therapy in this disease

Answer 2

fibromyalgia

Question 3

muscle strengthening is important treatment for these conditions

Answer 3

OA and LBP

Question 4

treatment option for underlying immune defect in many autoimmune diseases

Answer 4

disease modifying anti-rheumatic drugs (DMARDS)

Question 5

this calcium pyrophosphate deposition diseases is associated with OA (either result or cause)

Answer 5

chondrocalcionsis

Question 6

matrix degrading enzymes responsible for collagen network degradation (cannot be reversed)

Answer 6

aggrecanases and collagenases (metalloproteinases)

Question 7

Wolff’s hypothesis (of bone remodeling)

Answer 7

distribution/material of bone determined by magnitude/direction of load

Question 8

stain that has high affinity for proteoglycans (paler staining of cartilage)

Answer 8

safranan O

Question 9

can last for 15-30 min in OA….stiffness when first using the joint after period of rest

Answer 9

gelling

Question 10

how many joints affected in OA?

Answer 10

one or few

Question 11

knee in this position if lateral compartment degrades

Answer 11

valgus

Question 12

commonalities among classification criteria of OA

Answer 12

pain in joint, aging, no inflammation, osteophytes

Question 13

DDX for OA

Answer 13

CPPD, RA, infectious monoarticular disease, psoriatic arthritis

Question 14

topical options for hand OA

Answer 14

capsacin or NSAID

Question 15

oral treatments for hand OA

Answer 15

NSAIDs, COX 2 selective NSAID, tramadol (weak SSRI)

Question 16

recommended pharmacological treatments for Hip and Knee OA

Answer 16

acetaminophen, NSAID, intraarticular corticosteroid, tramadol

Question 17

this is hallmark of systemic onset JRA

Answer 17

quotidian fever (spiking 1-2x per day)

Question 18

diagnostic for systemic onset JRA

Answer 18

fever and rash

Question 19

description of rash in JRA

Answer 19

macular, evanescent, migratory rash on trunk and proximal extremities

Question 20

extra-articlar manifestations of JRA

Answer 20

pericarditis, myocarditis, chronic uveiitis, growth retardation

Question 21

polyarthritis JRA clinical features

Answer 21

PIP, MCP wrist (hands like adult RA), cervical spine disease, micrognathia (temporal mandibular disease)

Question 22

oligoarthritis JRA clinical features

Answer 22

primarily knees/ankles/feet, uveitis (young females with ANA)

Question 23

systemic JRA clinical features

Answer 23

quotidian fever, evaescent rash with Koebner phenomenon, hepatosplenomegaly/lymphadenopathy/pericarditis

Question 24

describes rash in systemic JRA –> can be induced by rubbing or scratching the skin

Answer 24

Koebner phenomenon

Question 25

growth retardation of TMJ --\> shortening of jaw/chin

Answer 25

micrognathia

Question 26

diagnostic criteria for JRA

Answer 26

6 weeks

Question 27

primary site of pathologic anatomy/inflammation in seronegative spondyloarthropathies

Answer 27

enthesis

Question 28

basic pathogenesis of seronegative spondyloarthropathies

Answer 28

fibrosis/ossification of enthesis (reducing ROM)

Question 29

seronegative spondyloarthropathy involving primarily axial spine, pain/stiffness --\> leading to fusion

Answer 29

ankylosing spondylitis

Question 30

epidemiology if ankylosing spondylitis

Answer 30

male, young adult (by 20s), caucasian

Question 31

symptoms of ankylosing spondylitis...typically longer than 3 months

Answer 31

LBP (insidious onset, better with exercise, pain at night), morning stiffness, fatigue/weight loss/low fever

Question 32

extra-articular manifestations of ankylosing spondylitis

Answer 32

prostatitis (80%), iritis/conjunctivitis (25%), upper lobe fibrosis, CV disease

Question 33

DDX for ankylosing spondylitis

Answer 33

mechanical BP, OA, osteitis condensans IIii, Reiter's syndrome, psoriatic arthritis

Question 34

special studies for ankylosing spondylitis

Answer 34

pelvic Xray (look at SI joint), MRI (and possibly HLA B27)

Question 35

treatment for ankylosing spondylitis

Answer 35

stretching/flexibility, NSAIDs, sulphasalazine (peripheral), TNF blockers

Question 36

triad of Reiter's syndrome

Answer 36

urethritis, conjunctivitis, arthritis (\> 1mo)

Question 37

time it takes for Reiter's syndrome to develop after diarrheal illness or sexual exposure

Answer 37

2-4 weeks

Question 38

this condition is usually pauciarticular, affecting large joints, and the lower extremity; also sausaging or dactylitis of toes (due to swelling)

Answer 38

Reiter's

Question 39

mucocutaneous manifestation of Reiters --\>skin lesions on soles and palms, toes, glans penis

Answer 39

keratoderma blenorrhagica

Question 40

UG manifetation of Reiter's....painless and superficial erosions on glans penis

Answer 40

circinate balantis

Question 41

venereal organisms that can cause Reiter's

Answer 41

Chlamydia trachomatis and Mycoplasma

Question 42

HLA associated with Reiter's

Answer 42

HLA B27

Question 43

late manifestations of Reiter's

Answer 43

sacroiliitis, iridiocyclitis, CV (palpitations, murmurs, rub), peripheral neuropathy

Question 44

special studies for Reiter's

Answer 44

joint aspiration, STD exam, SI xray (also CBC, WSR, UA, ANA, RF)

Question 45

mainstay of therapy for Reiter's syndrome

Answer 45

NSAIDs

Question 46

mechanisms that estrogen may aggravate SLE

Answer 46

prolong survival autoimmune cells, increase CD4 CK production, stimulate B cells (to make Ab)

Question 47

ANA associated with limited scleroderma (CREST)

Answer 47

anti-centromere

Question 48

these are present in 100% of cases of drug induced SLE

Answer 48

antihistones

Question 49

lace-like, purple rash seen in SLE

Answer 49

livedo reticularis

Question 50

serositis manifestations of SLE

Answer 50

pleurisy and pericarditis

Question 51

hematologic manifestations of SLE

Answer 51

anemia, leukopenia, thrombocytopenia

Question 52

GN seen in SLE where immune deposits only in mesangial area

Answer 52

mesangial

Question 53

renal involvement in SLE....less that 50% glomerular tufts affected with segmental proliferation --\> Ig in mesangium, subendothelial/subepithelial/intraBM areas

Answer 53

focal proliferative nephritis

Question 54

renal involvement in SLE...\>50% glomerular tufts affected by hypercellularity (mesangial, endothelial, monocytes, PMN)

Answer 54

diffuse proliferative GN

Question 55

renal involvement in SLE...little cellular proliferation, uniform thickening of glomerular BM (Ig and complement along glomerular BM)

Answer 55

membranous GN

Question 56

Ab seen in sjogrens syndrome --\> associated with ANA neg lupus, congenital lupus

Answer 56

anti Ro (SSA) and La (SSB)

Question 57

diagnostic criteria for SLE (Need 4/11)

Answer 57

renal, arthriris, serositis, hematologic, oral ulcers, neurlogical (seizures/psychosis), malar rash, ANA, immunologic disorder, discoid rash, sun sensitivity

Question 58

treatment for mild manifestations of SLE

Answer 58

antimalarials (hydroxychloroquin)

Question 59

cytotoxic medications for major organ involvement in SLE

Answer 59

azathioprine, cyclophosphamide