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Rheuma Recall > Mixed > Flashcards

Mixed Flashcards

1
Q

MC abnormality of valves in RA?

A

Mitral regurgitation

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2
Q

MC part affected by OA

A

Base of the thumb

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3
Q

OA Joints affected by heritability

A

Hip and hand - 50%
Knee - 30%

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4
Q

Common RA diseases in men

A

AS, Spondylitis, Gout

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5
Q

3 Rheuma diseases more common in Men than women

A

Gout
Spondyloarthritis
AS

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6
Q

Expected synovial fluid for gouty arthritis

A

2000-60,000

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7
Q

Colchicine and NSAID may be poorly tolerated in what conditions?

A

Elderly
GI dse
Renal insufficiency

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8
Q

Involvement of what joint in RA will predispose to concomittant OA

A

DIP

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9
Q

Involved joints in RA

A

wrist, MCP, PIP

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10
Q

Most sensitive and specific marker for RA

A

Most specific - Anti CCP
Sensitivity Anti CCP = RF

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11
Q

Expected cell count for infectious arthtitis

A

25,000 - 250,000 (ave 100,000)

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12
Q

Gonorrhea is best cultured in what organ?

A

Mucosa sites aka cervix

Synovial- almost none
Blood - 45%

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13
Q

Protective factor against SLE

A

Alcohol drinking

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14
Q

Which class of nephritis requires aggressive immunosuppression to avoid ESRD

A

Class III, IV

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15
Q

Autoantibody associated with dry eyes and mouth

A

Anto Ro (SSA)

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16
Q

Benefit of anti malarials in SLE

A

FAD

Fatigue
Arthritis
Dermatitis

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17
Q

Distinguishing hallmark for systemic sclerosis

A

WOF

Widespread capillary loss
Obliterative microangiopathy
Fibrosis

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18
Q

Avoid in scleroderma renal crisis

A

Steroids

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19
Q

Treatment of choice in scleroderma crisis

A

Symptomatic - acei arbs ccb endothelim antagonists

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20
Q

Most frequent complication SSc

A

Raynaud’s Disease

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21
Q

Clinical presentation of inclusion body myositis

A

Early predilection of wrists and finger with atrophy at age 50 or older with slightly elevated CK leves

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22
Q

Myositis mechanic hands and fever and non erosive arthritis indicate what?

A

Anti synthetase syndrome

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23
Q

Characterized by acute symmetric proximal weakness with underlying CTD/ statin use

A

Immune mediated necrotizing myopathy

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24
Q

For inflammatory myopathies when is it indicated to start a second line agent aside from steroids?

A

Severe weakness
Increases steroid complications
Development of necrotizing myopathy
Failure to improve 2-4 weeks

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25
Q

Drug to start if refractory to steroids and other second line agent

A

Rituximab

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26
Q

Inflammatory myopathy (IM) where M=F and M > F

A

M=F: NM
M> F: IBM

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27
Q

Adult onset predilection for IM types

A

PM
IBM > 55 yo

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28
Q

Most IM are proximal muscle group involvement except for what which involves finger, wrist, knee extensors

A

IBM

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29
Q

Associated with HMGCR or anti SRP antibodies

A

NM

30
Q

Associated with anti CN1A antibodies, granular lymphocytes and reduced CD4/CD8 ratio

A

IBM

31
Q

Match muscle biopsy findings with IM type

Perimysial and perivascular
Endomysial and perivascular
Necrotic
Perimysial fragmentation with Alk phos staining
Endomysial and perivascular with MHC-1 expression

A

Perimysial and perivascular: DM
Endomysial and perivascular: PM
Necrotic: NM
Perimysial fragmentation with Alk phos staining: ASS
Endomysial and perivascular with MHC-1 expression:IBM

32
Q

Cellular infiltrate to IM typing: CD 4 and CD8

A

CD4: DM, ASS
CD8: PM, IBM
Macrophage: NM

33
Q

IM with no to minimal response to Tx

A

IBM

34
Q

IM triggered by statin use

A

NM

35
Q

Mechanic hands, ILD, non errosive arthritis, Raynaud phenomenon IM

A

ASS

36
Q

IM type: Sarcoidosis, scleroderma

A

IBM

37
Q

Drugs that need G6PD testing in RA

A

Sulfasalazine

38
Q

ACR criteria for diagnosis

A

Fulfillment of 6 or more

Joints
1 large joint-0
2 -10 large joints -1
1-3 small joints -2
4-10 small joints -3
>10 joints- 5

Acute phase reactants
Normal 0
Abnormal ESR or CRP 1

Serology
Normal anti CCP or RF 0
<= 3x elevation 2
>3x elevation 3

Duration
< 6 weeks - 0
>= 6 weeks - 1

39
Q

Environmental factors in RA

A

Smoking
Porphyromonas gingivalis

40
Q

Xray findings in RA

A
  • Peri-articular osteopenia → initial radiographic finding
  • Soft tissue swelling, symmetric joint space loss, subchondral erosions (MCPs, PIPs, MTPs)
  • Lateral aspect of 5th MTP is usually targeted first
  • ADVANCED DISEASE → joint subluxation and collapse
41
Q

Chronic inflammation leads to ____ in RA

A

Chronic inflammation leads to synovial lining hyperplasia and formation of pannus

42
Q

RA is often considered to be a _-driven disease

A

Macrophage

43
Q

MC cause of death in RA

A

CV disease

44
Q

Best diagnostic imaging for AS?

A

Pelvic MRI

45
Q

Risk Factors for Extra-Articular Disease in RA

A
  • History of Smoking
  • Early onset significant physical disability
  • Positive serum RF or anti-CCP antibodies
46
Q

Types of fractures MC caused in RA

A

Hip

47
Q

MC type of lymphoma in RA

A

DLBCL

48
Q

initial treatment of moderate-severe RA

A

MTX

49
Q

Administered in low-to-moderate doses to achieve rapid disease control before onset of fully effective DMARD therapy

A

Steroids

50
Q

Administered in low-to-moderate doses to achieve rapid disease control before onset of fully effective DMARD therapy

A

Steroids

51
Q

Contraindication for Anti TNF

A

Chronic HBV; HF NYHA FC III-IV

51
Q

Contraindication for Anti TNF

A

Chronic HBV; HF NYHA FC III-IV

52
Q

Definition of remission in RA

A

<=1 Tender, swollen joints; CRP <=1
SDAI score <= 3.3

53
Q

DOC RA in flare during pregnancy

A

Low dose prednisone

May use HCQ and Sulfasalazine

54
Q

MC systemic manifestation in SSC

A

Raynaud’s phenomenon

55
Q

More common manifestations in lssc?

A

Mucocutaneous telangiectasia
GERD
PAH
Barretts
Calcinosis cutis
Digital ischemic ulcers

56
Q

More common manifestations in lssc?

A

Mucocutaneous telangiectasia
GERD
PAH
Barretts
Calcinosis cutis
Digital ischemic ulcers

57
Q

LSSC VS DSSC

Raynauds antedates skin involvement
Frequent calcinosis cutis
Autoantibodies

A

Raynauds antedates skin involvement
Frequent calcinosis cutis
Autoantibodies
-lssc: Anti centromere
-dssc: Anti topoisomerase I anti RNA polymerase III

58
Q

Pathophysiology of Scleroderma renal crisis

A

Obliterative vasculopathy
intravascular hemolysis,
- activation of the complement pathways
-

59
Q

Pathophysiology of Scleroderma renal crisis

A

Obliterative vasculopathy
intravascular hemolysis,
- activation of the complement pathways
-

60
Q

Most commonly implicated organism in infectious arthritis?

A

N. gonnorhea

If non gonorrhea –> S. aureus

61
Q

Diagnosis of ARF

A

2 major or 1 major + 2 minor

62
Q

Diagnosis of recurrent ARF

A

2 major
1 Major + 2 minor
3 minor

63
Q

Major criteria for ARF

A

<3 PECS

Carditis
Polyarthritis/arthralgia
Erythema marginatum
Chorea
SC nodules

64
Q

Difference in criteria between low/high risk population for ARF

A

MAJOR
Polyarthritis - Monoarthritis

MINOR
Polyarthralgia - Monoarthralgia
Fever >= 38.5C - > 38C
ESR >= 60 - ESR >= 30

65
Q

Diagnosis of AS

A

< 45 y/o, chronic back pain > 3mos, IBP

66
Q

Diagnostic of choice

A

Pelvic MRI

67
Q

First-line of pharmacologic therapy for AS

A

NSAIDS

68
Q

First-line of pharmacologic therapy for AS

A

NSAIDS

69
Q

MOST COMMON INDICATION FOR SURGERY IN PATIENTS WITH AS

A

Severe hip joint arthriti

Rheuma Recall (1 decks)

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