MTB 2 CK - Rheumatology Flashcards Preview

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Flashcards in MTB 2 CK - Rheumatology Deck (133):
1

Deposits of urate crystals with foreign body reaction. From longstanding gout

Composition of Tophi

2

Arthrocentesis (esp. to rule out infectious pathology)

Most accurate diagnostic test for gout

3

Acetaminophen (if not controlled, use NSAIDs like aspirin)

Best initial treatment for Osteoarthritis

4

Used in Acute attack in pts. resistant to NSAIDs or those with c/i to NSAIDs (renal insufficiency)

Corticosteroid role in management of gout

5

Used in patients with c/i to both NSAIDs and Steroids in acute attack; Chronic management to prevent second attack

Colchicine role in management of Gout

6

Used for chronic management (Febuxostat also acts via xanthine oxidase inhibition)

Allopurinol role in management of gout

7

Rarely used in chronic management (inc. secretion in kidneys)

Probenecid role in management of gout

8

Losartan (ARB) -also lowers uric acid; STOP thiazides

Rx for Hypertension in gout patient

9

Diarrhea, Neutropenia

Colchicine toxicity

10

Stevens-Johnson rash >> Toxic epidermal necrolysis

Allopurinol major toxicity

11

Hemochromatosis and HyperPTHism; minor: DM, Hypothyroidism, Wilson's (calcium salts deposition in articular cartilage)

Risk factors for Pseudogout

12

CPPD disease (rhomboid shaped crystals)

Athrocentesis revealing positively birefringent crystals in ________________ disease

13

Gout (needle shaped crystals)

Athrocentesis revealing negatively birifringent crystals in _______________ disease

14

Aspirin (NOT Acetaminophen -its inflammatory disease)

Best initial drug for CPPD disease

15

Dissolves uric acid (useful in gout)

Pegloticase mechanism of action

16

S aurues epidural abscess

Signs of Cord compression with high fever and elevated ESR in _____________ pathology

17

Suspect cord compression (neurologic emergency)

Management of Pt. with a hx of cancer presenting with sudden onset neurologic deficit (sensory level)

18

Point tenderness over vertebra

Sensitive Clinical sign of Cord compression

19

disk herniation -50% chance only (can be present for other reasons too)

Pain upon Straight leg raise clinical significance

20

Disk herniation excluded -high sensitivity (negative PPV)

No pain upon straight leg raise clinical significance

21

L5

Dorsiflexion of toe affected in ___________ nerve root compression

22

L4

Dorsiflexion of foot affected in ____________ nerve root compression

23

S1

Eversion of foot affected in ______________ nerve root compression

24

Do not image (unless serious pathology suspected)

Best initial test for uncomplicated back pain

25

CXR

Best initial test for back pain with compression or infection suspected

26

MRI (do CT myelogram if MRI is contraindicated -pacemaker)

Most accurate test for back pain with compression or infection suspected

27

Do MRI if accompanied by neuro deficits (isolated SLT pain is 50% of times not herniation)

MRI indications in case of pain upon straight leg raise

28

Steroids for decompression; chemo/radiation for tumor -surgical decompression if fails

Rx for Cord compression

29

Steroids to control acute neurologic deficits, Vancomycin/Linezolid until sensitivity is found; then switch to oxacillin/nafcillin + Gentamicin >> surgical drainage if resistant

Initial treatment for Epidural abscess

30

NSAIDs with ordinary mobility >> Steroid injection (resistant) >> Surgery (rarely needed)

Treatment for Disk herniation

31

PAD (vascular studies and physical findings are normal)

Important diseases to rule out in suspected spinal stenosis

32

Person > 60yrs, pain while walking radiating to buttocks and thighs b/l, worse on extending back/walking downhill, relieve in cycling/bending

Spinal Stenosis clinical picture

33

MRI

Most accurate test to diagnose Spinal Stenosis

34

Weight loss, pain meds, Steroid injections, PT/exercise >> Surgical dilation of spinal canal in 75%

Spinal Stenosis Management

35

Young woman, chronic generalized MS pain and tenderness with trigger points

Fibromyalgia clinical picture

36

amitriptyline and Milnacipran (SNRI specifically for Fibromyalgia)

Best initial treatment for Fibromyalgia

37

Pregnancy, Diabetes, RA, Acromegaly, Amyloidosis, Hypothyroidism

Systemic disease that can cause Carpal Tunnel Syndrome

38

Electomyography, Nerve Conduction Testing

Most accurate diagnostic test for Carpal Tunnel Syndrome

39

Wrist splints, avoidance >> Steroid injections and surgically cutting the flexor retinaculum in resistant cases

Best initial therapy for Carpal Tunnel Syndrome

40

NSAIDs, rest and physical therapy

Best initial therapy for Rotator Cuff tear

41

Complete tear, failure to respond to NSAIDs, steroids and physical therapy

Surgery indications for rotator cuff tears

42

Anterior knee pain at patella that is worse just after starting to walk after prolonged sitting

Patellofemoral Syndrome clinical picture

43

Trauma, imbalance of quadriceps strength, meniscal tear

Causes of Patellofemoral Syndrome

44

NO indication (nothing to fix)

Surgical indications of Patellofemoral syndrome

45

Plantar fasciitis (tarsal tunnel pain worsens)

Pain of _________________ (Tarsal tunnel syndrome/Plantar Fasciitis) improves with use

46

Very severe pain at the calcaneus with point tenderness

Plantar fasciitis clinical picture

47

Collagenase injection, Triamcinolone

Rx for Dupuytren Contracture

48

RA

Episcleritis is a feature of _____________ chronic inflammatory disease

49

C1 and C2 (leading to subluxation)

Vertebral joint commonly affected in RA

50

Joint involvement (up to 5), ESR/CRP (1), >6 wks (1), RF/CCP (1) (6 points = RA)

Factors for point-based diagnoses of RA

51

Coronary artery disease (due to vasculitis)

Most common cause of death due to RA

52

Felty Syndrome

RA with splenomegaly and neutropenia in _____________ syndrome

53

Caplan Syndrome

RA with pneumoconiosis and lung nodules in _______________ syndrome

54

Erosive disease (joint space narrowing, physical deformities, X ray abnormalities)

Methotrexate indications in RA

55

As a combination with MTX as initial DMARDS, Disease unresponsive to MTX

TNF-inhibitors indications in RA

56

PPD skin test

Labs to accompany TNF-inhibitor therapy

57

When NSAIDs do not control symptoms; while DMARDs take effect (Steroids do not halt progression)

Steroids indications in RA

58

Lung, LIver and marrow toxicity

MTX major toxicity

59

Retinal damage (do dilated eye exam)

Hydroxychloroquine major toxicity

60

Infection (anti-CD20 antibody -useful in Hodgkins and in RA)

Rituximab major toxicity

61

JRA (joint symptoms are relatively mild)

High fever of unknown origin in a young person accompanied with salmon colored truncal rash. Likely diagnoses is ______________

62

Positive ANA, or any of: Anti-dsDNA, Anti-Sm, VDRL, Positive LE cell prep)

Immunologic labs that form SLE diagnostic criteria

63

None (no deformation -just pain brings pt. to physician)

Xray findings in SLE arthritis

64

ANA (sensitive -negatives are not false )

Diagnostic test for SLE with high NPV

65

Anti-dsDNA, Anti-Sm (specific -positives are not false)

Diagnostic test for SLE with high PPV

66

Correlate with disease activity (drop with exacerbations); Dec. C3

Complement levels in SLE

67

Dec. complement, rise in Anti -dsDNA

Acute SLE flareup diagnostic labs

68

mildly chronic disease limited to skin and joint

Hydroxychloroquine indications for SLE

69

Bolus prep used in acute flare ups, Nephrotic disease

Steroids indication in SLE

70

Belimumab

SLE drug that controls progression

71

Steroids, alone or in combination with Cyclophosphamide and Mycophenolate

Rx for Lupus nephritis

72

Lupus anticoagulant and Anticardiolipin antibodies

2 main types of anti-phospholipid antibodies

73

high APTT, normal PT, normal INR

Clotting profile in Antiphospholipid syndrome

74

Anti-cardiolipin

_________________ antibodies are associated with spontaneous abortion in Antiphospholipid sydnrome

75

Lupus anticoagulant

_________________ antibodies are associated with arterial/venous thromboses in Antiphospholipid sydnrome

76

Mixing studies

Best initial test for Antiphospholipid syndrome with clotting abnormality

77

Russel viper venom test (RVVT) prolonged

Most specific test for lupus anticoagulant

78

Cannot stop an imminent abortion; heparin and aspirin for recurrence

Rx for abortion due to Antiphospholipid syndrome

79

Large-mouthed diverticuli

Intestinal manifestations of Systemic sclerosis

80

Sudden hypertensive crisis

Renal manifestations of systemic sclerosis

81

high PPV (specific but not sensitive -present only in 30%)

Role of anti-Scl70 positivity in systemic sclerosis diagnostics

82

ANA (high NPV but non specific)

Most sensitive test for Systemic sclerosis

83

Dermatomyositis (of ovary, lung, GI and Lymphoma)

_______________ (Dermatomyositis/polymyositis) is associated with cancer

84

CPK and aldolase

Best initial test for Dermatomyositis/polymyositis

85

Often associated with lung fibrosis

Anti-Jo antibody positivity clinical significance

86

Primary biliary cirrhosis

Hepatobilliary condition associated with Sjogren's

87

Lymphoma (up to 10%)

Most dangerous complication of Sjogren's

88

Schirmer test (filter paper against the eye)

Best initial test for Sjogren's

89

Lip or parotid gland biopsy showing lymphoid infiltration

Most accurate test for Sjogren's

90

SS-A and SS-B (also present in SLE -sensitivity also only 65%)

Best initial blood test for Sjogren's

91

NO findings (always spares the lungs)

PFT findings in PAN

92

Foot drop (also stroke in a young person)

Most common neurologic abnormality in PAN

93

Biopsy of symptomatic site

Most accurate test for PAN

94

Beading/abnormal dilation of renal, mesenteric or hepatic artery

Angiography findings in PAN

95

Normal CPK and aldolase in PMR

Test to differentiate polymyositis/dermatomyositis from Polymyalgia rheumatica

96

Anti-proteinase-3 (c-ANCA; Anti-myeloperoxidase associated with Churg Strauss)

Wegener's is associated with positive _________________ (Anti-proteinase-3 Ab/Anti-myeloperoxidase Ab)

97

Unresolving pneumonia not better with Antibiotics

Clinical picture of Wegener's lung involvement

98

Churg Struass Syndrome (also has asthma)

Eosinophillia is most strongly associated with _______________ vasculitis

99

Leukocytoclastic vasculitis

Biopsy findings in HSP

100

None (IgA levels not reliable) -clinical diagnoses + biopsy

Lab findings to diagnose HSP

101

Cryoglobulins (Cryoglobunemia)

chronic HCV infection is associated with increased _________ Ig levels

102

Joint pain, Glomerulonephritis, Purpuric lesions, neuropathy

Cryoglobulinemia clinical findings

103

Treat underlying HCV with interferon/Ribavirin (steroids NOT effective)

Rx for Cryoglobulinemia

104

Cold Agglutinins (cause hemolytic anemia in EBV, mycoplasma, lymphoma)

IgM associated with EBV infection

105

Pathergy -Sterile skin pustules from minor trauma (needlestick)

Characterstic Behcet Syndrome skin lesions

106

Behcet Syndrome (also can have ocular, joint and CNS lesions)

Oral and Genital ulcers; Erythema nodosum like lesions on the skin. Likely diagnoses

107

Men

Characteristic clinical picture of seronegative spondyloarthropathy

108

Early Ankylosing Spondylitis

Backache and stiffness in young man that improves with activity and worsens with rest. Likely diagnoses

109

Xray of Sacroiliac joint showing space narrowing

Best initial test for Ankylosing spondylitis

110

MRI

Most accurate test for ankylosing spondilitis

111

Ankylosing spondylitis (causing bamboo spine)

Bridging syndesmophytes over vertebral bodies seen in ________________ disease

112

Sausage digits (from enthesopathy), Nail pitting, Xray showing pencil-in-a-cup deformity of DIP

Findings in psoriatic arthritis

113

Xray of DIP

Best initial test for psoriatic arthritis

114

NSAIDs >> MTX >> Anti-TNF

Rx Treatment order for Psoriatic arthritis

115

No specific test. Rule out Reactive arthritis and look for underlying cause (IBS, Chlamydia infection, GI infection)

Best initial test for Reactive arthritis

116

Bone Densitometry (DEXA)

Most Accurate test for Osteoporosis

117

T-score between 1 to 2.5 SD lower than normal

Osteopenia diagnostic criteria

118

T-score below 2.5 SD lower than normal

Osteoporosis diagnostic criteria

119

Prosthetic joint > RA > OA

Risk factors for Septic arthritis

120

Ceftriaxone and Vancomycin

Best Initial therapy for Septic arthritis

121

Oxacillin, Nafcillin (beta-lactam sensitive), Linezolid, Daptomycin (resistant)

Therapy for Septic arthritis with culture showing S aureus

122

Removal first, Antibiotic for 6-8 wks, replacement

Management of Infected prosthetic joints

123

Accompanied by rash and tenosynovitis, and with polyarticular involvement

Distinct presentation of arthritis caused by Gonorrhea

124

Culture multiple sites -pharynx, rectum, urethra, cervix as well as joint and blood

Gonococcal arthritis diagnostics

125

Third gen cephalosporin (ceftriaxone, cefotaxime, ceftizoxime); Fluroquinolones if determined sensitive

Rx for Gonococcal arthritis

126

Complement levels for MAC

Lab diagnostics for recurrent gonorrhea

127

Vascular insufficiency, DM, SCD (Salmonella)

Risk factors for Osteomyelitis

128

Contiguous (from nearby foot ucler in DM, for eg)

Route of infection to bone is most commonly __________________ in adults

129

Hematogenous

Route of infection is most commonly _______________ in adults

130

Warmth, redness and swelling in the area that takes weeks to develop, with/without draining ulcer

Clinical picture of Osteomyelitis

131

X ray; if normal, MRI

Best initial test for Osteomyelitis

132

Biopsy (also imp. to know sensitivity)

Most accurate test for osteomyelitis

133

None (obtain culture on biopsy first and treat acc. to sensitivity -takes wks. to develop)

Emperic therapy for osteomyelitis