MTB Rheuma Flashcards Preview

USLME Step 2 > MTB Rheuma > Flashcards

Flashcards in MTB Rheuma Deck (26):

The most common risk factors of CPPD are

hemochromatosis and hyperparathyroidism.


Felty syndrome:
Caplan syndrome:

• RA • Splenomegaly • Neutropenia
• RA • Pneumoconiosis • Lung nodules



Fever in young
Features of JRA rash:
• Often only with fever spikes • "Salmon" colored • On chest and abdomen
Other features of JRA:
• Splenomegaly • Pericardial effusion • Mild joint symptoms


SLE presentation

Skin: Four of the manifestations of SLE are of the skin:
1. Malar rash 2. Discoid rash 3. Photosensitivity 4. Oral ulcers
Joint: Arthritis is present in 90% of those with SLE and is often the first symp-tom that brings patients to seek medical attention. SLE gives joint pain without deformation or erosion. That is why the x-ray is normal.
Serositis: Inflammation of the pleura and pericardium gives chest pain poten-tially with both pericardia! and pleural effusion.
Renal: Any degree of abnormality can occur, from mild proteinuria to end-stage renal disease requiring dialysis. The most common glomerulonephritis is membranous. Red cell casts and hematuria occur.
Neurologic: Symptoms include psychosis, seizures, or stroke from vasculitis.
Hematologic: Hemolytic anemia is part of the diagnostic criteria, but the ane-mia of chronic disease is more commonly found. Lymphopenia, leukopenia, and thromobocytopenia are also seen.
Immunologic (laboratory) abnormalities: Criteria include positive ANA, or any one of the following:
• Anti-double-stranded DNA • Anti-Sm • False positive test for syphilis • Positive LE cell preparation

Additional findings:
• Mesenteric vasculitis • Raynaud phenomenon • Antlphosphollpld syndromes


SLE diagnostic lab

anti DS DNA
anti sm
Decreased complements


In an acute lupus flare,

complement levels drop and anti-DS DNA levels rise.



Mixing test
the aPTT will remain elevated.
Russell viper venom test (RVVT).
The RVVT is prolonged with APL antibodies and does not cor-rect on mixing with normal plasma.


Scleroderma CREST syndrome

CREST syndrome (Calcinosis, Raynaud, Esophageal dysmotility, Sclerodactyly, Telangiectasia).


Scleroderma presentation

Raynaud syndrome: increased vascular reactivity of the fingers beginning with pain and pallor (white) or cyanosis (blue) followed by reactive hyperemia (red). Raynaud is precipitated by cold and emotional stress. Some cases lead to ulceration and gangrene.

Skin manifestations: fibrosis of the hands, face, neck, and extremities; telan-giectasia and abnormalities of pigmentation occur

Gastrointestinal: esophageal dysmotility with GERD, large-mouthed diver-ticuli of small and large bowel

Renal: sudden hypertensive crisis

Lung: fibrosis leading to restrictive lung disease and pulmonary hypertension

Cardiac: myocardial fibrosis, pericarditis, and heart block; lung disease gives right ventricular hypertrophy


Scleroderma diagnosis

Diagnostic Tests

ANA: positive in 85% to 90%, but nonspecific

ESR: usually normal

SCL-70: the most specific test is the SCL-70 (anti-topoisomerase), but present in only 30% of those with diffuse disease and 20% of those with limited disease

Anticentromere: present in half of those with CREST syndrome


Scleroderma treatment


Methotrexate slows the underlying disease process of limited scleroderma. Penicillamine is not effective.

Renal crisis: ACE inhibitors (use even if the creatinine is elevated)

Esophageal dysmotility: PPis for GERD

Raynaud: calcium channel blockers

Pulmonary fibrosis: Cyclophosphamide improves dyspnea and PFTs.

Pulmonary hypertension: • Bosentan ambrisentan (endothelin antagonist) • Sildenafil • Prostacyclin analogs: iloprost, treprostinil, epoprostenol


Dermatomyositis presents with:

Proximal muscle weakness
They do not affect facial or ocular muscles as occurs in myasthenia gravis

• Malar involvement • Shawl sign: erythema of the face, neck, shoulders, upper chest, and back • Heliotrope rash: edema and purplish discoloration of the eyelids • Gottron papules: scaly patches over the back of the hands, particularly the PIP and MCP joints


Shawl sign:
Heliotrope rash:
Gottron papules:

erythema of the face, neck, shoulders, upper chest, and back

edema and purplish discoloration of the eyelid

scaly patches over the back of the hands, particularly the PIP and MCP joints


Sjogren s Dx

Schirmer test



All vasculitides (e.g., polyarteritis nodosa, Wegener granulomatosis, Churg-Strauss, giant cell) give:

• Fever • Malaise/fatigue • Weight loss • Arthralgia/myalgia


Sjögren's syndrome Evaluate for ???, which occurs in·up to 10% of patients.



Wegener Granulomatosis
"What Is the Most Likely Diagnosis?"

Look for a combination of upper and lower respiratory tract findings in asso-ciation with renal insufficiency.
The clue to answering the "most likely diagnosis" question is unresolving pneumonia not better with antibiotics. You will not first think of Wegener when presented with the case.


Churg-Strauss Syndrome

A pulmonary-renal syndrome, Churg-Strauss also has: • Asthma • Eosinophilia
Pulmonary-renal syndrome is a rare medical syndrome involving bleeding in the lungs and kidney damage (glomerulonephritis).


Henoch-Schonlein Purpura
When the case describes xxx vasculitis on biopsy, the answer is Henoch-Schonlein purpura.

A vasculitis more frequently seen in children



Osteoarthritis Laboratory tests are normal:
X-rays show:

• Erythrocyte sedimentation rate (ESR)
• Complete blood count (CBC)
• Antinuclear antibody (ANA)
• Rheumatoid factor

• Joint space narrowing • Osteophytes
• Dense subchondral bone
• Bone cysts


CPPD It differs from DJD in that

the DIP and PIP are not affected.


Cause of Back pain not to miss

Cord compression
Epidural abscess
Cauda equina
Ankylosing Spondylitis


Fibromyalgia The best initial therapy is



Tumor Necrosis Factor Inhibitors

{infliximab, adalimumab, etanercept)


Sausagedigitsfromenthesopathy • Nailpitting

Psoriatic arthritis


Septic arthritis treatment

Ceftriaxone and vancomycin