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Course 2 - Rheumatology > Polyarthritis > Flashcards

Polyarthritis Flashcards

1
Q

articular diseases cause ____ for active ROM and ____ for passive ROM

A

pain, pain

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2
Q

non- articular diseases cause ____ for active ROM and ____ for passive ROM

A

pain, no pain

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3
Q

non-MSK related diseases cause ____ for active ROM and ____ for passive ROM

A

no pain, painful

psychological (?)

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4
Q

features (stiffness, systemic symptoms, joint pattern, etc.) for inflammatory diseases

A

stiffness: morning, last >30 min
systemic symptoms (B symptoms): present
joint pattern: RA or PsA or other
other: nodules, rashes, other organ involvement

not confined to joints

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5
Q

features (stiffness, systemic symptoms, joint pattern, etc.) for non-inflammatory diseases

A

stiffness: after inactivity, lasts few min
systemic: no
joint pattern: OA
other: no

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6
Q

what is the number one route of infection for adult septic arthritis?

A

hematogenous

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7
Q

what is a common route of infection for paediatric septic arthritis

A

contiguous spread from osteomyelitis

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8
Q

what are some medical conditions that predispose to MSK infections

A 
compromised host defence 
(hematological & metabolic disorders, immunosuppressive drugs
direct penetration of joint 
joint damage (rheumatic, prosthetic joints)
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9
Q

septic arthritis organism for neonates

A

staph
strep
coliform bacteria

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10
Q

septic arthritis organism for children

A

staph

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11
Q

septic arthritis organism for young adults

A

staph

neisseria gonorrhoeae

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12
Q

septic arthritis organism for adult

A

staph

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13
Q

septic arthritis organism for immunocompromised patients

A

gram negatives

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14
Q

investigations for septic arthritis

A

aspirate, send for:
cell count and differential
crystal analysis
culture and sensitivity, including gram stain

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15
Q

joint aspirate feature for OA

A

clear
1-10mL (slightly higher than normal)
high viscosity,
200-10,000 WBC/cubic mm (higher than normal)
<50 polymorphonuclear cells (slightly higher than normal)

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16
Q

joint aspirate feature for inflammatory arthritis

A 
opaque (abnormal)
5-50mL (higher than normal)
low viscosity (abnormal)
500-75,000 cell count (higher than normal)
>50 (higher than normal)
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17
Q

joint aspirate feature for septic arthritis

A 
opaque (abnormal)
5-50mL (higher than normal)
low viscosity (abnormal) 
>50,000 cell count (much higher than normal)
>75 (much higher than normal)

higher the white count, higher the % of PMN’s, higher the chance of septic arthritis

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18
Q

what is gout and describe the epidemiology?

A

buildup of uric acid crystals in joints
most common cause of inflammatory arthritis in men over 40yr old
does not occur in premenopausal females

19
Q

what are risk factors for gout

A 
alcohol - purines 
obesity 
diabetes 
medication use 
renal insufficiency 
concurrent illness
past kidney stones 
FHx
myeloproliferative disorders
20
Q

what is pseudogout?

A

deposit of calcium pyrophosphate crystals
set off inflammatory response
episodic mono-arthritis
knee & wrist

21
Q

how to Dx pseudogout?

A

synovial fluid
birefringence
XR showing chondrocalcinosis

22
Q

what is rheumatoid arthritis and its epidemiology?

A

autoimmune
prevalence of 1%
3:1 (F:M)
onset 20’s - 40’s

23
Q

clinical presentation of rheumatoid arthritis

A 
fluctuating joint pain and swelling 
morning stiffness > 1 hour 
alleviated by moving and heat 
systemic symptoms 
MCP + wrist > PIP + MTP > knees and shoulders and ankles > elbows and hips
24
Q

what is the pattern of joint involvement in RA?

A

small joint, symmetrical, polyarthritis

may start as monoarthritis

25
Q

what are extra-articular diseases of RA?

A 
subcutaenous nodules 
pulmonary &amp; cardiac involvement
eye involvement 
neurologic
renal 
muscular atrophy
rheumatoid vasculitis
26
Q

epidemiology of SLE

A

9 females : 1 male

African and Asian more common/severe presentation

27
Q

common features of lupus

A 
(SOAP BRAIN MD)
serositis (lining of heart/lungs)
oral ulcers
arthritis 
photosensitivity 
cytopenias 
renal problems 
ANA positive 
antiDNA antibodies 
neurologic 
malar rash 
discoid rash
28
Q

what are seronegative arthritis diseases

A

rheumatoid factor negative

ankylosing spondylitis
psoriatic arthritis
reactive arthritis
enteropathic arthritis

29
Q

epidemiology of ankylosing spondylitis

A

males > females
late teens/early 20s
rare in black populations
high prevalence in Native Americans (HLA B27)

30
Q

Clinical presentation of ankylosing spondylitis

A

alternating butt pain (SI joints)
inflammatory back pain worse with rest, improve with exercise
morning stiffness > 60 min
q/3 get peripheral joint disease

31
Q

describe enteropathic arthritis

A

~5% of patients with IBD
often indistinguishable from primary AS
affects M/F equally
usually follows onset of bowel disease

32
Q

describe psoriatic arthritis

A

M=F
7-15% with curaneous psoriasis
psoriasis precedes arthritis in 2/3
nail changes

33
Q

describe reactive arthritis

A

mostly M
follows infectious diarrhea
(salmonella, yersinia, shigella, campylobacter, chlamydia)

34
Q

clinical presentation of reactive arthritis

A 
Sx appear 1-4 weeks post-infection 
TRIAD: arthritis, conjunctivitis, urethritis 
systemic features 
acute, asymmetric, additive oligoarthritis 
lower > upper limbs 
oral ulcers 
penile rash (circinate balanitis) 
keratoderma blenorrhagicum
35
Q

describe scleroderma

A 
skin thickening, calcinosis, fingertip ulcertation 
Raynaud's (fingers turning white)
GI reflux symptoms, hypomotility 
renal insufficiency, malignant HTN 
pulmonary fibroisis
36
Q

what are the 2 forms of scleroderma?

A

limited and diffuse

37
Q

describe limited scleroderma

A

CREST

calcinosis
raynauds 
esophageal dysmotility 
sclerodactyly
telangiectasia

anti-centromere +
skin thickening doesn’t go above elbows or knees

38
Q

describe diffuse scleroderma

A

spread above elbows and knees
internal organ involvement early and severe
scl-70 topoisomerase positive

39
Q

what is inflammatory muscle disease

A

progressive symmetrical proximal muscle weakness
pulmonary disease
GI symptoms
rash over eyelids, hands and neck, chest, shoulders

40
Q

labs for inflammatory muscle disease

A 
high creatine
autoantibodies- anti-Jo-1 or anti-tRNA synthetase 
CXR: interstitial lung disease
EMG: myopathic features 
muscle biopsy
41
Q

describe granulomatous polyangiitis (wegener’s) vasculitis

A 
inflammation of blood vessels
systemic features 
ENT
lung 
skin 
neuro 
renal
MSK
42
Q

describe polymyalgia rheumatica

A

proximal muscle pain, weakness and stiffness
difficulty rising from seated position
reduced ROM in shoulders

43
Q

describe temporal arteritis/giant cell arteritis

A

blockage of large blood vessels of the scalp, neck and arms due to inflammation
severe headache, fatigue, scalp tenderness
visual disturbance (double vision, blindness)

44
Q

describe fibromyalgia

A

F>M
common in those w chronic inflammatory conditions
widespread msk pain, fatigue, headache, forgetfulness (fibro fog)
Dx using symptom severity score

Course 2 - Rheumatology (8 decks)

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