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Clin Med II MHM - FINAL > Pope Need to Know > Flashcards

Flashcards in Pope Need to Know Deck (59):
1

Which rheumatological diseases are MC in men?

Gout
Ankylosing spondylitis

2

Which rheumatological diseases are MC in women?

Fibromyalgia
Sjogren's
SLE
PMR
RA

3

Which rheumatologic disorders result in pain with exercise/movement?

OA and fibromyalgia

4

Pain is improved with exercise/movement in which rheumatologic disorders?

Ankylosing spondylitis

5

What are the diagnostic criteria of fibromyalgia?

1. Widespread body pain (11 of 18 tender points)
2. 3 or more quadrants
3. 3 or more months duration
4. No other cause

6

Non-pharm treatments of fibromyalgia

PIE
Pt education
Improved sleep
Exercise

7

Pharm treatments of fibromyalgia

ATP
Anti-depressants
Tramadol
Pregabalin

8

FDA approved treatments of fibromyalgia

Duloxetine
Pregabalin
Milnacipran

9

What are inflammatory vs. non-inflammatory rheumatologic diseases?

Inflamm: RA, gout, SPA
Non-inflamm: OA, fibromyalgia

10

Differences between inflammatory and non-inflammatory rheumatologic disorders?

Inflamm: AM stiffness more than 30 minutes, symptoms IMPROVE with activity

11

What indicates poor prognosis in RA?

High titer RF and/OR anti-CCP

12

If a patient has positive RF and anti-CCP, what is the likely diagnosis?

98% RA as long as they also have clinical s/s

13

Which joints are affected by RA?

2nd and 3rd MCPs, PIPs

14

What is the mainstay drug of RA?

MTX

15

What are the x-ray findings a/w RA?

Symmetric joint space loss
MCPs and PIPs affected
Corner erosions of small joints (mouse bites)

16

How do symptoms cluster in lupus?

CAR: Cutaneous, Articular, Renal
CTM: CNS, Thrombotic, Muscular

17

Which enzymes are muscle specific?

CK and aldolase

18

Which enzymes are muscle AND liver specific?

AST and LDH

19

Which enzymes are liver specific?

ALT

20

Which organs are affected by Sjogren's?

Exocrine glands (lacrimal, salivary)
Eyes
Lungs
Kidneys
Heart
Skin
Neural (CNS and PNS)
Hematopoietic

21

S/S of OA

Pain with increasing use
Stiffness less than 30 mins
Limited ROM
Swelling
Crepitus

22

Body parts affected by OA

Hands (70%)
Spine (60%)
Knees (30%)
Hips (10%)

23

Where are men with OA MC affected?

Hips

24

Where are women with OA MC affected?

Hands and knees

25

Which joints are involved in OA?

DIPs

26

Define enthesitis and what it is a/w

-Inflammation where a tendon/ligament inserts on bone
-Reactive arthritis

27

Define synovitis and what it is a/w

-Inflammation of synovial membrane
-OA

28

MC cause of low back pain?

Idiopathic (70%)

29

Treatment of low back pain

-AVOID bed rest
-Anti-inflamm, opioids, muscle relaxants

30

Differential categories of low back pain

1. Mechanical
2. Rheum
3. Endocrine
4. Neuro/Psych
5. Neoplastic
6. Referred

31

Red flags with low back pain

1. Over 50
2. Trauma
3. Neuro deficit
4. Unexplained wt loss
5. Substance abuse
6. AS
7. Night pain
8. Malignancy hx
9. Systemic steroids
10. Fever over 100F
11. Persistent pain
12. Compensation issues
13. Increased pain when recumbent
14. Bowel and bladder dysfunction

32

What do the spondyloarthropathies (SPA) include?

PARE
-Psoriatic arthritis
-AS
-Reative arthritis
-Enteropathic arthritis

33

Extra-articular manifestations of SPA and when do they occur?

May occur prior to diagnosis
-Acute anterior uveitis
-IBD
-Prostatitis
-Aortic regurge

34

What occurs with progression of spondyloarthritis?

-Loss of spinal mobility
-Bamboo spine (fusion)

35

Synovial fluid analysis consists of:

Three Cs
1. Cell count
2. Culture
3. Crystal analysis

36

What disease has monosodium urate crystals?

Gout

37

What disease has calcium pyrophosphate dihydrate (CPPD) crystals?

Pseudogout

38

What disease has basic calcium phosphate (BCP) crystals?

Calcific periarthritis (Milwaukee shoulder)

39

MC way that gout develops?

Underexcretion of uric acid by the kidney (MC than overproduction)

40

X-ray findings of gout

"Overhanging edges" and asymmetric erosions

41

X-ray finding of pseudogout

-Chondrocalcinosis
-Punctate linear deposits of CPPD crystals in the menisci and cartilage

42

Who is MC affected by PMR?

Females over 50

43

Clinical features of PMR

-Symmetric proximal muscle pain and stiffness (shoulder, neck, pelvis)
-Constitutional symptoms

44

What areas of the body are MC affected by PMR?

Shoulder girdle (90%)
Neck and pelvis (70%)

45

Treatment of PMR

Low dose prednisone

46

Who is MC affected by giant cell/temporal arteritis?

Over age 50

47

Clinical features of giant cell/temporal arteritis?

HA
Jaw claudication
PMR
Fever
Vision loss

48

Treatment of giant cell/temporal arteritis

Prednisone ASAP - do NOT wait for biopsy results

49

What is polyarteritis nodosa (PAN)?

Necrotizing inflammation of MEDIUM to SMALL arteries (but not the smallest vessels)

50

What is PAN a/w?

HBV

51

Which organs are affected by PAN?

Multiple BUT spares the lungs and glomerulus

52

Clinical features of PAN

-PNS
-GI
-Skin
-NOT ANCA positive

53

Best method of diagnosis for PAN

Tissue biopsy

54

What is Henoch-Schoenlein purpura?

MC vasculitis in children

55

Clinical features of Henoch-Schoenlein purpura?

-Most have preceding URI
-Triad: palpable purpura, abdominal pain, glomerulonephritis

56

What is the triad of Henoch-Schoenlein purpura?

GAPP
Glomerulonephritis
Abdominal pain
Palpable Purpura

57

What is the prognosis of Henoch-Schoenlein purpura?

Self limited and excellent prognosis

58

What is Takayasu's arteritis? Who is MC affected and how does it present?

-Inflammation of LARGE arteries (aorta and its major branches)
-Asian women under 50
-FUO, malaise, different BPs on R vs. L, bruit over R axilla

59

What are symptoms a/w fibromyalgia (but not diagnostic)?

Cognitive dysfunction
Autonomic dysfunction
Multiple sensitivities
Paresthesia
Severe fatigue
Insomnia
Restless legs
Exercise intolerance
HA
Irritable bladder/bowel
Depression/anxiety
Dizziness
Endocrine imbalance