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Rhumatology > R1 > Flashcards

R1 Flashcards

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1
Q

Systemic-Sclerosis pathogenesis?

A

 Progressive tissue fibrosis

 Vascular dysfunction

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2
Q

Clinical features?

A

 Fatigue and weakness
 Telangiectasia, Sclerodactyly, digital ulcer ,calcinosis cutis,pruritis and edema
 Arthralgia, myalgia, and contracture
 Esophageal dysmotility, dysphagia, and dyspepsia
 Raynaud’s Phenomena

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3
Q

Serology?

A

 Antinuclear
 Anti-topoisomerase I
 Anti- centromere

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4
Q

Complication?

A

 Lung: ILD, PAHTN
 Kidney: HTN, Scleroderma renal crisis
 Heart: Myocardial fibrosis, pericarditis, and pericardial effusion

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5
Q

Scleroderma renal crisis?

A

 Oligouria,MAHA,thrombocytopnia

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6
Q

Manometry?

A

Hypomotility with defective lower esophageal sphincter relaxation

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7
Q

Triads of disseminated gonococcus?

A

Disseminated arthralgia
Tenosynovitis
Painless pustular

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8
Q

Suprascapular nerve entrapment?

A

Compression of SSN at SS foramen(formed by TSS ligament and SS noch, found on superior mid scapular)

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9
Q

Cause?

A

Heavy backpack
Direct blow
Heavy weight lifting(ex.shoulder movt_)

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10
Q

Sx and Sign?

A

shoulder pain
defect in shoulder abduction(supraspinatus)
defect in shoulder ex.rotation(infraspinatus)
No other neurologic finding

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11
Q

Clinical features of RA?

A

Pain, Swelling, and morning stiffness in multiple joint
Small Joint(MCP,PIP, and MTP)
Spares DIP
Fever, weight loss, and anemia
Cervical S.(Subluxation & Cord compression)

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12
Q

Lab?

A

Positive RF & anti–CCP Ab.
C-RP and ESR(correlate with activity)
X-Ray: Soft tissue swelling, Joint space narrowing, and boney erosion

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13
Q

CM of Paget disease?

A

Asymptomatic(MC)
Headache, hearing loss
Spinal stenosis and radiculopathy

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14
Q

Laboratory?

A

Elevate ALP
Elevated B.Turnover marker(PINP, urine hydroxyproline)
Normal Ca, P and PTH

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15
Q

Pathogenesis?

A

osteolytic/mixed lytic/sclerotic lesion

B.Scan: Focal increase in uptake

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16
Q

Tx?

A

Biphosphonate

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17
Q

Pathogenesis?

A

Osteoclast dysfunction

High bone turnover

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18
Q

CM of SLE?

A 
fever, fatigue, and wt loss
symmetric migratory arthritis
butterfly rash and photosensitivity
pleuritis, pericarditis and peritonitis
thromboembolic sign(due to vasculitis and APA)
cognitive dysfunction and seizures
DMP and M nep
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19
Q

Laboratory?

A 
HA, thrombocytopenia and leukopenia
Low C3 & C4
ANA(sensitive)
Anti DNASE and ANTI smith(specific)
elevated proteinuria and creatinin
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20
Q

Arthritis Cxs in SLE?

A 
Polyarticular
Migratory
Symmetric
Morning stiffness(shorter than RA)
Normal joint X-ray
Pain exceeds the PE
Oral ulcer
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21
Q

antiphospholipid syndrome?

A

MC: occurs in SLE patient
Venous or Arterial TE(DVT/PE/IS/TIA)
Unexplained Px loss(abortion)
Preterm birth due to PI and PE

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22
Q

Laboratory?

A

LA(Paradoxical PTT elevation does not respond to plasma mixing)
Presence of SAb(Anti-cardiolipin and anti-B2G-1-Ab)

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23
Q

Risk factors for septic arthritis?

A 
OA,RA,Gout,Prostetic joint
Frequent IA GC injection
Age >80
DM
IV drug abuse
Alcoholism
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24
Q

CM?

A

Monoartheritis
Hot, painful, and tender joint
ROM decrement
Elevated ESR and CRP

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25
Diagnosis?
SFA(WBC>50,000,culture and GS) | Blood culture
26
Initial treatment?
G+ Cocci--Vancomycin G_ve--3rd gen.C Negativ--Vanco +(3rdGC,if Immunocompromised)
27
Managment of RA?
Acute Sx.relief(NSAID & Predisolon) | DMARD--As soon as posible
28
DMARD?
``` MTX(the first line, determine LFT before starting) Leflunomide Hydroxychloroquine Sulfasalazine TNF alpha inhibitors ```
29
MTX S/E?
Hepatitis--ALF/Cirrhosis: MC Pancytopnia Mucosal ulcers(stomatitis) Avoid alcohol and give concomitant leucovorin
30
Leflunomide?
Pyrimidine Sx inhibitor Hepatotoxicity Cytopenias
31
Hydroxy chloroquine?
TNF and IL-1 inhibitor | Retinopathy
32
Sulfasalazine
TNF and IL-1 inhibitor Hepatotoxicity Stomatitis H.Anemia
33
TNF inhibitor?
``` Adalizumab,intracept... Infection(TB) Demyelination CHF Malignancy ```
34
Acute back pain < 4 weeks managment?
Moderate activity NSAID & acetaminophen Muscle relaxant and spinal manipulation
35
Subacute and chronic(>4 weeks)?
Intermitent NSAID & acetaminophen Exercise (stretching, aerobic and strengthing) Consider: TCA and Deloxitine
36
Secondary prevention?
Exercise | Education
37
case of vertebral compresion #?
``` Trauma Osteoporosis.Osteomylaisa Bone metastasis Metabolic(HPT) Paget disease osteomylitis ```
38
CM?
``` Acute sudden Low Back pain & dec. spinal mobility after heavy lifting, coughing, and sudden bending Pain inc. In standing, walking, and lie back tenderness at affected level Chronic Painless Progressive kyphosis Loss of stature ```
39
Comp.
Increase future # risk | Hyperkyphosis: Protuberant Abd, early satiety, weight loss, and decrease respiratory capacity
40
Ankle reflex and aging?
May be absent finding in Pt age > 70
41
Mechanical cause of back pain and their caracter?
Muscle strain and disk degeneration | Tenderness on paraspinal area
42
Inflammatory cause of back pain and cx?
MCC: Spondyloartherophaty(AP, SNA) Worse at rest and better by activity Sacroiliitis Tenden site insertion Infn--cartilage destruction
43
Osteoarthritis pathogenesis?
Non-inflamatory articular cartilage distraction | idiopathic but may Ass with joint injury and SD(hemochromatosis)
44
CM?
Joint pain and stiffness Herben(DIP) and Bouchard(PIP) joint area node-due to osteophyte Wight being joint mainly affected
45
Pul.A Complication of RA?
Fibrotic lung disease Plural effusion Lung nodule Pul.HTN
46
CVS?
Atherosclerosis and vasculitis
47
MSK?
Osteopenia and osteoporosis
48
Dermatology?
RA nodule(firm, SC non-tender nodule occur in pressure area)
49
Hematology?
anemia
50
CNS?
Neuropathy and Depression
51
other?
Sjorgen Raynaud's Scleritis episcleritis
52
X-Ray indication in Back pain?
Osteoporosis Compression # Suspected malignancy Ankylosing spondilitis
53
MRI--indication for back pain?
Sensory deficit Motor deficit Cauda equina syndrome Suspected epidural abscess/infection
54
Red flag sign in back pain requires imaging?
Sudden onset back pain with spine tenderness History of cancer constitutional symptoms(fever ,weight loss) Trauma Significant/Progressive neurologic deficit Elevated infection risk(Recent inf,Imunocompromization,IV drug usage)
55
Felty syndrome pathogenesis?
Long-standing Erossive RA complication | Marked by the formation of Ab against neutrophil and GCSF
56
Clinical feature?
1) Rheumatoid arthritis(S.erosive Joint disease & deformity, R.Nodule, and vasculitis(mononeuritis multiplex, necrotizing skin lesion) 2) Netrophinia(ANC<2000)--Due to destruction by A.Ab--a recurrent bacterial infection 3) Splenomegaly(B/C traped Ab bound neutrophil)
57
Diagnosis?
Ant-CCP and RF Elevated ESR Pheripherial smear and BM biopsy to r/o other causes
58
Treatment?
Managing The RA will treat it
59
Managment Raynaud's phenomena?
Primary: Avoid aggravating factors(smoking,Cold T and emotional stress) & CCB for persistent symptoms Secondary: Treat the underlying disease, CCB for persistent symptoms, and aspirin for patients at risk of hand ulcer
60
Primary and secondary Raynaud's phenomena D/C?
PR:start at young age15-30),symetric SR:Start age >40.asymetric,hand ischemia sign
61
Tests should do in patients with RP?
``` CBC Metabolic panel ANA/RF Urinalysis ESR Complement level ```
62
adhesive capsulitis pathogenesis?
Loss of GH distensibility due to C.Inflamation, fibrosis, and contracture.
63
manifestation?
Gradual onset shoulder pain Shoulder stiffness Defective both passive and active movement Normal X-Ray Risk increase in DM, Hypothyroid, and immobile patients
64
RA treatment If symptoms persist for more than 6 months of treatment?
ADD TNF inhibitors
65
Tophaceous gout?
``` Multiple white nodule A common location is an area where tendon meet joints(finger) Common in advanced gout Due to UA crystal deposition in tissue Can drain whitish choky discharge ```
66
How to d/t from osteoarthritis (B & H) nodule and R.Nodule/
OAN: Bonny AT area of PIP and DIP R.N: Occurs at pressure areas like wrist and post. ulna. G.T: Occur in multiple joint areas
67
Reactive arthritis triads?
Non-Gonococcal uretritis Asymmetric oligoarthritis Conjunctivitis
68
Other Cxs?
``` Mucosal ulcer Seronegative Sterile SFA NSAID is the first line TX. Knee and sacroiliac joint MC involved ```
69
Sicca syndrome CXS?
Dry eye Con..erosion--D.vision Dry mouth Common in women
70
Cause?
Age-related: Usually, start age >75 | Sjorgen S: Usually start at young age, ANA positive and systemic A.I disease sx. mainly SS
71
Age-related SS managment?
due to gland atrophy artificial tear topical cyclosporine
72
polymyalgia rheumatic symptoms?
``` age > 50 bilateral joint pain mainly around tissue not joint morning stiffness 2 joint involvement(with decrease AOM) 1)neck or torso 2)Shoulder or PUE 3)Pelvis or proximal Le 4)Constitutional symptoms(F,WL and fatigability) May have associated TA No tenderness ```
73
LAB?
``` Elevated ESR and CRP 15 15 15% may have normal lab Normocytic anemia Symptoms respond to steroid Normal CK(22-198) ```
74
Whipple disease CM?
Chronic diarrhea Non-deforming arthritis LDP May damage eye, cardiac, and CNS tissue
75
Diagnosis?
PAS-positive macrophage in SI lamina porphyria | +PCR for G-ve T.whipli
76
Disease-associated with pseudogout?
Primary HPT with chronic Ca elevation Hypothyroidism Hemochromatosis
77
Cxs?
Due to CPP deposition Commonly affect knee SFA:rhomboid-shaped + birefringence cristal X-Ray: Chondrocalcinosis
78
CXS of back pain associated with malignancy?
Progressive Worse at night Unrelieved by rest Focal vertebral tenderness
79
Inflammatory back pain(AS) feature??
``` Insidious onset age <40 Sx more than 3 month Relived y exercise Worse at night Lumbosacral tenderness Decrease range of motion ```
80
Ankylosing spondylitis CM?
``` MCC of inflammatory BP Arthritis (sacroiliitis) Reduced CE and spinal mobility Enthesitis Dactylitis(swelling of hand and finger) Uveities ```
81
complication?
osteoporesis cauda equina AR Vertebral #
82
Diagnosis?
Elevated ESR and CRP HLAB-27 X-Ray(sacroiliac joint infn, vertebral bodies fusion) If negative do MRI
83
Goaty arteritis SFA?
Inflammatory MSU cristal Needle shaped % NBR(yellow to parallel light)
84
Lateral epicondilitis CM?
Subacute or chronic Lateral elbow pain Hx repetitive/forceful wrist extension Peak incidence age 45-54
85
Diagnosis?
Tenderness at Lat. epicondyle & P.E.Muscle pain with resisted wrist extension/supination Pain with passive wrist flexion
86
Managment?
``` Modified activity Inelastic counterforce brace NSAID Stretching and progressive ex. resistance Physical therapy ```
87
Pathogenesis?
Non-inflammatory extensor tendinosis due to EX.Extensor muscle usage like tennis
88
chondrocalcinosis in CPP arthritis?
Calcification of articular cartilage
89
Acute goit atack treatment?
NSAID Colchicine Glucocorticoids
90
Urate lowering medication(Alllopirinol and febuxostat) indication?
Recurrent gout | Gout complicated by topi and uric acid stone
91
Does practice doing reduce future got attacks?
Wight reduction BMI<25 Low-fat diet Lower seafood and red meat intake Protein intake preferably from vegetable and low-fat dairy product Avoidance of organ rich food(liver and sweat bread) Avoidance of beer & distilled sprint Avoid diuretic if posible
92
Managment of ostoarteritis?
exercise and wt loss--If the symptom persists--Topical NSAID---If still persist---Surgery, Chronic pain managment

Rhumatology (4 decks)

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