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Clin Med > Rheum > Flashcards

Rheum Flashcards

1
Q

What presents as a sudden onset of severe joint pain with swelling, warmth, and redness occurring over 12-24 hrs and resolving within 2 weeks, and commonly involves the big toe?

A

Gout

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2
Q

What is the classic presentation of a pt with a gout flare?

A

Severe pain in the big toe so bad that the bedsheet cannot touch it

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3
Q

What is the gold standard diagnostic test for gout?

A

Synovial fluid analysis for MSU crystals

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4
Q

What is the treatment of choice for gout?

A

Rapid-acting NSAID (indomethacin, Naproxen, Ibuprofen, Diclofenac)

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5
Q

What is a urate lowering drug that must be started within 24 hrs of the onset of a gout flare?

A

Colchicine

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6
Q

What presents with a sudden onset of joint pain/swelling/warmth/redness, a fever, and usually involves the knee that looks like a gout flare?

A

Pseudogout

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7
Q

What is the gold standard diagnostic test for pseudogout?

A

Arthrocentesis for synovial fluid analysis (crystals are rhomboid shape)

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8
Q

What is the treatment of choice for pseudogout?

A

1-2 joints: joint aspiration w/steroid injection
> 3 joints: NSAID (colchicine or systemic steroids if CIs to NSAIDs)

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9
Q

What is characterized by abnormal inflammation of blood vessels?

A

Vasculitis

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10
Q

What is the treatment of choice of vasculitis?

A

High-dose steroids

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11
Q

Which form of vasculitis more commonly affects kids < 5 yo and affects medium muscular arteries?

A

Kawasaki’s

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12
Q

What is the treatment for Kawasaki’s?

A

NOT high-dose steroids
High-dose aspirin with IVIG

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13
Q

Which vasculitis affects large-sized arteries such as the aorta and the large branches?

A

Giant cell arteritis (temporal arteritis)

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14
Q

What vasculitis is more commonly seen in countries that border the Silk Road?

A

Bechet’s

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15
Q

What vasculitis is more commonly seen in South Asian countries?

A

Takayasu

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16
Q

Polyarteritis nodosa, microscopic polyangiitis, and Churg-Strauss are all treated with high-dose steroids along with what?

A

Cytotoxic agents

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17
Q

What is the most common form of arthrtitis?

A

Osteoarthritis

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18
Q

What is the classic triad of symptoms of osteoarthritis?

A

Asymmetrical joint pain, joint stiffness, and locomotor restriction (joint pain is worse in the AM and lasts < 30 mins)

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19
Q

Since osteoarthritis is a clinical diagnosis, what characteristics would be diagnostic?

A

Pain worse with activity and better with rest
> 45 yo
Morning stiffness lasting < 30 mins
Bondy joint enlargement
Limited ROM

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20
Q

What are the goals of treatment for osteoarthritis?

A

Minimize pain and prevent loss of function

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21
Q

What is the treatment for osteoarthritis?

A

Non-pharm: avoid activities that exacerbate pain, exercise, weight loss, PT/OT
Pharm: Tylenol or NSAIDs, SNRIs (cymbalta or effexor), maybe opioids
Intra-articular steroid injections (no more than once every 3 months)

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22
Q

What classically presents with symmetrical joint pain/swelling starting insidiously over weeks to months that starts in the small joints (hands/feet) and moves to larger ones, and has joint stiffness that is the worst in the AM and lasts > 30 mins?

A

Rheumatoid arthritis

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23
Q

What lab is present in > 90% of pts with RA?

A

RF

24
Q

What are the goals of treatment for RA?

A

Prevent irreversible joint damage

25
Q

What is the treatment for RA?

A

DMARDs (methotrexate, hydroxychloroquine, sulfasalazine, etanercept, infliximab, rituximab)
Oral steroids for RA flares/treatment failure

26
Q

What medications should pts be tested for Hep B, C, and TB before starting?

A

Etanercept
Infliximab
Rituximab

27
Q

What presents with fatigue, weight loss, fever without a focal infection, arthralgia, myalgia, and can have a malar (butterfly) rash?

A

Systemic Lupus Ertyhematosus (SLE)

28
Q

What lab is primarily drawn when diagnosing for lupus?

A

ANA

29
Q

What is the cornerstone of treatment for lupus?

A

Hydroxychloroquine

30
Q

50% of pts with RA and lupus also have what other syndrome?

A

Sjogren syndrome

31
Q

Out of the 11 symptoms of SLE (malar rash, discoid rash, photosensitivity, oral ulcers, arthritis, serositis, abnormal ANA titer, renal disorder, neurologic disorder, hematologic disorder, immunologic disorder) how many are required to meet criteria for the diagnosis?

A

4

32
Q

What presents with proximal muscle weakness, dysphonia, dysphagia, heliotropes, and a shawl sign or a V-sign rash?

A

Dermatomyositis/polymyositis

33
Q

What lab is commonly drawn and what is found most often in pts with dermatomyositis/polymyositis?

A

Antisynthetase antibodies
Jo-1 is found most often

34
Q

What is the treatment of choice and the 1st line adjuvant therapy for dermatomyositis/polymyositis?

A

TOC: oral steroids
1st line adjuvant: methotrexate

35
Q

What commonly presents as a young/middle aged female with a history of Raynaud that now has skin induration and internal organ dysfunction and diffusely puffy hands?

A

Scleroderma

36
Q

How do you treat scleroderma?

A

Depends on the organ system involved
Derm: topical steroids
Esophagus: PPIs/prokinetic agent
Joint/muscular: systemic steroids
Dihydropyridine CCBs for Raynaud’s

37
Q

What are the signs/symptoms of Sjogren syndrome?

A

Sensation of foreign body in the eyes
Dry eyes
Dry mouth
Polyarthritis
Lower extremity purpura
Peripheral neuropathy

38
Q

When doing a physical exam on a pt that you believe may have Sjogren’s, what finding is pathognomonic?

A

Keratoconjunctivitis (KCS) on optho exam

39
Q

What is the most specific diagnostic test for Sjogren’s and what does it show if the pt does have this syndrome?

A

Minor salivary gland (lip) biopsy
Will show focal lymphocytic sialadenitis (FLS)

40
Q

What are treatment options for Sjogren’s?

A

Artificial tears, optho referral
Frequent H20 intake, chewing gum
DMARDs or hydroxychloroquine for extra-glandular manifestations (not FDA approved)

41
Q

What occurs in a classic Raynaud attack?

A

Acute cold sensation to affected digits (thumb usually spared)
White color to digits (blanching, vasoconstriction)
Blue color to digits (prolonged vasoconstriction)
Red color to digits (reperfusion, vasodilation)

42
Q

What is the gold standard diagnostic test for Raynaud’s?

A

Nailfold capillary microscopy

43
Q

What is the 1st line pharm treatment for Raynaud’s?

A

Dihydropyridine CCBs (amlodipine, nifedipine)

44
Q

What is characterized by widespread MSK pain (upper and lower body), fatigue, cognitive disturbances, anxiety/depression, and HA?

A

Fibromyalgia

45
Q

What diagnostic test is used for fibromyalgia?

A

There is not current test/imaging
It is a diagnosis of exclusion

46
Q

What meds are FDA approved for fibromyalgia?

A

Pregabalin (lyrica)
Duloxetine (cymbalta)
Milnacipran

47
Q

What is the most common rheum disorder reported in children?

A

Juvenile onset arthritis (juvenile idiopathic arthritis)

48
Q

What is the mainstay treatment for juvenile onset arthritis?

A

NSAIDs

49
Q

What is the classic presentation of juvenile onset ankylosing spondylitis?

A

Lumbar back pain and stiffness in a young male 13-17 yo

50
Q

What are the symptoms for a diagnosis of ankylosing spondylitis?

A

Inflammatory type back pain w/at least 4 of the following:
Age of onset < 40
Insidious onset
Improvement w/exercise
No improvement w/rest
Pain at night that improves after getting out of bed

51
Q

What is the 1st line diagnostic test for ankylosing spondylitis?

A

X-ray (“bamboo spine”)

52
Q

What is an inflammatory arthritis that occurs days to weeks after a GI/GU infection?

A

Reactive arthritis

53
Q

What is the classic triad of reactive arthritis?

A

Arthritis, urethritis, conjunctivitis
Can’t see, can’t pee, & can’t climb a tree

54
Q

What PE finding is common in reactive arthritis?

A

Sausage shaped fingers or toes

55
Q

How long does a pt with reactive arthritis have to be on antibiotics?

A

3-6 months
Specific for infectious agent

Clin Med (15 decks)

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