Rheum Flashcards Preview

Step 2 CK > Rheum > Flashcards

Flashcards in Rheum Deck (261):
1

MCC of joint degeneration

Osteoarthritis (DJD)

2

Where is DJD syptomatic

Weight bearing joints

3

What joints of the hand are most affected by OA

DIP

4

What are DIP enlargements in OA called

Heberden nodules

5

What are PIP enlargements in OA called

Bouchard nodules

6

Are there lab abnormalities in DJD

No

7

Most accurate test for DJD

Radiography of affected joint

8

XR findings in OA

Joint space narrowing
Osteophytes
Dense subchondral bone
Bone cysts

9

Most important rx in OA

Weight loss
Exercise

10

Best initial analgesic in OA

Acetaminophen

11

Other rx in OA

NSAIDS
Capsaicin
Intraarticular steroids
Hyaluronan injection
Joint replacement

12

Who gets gout

M>F

13

What causes overproduction of uric acid

Idiopathic
Increased cell turnover - cancer, hemolysis, psoriasis, chemo
Enzyme deficiency- lesch-nyan, GSDs

14

What causes underexcretion of uric acid

Renal insufficiency
Ketoacidosis, lactic acidosis
Thiazides and aspirin

15

Presentation of gout

Man, sudden excrutiating pain, redness, tenderness of big toe at night after binge drinking beer

16

Most frequently affected site in gout

MTP of great toe

17

Where do tophi most often occur (can occur anywhere)

Cartilage
SubQ tissue
Bone
Kidney

18

Most accurate test for gout

Aspiration of joint
Shows negatively birefringent needle shaped crystals under polarized light

19

WBC count in gout

2000-50000

20

Why tap the joint in gout

Exclude infection

21

What labs are gouty attacks associated with

Elevated, uric adic, ESR, leukocytosis

22

Best initial therapy of acute gouty attack

NSAIDs

23

When to give steroids in acute gout

No response to NSAIDs
Contraindication to NSAIDs

24

When to give Colchicine in acute gout

Can't use NSAIDS or steroids

25

Colchicine AE

Diarrhea and BM suppression

26

Diet management of chronic gout

No EtOH
Lose weight
Less meat, seafood

27

What to use for HTN management in chronic gout

Lorsartan

28

Why give colchicine in chronic gout

Prevent subsequent attacks

29

Action of allopurinol

Decrease production of uric acid

30

Action of pegloticase

Dissolves uric acid

31

Gout drugs contraindicated in renal insufficiency

Probenecid
NSAIDs
Sulfinpyrazone

32

Action of probenecid and Sulfinpyrazone

Increase excretion of uric acid

33

Allopurinol AE

Toxic epidermal necrolysis
Stevens-Johnson
Hypersensitivity

34

Common risk factors for CPPD

Hemochromatosis
Hyperparathyroidism

35

Other associations w/ CPPD

DM
Hypothyroidism
Wilson

36

What does CPPD affect

Large joints

37

WBC count in DJD

200

38

Best initial therapy for CPPD

NSAIDs

39

What diseases to exclude in lower back pain

Spinal cord compression
Disk herniation

40

Features of spinal cord compression

Hx CA
Sudden onset focal neuro deficit
Point tenderness on spine w/ percussion

41

MCC epidural abscess

Staph aureus

42

Location for disk herniations

L4/5, L5/S1

43

Best initial test for disk herniation

Straight leg raise (very specific)

44

Effects of L4 loss

Motor - Dorsiflexion of foot
Reflex - Knee jerk
Sensory - Inner calf

45

Effects of L5 loss

Motor - Dorsiflexion of toe
Sensory - Inner forefoot

46

Effects of S1 loss

Motor - Eversion of foot
Reflex - Ankle jerk
Sensory - Outer foot

47

Best initial test for cancer w/ compression, infection, fractures

Plain XR

48

Most accurate test for cancer w/ compression, infection, fractures

MRI

49

MRI for lower back pain w/ SLR +

No

50

Back pain w/ Hx CA

Cord compression

51

Back pain w/ fever, high ESR

Epidural abscess

52

Back pain w/ bowel/bladder incontinence, ED

Cauda equina syndrome

53

Back pain under 40 worse at rest, improves w/ exercise

Ankylosing spondylitis

54

Back pain w/ pain/numbness of medial calf or foot

Disk herniation

55

Rx cord compression

Glucocorticoids (don't wait for test results)

56

Rx cauda equina

Surgical decompression

57

Rx disk herniation

NSAIDS and continue regular activity
Steroid injection if that doesn't work

58

Presentation of lumbar spinal stenosis

Over 60
Back pain on walking radiating to buttocks and thighs
Worse when walking downhill
Pulses NL
Better when leaning forward

59

Dx test for lumbar stenosis

MRI

60

Rx lumbar stenosis

Weight loss, NSAIDs
Surgical dilation

61

Features of fibromyalgia

Young women
Tenderness w/ trigger pts at traps, medial knee, lateral epicondyle

62

Associations w/ fibromyalgia

Stiffness, numbness, fatigue
HA
Sleep disorder

63

Best initial therapy for fibromyalgia

Amitryptilyne

64

Other fibromyalgia treatments

Milnacipran and pregabalin

65

Causes of carpal tunnel aside from mechanical

Pregnancy
DM
RA
Acromegaly
Amyloidosis
Hypothyroidism

66

Features of carpal tunnel

Pain in hand
Atrophy of thenar eminence
Worse at night

67

PE findings of carpal tunnel

Tinel sign
Phalen sign

68

Most accurate test for carpal tunnel

Electromyography
Nerve conduction testing

69

Best initial therapy of carpal tunnel

Wrist splints
Can give NSAIDs

70

Curative for carpal tunnel

Surgical decomression

71

What is dupuytren contracture

Hyperplasia of palmar fascia causing contracture of 4th and 5th fingers

72

Associations of dupuytren contracture

Genetic
Alcoholism and cirrhosis

73

Rx dupuytren contracture

Triamcinolone, Lidocaine, collagenase
Surgery if functionally impaired

74

Features of rotator cuff injury

Inability to flex and abduct shoulder
Worse when lying on it
Severe tenderness on insertion point of supraspinatus

75

Most accurate dx test for rotator cuff injurt

MRI

76

Rx rotator cuff injury

NSAIDS, rest, PT
Surgery for complete tears

77

Causes of patellofemoral syndrome

Trauma
Imbalance of quadriceps strength
Meniscal tear

78

Features of patellofemoral syndrome

Pain in front of knee
Worse when walking up and down stairs
Worse after prolongued sitting

79

Rx patellofemoral syndrome

PT and strength training

80

Features of plantar fasciitis

Pain at bottom of foot near calcaneus
Worse in morning, improves with steps
Point tenderness at insertion

81

Rx plantar fasciitis

Stretching
Arch supports
NSAIDs
Steroids if above fail

82

Presentation of RA

B/L symmetrical joint involvement
Morning stiffness = inflammation
Nodules
Ocular sx
Lung involvement
Vasculitis
Cervical joint involvement
Baker cyst
Pericarditis
Carpal tunnel

83

What to screen for in RA before anesthesia/Intubation

Cervical involvement (C1, C2)
Can cause para/quadriplegia

84

What joint is spared in RA

DIP

85

What are the hand deformities in RA

Boutonniere
Swan neck

86

What is related to poor prognosis in RA

High RF

87

More specific than RF in RA

Anti-cyclic citrulinated peptide (Anti-CCP)

88

What kind of anemia is in RA

Normocytic (can be AOCD)

89

Why do arthrocentesis in RA

Initially when Dx not clear
Can have 5000-50000 WBCs but no crystals so exclude gout

90

Dx criteria for RA (6 or more pts = RA)

Joint involvement (up to 5)
ESR/CRP (1)
Longer than 6wks (1)
RF or Anti-CCP (1)

91

Components of Felty syndrome

RA
Splenomegaly
Neutropenia (prone to G+ infection)

92

Components of Caplan syndrome

RA
Pneumoconiosis (interstitial lung disease)
Lung nodules

93

MCC death in RA

CAD

94

What is the purpose of DMARDs in RA

Stop progression

95

What is "erosive" RA

Joint space narrowing
Physical deformity
XR abnormalities

96

Best initial DMARD

MTX

97

MTX AE

Liver tox
BM suppression
Pulm tox
May cause flare

98

What to monitor w/ MTX

LFTs and CBC every 2-3 months

99

First line DMARD if MTX fails

TNF inhibitors

100

AE TNF inhibitors

Reactivation of TB
Infection

101

When to use Rituximab

Long term control
Anti-TNF fail

102

What does Rituximab do

Remove CD20 lymphocytes from circulation

103

When to use Hydroxychloroquine in RA

Monotherapy in mild disease

104

Hydroxychloroquine AE

Toxic to retina

105

When to use sulfasalazine, leflunomide, abatacept

Combo w/ MTX if anti-TNF fails

106

Sulfasalazine AE

BM tox
Hemolysis in G6PD
Rash

107

Best initial therapy for pain control in RA

NSAIDs

108

When to use steroids in RA

NSAIDs don't work
Bridge while waiting for DMARDs to take effect

109

AE gold salts in RA Rx

Nephrotic syndrome

110

Features of Juvenile RA

Spiking fever (>104)
Salmon coloured rash on chest and abd
Splenomegaly
Pericardial effusion
Mild joint sx

111

Dx test for JRA

No clear one

112

Rx JRA

Aspirin or NSAIDs
Steroids if fail
Anti-TNF is steroids fail

113

Causes of drug-induced SLE

Hydralazine
Isonizid
Procainamide
Quinidine

114

Which drugs causing SLE can be ANA neg

Hydralazine
Quinidine

115

Ab associated w/ drug induced SLE

Anti-histone

116

Skin manifestations of SLE

Malar rash
Discoid rash (raised)
Photosensitivity
Oral ulcers

117

Joint manifestations of SLE

Arthritis
No deformity or erosion

118

Chest manifestations of SLE

Serositis (inflammation of pleura and pericardium)

119

Renal manifestations of SLE

Mild proteinuria to ESRD
MC glomerulonephritis is membraneous
Must do Renal Bx

120

Neuro manifestations of SLE

Psychosis
Seizures
Stroke

121

Heme manifestations of SLE

Hemolytic anemia
AOCD more common

122

Abs in SLE

Anti-dsDNA
Anti-Sm
False positive VDRL
Positive LE cell preparation

123

Ab in mixed connective tissue disease

Anti-RNP

124

Additional findings in SLE (not in criteria)

Mesenteric vasculitis
Raynaud
APL
Alopecia
PN, alveolar hemorrhage, restrictive lung disease
Photophobia, cotton wool spots, blindness

125

Most sensitive test for SLE

ANA - if ned, then definitely NOT SLE

126

Most specific tests for SLE

Anti-dsDNA
Anti-Sm

127

Ab in neonatal SLE

Anti-SSA

128

What is seen in acute SLE exacerbations

Drop in complement (C3, 4, CH50)
Rise in Anti-dsDNA

129

Rx acute SLE flare

High dose Steroid bolus

130

Rx mild chronic lupus

Hydroxychloroquine

131

Rx progression of lupus

Belimumab

132

MCC death young pt w/ SLE

Infection

133

MCC death old pt w/ SLE

MI (2/2 accelerated atherosclerosis)

134

Rx lupus nephritis

Steroids
Cyclophosphamide
Mycophenolate

135

2 types of APL

Lupus anticoagulant
Anticardiolipin Ab

136

What does APL affect

Both arteries and veins
Arteries > veins

137

Important association w/ APL

Multiple spontaneous abortion

138

Coag profile in APL

Clotting w/ elevated PTT and NL PT

139

Don't confuse APL w/

Syphilis
False positive VDRL or RPR

140

Best initial test for APL

Mixing study

141

Most specific test for APL

Russell viper venom test for lupus anticoagulant

142

When to rx APL

Only when symptomatic

143

Rx thrombosis in APL

Heparin then warfarin (like normal)

144

When can anticardiolopin be the cause of spontaneous abortion

2 or more 1st trim events or single 2nd trim event

145

How to prevent recurrence of spontaneous abortion in ABL

Heparin and Aspirin

146

Breakdown of scleroderma subtypes

Diffuse (20%)
Limited (80%)

147

Manifestations of limited scleroderma

CREST syndrome

148

CREST stands for

Calcinosis
Raynaud
Esophageal dysmotility
Sclerocadtyly
Telangiectasia

149

Who gets Scleroderma

Women 20s-40s

150

100% of scleroderma pts have

Raynaud
Skin manifestations

151

MCC secondary raynaud

Scleroderma

152

Precipitation of raynaud

Cold
Emotional stress

153

Renal manifestation of scleroderma

Sudden hypertensive crisis 2/2 ARF

154

Lung manifestations of scleroderma

Restrictive lung disease
Pulm HTN

155

MCC death in Scleroderma

Pulm fibrosis

156

Dx tests in Scleroderma

ANA
ESR is NL
Scl-70 (most specific)
Anti-centromere

157

Rx scleroderma

MTX slows underlying disease

158

Rx renal sx in scleroderma

ACEis

159

Rx esophageal dysmotility in scleroderma

PPIs

160

Rx raunaud in scleroderma

CCBs

161

Rx pulm fibrosis in scleroderma

Cyclophosphamide

162

Rx pulm HTN in scleroderma

Bosentan
Sidenafil
Prostacyclin

163

Features of inflammatory myopthies

Proximal muscle weakness
Difficulty getting up from seated
Difficulty walking up stairs
Dysphagia

164

Presentation of dermatomyositis

Malar involvement
Shawl sign
Heliotrope rash
Gottron papules (MCP, PIP)

165

CA site associations w/ dermatomyositis

Ovary
Lung
GI
Lymphoma

166

Best initial test for inflammatory myopathies

CPK
Aldolase

167

Most accurate test for inflammatory myopathies

Muscle Bx

168

What are Anti-Jo Abs associated with in inflammatory myopathies

Pulm fibrosis

169

Rx inflammatory myopathies

Steroids
MTX, azathioprine, IVIG, Mycophenolate if fail

170

Role of hydroxychloroquin in rx of inflammatory myopathies

Skin lesions

171

What does Sjogren's attack

Lacrimal and salivary glands

172

Who gets Sjogren's

Women

173

Associations w/ Sjogren's

RA
SLE
PBC
Polymyositis
Hashimoto's

174

Presentation of Sjogren's

Dryness of eyes and mouth
"Sand in the eyes" - Keratoconjunctivits sicca
Dental caries from lack of saliva
Dyspareunia from vaginal dryness

175

Most dangerous complication of Sjogren's

Lymphoma

176

Best initial test for Sjogren's

Schirmer test

177

Most accurate test for Sjogren's

Lip/Parotid Bx

178

Best initial blood test for Sjogren's

SSA, SSB

179

What is seen on rose bengal test for Sjogren's

Abnormal corneal epithelium

180

Best initial therapy for Sjogren's

Water the mouth

181

Other rx Sjogren's

Sugar-free gum
Fluoride
Artificial tears
Pilocarpine and Cevimeline to increase Ach

182

What is common about all vasculitides

Fever
Malaise
Wt loss
Arthralgia/Myalgias

183

Association with PAN

Hep B, C
Spares the lungs

184

Features of PAN

Glomerulonephritis
Foot drop (peroneal nerve palsy)
Stroke in young person
ABD pain worse w/ eating
Lower extremity ulcers

185

What is mononeuritis multiplex

Multiple peripheral neuropathies of large nerves

186

Most accurate test for PAN

Bx of symptomatic site

187

What is seen in angiography of PAN

Beading

188

Other lab features of PAN

Anemia
Leukocytosis
PANCA

189

Rx PAN

Prednisone
Cyclophosphamide

190

Features of polymyalgia rheumatica

>50
Pain stiffness in shoulder, pelvis
Can't comb hair, rise from chair
Elevated ESR
Normochromic normocytic anemia

191

Lab findings in PMR

Normal CPK, Aldolase

192

Rx PMR

Steroids

193

Features of temporal arteritis

Visual Sx
Jaw claudication
Scalp tenderness
HA
Decreased arm pulses

194

Most accurate test for temporal arteritis

Affected artery Bx

195

Rx giant cell arteritis

Steroids BEFORE Bx result

196

Features of Wegener's

Upper and lower resp tract findings
Renal insufficiency

197

Presentation of Wegener's

Sinusitis
Otitis media
Mastoiditis
Oral/Gingival involvement
Unresolving PN even w/ ABX

198

Best initial test for Wegener's

CANCA

199

Most accurate test for Wegener's

Bx (Lung > Renal)

200

Rx Wegener's

Prednisone
Cyclophosphamide

201

Associations w/ PANCA

Churg-strauss
Microscopic polyangiitis
PAN

202

Features of Churg Strauss

Asthma
Eosinophilia

203

Most accurate test for Churg-Strauss

Bx

204

Rx churg strauss

Prednisone
Cyclophosphamide

205

Features of Henoch-Schonlein

GI
Purpura (Painless, palpable)
Arthralgias
Hematuria

206

Most accurate test for Henoch-Schonlein

Bx of lesion

207

Rx Henoch-Schonlein

Spontanteous resolution
Steroids

208

Associations w/ cryoglobulinemia

Chronic hep C
Endocarditis
Sjogren's

209

What complement is decreased in SLE

C3

210

What complement is decreased in Hep C

C4

211

Abnormal lab test in cyoglobulinemia

RF positive

212

Rx Cryoglobulinemia

Rx underlying cause

213

Features of Behcet

Asian/Middle eastern
Painful oral and genital ulcers
Ocular lesions
Arthrits
CNS lesions mimicking MS
Pathergy

214

Rx Behcet's

Steroids
Wean off w/
- Azathioprine
- Cyclophosphamide
- Colchicine
- Thalidomide

215

3 seronegative spondyloarthropathies

Ankylosing spondylitis
Psoriatic arthritis
Reactive arthritis

216

Features of seronegative spondyloarthropathies

Men under 40
Spine involvement
Negative RF
Inflammation at tendon attachment points
Uveitis
HLA B27
Rx w/ steroids

217

Features of Ankylosing spondylitis

Young man
Backache and stiffness radiating to buttocks
Flattening of normal spine curvature
Decreased chest expansion
Pain at achilles

218

Back pain quality in Ankylosing spondylitis

Worse w/ rest
Relieved w/ activity

219

Other Ankylosing spondylitis findings

Arthritis - hips, shoulders, knees
AV block, aortic insufficiency
Uveitis

220

Best initial test for Ankylosing spondylitis

XR of SI joint

221

Most accurate test for Ankylosing spondylitis

MRI

222

Best initial therapy for Ankylosing spondylitis

Exercise program and NSAIDs
Anti-TNF if NSAIDs fail

223

Characteristic findings in psoriatic arthritis

Sausage digits
Nail pitting

224

Besst initial test for psoriatic arthritis

XR of joint showing pencil in cup deformity

225

Best initial therapy for psoriatic arthritis

NSAIDs
MTX when no response
Anti-TNF when MTX fails

226

Reactive arthritis occurs secondary to

IBD M=F
STI M>W
GI infection

227

Features of Reactive arthritis

Joint pain
Ocular findings
Genital abnormalities

228

What finding is unique to Reactive arthritis

Keratoderma blennorhagicum
Looks like pustular psoriasis

229

Dx Reactive arthritis

Tap joint to r/o septic arthritis

230

Rx Reactive arthritis

NSAIDs
Sulfasalazine if they fail

231

Features of osteoporosis

Older woman
Vertebral fractures leading to shorter height

232

Most accurate test for osteoporosis

DEXA
Penia - 1-2.5
Porosis - >2.5

233

Best initial therapy for osteoporosis

Vit D and Ca

234

Other Rx osteoporosis

Bisphosphonates - >2.5
Estrogen - postmenopausal
Raloxifene - reduces risk of breast CA and decreases LDL
Teriparatide - New matrix formation
Calcitonin - decreases risk of vertebral Fx

235

Bisphosponates AE

Osteonecrosis of jaw
Esophagitis

236

Teriparatide AE

Osteosarcoma
Hypercalcemia

237

Greatest risk of septic arthritis

Prosthetic joint
Septic arthritis doesn't really affect undamaged joints

238

Other risk factors for septic arthritis

DJD
RA

239

Top 3 etiologies of septic arthritis

Staph - 40%
Strep - 30%
G- rods - 20%

240

Best initial and Most accurate test for septic arthritis

Joint aspiration (arthrocentesis)

241

Features of joint aspirate in septic arthritis

5000-100000 WBCs
G stain
Cx
Blood Cx

242

Best empiric therapy for septic arthritis

Ceftriaxone
Vanco

243

Imaging findings on prosthetic joint infection

Lucency around implantation
Physically loose joint

244

Rx prosthetic joint infection

Remove joint
ABX 6-8wks
Replace joint

245

MC organism in prosthetic joint infection

Staph epi

246

When is gonococcal arthritis more frequient

During menses

247

Unique features of gonococcal arthritis

Polyarticular
Tenosynovitis
Petechial rash

248

What to Cx to maximize sensitivity in gonococcal arthrits

Pharynx
Rectum
Urethra
Cervix

249

Best empiric therapy for gonococcal arthritis

Ceftriaxone
Cefotaxime
Ceftizoxime

250

What to test for w/ recurrent gonorrhea infection

Terminal complement deficiency

251

MCC osteomyelitis

S. aureus

252

MCC osteomylitis specific to sickle cell

Salmonella

253

Spread of osteomyelitis

Peds - Hematogenous
Adults - Contiguous

254

What to look for to suspect osteomyelitis

DM pt w/ ulcer

255

Best initial test in osteomyelitis

XR

256

Most accurate test in osteomyelitis

Bx

257

Most important step if XR is NL

MRI (bone scan if contraindicated)

258

What is the purpose of ESR in osteomyelitis

Monitor response to therapy

259

Rx Osteomyelitis

Abx against the organism found

260

Only oral therapy for osteomyelitis

Ciprofloxacin - Only use if organism is sensitive

261

AE Fluoroquinolones

Achilles tendon rupture
Contra in pregnant and kids