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Rheum Flashcards

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1
Q

MCC of joint degeneration

A

Osteoarthritis (DJD)

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2
Q

Where is DJD syptomatic

A

Weight bearing joints

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3
Q

What joints of the hand are most affected by OA

A

DIP

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4
Q

What are DIP enlargements in OA called

A

Heberden nodules

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5
Q

What are PIP enlargements in OA called

A

Bouchard nodules

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6
Q

Are there lab abnormalities in DJD

A

No

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7
Q

Most accurate test for DJD

A

Radiography of affected joint

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8
Q

XR findings in OA

A

Joint space narrowing
Osteophytes
Dense subchondral bone
Bone cysts

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9
Q

Most important rx in OA

A

Weight loss

Exercise

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10
Q

Best initial analgesic in OA

A

Acetaminophen

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11
Q

Other rx in OA

A 
NSAIDS
Capsaicin
Intraarticular steroids
Hyaluronan injection
Joint replacement
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12
Q

Who gets gout

A

M>F

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13
Q

What causes overproduction of uric acid

A

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

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14
Q

What causes underexcretion of uric acid

A

Renal insufficiency
Ketoacidosis, lactic acidosis
Thiazides and aspirin

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15
Q

Presentation of gout

A

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

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16
Q

Most frequently affected site in gout

A

MTP of great toe

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17
Q

Where do tophi most often occur (can occur anywhere)

A

Cartilage
SubQ tissue
Bone
Kidney

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18
Q

Most accurate test for gout

A

Aspiration of joint

Shows negatively birefringent needle shaped crystals under polarized light

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19
Q

WBC count in gout

A

2000-50000

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20
Q

Why tap the joint in gout

A

Exclude infection

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21
Q

What labs are gouty attacks associated with

A

Elevated, uric adic, ESR, leukocytosis

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22
Q

Best initial therapy of acute gouty attack

A

NSAIDs

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23
Q

When to give steroids in acute gout

A

No response to NSAIDs

Contraindication to NSAIDs

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24
Q

When to give Colchicine in acute gout

A

Can’t use NSAIDS or steroids

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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

Step 2 CK (21 decks)

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