Rheum final review pt3

Question 1

NY 1984 Criteria for Ankylosing Sponylitis:

Answer 1

1. **Low back pain and stiffness for more than 3 months that improves with exercise, but is not relieved by rest (this shows it’s an inflammatory-type)
2. Limitation of motion of the lumbar spine in both the sagittal and frontal planes
3. Limitation of chest expansion relative to normal values correlated for age and sex (b/c costal junctions may be fused)

Question 2

Nondrug therapy for Spondyloarthropathies

Answer 2

sx improves with exercise

Question 3

infectious organisms in GI (1), GU (4) that lead to reactive arthritis:

Answer 3

GU: Chlamydia trachomatis
GI: SHIGELLA, SALMONELLA, CAMPYLOBACTER, YERSINIA

Question 4

Classic triad of Reactive Arthritis

Answer 4

ARTHRITIS
UVEITIS/CONJUNCTIVITIS
URETHRITIS
(can have 2 of 3 though)

Question 5

of fishing trip with subsequent Campylobacter and resultant ___

Answer 5

Reactive Arthritis

Question 6

Pattern associated w/ IBD-Associated Arthritis (Crohn’s, UC) (a little bit different) (2)

Answer 6

Arthritis may precede GI tract symptoms

Can occur in a peripheral axial joint pattern or mixed pattern

Question 7

Skin and nail findings in Psoriatic Arthritis (5)

Answer 7

skin/nail: Nail pitting, Onycholysis (transverse ridging), Dactylitis of the second toe, sausage digits & rash,

Question 8

Distinguishing x-ray finding of Psoriatic Arthritis

Answer 8

*Psoriatic Arthritis has both erosive component & an overgrowth of bone

Question 9

GI complaints can be in any type of __

Answer 9

arthritis

Question 10

Genetic association of Spondyloarthropathies:

Answer 10

HLA-B27

Question 11

HLA-B27 is a key genetic factor to test for in:

Answer 11

AS

Question 12

Avg age of getting Crystal-induced arthritis

Answer 12

75-80 years old

Question 13

Gout vs Pseudogout crystals

Answer 13

Gout: Uric acid crystal
Pseudogout: calcium pyrophosphate

Question 14

1 in 4 patients develop gout who have ___

Answer 14

hyperuricemia

Question 15

What is the mechanism for Gout?

Answer 15

Hyperuricemia with elevated serum uric acid (uric acid pool)

Question 16

2 key clinical sx of Acute Gout

Answer 16

acute monoarticular arthritis with crystal deposition

Question 17

What x-ray finding is an overlap between OA and RA?

Answer 17

Subchondral cyst formation

Question 18

The 3 ways you do x-rays in Rheumatology:

Answer 18

weight-bearing
standing
bilateral

Question 19

What is a prognosticator for anterior uveitis (with Juvenile Rheumatoid Arthritis)?

Answer 19

ANA positive

Question 20

4 control points of FMS:

Answer 20

Mid-forehead
Thumbnail
Volar surface of mid-forearm
Anterior mid-thigh

Question 21

a key sx of FMS is ___ sleep

Answer 21

Non-restorative

Question 22

Name the 4 big types of Spondyloarthritis

Which is prototypical?

Answer 22

Ankylosing spondylitis (AS)* - Prototypical
Psoriatic arthritis (PSA)* - primarily in spine, not in peripheral joints
Reactive arthritis (ReA)* - caused by infxn
Inflammatory Bowel disease (IBD) associated arthritis*
Crohn’s disease
Ulcerative colitis

Question 23

If a patient has Advanced Sacroilitis (late stage ankylosing spondylitis), don’t ever _____.
Do what instead?

Answer 23

Don’t ever inject the tendon.

Put on NSAIDs

Question 24

What is the tx for Reactive Arthritis? (if they can handle it)
Why wouldn’t they be able to handle it?

Answer 24

Full dose NSAIDs

Won’t tolerate if: Salmonella or other GI acute ill infxn

Question 25

Psoriasis | 5 most common sites of skin involvement

Answer 25

``` Elbows Knees Behind ear Umbilicus Gluteal cleft ```

Question 26

Lupus big car scenario:

Answer 26

Lupus is an Autoimmune complex – body recognizes nucleus of cell as foreign. Then a whole bunch of autoimune antibiotics attack & make very large proteins. So these are like big trains with big cars. These big protein immune complexes get stuck in areas that transfer fluid from one space into another. So the kidney (nephritis), BBB, skin (through diff mechanism), lung pleura (fluid in pleural space), lining of heart (pericarditis). We don’t know why it happens

Question 27

What distinguishes the Malar rash of SLE from Rosacea?

Answer 27

SLE malar rash does not spare nasolabial folds*

Question 28

The main medication for SLE is:

Answer 28

Hydroxychloroquine (Plaquenil)

Question 29

Limited vs systemic/diffuse Scleroderma

Answer 29

Above elbow crease or knee crease = diffuse, systemic.

Question 30

CREST Syndrome is a variant of ____. What does it stand for?

Answer 30

Scleroderma. ``` calcinosis raynaud’s esophageal dysmotility sclerodactyly telangestasia ```

Question 31

The 2 key phys exam symptoms of Sjorgen's Syndrome

Answer 31

Dry eye, dry mouth

Question 32

What is the unique, symptom of Myositis?

Answer 32

WEAKNESS in proximal muscles (not pain or stiffness, but weakness)

Question 33

Name 2 common autoantibodies found in Myositis

Answer 33

Anti-PM-Scl Anti-Jo-1