Flashcards in Rheuma Deck (79):
Thiazide diuretics SE?
High GLUC + Low MgNak
High => Glucose, lipid, uric acid, Ca
Low=> Mg, Na, K
Medication cause osteoporosis?
Indication of raloxifene?
Osteoporosis in post-menopausal women.
Lab indications of disease activity in SLE?
Active SLE > high anti-dsDNA + low C3 / C4
Dx of osteoporosis?
Sensitivity of X-ray in osteoporosis?
Not sensitive until bone density is decreased by >50%
Dx of ankylosing spondylitis?
X-ray of sacroiliac joint.
Instructions for alendronate (bisphosphonate)
Empty stomach (food decreases absorption)
30 min before food.
Remain upright for 30 min (prevent GERD)
Rx of male osteoporosis?
Recombinant parathyroid hormone
Contraindication to using testosterone replacement?
Hx of prostate Ca
Dx of giant cell arteritis
Biopsy of temporal artery
Food increase risk of gout?
Food help in gout?
Milk and dairy products.
Acute mono arthritis (MTP) peaks in 10 hr
Warmth, tenderness, swelling
Gout is associated with what Dz?
Dx of gout?
Joint aspirate in gout vs pauedogout?
Gout: needle shaped, negative birefringent, monosodium urate
Pseudogout: rhomboid shaped, positive birefringent, CPPD
WBC in joint aspirate of gout?
50 x 10^9 mostly neutrophils.
Importance of glucose level in joint aspirate of gout?
R/o septic arthritis
Glucose is low in SA
Are there specific X-ray changes in gout?
Role of pharmacological Rx in preserving joint in OA?
Rx of OA?
- Ideal weight
- Avoid excessive use of knees
- acetaminophen (1st line)
- IA HA or steroids => symptomatic relief.
No role of DMARD in OA
Classic X-ray changes in OA?
Decrease joint space
What's it used for?
SERM (selective estrogen modulator)
Prophylactic of osteoporosis.
Mechanism of action of raloxifene?
Estrogen agonistic effect on bone and lipids.
So lowers lipoprotein cholesterol and augment bone mineral density.
Risk of thromboembolic
Causes of osteoporosis in men?
Low Vit D
Effect of allopurinol in acute gout?
Rx of acute gout?
- NSAIDs (indomethacin 1st choice)
NB: combination of steroids and colchicine is not recommended.
Poor prognostic factors in SLE?
Young or elderly
Drugs induce lupus?
Effect of thiazide on bone density?
Improves bone density
Indication of thiazide in osteoporosis?
Reduce risk of osteoporosis in postmenopausal women
Ankylosing spondylitis (age + sex)
Men > F
Osteoarthritis effect in hands?
PIP + DIP of 2-5th fingers
CMC joint of thumb.
Osteoporosis screen in F?
If has > 1 risk factor (other than menopause)
Should be screened regardless of risks
Risk factors of osteoporosis?
High caffeine intake
Low Ca intake
Most serious association of polymyalgia rheumatica?
Temporal arteritis > Monocular visual loss
Polymayalgia Rheumatica classic?
1. Shoulder + hip pain > 1 mo (bilateral)
Affects daily activity
2. Morning stiffness > 1hr
3. Age > 50 (~70)
4. ESR >40-100
5. Rapid response to steroids < 20mg
Not a feature of PMR?
Abnormal labs in PMR?
ESR > 40-100
Complication of advance osteoarthritis?
Rx doesn't help.
X-ray of osteomyelitis?
Periosteal thickening, cortical thickening, sclerosis
Anaserine bursitis classic?
Nocturnal pain in medial knee region over upper tibia (2-3 cm below medial joint line)
Unit or bilateral.
Dx of anserine bursitis?
Local tenderness confined to quarter-sized area of medial tibial plateau.
-ve valgus stress
Normal X-ray of tibia
Area of de quervain's tendinitis?
Medial joint line of knee pain is characteristic of what Dz?
Medial collateral ligament injury
Medial meniscal tear
Fracture of tibial plateau
Most important factor to improve bone density in anorexia?
Effect of OCP on osteoporosis?
Mechanism of action of alendronate?
Decrease bone resorption
Increase new bone formation
Gout vs pseudogout
in age, joint
Gout: male + MTP joint
Pseudo: female + knee, wrist, ankle.
Generalized pain with multiple point tenderness
Gonococcal septic arthritis classic?
1. Migratory arthritis
2. Papular rash
3. Multiple sexual partners
4. +/- urogenital Sx
Dx of septic arthritis?
Nucleic acid amplification
Cultures of sensitivity
Rx of septic arthritis?
IV ceftriaxone (Gonorrhea)
Rx of bite associated septic arthritis?
Risk of gout?
Moonshine ingestion (lead)
Drugs causing gout?
How long does acute gout attack take to resolve?
Does colchicine alter high uric acid or prevent tophi?
Triad of reactive arthritis?
Iritis + conjunctivitis
(+ GI sx + rash)
Source of infection in reactive arthritis?
Most effective drug to reduce fracture in osteoporosis?
Raloxifene prevents what fractures?
HLA-B27 is associated with what erheumatological Dz?
Myasthenia graves associate with what HLA?
Pathophysiology of gout?
Purine metabolism defect > high uric acid.
Risk of hip involvement in osteoarthritis?
High bone mass
Weight Bearing sports
Specific labs for rheumatoid arthritis?
Indicator of pulmonary vascular fibrosis in scleroderma
TLC/DLCO > 1.6
Pulmonary fibrosis changes in DLCO?
Side effect of gold salts?
Skin discoloration (mauve + grey) over sun exposed areas.
Blue grey skin + teeth
SE of high dose steroids (>40)?
Psychiatric Sx (esp mood swings)
Fibromyalgia trigger points location?
Along medial scapular borders
Upper outer gluteal muscle
Medial fat bass of knees
Myopathies associated with high CK?
Hypothyroidism ass myopathy
Myopathy with normal CK at all times?