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Flashcards in Rheuma Deck (79):
1

Thiazide diuretics SE?

High GLUC + Low MgNak


High => Glucose, lipid, uric acid, Ca
Low=> Mg, Na, K

2

Medication cause osteoporosis?

Phenytoin
Glucocorticoid
Cyclosporine
Phenobarbital
Heparin

3

Indication of raloxifene?

Osteoporosis in post-menopausal women.

4

Lab indications of disease activity in SLE?

Active SLE > high anti-dsDNA + low C3 / C4

5

Dx of osteoporosis?

DEXA

6

Sensitivity of X-ray in osteoporosis?

Not sensitive until bone density is decreased by >50%

7

Dx of ankylosing spondylitis?

X-ray of sacroiliac joint.

8

Instructions for alendronate (bisphosphonate)

Empty stomach (food decreases absorption)
30 min before food.

Remain upright for 30 min (prevent GERD)

With water.

9

Rx of male osteoporosis?

Alendronate
Recombinant parathyroid hormone

10

Contraindication to using testosterone replacement?

Hx of prostate Ca

11

Dx of giant cell arteritis

Biopsy of temporal artery

12

Food increase risk of gout?

Red meat
Seafood
Nuts (purine)
Beans (purine)

13

Food help in gout?

Milk and dairy products.

14

Gout classic?

Acute mono arthritis (MTP) peaks in 10 hr

Warmth, tenderness, swelling

15

Gout is associated with what Dz?

HTN

16

Dx of gout?

Joint aspirate

17

Joint aspirate in gout vs pauedogout?

Gout: needle shaped, negative birefringent, monosodium urate


Pseudogout: rhomboid shaped, positive birefringent, CPPD

18

WBC in joint aspirate of gout?

50 x 10^9 mostly neutrophils.

19

Importance of glucose level in joint aspirate of gout?

R/o septic arthritis

Glucose is low in SA

20

Are there specific X-ray changes in gout?

No

21

Role of pharmacological Rx in preserving joint in OA?

No role.

22

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

23

Classic X-ray changes in OA?

Decrease joint space
Osteophyte formation
Subchondrial sclerosis
Subchondrial cyst

24

What's raloxifine?
What's it used for?

SERM (selective estrogen modulator)

Prophylactic of osteoporosis.

25

Mechanism of action of raloxifene?

Estrogen agonistic effect on bone and lipids.

So lowers lipoprotein cholesterol and augment bone mineral density.

26

Raloxifene SE?

Hot flushes
Leg cramps
Risk of thromboembolic

27

Causes of osteoporosis in men?

Obesity
Alcohol
Hypogonadism
Low Vit D
Low BMI
Steroid use

28

Effect of allopurinol in acute gout?

Worsen Sx

29

Rx of acute gout?

- NSAIDs (indomethacin 1st choice)
- Steroids
- Colchicine

NB: combination of steroids and colchicine is not recommended.

30

Poor prognostic factors in SLE?

Renal Dz
HTN
Male
Young or elderly
Anti-phospholipid syndrome
Black race

31

Drugs induce lupus?

Procainamide
Hydralazine
INH
Carbamazepine
Phenytoin

32

Effect of thiazide on bone density?

Improves bone density

33

Indication of thiazide in osteoporosis?

Reduce risk of osteoporosis in postmenopausal women

34

Ankylosing spondylitis (age + sex)

> 40
Men > F

35

Osteoarthritis effect in hands?

PIP + DIP of 2-5th fingers
CMC joint of thumb.

36

Osteoporosis screen in F?

<65
If has > 1 risk factor (other than menopause)


> 65
Should be screened regardless of risks

37

Risk factors of osteoporosis?

Petite
White
Inactive
Nulliparity
Smoking
High caffeine intake
Alcohol
Postmenopausal F
Low Ca intake

38

Most serious association of polymyalgia rheumatica?

Temporal arteritis > Monocular visual loss

39

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

40

Not a feature of PMR?

Muscle weakness
Muscle atrophy

41

Abnormal labs in PMR?

Anemia
ESR > 40-100
CRP high

42

Complication of advance osteoarthritis?

Meniscal tear
Rx doesn't help.

43

X-ray of osteomyelitis?

Periosteal thickening, cortical thickening, sclerosis

44

Anaserine bursitis classic?

Nocturnal pain in medial knee region over upper tibia (2-3 cm below medial joint line)

Unit or bilateral.

45

Dx of anserine bursitis?

Local tenderness confined to quarter-sized area of medial tibial plateau.

-ve valgus stress

Normal X-ray of tibia

46

Area of de quervain's tendinitis?

Wrist

47

Medial joint line of knee pain is characteristic of what Dz?

Osteoarthritis.

Medial collateral ligament injury

Medial meniscal tear

Fracture of tibial plateau

48

Most important factor to improve bone density in anorexia?

Normalizing weight.

49

Effect of OCP on osteoporosis?

None

50

Mechanism of action of alendronate?

Decrease bone resorption
Increase new bone formation

51

Gout vs pseudogout

in age, joint

Gout: male + MTP joint
Pseudo: female + knee, wrist, ankle.

52

Fibromyalgia classic?

Childbearing F
Generalized pain with multiple point tenderness
Sleep disturbance
Normal labs

53

Fibromyalgia Rx?

Amitriptyline
Cyclopenzaprine
CBT
Aerobic exercise

54

Gonococcal septic arthritis classic?

1. Migratory arthritis
2. Papular rash
3. Multiple sexual partners
4. +/- urogenital Sx
5. Tenosynovitis

55

Dx of septic arthritis?

Nucleic acid amplification
Cultures of sensitivity

56

Rx of septic arthritis?

IV ceftriaxone (Gonorrhea)
Doxycycline (Chlamydia)

57

Rx of bite associated septic arthritis?

IV ampicillin-sulbactam

58

Risk of gout?

Renal failure
HTN
Obesity
Moonshine ingestion (lead)
Alcohol
Drugs

59

Drugs causing gout?

Diuretics (thiazide)
Salicylates
Niacin
Cyclosporine
Ethambutol
Pyrazinamid

60

How long does acute gout attack take to resolve?

2 weeks

61

Does colchicine alter high uric acid or prevent tophi?

No

62

Triad of reactive arthritis?

Arthritis,
Iritis + conjunctivitis
Urethritis

(+ GI sx + rash)

63

Source of infection in reactive arthritis?

Urethral
GI

64

Most effective drug to reduce fracture in osteoporosis?

Bisphosphonate

65

Raloxifene prevents what fractures?

Vertebral only.

66

HLA-B27 is associated with what erheumatological Dz?

Reactive arthritis
Psoriatic arthritis
Ankylosing spondylitis

67

Myasthenia graves associate with what HLA?

HLA-DR3

68

Pathophysiology of gout?

Purine metabolism defect > high uric acid.

69

Risk of hip involvement in osteoarthritis?

Obesity
High bone mass
Old age
Female
Weight Bearing sports
Hypothyroid.

70

Specific labs for rheumatoid arthritis?

RF
Anti-CCP

71

Indicator of pulmonary vascular fibrosis in scleroderma

TLC/DLCO > 1.6

72

Pulmonary fibrosis changes in DLCO?

Low DLCO

73

Side effect of gold salts?

Skin discoloration (mauve + grey) over sun exposed areas.

74

Minocycline SE?

Photosensitivity
Lupus
Blue grey skin + teeth
Diarrhea.

75

SE of high dose steroids (>40)?

Psychiatric Sx (esp mood swings)

76

Fibromyalgia trigger points location?

Along medial scapular borders

Posterior neck


Upper outer gluteal muscle

Medial fat bass of knees

77

Myopathies associated with high CK?

Polymyositis
Dermatomyositis
Alcoholic myopathy
Hypothyroidism ass myopathy

78

Myopathy with normal CK at all times?

PMR

79

Is there a correlation between bone mineral density and risk of fracture in osteoporosis?

No

All patient with Hx of fracture should be on Rx regardless of T score.