Rheumatology Flashcards

Question

**What causes Neonatal Lupus Erythematosus (NLE)** ⁉️

Answer 1

👩‍🍼 Caused by **transplacental passage** of maternal autoantibodies: 🧪 **Anti-SSA (Ro)** or **Anti-SSB (La)** 🧠 Can occur even if the mother is asymptomatic

Answer 2

🔻 **Rash** (transient) 💓 **Congenital heart block** (seen in ~30%) 🩺 **Fetal bradycardia** may be the first sign 🧠 Heart block is often **irreversible**

Answer 3

✅ Most **non-cardiac symptoms resolve by 6 months** 🚨 **Heart block does not resolve** ➡️ **30–50%** of affected infants require a **pacemaker**

Answer 4

💊 **Dexamethasone** may be given prenatally ⚙️ **Pacemaker** may be needed postnatally for symptomatic bradycardia

Answer 5

📉 **Bradycardia** 📊 **Complete AV block (3rd-degree)** ➡️ **P waves and QRS complexes dissociated** 🧠 Seen in **Lead II** with regular atrial and ventricular rates that are **independent**

Answer 6

👩‍🍼 **Positive anti-Ro (SSA) or anti-La (SSB)** antibodies 🧬 Often seen in mothers with **SLE** or **Sjögren’s syndrome** 🩺 May present with **rash** and/or **anti-phospholipid antibodies**

Answer 7

👏 **B. Anti-phospholipid antibodies + rash** ## footnote Anti-Ro/SSA antibodies in mothers with SLE or Sjögren’s cause neonatal lupus → congenital heart block.

Answer 8

🦴 **Inflammatory low back pain** ⏰ Worse in the **morning** , improves with **exercise** 📈 **Elevated ESR & CRP** 🧬 Associated with **HLA-B27**

Answer 9

📸 **Sacroiliitis with sclerosis** 🪵 **“Bamboo spine”** due to **bridging syndesmophytes** 🧠 Axial skeleton involvement is progressive

Answer 10

🧬 **HLA-B27** positivity ✅ Found in most patients with AS and related spondyloarthropathies

Answer 11

👧🏼 **Children** : recurrent **parotitis** 👩🏼 **Adults** : • **Keratoconjunctivitis sicca** (dry eyes) • **Xerostomia** (dry mouth) 🧠 Can also cause **skin rash, arthritis**, and fatigue

Answer 12

🧪 **Anti-Ro (SSA)** 🧪 **Anti-La (SSB)** 🧠 Also seen in **neonatal lupus**

Answer 13

💧 **Artificial tears** for dry eyes 💊 **Pilocarpine tablets** for dry mouth 💊 **Antimalarials (e.g., hydroxychloroquine)** for rash and arthritis

Answer 14

🚨 **Increased risk of lymphoma** 🧠 Especially **non-Hodgkin’s B-cell lymphoma**

Answer 15

🧠 **Mnemonic** : “Can’t see, can’t pee, can’t climb a tree” 👁️ **Conjunctivitis** 🚻 **Urethritis** (non-infectious) 🦴 **Arthritis** (usually asymmetric, lower limb)

Answer 16

⚠️ **Gastrointestinal pathogens** : • Shigella, Salmonella, Yersinia, Campylobacter ⚠️ **Genitourinary pathogens** : • Chlamydia trachomatis

Answer 17

⏰ **2–4 weeks** after GI or GU infection 🧠 Arthritis appears after infection has resolved

Answer 18

📈 **Elevated ESR and CRP** 🧬 **HLA-B27 positive** in 65–96% of cases

Answer 19

💊 **Supportive care** : • NSAIDs • Physical therapy ❌ Antibiotics are **not** effective once arthritis develops 🧠 Chronic cases may require **DMARDs**

Answer 20

🦵 **Proximal muscle weakness** (pelvic/shoulder girdle) 🌞 **Photosensitive skin rash** 🟣 **Heliotrope rash** (upper eyelids) 🟪 **Gottron papules** (over knuckles) 🧊 **Calcinosis cutis** ⚠️ **GI involvement** : abdominal pain, gastritis

Answer 21

🧪 **Elevated creatine kinase (CK)** 📈 Indicates muscle inflammation and damage

Answer 22

💊 **Prednisone** (corticosteroids) 💊 **Hydroxychloroquine** for skin rash 🌤️ **Sun avoidance** is crucial to prevent rash flares

Answer 23

🟪 **Gottron papules** : scaly, violet plaques over extensor surfaces of fingers 🟣 **Heliotrope rash** : violet discoloration and swelling of the eyelids

Answer 24

🧴 **Pruritic skin tightening** ❄️ **Raynaud’s phenomenon** 🥣 **Dysphagia** (difficulty swallowing) 💨 **Shortness of breath** 🦴 **Joint pain, stiffness, limited ROM** 💪 **Muscle weakness**

Answer 25

🧪 **Anti-Scl-70** (anti-topoisomerase I) 🧠 Suggests diffuse cutaneous systemic sclerosis

Answer 26

⚔️ **Linear streak on the face = “En Coup de Sabre”** 🧠 Resembles a sword strike

Answer 27

🧠 **Seizures** 👁️ **Uveitis** (eye inflammation) ⚠️ Especially if the lesion is on the face or scalp

Answer 28

🧴 Mainly **supportive care** 🏃 **Physical therapy** if joints are involved ⏳ Often **resolves spontaneously** in **3–4 years**

Answer 29

🔹 **Recurrent oral ulcers ≥3 times in 1 year** ➕ Plus **≥2 of the following** : • Recurrent **genital ulcers** • **Eye inflammation** (e.g., anterior uveitis, hypopyon) • **Characteristic skin lesions** • **Positive pathergy test** (skin hyperreactivity)

Answer 30

👄 **Oral ulcers** 🩸 **Genital ulcers** 👁️ **Anterior uveitis** , sometimes with **hypopyon** 🩻 Skin lesions + pathergy reaction (papule after needle prick)

Answer 31

💊 **Azathioprine** (Imuran) 💉 **Infliximab** in severe/refractory cases ## footnote 🧠 Aim: control inflammation and prevent vision loss or ulcers

Answer 32

🧠 **HSP = IgA-mediated small vessel vasculitis** 🧬 Common in children 🟣 Presents with **palpable purpura** (esp. lower limbs)

Answer 33

🔻 **Purpura** (non-thrombocytopenic) 🦴 **Arthritis** or arthralgia 🩸 **GI involvement** : • Abdominal pain • GI bleeding • ⚠️ **Ileo-ileal intussusception** 🧪 **Renal** : hematuria, proteinuria (nephritis) 💧 Subcutaneous & **scrotal edema**

Answer 34

✅ **Clinical diagnosis** 📈 **Platelet count** : normal or elevated 🩺 **Urinalysis** : screen for hematuria or proteinuria 🩸 **ESR** : may be elevated ⚠️ **Monitor BP & urinalysis for at least 6 months**

Answer 35

💧 **Supportive** : hydration, NSAIDs for joint pain 💊 **Corticosteroids** if: • Severe abdominal pain • Nephrotic-range proteinuria • Severe scrotal edema • Neurologic involvement 🧬 Immunosuppressives for **complicated renal disease**

Answer 36

✅ Most cases resolve spontaneously 🩺 **Urine & BP monitoring** for **≥6 months** ⚠️ Watch for development of **glomerulonephritis**

Answer 37

🔥 **Fever >5 days** ➕ **≥4 of the following 5 features** : 1️⃣ **Peripheral extremity changes** (erythema, edema, desquamation) 2️⃣ **Polymorphous rash** 3️⃣ **Oropharyngeal changes** (red tongue, cracked lips) 4️⃣ **Nonexudative bilateral conjunctivitis** 5️⃣ **Cervical lymphadenopathy** (often unilateral)

Answer 38

🧠 Core signs: • Fever • Rash • **Strawberry tongue** • **Nonexudative conjunctivitis** • **Desquamation** (fingertips) ➕ Associated: • Abdominal pain, vomiting • Hydrops of gallbladder • Joint pain, irritability

Answer 39

📈 **CRP ≥ 3.0 mg/dL** or **ESR ≥ 40 mm/h** 📊 WBC ≥ 15,000/μL 📉 **Low albumin ≤ 3.0 g/dL** 🩸 **Anemia, pyuria, ↑ ALT** 🔼 **Platelets ≥ 450,000/μL** after day 7

Answer 40

🫀 **Echocardiogram at** : 1. Diagnosis 2. 2nd week 3. 1 month after labs normalize 4. At 1 year if no coronary artery involvement 👨‍⚕️ Refer to cardiologist if **any echo abnormality**

Answer 41

💉 **IVIG** 2 g/kg over 12–14 hours 💊 **High-dose Aspirin** : 80–100 mg/kg/day until fever resolves ➡️ Then **low-dose aspirin** (3–5 mg/kg/day) for 6–8 weeks if no coronary involvement 🛡️ **IVIG** : reduces risk of **coronary aneurysms** ⚠️ Monitor for anaphylaxis or aseptic meningitis

Answer 42

✅ Relieve inflammation ✅ Antiplatelet effect ➕ Synergistic benefit with IVIG in preventing coronary aneurysms

Answer 43

🧠 **Diagnosis of exclusion** 👧 Typically in **preschool or school-age** 🦵 **Bilateral leg/extremity pain** 🌙 Pain occurs in the **evening or night** , may **wake child from sleep** ☀️ **Resolves by morning** 🏃 **No activity limitation during the day** 🔄 Often after **days of high physical activity**

Answer 44

✅ **Normal physical exam** 🧪 If concern arises (fever, limp, joint swelling): • X-ray • CBC with differential • **ESR** and **CRP** ⚠️ Helps rule out infection, malignancy, or arthritis

Answer 45

💬 **Reassurance** ❄️ Ice or **heat therapy** 🤲 Massage 💊 **NSAIDs** for pain relief 🧠 No need for long-term treatment

Answer 46

🧬 **Autosomal recessive autoinflammatory disorder** 🧠 Characterized by **recurrent episodes of fever and serositis** 🧑‍👩‍👧 Often seen in individuals with a **positive family history**

Answer 47

🔥 **Periodic fever attacks** 💢 **Severe abdominal pain** 🫁 **Pleuritis or pericarditis** 🩺 **Scrotal swelling** 🦵 **Arthritis/arthralgia/myalgia** 🩸 **Erysipelas-like rash** around the ankle

Answer 48

🚨 **AA amyloidosis** ➡️ **proteinuria** , ➡️ **renal failure** 🧪 Proteinuria may be the first clue

Answer 49

🧠 **Clinical diagnosis** (supported by genetic testing) 📈 During attacks: **↑ ESR, CRP, WBCs** 🧪 Monitor **urinalysis** for protein 📅 **Follow-up** : every 3–6 months

Answer 50

💊 **Colchicine** ✅ Prevents attacks and reduces risk of **amyloidosis** ⚠️ Monitor for **colchicine toxicity**

Answer 51

🧠 **Benign periodic fever syndrome** 🧒 Occurs between **6 months to 7 years** (mean age ~3 years) 🔥 **Fever episodes** last **5–7 days** , recur every **<4 weeks** ✅ Child appears **healthy between episodes**

Answer 52

🔁 **Recurrent periodic fever** 👄 **Aphthous stomatitis** (mouth ulcers) 👃 **Pharyngitis** (sore throat) 🦠 **Cervical lymphadenitis** (swollen neck nodes) 🧪 **No signs of active infection**

Answer 53

🧠 **Clinical diagnosis** 🧪 Labs may show mild elevation in CRP/ESR during flares 🧒 **No specific test** , and cultures are negative

Answer 54

💊 **Single dose of steroids** (e.g. prednisolone) 💊 **NSAIDs** for fever control ⚔️ **Tonsillectomy** may eliminate episodes in some cases

Answer 55

✅ **Self-limiting** – typically resolves by **teenage years** 🧠 No long-term complications

Answer 56

انتهينا بأمر الله الحمدلله ربِّ العالمين 🔻

Rheumatology Flashcards

(80 cards)