Rheumatology 2 Flashcards
(99 cards)
1
Q
Treatment of ILD associated with systemic sclerosis
A
Mycophenolate
2
Q
Specific lab feature for diagnosis of TB in pleural effusion
A
HIGH adenosine deaminase
3
Q
Most common pulmonary manifestation of RA
A
Rheumatoid pleuritis
4
Q
Specific lab feature of adult still disease
A
Extremely high serum ferritin
5
Q
SE’s of lyrica
A
- weight gain, peripheral edema, lethargy, dizziness
6
Q
HSP diagnosis
A
Skin biopsy with immunofluorescence
7
Q
Treatment of relapsed GPA
A
Rituximab
8
Q
management of refractory SLE
A
Belimumab
9
Q
what is acute cutaneous lupus erythematosus?
A
- derm presentation of SLE – classic malar (butterfly) rash
10
Q
clinical description of malar rash
A
bright patches over both cheeks AND nasal bridge
*No nasolabial fold involvement
11
Q
What is subacute cutaneous lupus erythematous in general?
A
- different subtype of cutaneous lupus
12
Q
Rosacea vs. SLE
A
rosacea = inflammatory papules, pustules, telangiectasisas
*nasolabial fold involvement
13
Q
Treatment of primary angiitis of the CNS
A
Cyclophosphamide
14
Q
When patients on chronic steroids need to be on bisphosphonates
A
*moderate or high 10 yr risk of major fracture + at least 2.5 mg of pred daily for 3 months
15
Q
subacute cutaneous lupus erythematosus clinical features
A
young woman with lupus features + annular rash with central clearing or papulosquamous with patchy erythematous plaques and papules
16
Q
Treatment options for chronic calcium pyrophosphate arthropathy
A
- low-dose steroids
- low dose colchicine
- NSAIDS
- you don’t use allopurinol because allopurinol is urate-lowering therapy, but calcium pyrophosphate deposition results from calcium pyrophosphate rather than uric acid deposition
17
Q
medical term for pseudogout
A
acute calcium pyrophosphate crystal arthritis
18
Q
good treatment option for OA with NSAID contraindications
A
Duloxetine
19
Q
c-ANCA (GPA) antigen
A
proteinase 3 (PR3)
20
Q
p-ANCA antigen
A
myeloperoxidase (MPO)
21
Q
CREST syndrome is
A
Calcinosis
Raynaud’s
Esophageal dysmotility, Sclerodactyly
Telangiectasias.
22
Q
anti synthetase syndrome clinical features
A
- myositis + raynaud’s + mechanic’s hand + ILD
- 1/3 of patients with immune-mediated myopathy have constellation of findings termed “antisynthetase syndrome”
23
Q
Mechanic’s hands + clinical association
A
- thickened skin resembling skin of mechanic
- feature of patients with myositis
24
Q
Polyarteritis nodosa clinical features
A
He is pissing blood + has a BP cough around his neck + right foot and left hand in bowling water + covered in darts + in a wheelchair/presentation is multi-systemic: renal: glomerulonephritis + hypertension, nervous: peripheral neuropathy + mononeuritis multiplex, GI: mesenteric ischemia/bowel infarction, bleeding, Musculoskeletal: myositis, arthritis.
25
Medical term for Churg-Strauss
Eosinophilic granulomatosis with polyangiitis
26
Eosinophilic granulomatosis with polyangiitis clinical features
Poly Nichols laying in bed. Andrew purpura to the right of the bed + has big headphones on + red eyes + + feet and hands in a bucket. Polly Nichols has nails driven into her sinuses and wrist/foot drop + she’s using a huge inhaler/presentation = asthma + sinusitis + skin nodules or purpura + peripheral neuropathy (eg wrist/foot drop) + uveitis + conductive/hearing loss + muscle/joint pain.
27
Complement levels in mixed cryoglobulinemia
- C3 is unaffected
- C4 is low
- CH50 is low (CH50 is total hemolytic complement)
28
anti-centromere antibodies association
CREST syndrome
29
antibody associated with systemic sclerosis
anti-topoisomerase
30
Principles of RA care
1) Care by rheumatologist
2) DMARD ASAP
3) Tight control, treat to target strategy (adjusting therapy to treat a composite clinical outcome)
31
Management of RA patient resistant to initial DMARD therapy
Combination of DMARDS
- MTX + sulfasalazine and hydroxychloroquine
OR
- MTX + TNF inhibitor
32
Screening prior to starting DMARD
- Hep B AND C
| * latent TB
33
Hep B testing prior to starting DMARD
Hep B surface antigen and HBV core antibody
34
Screening prior to starting hydroxychloroquine
- baseline optho exam
35
Management of active RA
- anti-inflammatory therapy with NSAID or steroid (depending on degree of disease activity)
- start DMARD therapy with MTX (may take weeks to months to achieve optimal effects)
36
contraindication to DMARD
active infection
37
RA during pregnancy
RA often improves or remits completely during pregnancy
38
HPV screening age interval
21 to 65
39
HPV testing for different age groups per USPSTF
21-29 = Pap test q 3 years
30 and over = Pap test q 3 years OR primary HPV testing alone (only certain tests are approved) q 5 years OR contesting (Pap and HPV testing) q 5 years
*can cotest once you're 30
40
Behcet's disease clinical features
recurrent and painful oral ulcers + genital ulcerations + ocular disease (uveitis) + skin lesions, gastrointestinal involvement, neurologic disease, vascular disease, or arthritis
41
Countries where Behcet's incidence is higher
- Turkey (80 to 370 cases per 100,000) while the prevalence ranges from 13.5 to 35 per 100,000 in Japan, Korea, China, Iran, Iraq, and Saudi Arabia
42
Treatment of Behcet's syndrome
IF oral or genital ulcers --> topical steroids
For prevention of recurrent oral and genital ulcers --> colchicine
IF more severe disease --> systemic steroids
43
Anti-GBM disease is
Goodpasture's
44
Anti-GBM disease clinical features
Lungs on + and attacking the basement membrane with a pickaxe + pissing blood all over the place + coughing up blood all over himself (NEPHRITIC)/patients are typically young men with onset of pulmonary symptoms like fatigue, dyspnea, and hemoptysis and renal symptoms – dysuria, hematuria, and renal failure.
45
Anti-GBM disease treatment
Diego hooked up to plasmapheresis machine/treatment = emergent plasmapheresis.
46
Treatment of MPGN
IF immune complex-mediated (hep C or b associated) -- treat underlying disease
47
Initial treatment of GPA
steroids = rituxan
48
Serology in RA
- Many patients have "seronegative" RA, typically early on in disease course (thus often have negative ANA, RF, and CCP
- RA is A CLINICAL DIAGNOSIS
49
RA presentation
- morning stiffness improving with activity
- small joint involvement (PIP, MCP, MTP) sparing DIP
- joints are warm and tender to touch
- rheumatoid nodules
- symmetric, polyarticular joint pain
50
Derm presentation of systemic sclerosis
- skin thickening over hands and fingers + digital ulceration
51
Presentation of ILD associated with systemic sclerosis
- basilar crackles
| - interstitial markings on CXR
52
alopecia areata clinical features
- commonly associated with other autoimmune disorders
- chronic, recurring, often spontaneously recover but commonly relapse
- smooth, circular patches of hair loss
- exclamation point hairs seen at margins (larger on top than at their base) + extractable with minimal traction
53
management of alopecia areata
- intralesional steroid injections (or topical if refusing steroids)
- sometimes no treatment
54
Management of AIHA
First line = steroids
| Second line = splenectomy
55
MAHA on peripheral smear
red cell fragmentation (schistocytes)
56
Peutz-Jeghers syndrome presentation
- mucocutaneous pigmentation (multiple brown spots on lips and buccal mucosa)
- multiple hamartomatous GI tract polyps and pigmented mucocutaneous papules
- GI symptoms: rectal bleeding, obstruction, abdominal pain
- young age
57
Peutz-Jeghers syndrome is associated with increased risk for what?
- malignancy (both GI and non-GI malignancy)
58
Screening for Peutz-Jeghers
- c-scope at age 18
- EGD and small-bowel series starting at age 8
- early mammograms
- testicular exam starting at age 12
59
ovarian cancer presentation
- subtle (bloating, pelvic pressure)
60
Other clinical + lab features of eosinophilic granulomatosis with polyangiitis
```
CLINICAL:
- ***asthma
- chronic rhinosinusitis with nasal polyps
- necrotizing glomerulonephritis
- tender subcutaneous nodules
- migratory polyarthritis
LAB:
- eosinophilia
- granulomatous
```
61
Treatment of churg strauss
- systemic steroids with or without cyclophosphamide
62
Diagnosis of churg strauss
- tissue biopsy (lung or kidney)
63
GPA vs. churg-strauss
Churg-strauss = asthma + nasal polyps + eosinophilia
64
Management of joint destruction in RA causing refractory pain, functional disability
refer to orthopedics (pain is typically from mechanical stress of joint deformities and or destruction)
65
Reactive arthritis features
- asymmetric oligoarthritis
- enthesisitis
- conjunctivitis
- OR oral ulcers
66
First line therapy for reactive arthritis
NSAIDS
67
Most common complications of tattoos
1) local staph infections
| 2) hypersensitivity reactions from metals in ink
68
Variable correlated with poorer functional outcomes in RA
- High titer CCP
- higher number of involved joints
- positive RF
- higher inflammatory markers
69
Presentation of septic olecranon bursitis
- warmth, swelling, fever of elbow joint
* synovial fluid count greater than 3K
* gram stain may be negative
70
Treatment of septic olecranon bursitis
drain fluid + systemic anti-staphylococcal abx
71
Finding that commonly causes DXA result to be inaccurate
osteophytes + other abnormal calcifications (this is why treatment decisions should be based on lowest bone density measurement)
72
Antihypertensives of choice for patients with gout
Losartan
| CCBs
73
Meds that can increase risk of gout flair
- diuretics
| * beta blockers
74
Next step after suspected Raynaud's
Nailfold capillary examination (differentiates between primary and secondary raynaud's -- normal nail fold capillaroscopy suggests primary reynaud's, abnormal suggests secondary, so patient should be evaluated for an underlying disorder)
75
HSP clinical features
- renal dysfunction
- palpable purpura
- abdominal pain
- arthritis
* can be in adults too
76
description of palpable purpura
- multiple raised, erythematous, non blanching lesions on lower extremities
77
PMR clinical features
- elevated ESR
- elderly patient
- neck, shoulder, proximal thigh or hip involvement (may not have hip)
- decreased ROM in shoulders, neck, and hips
- constitutional symptoms
78
Diabetic amyotrophy clinical features
- acute asymmetrical pain followed by gradually worsening proximal lower extremity and back weakness
79
atypical features of hyperthyroidism in elderly patients
- dyspnea, apathy (rather than hyperactivity), paradoxical constipation
- Afib
80
Long term complication of Sjogren syndrome
- NHL
81
What is a pleomorphic adenoma?
Common benign salivary gland tumor
82
Treatment of Lofgren syndrome
NSAIDs
83
Lofgren syndrome clinical features
- erythema nodosum + bilateral ankle arthritis + hilar adenopathy
(variant of sarcoidosis)
84
Sjogren syndrome clinical features
- chronic dry eyes + dry mouth
- 25% have extra glandular manifestations: *RTA + DI, chronic interstitial nephritis, lung, nervous system, heart involvement, *Rayonouds
85
clinical features of mixed cryoglobulinemia
- palpable purpura, arthralgias, MPGN, neuropathy
| - can see skin necrosis and gangrene in some patients
86
mixed cryoglobulinemia lab features
- positive ANA + RF
| - low C3 + C4 (confirm)
87
Other presentation of GPA
- ocular involvement
88
Drugs causing drug-induced SLE
- hydralazine
- procainamide
- minocycline
- anti-tumor necrosis factor agents
89
drug-induced SLE clinical and lab features (distinct from SLE
* normal complement
| - less likely to cause CNS, heme, or renal abnormalities
90
autoantibodies positive in drug-induced SLE
histone autoantibodies
91
Sarcoidosis diagnosis
- requires biopsy (demonstrating pathologic evidence of noncaseating granulomas)
- biopsy most accessible site of disease involvement, which is typically endobronchial ultrasound with nodal aspiration for mediastinal lymph node sampling
92
pseudogout caveat
- crystal microscopy has low sensitivity (CPPD crystals are small and often scarce)
93
Preferred antihypertensive for suspected aortic dissection
First line: Beta blockers (labetalol) (you also want to decrease LV contractility to reduce aortic wall shear stress)
Second line: nitroprusside
94
Symptomatic PDA presentation
- continuous murmur
- wide pulse pressure
- bounding pulses
- best auscultated pulmonic position
95
Sequela of unprepared PDA
Increased risk of infective endarteritis
96
description of murmur from PDA
- continuous murmur in the left infraclavicular region
97
Allopurinol titration in gout
- never adjust dose or discontinue until 3-4 weeks after the acute inflammation subsides
- typically increased until serum uric acid is below 6
98
Management of dermatitis associated with SLE
Mild -- topical steroids
Moderate -- plaquenil
Severe -- immunosuppressive drugs
99
Limited cutaneous systemic sclerosis features
- puffy fingers distal to MCP joints
| - sclerosis distal to elbows and knees, sparing trunk and proximal extremities
