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Rheumatology Flashcards

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0
Q

Fibromyalgia treatment

A

Best initial- amitryptyline
Other treatments- milnacipran (serotonin and norepinephrine uptake
inhibitor), pregabalin

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1
Q

Fibromyalgia diagnosis

A

Clinical

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2
Q

Causes of carpal tunnel syndrome

A 
Pregnancy
Diabetes
RA
Acromegaly
Amyloidosis
Hypothyroidism
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3
Q

Nerve involved in carpal tunnel syndrome

A

Most commonly median nerve

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4
Q

Diagnosis of carpal tunnel syndrome

A

Mostly clinical to confirm
-Tinel sign: pain with tapping of median nerve
-Phalen sign: pain with flex ion of wrist to 90 degrees
Most accurate test: electromyography and nerve conduction testing.

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5
Q

Carpal tunnel treatment

A

Best initial: wrist splints
First line medical therapy: NSAIDs

If no response to NSAIDs, use STEROID injections
LAST RESORT: surgery

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6
Q

What is Dupuytren contracture?

A

Nodule formation and contracture of the forth and fifth fingers.
Associated with alcoholism and cirrhosis
Patients lose ability to extend their fingers

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7
Q

Dupuytren contracture treatment

A

Triamcinolone
Lidocaine
Collagenase injections- helpful in early stages

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8
Q

Rotator cuff injury diagnosis

A

Mostly clinical-inability to flex or abduct shoulder

Most accurate: MRI- tear of primal end of long head of bicep tendon

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9
Q

Treatment of rotator cuff injury

A

Best initial: NSAIDs, rest and PT.

If above fails: STEROID injections

SURGERY for complete tears and those not responding to the above

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10
Q

Patellofemoral syndrome

A

Anterior knee pain secondary to trauma, imbalance of quadriceps strength, or meniscus tear.
Pain is in front of the knee and under the patella
Symptoms worse walking just after having been seated for a long time
PE: crepitus, joint locking, instability

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11
Q

Diagnosis and treatment of patella femoral syndrome

A

DX: X-ray are normal

Tx: physical therapy, strength training with cycling

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12
Q

Diagnostic tests for RA

A 
Rheumatoid factor ( nonspecific)
Anti-CCP - most specific
Radiographs: erosive joints, osteopenia
Diagnosis is based on point system: 6 or more points needed
  -joint involvement (up to 5 points)
  -ESR or CRP (1 point)
  -duration longer than 6 weeks (1 point)
  -RF or anti-CCP (1 point)
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13
Q

What is the most common cause of death in RA patients?

A

Coronary artery disease

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14
Q 
A patient with long standing RA is having a coronary bypass surgery. Which of the following is the most important prior to surgery?
A. Cervical spine X-ray
B. Rheumatoid factor
C. Extra dose of methotrexate
D. ESR
E. Pneumococcal vaccination
A

A. Cervical spine X-ray

RA is associated with C1/C2 subluxation. Cervical spine imaging to detect possible instability of thr vertebra is essential prior to the hyperextension of the neck that typically occurs with endotracheal intubation.

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15
Q

RA treatment

A

Best initial DMARD: methotrexate
Tumor necrosis factor inhibitors -1st line if no response to MTX
- infliximab, adalimumab, etanercept
Rituximab (removes CD20 positive lymphocytes from circulation)
- used in combination with MTX if no response to TNF agents
Hydroxychloroquine- mild disease. Used in combination with MTX
Sulfasalazine, leflunomide, abatacept- combined with MTX
Symptomatic and pain control: NSAIDs and steroids

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16
Q

Methotrexate- folate antagonist

Toxicity?

A

Liver toxicity
Bone marrow suppression
Pulmonary toxicity

Folic acid supplements required

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17
Q

TNF alpha toxicity

A

Reactivation of TB: screen with a PPD prior to their use

Infection

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18
Q

Hydroxychloroquine toxicity

A

Retinal toxicity

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19
Q

Sulfasalazine toxicity

A

Bone marrow toxicity
Hemolysis with G6PD deficiency
Rash

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20
Q

Juvenile rheumatoid arthritis treatment

A

Best initial: aspirin or NSAIDs
If no response to either, STEROIDS
If fails: TNF drugs

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21
Q

What 2 changes are seen in acute lupus flare?

A

Complement levels drop and anti-DS DNA levels rise

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22
Q

Treatment of acute lupus flare

A

Bolus of STEROIDS

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23
Q

When is kidney biopsy recommended in lupus patients?

A

If patients present with anti double-stranded DNA

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24
Lupus treatment mostly recommended for skin and joint manifestations
Hydroxychloroquine
25
Drug that controls progression of lupus
Belimumab
26
Treatment of lupus NEPHRITIS
Steroids + Cyclophosphamide/mycophenolate
27
Hydroxychloroquine toxicity
Retinal toxicity therefore need eye exams every 6 months
28
Most common cause of death in elderly SLE patients
MI due to accelerated atherosclerosis
29
Coagulation studied in Antiphospholipid syndrome
Elevated PTT | Normal: PT and INR
30
Is VDRL positive or negative in antiphospholipid syndrome
Usually false positive VDRL or RPR seen with normal FTA (distinguishes APS from syphillis)
31
Antibodies responsible for spontaneous abortions in antiphospholipid syndrome
Anticardiolipin antibody
32
Best initial test for antiphospholipid syndrome
mixing study-to distinguish between clotting factor deficiency and APL. Patients plasma is mixed with an equal amount of normal plasma. In clotting factor deficiency, PTT will normalize after mixing study. In APL, antibody present in the patients plasma will keep PTT elevated.
33
The mot specific test Lupus anticoagulant in APL
Russell viper venom test- prolonged with APL antibodies
34
Treatment of asymptomatic Antiphospholipid antibody syndrome
asymptomatic disease does not need to be treated
35
treatment of first thrombotic episode of APL syndorme
wrfarin and heparin with INR target of 2-3
36
treatment of recurrent thrombotic episdes
LIFELONG treatment of warfarin
37
treatment of recurrent spontaneous abortions due to APL syndrome
heparin and Aspirin avoid warfarin and steroids!!!!
38
treatment of scleroderma that slows the process
methotrexate
39
scleroderma treatment - renal crisis - esophageal dysmotility - raynauds - pulmonary fibrosis - pulmonary hypertension
-renal crisis:ACE inhibitor -esophageal dysmotility: PPI -Raynauds: CCB -Pulmonary fibrosis: Cyclophosphamide- improves dyspnea and PFTs -pulm HTN: Bosertan ambrisentan (endothelin antagonist), sildenafil, postacyclin analog (ilopost, treprostinil, epoprostenol)
40
cancers associated with dermatomyositis
ovary lung GI Lymphoma
41
best initial test of polymyositis and dermatomyositis
CPK and aldolase
42
most accurate test for polymyositis and dermatomyositis
muscle biopsy--> mononclear infiltrate surrounding necrotic and degenerating muscle fibers
43
antibodies associated with lung fibrosis in polymyositis and dermatomyositis
Anti- Jo antibodies
44
Labs associated with polymyositis and dermatomyositis
increase ESR/CRP/RF
45
treatment of polymyositis and dermatomyositis
``` STEROIDS -if unresponsive or intolerant: Methotrexate Azathioprine IVIG Mycophenolate Hydroxychloroquine- helps with skin lesions ```
46
most dangerous complication of sjogren syndome
Lymphoma
47
sjogren syndrome: best initial test
Schirmer test (measures the amount of tears)
48
sjogren syndrome: most accurate test
Lip or parotid gland biopsy ( lymphoid infiltration in the salivary gland)
49
sjogren syndrome: best initial blood test
SS-A and SS-B (Ro and La)
50
What disease is Rose bengal stain used to diagnose
Sjogren syndrome - it shows abnormal corneal epithelium
51
Sjogren syndrome: treatment
drinking lots of water, use sugar free gum, and fluoride treatment. Use artificial tears Pilocarpine and cevimeline increases acetylcholine : stimulates production of saliva
52
common presentation of all vasculitis
fever malaise/fatigue weight loss arthralgia/myalgia
53
Polyarteritis Nodosa includes all organ systems EXCEPT
Lungs
54
PAN is associated with
Hepatitis B and C
55
2 neurologic features associated with PAN
- peroneal neuropathy leading to foot drop | - stroke in a young person
56
PAN: most accurate test
biopsy of a symptomatic site
57
What does angiography of a patient with PAN show
abnormal dilation or beading
58
PAN treatment
STEROIDS and CYCLOPHOSPHAMIDE
59
Polymyalgia rheumatica treatment
LOW dose STEROIDS
60
complication of temporal arteritis
Irreversible Blindness
61
Temporal arteritis: Labs
elevated ESR and CRP
62
Temporal arteritis: most accurate test
Temporal artery biopsy
63
Temporal arteritis: treatment
Steroids ( should be stated right away instead of waiting for biopsy confirmation)
64
Wegener Granulomatosis: best initial test
C-ANCA
65
wegener granulomatosis: most accurate test
Biopsy (most commonly lung)
66
Wegener granulamatosis: treatment
Steroids and Cyclophosphamide
67
Churg-stauss syndrome buzz words
Asthma and eosinophilia
68
Diagnosis and treatment of Churg-Stauss Syndrome
Dx: most accurate- Biopsy Tx: steroids and cyclophosphamide
69
Henoch-Schonlein Purpura diagnosis and treatment
Dx: most accurate- biopsy (leukocytoclastic vasculitis) Tx: Can resolve spontaneously - Steroids for abdominal pain or progressive renal insufficiency
70
Cryglobulinemia is associated with what diseases
Most commonly with :Chronic Hepatitis C | Other diseases: endocarditis and Sjogren syndrome
71
cryglobulinemia treatment
Interferon Ribavirin Telaprevir Boceprevir
72
Presentation of Behcet syndome
``` Painful oral and genital ulcers + skin lesions can also present with: -ocular finding -arthritis -CNS lesions ```
73
Behcet syndrome: "Pathergy"
Sterile skin pustules from minor trauma like a needle stick
74
Bachet syndrome treatment
STEROIDS ``` -to wean patients off of steroids, use: Azathioprine Cyclophosphamide Colchicine Thalidomide ```
75
Ankylosing spondylitis diagnosis: best initial and most accurate
Best initial test: X-ray of the sacroiliac joint. Most accurate: MRI Elevated ESR is seen in 85%
76
Ankylosing spondylitis treatment
Best initial: exercise and NSAIDs If no response to above: anti-TNF drugs (etanercept, adalimumab, infliximab)
77
Psoriatic arthritis diagnosis: best initial
best initial: X-ray (pencil in a cup) Uric acid level is elevated form increased skin turnover!!!
78
Psoriatic arthritis treatment: best initial
Best initial: NSAIDs No response to NSAIDs: Methotrexate If no response to MTX: Anti-TNF agents are used
79
Skin lesion unique to reactive arthritis
Keratoderma blennorhagicum (looks like pustular psoriasis)
80
Reactive arthritis diagnosis
``` Mainly clinical (can't see, can't pee, can't climb a tree) -if hot swollen joint is present--> needs to tap to R/O septic joint ```
81
reactive arthritis treament
NSAIDs If no response to NAIDS: Sulfasalazine Steroid injections into the joint help!!!
82
Osteoporosis diagosis
Most accurate: DEXA scanning Normal levels of: Calcium, phoshpate, PTH hormones
83
Osteoporosis treatment
Vitamin D and Calcium Bisphophonates Estrogen replacement (if postmenopausal) Raloxifene (substitute for estrogen in posmenopausal) Teriparatide (PTH analogue- stimulates new bone matrix formation) Calcitonin nasal spray- decreases risk of vertebral fractures
84
Septic arthritis risk factors
Usually affects previously damaged joints: DJD, RA Increased risk in endocarditis patients and IV drug users
85
Most common organism causing septic arthritis
STAPH followed by strep and gram negative rods
86
Septic Arthritis diagnosis
Best initial and most accurate: aspiration of the joint X-ray, CT and MRI are not useful
87
Joint fluid analysis in septic arthritis: Leukocytosis level
More than 50,000 to 100, 000 | predominantly NEUTROPHILS
88
Septic arthritis treatment
Best initial: Ceftriaxone and vancomycin Gram - bacilli: Quinolones, Aztreonam, Cefotaxime, Piperacillin, Aminoglycosides Sensitive Gram +: Ox/nafcillin, Cefazolin, Piperacillin + tazobactam resistant Gram +: Linezolid, Daptomycin, Tigecycline, Ceftaroline
89
most common organism recently placed prosthetic joint
Staph Epidermidis
90
Management of prosthetic joint infection
Remove joint--> treat with antibiotics for 6-8 weeks--> replace joint
91
Presentation of Gonococcal Arthritis
Polyarticular involvement tenosynovitis (inflammation of tendon sheaths) petechial rash
92
Gonococcal arthritis diagnosis leukocytosis count
between 30,000-50,000 Gram stain and culture are not too sensitive
93
Gonococcal treatment
Ceftriaxone, cefotaxime, ceftizoxime
94
If recurrent gonorrhea infection occurs in a patient, what should be tested
Complement C5-C9 levels
95
osteomeylitis diagnosis: best initial and most accurate
Best initial test: X-ray (shows periosteal new bone formation) Most accurate test: Biopsy
96
If X-ray is normal in osteomyelitis, the most appropriate next step in management is:
MRI Bone scan is done if MRI is contraindicated
97
To follow response to therapy for osteomyelitis, check:
ESR level
98
Osteomyelitis treament
Check sensitivity after biopsy results return sensitive Staph: Ox/nafcillin, cefazolin, ceftriaxone resistant staph: vancomycin r linezolid Gram - bacilli (E.coli)- Qinolones(cipro)

Internal medicine (8 decks)

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