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ICM II > Rheumatology > Flashcards

Rheumatology Flashcards

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1
Q

What is the most common autoimmune arthritis?

A

Rheumatoid arthritis

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2
Q

What allele and what gene are associated with increased risk of RA?

A

Gene: HLA-D4

Allele: HLA-DRB1

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3
Q

Patient presents with symmetric arthritis with small joint involvement. Patient is experiencing early morning stiffness, and joints are tender and swollen. Sedimentation rate, c reactive protein, RF and anti-CCP are positive on labs. What is the likely diagnosis?

A

Rheumatoid arthritis

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4
Q

What is involved in the fluid phase of rheumatoid arthritis pathophysiology?

A
  • Overall:
    • vasodilation
    • swelling
    • pain
    • superficial cartilage damage
  • Neutrophil recruitment
  • Complement activation
  • Release of Pgs, LTs, and ROS
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5
Q

What is involved in the tissue phase of rheumatoid arthritis pathophysiology?

A
  • Overall:
    • Pannus formation that invades bone, cartilage, and ligaments
  • Mech
    • Stimulates
      • T cells: cytokines
      • B cells: RF, anti-CCP
      • Monocytes: IL-1, TNF alpha
    • Synovial cells proliferate
    • Synthesis of collagenase and metalloproteinases
      • break down cartilage and bone
    • Activation of osteoclasts
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6
Q

What is the function of metalloproteinases?

A

Break down of bone

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7
Q

What joints are most commonly affected by RA?

A

Hands

Feet

Ankles

Elbows

Large joints as well

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8
Q

What is present in the X-rays of RA?

A
  • Joint space loss
  • Erosions
  • Subluxation
  • Ulnar drift of MCPs
  • Swan neck deformities
  • Boutonniere
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9
Q

What complication can arise in the posterior popliteal fossa of RA patients?

A

Bakers cyst

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10
Q

What complication can arise in the neck of RA patients?

A

C1-C2 subluxation

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11
Q

Where are rheumatoid nodules found?

A

extensor tendons

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12
Q

What is Caplan Syndrome?

A

Multiple RA nodules in lung with pneumoconiosis

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13
Q

What is Felty’s syndrome?

A

Splenomegaly

Leukopenia

Recurrent pulm infections

(in RA patients)

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14
Q

What labs are elevated in RA?

A
  • Sedimentation rate
  • C reactive protein
  • RF
  • anti-CCP
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15
Q

RA patients are at an increased risk of what systemic disease? What neoplasm?

A

CV disease

Non-Hodgkin’s lymphoma

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16
Q

What is the most common population affected by SLE?

A

Females in reproductive years

Blacks and Hispanics

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17
Q

How does arthritis present in SLE?

A

Symmetric (like RA)

Non-erosive (unlike RA)

Causes joint laxity

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18
Q

What is the most common serious organ involvement in SLE?

A

Lupus Nephritis

Class V: diffuse membranous (nephrotic syndrome)

Class VI: diffuse proliferative

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19
Q

What are possible symptoms of Lupus Cerebritis?

A
  • Psychosis
  • Seizure
  • Coma
  • Transverse myelitis
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20
Q

How does SLE present in its mildest form?

A
  • Rash
    • Butterfly
    • Photosensitive
    • Alopecia
  • Arthritis
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21
Q

What occurs in Discoid rash of SLE?

A

Follicular plugging

Alopecia

Scarring

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22
Q

What auto-Abs are present in SLE?

A
  • ANA
    • sensitive
    • not specific
  • dsDNA and Smith
    • not sensitive
    • specific
  • SSA
  • SSB
  • Others
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23
Q

What causes increased rates of miscarriage in SLE patients?

A

Antiphospholipid Ab Syndrome

(clotting of placental vessels)

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24
Q

What is Rhupus?

A

erosive arthritis

evidence of RA and SLE

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25
What is Mixed Connective Tissue Disease?
SLE Myositis Scleroderma
26
Which drugs can cause SLE as a side effect?
Procainamide Hydralazine
27
How is Neonatal Lupus acquired?
Passive transfer of Ab to child thru placenta Will resolve in time after birth
28
Which Ab is associated with complete heart block in neonatal lupus?
SSA This complicatino is permanent
29
What are the signs and symptoms of Antiphospholipid Ab Syndrome?
Recurrent arterial or venous thrombosis Recurrent spontaneous abortions
30
What causes gout?
Deposits of uric acid (end product of purine metabolism) around joints = tophi Can form renal calculi
31
What population is most affected by gout?
Men Post-menopausal women
32
How and where does gout typically present?
* Presentation * Painful * Red * Swollen * Single joint * Location: * 1st MTP * Cooler temperature promotes deposition * most common in lower extremities
33
What is the gold standard for diagnosis of gout?
Synovial fluid examination Looks like toothpaste (white)
34
What is seen on polarized light microscopy in gout?
Strongly negatively birefringent crystals
35
What are the characteristics of pseudogout? * Joints affected * Population * Material Deposited * X-ray appearance * Polarized light microscopy appearance
* Joints * large joint involvement * Population * aging pop * Deposition of: * Calcium Pyrophosphate dihydrate crystals * X-ray * Chondrocalcinosis * Polarized light microscopy * Rhomboid crystals * Weakly positive
36
What is the difference in distribution of Diffuse Scleroderma vs CREST syndrome?
* Diffuse * Trunk, face, proximal extremities * Limited * Face, fingers, toes
37
What are the symptoms of CREST?
* Calcinosis * Raynauds * Esophageal hypomotility * Scleroderma * Telangectasia
38
What autoantibodies are present in Systemic Sclerosis?
ANA family * anti-topoisomerase I (scl-70) * more common in diffuse * Anti-centromere * more common in limited
39
What common symptom affecting tendons is found in diffuse sclerosis?
Tendon Friction Rub
40
Secondary Raynaud's is found in which rheumatic diseases?
* Scleroderma * SLE * RA
41
How are vessels affected by Systeic sclerosis?
Endothelial and smooth muscle cell proliferation Obliteration of vessel
42
Anti-topoisomerase is most associated with which form of systemic sclerosis? What complications are more likely to result?
Diffuse Sclerosis Increased risk of renal and lung involvement
43
Anti-centromere is most associated with which form of systemic sclerosis? What complications are more likely to result?
Limited Sclerosis Increased risk of Pulm HTN
44
What is Scleroderma sine scleroderma?
Findings of vascular and visceral involvement without skin findings
45
What is Morphea?
Inflamed skin, fibrosis, and atrophy (even down to the bone) w/o Raynaud's or other scleroderma features
46
What Auto-Ab is present in spondyloarthropathies?
None! Trick Question!
47
Which Spondyloarthropathises are related to HLA B27?
Ankylosing Spondylitis Reactive arthritis Psoriatic arthritis Enteropathic arthritis Uveitis (arthritic diseases with spinal involvement)
48
What are the causes of Reactive Arthritis?
Chlamydia trachomatis Shigella Salmonella Campylobacter Yersinia Klebsiella pneumonia
49
What are the symptoms of Reactive Arthritis?
Conjunctivitis Urethritis Arthritis (Can't see, can't pee, can't climb a tree) Skin (including palms) Oral ulcers Nail thickening
50
Enteropathic Arthritis * Path * Common location * Associated diseases
* Path * Non-erosive * Common location * Lwr Extremities * Associated diseases * Crohns * Ulcerative colitis
51
What is the treatment for Spondyloarthropathy affecting the spine?
Physical therapy Daily exercise
52
What auto-Ab is present in inflammatory myopathies?
Anti-Jo | (antisynthetase)
53
Inclusion Body Myositis * Population affected * Symptoms
* Population affected * \>50 * Symptoms * DIstal muscle weakness * Problems with balance and falls
54
Dermatomyositis * Symptoms * Lab results * Auto-Ab * Testing
* Symptoms * Slowly progressive, symmetrical, proximal weakness * Minimal pain * Shawl (v-shaped) rash * Gottron's Lesions * Lab results * increased muscle enzymes * Auto-Ab * Anti-Jo * Testing * muscle biopsy * quadriceps
55
What is the cancer risk in dermatomyositis?
2X increase
56
What extra-dermal symptoms are often present in dermatomyositis?
Pulm involvement
57
What type of crystals are found in osteoarthritis?
Calcium pyrophosphate crystals Apatite crystals
58
Which joint disease has cysts and osteophytes?
Osteoarthritis
59
What is the most common cause of Septic Bursitis?
S. aureus
60
Where is pain localized in subacromial bursitis?
Deltoid area Pain on abduction or external rotation
61
What are the characteristics of Hypertrophic osteoarthropathy? It is associated with which type of cancer?
* Characteristics * Clubbing * Periostitis (long bones) * Cancer * Lung cancer (90%)
62
What rheumatic manifestation presents in Leukemia and Lymphoma?
Arthritis
63
What rheumatic manifestation presents in Hemophilia?
Hemarthrosis Aspirate only if spetic joint is considered!!
64
What rheumatic manifestation presents in Sickle cell and thalassemia?
Bone pain Fractures Osteonecrosis
65
What rheumatic manifestation presents in Multiple Myeloma and amyloidosis?
Bone pain Osteoporosis Enlarged tongue
66
What is seen in tissue biopsy in amyloidosis?
_Apple gree_n birefringent fluorescence with congo red stain
67
What rheumatic manifestation presents in Hemochromatosis?
Pseudogoat Symmetric arthropathy of 2,3 MCP OA
68
What rheumatic manifestation presents in Whipple disease?
Arthritis
69
What rheumatic manifestation presents in Primary Biliary Chirrhosis?
Osteoporosis Pruritis Assoc. w/ other autoimmune disorders
70
What is diabetic hand syndrome?
Thickening of joint capsules, tendons, skin
71
What rheumatic manifestation presents with hyperparathyroidism?
Joint symptoms Pseudogout
72
What rheumatic manifestation presents in sarcoidosis?
Arthritis
73
What is Lofgren's Syndrome?
_Acute Sarcoidosis_ Hilar adenopathy Erythema nodosum Arthritis of ankles
74
Polymyalgia Rheumatica * Symptoms * Associated disorder * Labs
* Symptoms * proximal mm pain and stiffness * Associated disorder * Giant Cell Arteritis * Labs * Increased ESR
75
Polyarteritis Nodosa * Size of artery affected * Most common arteries affected * Diagnosis
* Size of artery affected * Medium * Most common arteries affected * Renal * Mesenteric * Diagnosis * Angiogram * ANCA
76
Churg Strauss Syndrome * Size of vessel affected * Population
* Size of vessel affected * Small to medium * Population * Middle aged * Chronic Asthma
77
Where are pseudotumors found in Wegener's Granulomatosis?
Lung Retro-orbital
78
What is Leukocytoclasstic Vasculitis?
Palpable purpura Seen w/ any vasculitis of small / medium vessels

ICM II (12 decks)

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