Rheumatology Flashcards Preview

Medicine Clerkship > Rheumatology > Flashcards

Flashcards in Rheumatology Deck (39):
1

Differential for hot swollen joint?

Septic arthritis, gout, pseudogout, hemarthrosis

2

How to work up hot and painful joint?

Tap it

3

Appearance of normal joint fluid

Serous,

4

Appearance of OA joint fluid

Normal! Serous

5

Appearance of inflammatory joint fluid

Cloudy, between 5 and 50,000 WBC
Poly predominance

6

Appearance of crystal arthropathy fluid?

Cloudy, between 5 and 50,000 WBC
Poly predominance. Intracellular crystals

7

Appearance of septic joint fluid

>50,000 WBC, Opaque, 90% polys. + gram stain (except for GC)

8

Sexually active female with hot swollen joint?

Think gonococcal arthritis. Careful because it doesn't gram stain well

9

ANA

Lupus

10

Anti-CCP

RA

11

RF

RA

12

Anti-histone

Drug induced lupus, procainamide, isoniazid, hydralazine

13

Anti ds DNA

Lupus, correlates with renal disease

14

Centromere

CREST

15

Anti topoisomerase

Scleroderma (systemic)

16

Anti smooth muscle

Autoimmune hepatitis

17

Ro+lA

Sjogrens

18

Antimitochondrial

PBC

19

Anti Jo

Myositis

20

Lupus

Autoimmune complex formation and deposition

21

Symptoms of LUPUS

MD SOAP BRAIN

Malar Rash
Discoid rash
Serositis
oral ulcers
arthritis
photosensitivity
blood (decreased ph and decresed hgb)
Renal failure
ana
immunologic complex
neuro (cerebritis, transverse myelitis)

Liebman sach's endocarditis

22

How to diagnose lupus

Need 4 sxs with ANA and DSDNA
U/A with biopsy for nephritis
Get complement levels (will be decreased) during a flare
ESR and CRP to track progress

23

How to treat Lupus?

Treat arthritis and serositis with NSAIDS (or hydroxychloroquine)
Treat flare with steroids
Treat severe disease with cyclophosphamide

24

RA

Autoimmune, affects women>men >40 years old. Pannus formation with joint destruction. Periarticular osteopenia.

25

Symptoms of RA

Symmetric joint involvement that spares dips. Morning stiffness, nodules filled with cholesterol, C1 and C2 spinal involvement

26

Diagnosis of RA

Anti CCP and RF

27

How to treat RA?

NSAIDs for symptomatic relief
DMARDS for everybody --MTX
If severe, then biologics like infliximab.
Steroids during a flare

28

Felty syndrome

RA + neutropenia + splenomegaly

29

Scleroderma

Collagen deposition that replaces smooth muscle
CREST and systemic

30

CREST syndrome

Calcinosis, raynauds, esophageal dysmotility, sclerodactyly, telangiectasias

31

Systemic sclerosis

Interstitial lung disease and scleroderma renal crisis (malignant hypertension with renal failure, hemolytic anemia and thrombocytopenia)

32

Pulmonary hypertension in scleroderma

Happens in both crest syndrome and systemic sclerosis

33

How to treat scleroderma

Can't do anything, can, however, treat interstitial lung disease with cyclophosphamide.

34

How to treat scleroderma renal crisis?

ACE inhibitors

35

Sjogren's Disease

Lymphocytic infiltration of exocrine glands,

dry eyes, dry mouth, parotid swelling. Shermer test
Treat with artificial tears and saliva.

36

Inclusion body myositis vs polymyositis vs dermatomyositis pathogenesis

Inclusion - t cell mediated
polymyositis - t cell mediated
dermatomyositis - immune complex deposition

37

How do patients with myositis present

Proximal muscle weakness with painful muscles.

Grotton's papules, heliotrope rash, shawl sign

38

How to diagnose myositis

EMG, muscle biopsy, anti jo

39

How to treat myositis

Steroids or find the cancer.