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Flashcards in Rheumatology Deck (45):
1

What disease is the pneumonic SOAP BRAIN MD for and what does it mean

Lupus: serositis, oral ulcers, arthritis, photosensitivity, blood disorders, renal disease, ANA, immunologic phenomena, neurologic disorder, malar rash, discoid rash

2

An IV drug user presents with buttock area pain. What is it?

Infectious sacroiliitis

3

If a patient has polymyositis/dermatomyositis, what type of screening should be done?

cancer screening - look for underlying malignancy

4

What type of kidney disease is seen with ankylosing spondylitis?

IgA nephropathy

5

White middle-aged man with diarrhea, fat malabsorption/weight loss, CNS symptoms (memory loss due to progressive dementia, osculomasticatory myorhythmia, and recurring episodes of inflammatory arthritis. What is it?

Whipple disease - due to Tropheryma whipplei

6

Chondrocalcinosis (calcification of cartilaginous tissue) is a hint to what underlying disease?

CPPD

7

What joints are rarely affected by OA?

It's non erosive; rarely affects ankle, wrist, and elbow or MCP's or small bones of the feet

8

What diagnoses should you consider if you see CPPD in a patient

primary hyperparathyroidism, hemochromatosis, hypothyroidism, hypomagnesemia, hypophosphatemia

9

Of the three, RA, Lupus, OA, which is erosive and which is non erosive?

RA is erosive; Lupus is non erosive; OA is non erosive

10

What areas are rarely affected by RA?

thoracic, lumbar, and sacral spine and the SI joints

11

In diffuse and limited scleroderma, there are 2 auto-antibodies. What are they? What type of lung dz does each increase the risk of?

Diffuse - anti-Scl-70 or anti-RNA polymerase III - interstitial lung dz for first (also more likely to dvlp scleroderma renal crisis for 2nd AB)
Limited - anti-centromere - pulmonary HTN (they also have more severe digital ischemia)

12

Sausage shaped digits (dactylics) are common in the spondyloarthropathies. Name 4 diseases in this category.

1. Ankylosing spondylitis 2. Reactive arthritis 3. Psoriatic arthritis 4. IBD-associated arthropathy

13

What is the classic triad of reactive arthritis?

urethritis, conjunctivitis, and asymmetric arthritis

14

What are common causes of erythema nodosum?

sarcoid
IBD
Infection - TB, strep, fungal
Drugs - OCP's, sulfa, PCN

15

If a young person presents with arthralgia, abdominal pain, renal disease, and palpable purpura, what should you think?

IgA vasculitis - formerly Henoch-Schonlein purpura

16

In which disease do you see a scarlet tongue?

Scarlett fever

17

Buzzwords for both RA and SLE: the arthritis is _____ and ________

1. symmetric
2. polyarticular

18

In RA, which joints of the hand are affected and which are spared?

involves the mcp and pip
spares the dip

19

Is RA and SLE joint involvement symmetric are asymmetric? What about joint involvement of hemochromatosis?

RA/SLE - symmetric
Hemochromatosis - asymmetric

20

What is the most common single joint initially involved in RA? What is the site of the earliest radiographic changes?

the knee
radiographic changes - the forefoot

21

What is felty syndrome?

RA, splenomegaly, neutropenia

22

A RA patient on rituximab has new onset of CNS symptoms. What do they have?

PML -progressive multifocal leukencephalopathy

23

What disease do you think when you see these 2 buzzwords: sausage-shaped digits (dactylitis) + pitted nails?

Psoriasis

24

What 2 arthritis syndromes do you see sausage shaped digits?

reactive arthritis and psoriatic arthritis

25

Describe OA changes in the hands

changes most often affect PIP's and DIP's and may have Bouchard nodes (PIP) and Heberden nodes (DIP)

26

Allopurinol dosing must be decreased by 66-75% in patients taking what medications?

Azathioprine or mercaptopurine

27

What joints does CPPD commonly affect?

Usually affects the knee; other joints include wrists, 2nd/3rd MCPs, shoulders, elbows, and ankles.

28

What are some other diagnoses associated with CPPD?

hemochromatosis, hyperparathyroidism, hypothyroidism, hypomagnesemia, hypophosphatemia

29

What diagnosis should you consider in an adolescent with knee pain?

gonococcal joint infection

30

Young adult female works with school aged children presents with symmetric synovitis of the hands and a macular rash. What is it?

Viral arthritis from parvovirus B19; she may describe a slapped cheek rash in the kids

31

What should you think about and further evaluate the patient for when you see polyarthritis, clubbing of the fingers and toes, and periostitis of the long bones?

Hypertrophic pulmonary osteoarthropathy and you should eval for lung cancer (usually adenocarcinoma)

32

People with Sjogren syndrome are at increased risk for developing what other disease?

B cell lymphoma
Babies can also have congenital heart block and neonatal lupus if the mom has SSA/SSB antibodies

33

What diagnosis might you want to consider in a young female who presents with acute malignant hypertension and renal failure?

diffuse scleroderma

34

What skin findings do you see with dermatomyositis?

heliotrope rash - violaceous rash on the upper eyelids
gottron papules - redish to violet scaling papules on the knuckles

35

Buzz word = weak handshake

inclusion body myositis
- most common inflammatory myopathy in people > 50
- can also have dysphagia
- requires a muscle biopsy

36

Polyarteritis nodosa doesn't classically cause disease of what?

pulmonary arteries or glomerulonephritis (although it can involve the kidneys)

37

olecranon bursitis is associated with which systemic dz?

RA

38

If a patient has plantar fasciitis, what other disease must be considered?

spondyloarthropathy

39

Which AB is associated with lupus nephritis?

anti-DS DNA

40

What is the classic tetrad of hemochromatosis?

cirrhosis, diabetes, hyperpigmentation, cardiac issues

41

Name examples of extra glandular involvement seen with Sjogrens

lymphocytic interstitial pneumonitis, non hodgkin lymphoma, peripheral neuropathy, RTA

42

What antihypertensive medication increases uric acid levels and can cause gout? What are some other drugs that increase uric acid?

HCTZ
cyclosporine, niacin, ethambutol/pyrazinamide

43

Men who present with fibromyalgia-like symptoms can have what?

Testosterone deficiency

44

What is anti-Jo-1 autoantibody?

associated with pulmonary fibrosis in patients who have dermatomyositis or polymyositis

45

Name an antibiotic used to treat MRSA that is contraindicated in patients on methotrexate

Bactrim