Flashcards in Rheumatology Deck (45):
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
An IV drug user presents with buttock area pain. What is it?
If a patient has polymyositis/dermatomyositis, what type of screening should be done?
cancer screening - look for underlying malignancy
What type of kidney disease is seen with ankylosing spondylitis?
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
Chondrocalcinosis (calcification of cartilaginous tissue) is a hint to what underlying disease?
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
What diagnoses should you consider if you see CPPD in a patient
primary hyperparathyroidism, hemochromatosis, hypothyroidism, hypomagnesemia, hypophosphatemia
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
What areas are rarely affected by RA?
thoracic, lumbar, and sacral spine and the SI joints
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)
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
What is the classic triad of reactive arthritis?
urethritis, conjunctivitis, and asymmetric arthritis
What are common causes of erythema nodosum?
Infection - TB, strep, fungal
Drugs - OCP's, sulfa, PCN
If a young person presents with arthralgia, abdominal pain, renal disease, and palpable purpura, what should you think?
IgA vasculitis - formerly Henoch-Schonlein purpura
In which disease do you see a scarlet tongue?
Buzzwords for both RA and SLE: the arthritis is _____ and ________
In RA, which joints of the hand are affected and which are spared?
involves the mcp and pip
spares the dip
Is RA and SLE joint involvement symmetric are asymmetric? What about joint involvement of hemochromatosis?
RA/SLE - symmetric
Hemochromatosis - asymmetric
What is the most common single joint initially involved in RA? What is the site of the earliest radiographic changes?
radiographic changes - the forefoot
What is felty syndrome?
RA, splenomegaly, neutropenia
A RA patient on rituximab has new onset of CNS symptoms. What do they have?
PML -progressive multifocal leukencephalopathy
What disease do you think when you see these 2 buzzwords: sausage-shaped digits (dactylitis) + pitted nails?
What 2 arthritis syndromes do you see sausage shaped digits?
reactive arthritis and psoriatic arthritis
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)
Allopurinol dosing must be decreased by 66-75% in patients taking what medications?
Azathioprine or mercaptopurine
What joints does CPPD commonly affect?
Usually affects the knee; other joints include wrists, 2nd/3rd MCPs, shoulders, elbows, and ankles.
What are some other diagnoses associated with CPPD?
hemochromatosis, hyperparathyroidism, hypothyroidism, hypomagnesemia, hypophosphatemia
What diagnosis should you consider in an adolescent with knee pain?
gonococcal joint infection
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
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)
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
What diagnosis might you want to consider in a young female who presents with acute malignant hypertension and renal failure?
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
Buzz word = weak handshake
inclusion body myositis
- most common inflammatory myopathy in people > 50
- can also have dysphagia
- requires a muscle biopsy
Polyarteritis nodosa doesn't classically cause disease of what?
pulmonary arteries or glomerulonephritis (although it can involve the kidneys)
olecranon bursitis is associated with which systemic dz?
If a patient has plantar fasciitis, what other disease must be considered?
Which AB is associated with lupus nephritis?
What is the classic tetrad of hemochromatosis?
cirrhosis, diabetes, hyperpigmentation, cardiac issues
Name examples of extra glandular involvement seen with Sjogrens
lymphocytic interstitial pneumonitis, non hodgkin lymphoma, peripheral neuropathy, RTA
What antihypertensive medication increases uric acid levels and can cause gout? What are some other drugs that increase uric acid?
cyclosporine, niacin, ethambutol/pyrazinamide
Men who present with fibromyalgia-like symptoms can have what?
What is anti-Jo-1 autoantibody?
associated with pulmonary fibrosis in patients who have dermatomyositis or polymyositis