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Flashcards in Rheumatology Deck (34):
1

Patient presents with an inflammatory pustule that progresses to an expanding ulcer with a purulent base and ragged violaceous borders. What underlying conditions might this patient have? Diagnosis? Treatment?

He has pyoderma gangrenosum, which can be associated with IBD, RA and myeloid leukemia. Diagnose with skin bx showing PMN infiltrate. Treat with steroids.

2

Sub specialist that should be tracking patients on hydroxychloroquine

Ophtho, they need to be watching out for retinopathy every 5 years

3

Labs to order in a patient with Raynaud's phenomenon

UA
CBC, CMP
ANA, RF
ESR and plasma C3 & C4 levels

4

Lab findings in patients with lupus

Hemolytic anemia, thrombocytopenia and leukopenia

Low C3 and C4

ANA, Anti-Sm, Anti-ds DNA

UA

5

Felty syndrome

RA with splenomegaly and neutropenia

6

Triad seen in reactive arthritis? Treatment?

Arthritis, uveitis and urethritis. NSAIDs

7

Morning stiffness seen in OA? RA?

OA 30 min

8

Who gets screening for osteoporosis? What defines osteopenia?

Women > 65 years old

Osteopenia = T score of -1 to -2.5

9

Causes of erythema nodosum

#1) Recent strep infection

Other: sarcoid, Tb, histoplasmosis and IBD

10

Preferred diagnostic test in evaluating a patient for suspected avascular necrosis of the femoral head?

MRI

11

Most common cause of isolated elevation of alk phos in the elderly? What urinary findings might you see?

Paget's. Urinary findings include hydroxyproline, deoxypyridinoline, N-telopeptide and C-telopeptide...which are bone degradation markers.

12

Common extracolonic findings in UC?

Positive p-ANCA, erythema nodosum, pyoderma gangrenosum, episcleritis, arthritis and cholangitis.

13

Bugs that commonly cause reactive arthritis

Salmonella, shigella, campylobacter, C. difficile

14

Conditions associated with pseudo gout

Pseudo gout is a result of calcium pyrophosphate crystal deposition. This occurs in hyperparathyroidism, hemochromatosis and hypothyroidism.

15

How to diagnose fibromyalgia

Widespread pain and symptom severity index score

16

Deadly complication of giant cell arteritis

Aortic aneurysm

17

Why do patients with systemic sclerosis get GERD?

Smooth muscle atrophy and fibrosis of the lower esophagus results in LES incompetence

18

Plain x-ray findings in patients with advanced avascular necrosis

Subchondral lucency (crescent sign)

19

Gout etiologies

Increased urate production (high protein diet, trauma/surgery, volume depletion, alcohol consumption, myelo/lympho proliferative disorders, tumor lysis syndrome, HGPRT deficiency)



Decreased urate clearance (CKD, loop and thiazide diuretics)

20

Antibodies present in systemic sclerosis

Anti-topoisomerase I

21

Inflammatory symmetric polyarthritis that resolves within 2 months, but had positive RF and weakly positive ANA

Viral: parvo, hepatitis, HIV, mumps, rubella, etc.

22

Criteria for diagnosis of OA

Age > 50, minimal morning stiffness, no bony tenderness, bony enlargement, crepitus on active motion and no warmth of joint...need 3+ criteria for > 70% specificity.

23

Treatment of fibromyalgia

Good sleep hygiene and aerobic exercise. Add TCAs if they do not respond to initial conservative treatment. Pregabalin, duloxetine and milnacipran can be used as 2nd line drugs.

24

Why take MESNA when on cyclophosphamide

Cyclophosphamide can produce a metabolite, acrolein, which can cause hemorrhagic cystitis and bladder cancer.

25

First line drug therapy for patients with rheumatoid arthritis

1) Methotrexate

Add TNF inhibitors as step up therapy if there is no improvement after 6 months.

26

Labs to run prior to treating a patient with methotrexate for rheumatoid arthritis

HBV, HCV and Tb

27

What conditions are associated with Charcot join?

B12 def., DM, tertiary syphilis and other nerve injury

28

Sjogren's antibodies

Anti SSA (Ro) and SSB (La) antibodies

29

Conditions associated with enthesitis

Spondyloarthropathies (ankylosing spondylitis, psoriatic arthritis and reactive arthritis)

30

Riluzole

Blocks Na channels in damaged neurons, used to slow progression of ALS

31

Risk factors for carpal tunnel syndrome

Obesity, diabetes, hypothyroidism and pregnancy

32

Auto-antibodies seen in patients with dermatomyositis

Anti-RNP, anti-Jo-1 and anti-Mi2

33

Malignancies with increased frequency in patients with dermatomyositis?

Ovarian, lung, colon, stomach, pancreas and non-Hodgkin lymphoma.

34

Next step in a patient with suspected giant cell arteritis?

Start high dose corticosteroids while awaiting temporal artery biopsy to confirm diagnosis.