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Rheumatology Flashcards

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1
Q

What are the criteria for SLE?

A

4/11

  1. Malar rash
  2. Discoid rash
  3. Photosensitivity
  4. seizures or psychosis
  5. oral ulcers
  6. pleuritis or pericarditis
  7. positive anti-ds, anti-smith, antiphospholipid
  8. positive ANA
  9. Renal
  10. hematologic disorder
  11. nonerosive arthritis
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2
Q

What endocrine problem is associated with SLE?

A

Hypo/hyperTH, Addisonian crisis

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3
Q

What neurologic problems are associated with SLE?

A

HA, memory loss, sz, psychosis, stroke, pseudotumor cerebri, cerebral venous thrombosis, aseptic meningitis, coma, chorea, global cognitive deficits, mood disorders, transverse myelitis, peripheral neuropthay

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4
Q

What pulmonary problem is associated with SLE?

A

Bleeding, HTN, interstitial lung disease

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5
Q

Morbidity for SLE occurs most often in which 2 disease systems?

A

Renal and CNS

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6
Q

What drugs typically cause drug-induced lupus?

A

diphenylhydantoin, ehtosuximide, carbamazepine

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7
Q

What are the most common lab findings in 1) drug induced lupus 2) neonatal lupus

A

1) antihistone and anti-DNA antibodies

2) Ro and La antibodies

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8
Q

What systematic problem is most common in

1) SLE
2) Neonatal lupus
3) Drug-induced

A

1) renal and CNS
2) heart block, rash, hepatitis
3) hematologic, pleural/pericardial disease

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9
Q

Pattern: rash in lower trunk and legs, appears in crops, eruptions last 3 weeks, has colicky abdominal pain, nausea, vomiting, large joint arthritis

A

HSP

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10
Q

How often is kidney involvement seen in HSP patients?

A

20-40% hematuria, proteinuria, oliguria, ARF

So measure microalbuminemia

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11
Q

What GI problems in HSP

A

intussusception, bowel infarction, bowel perforation, hydrops of the gallbladder, pancreatitis, massive GI bleeding

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12
Q

What labs must you do if you suspect HSP?

A

CBC, PT/PTT, CMP, ESR/CRP, urine for protein, stool for occult blood

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13
Q

What cardiac complications are associated with Kawasaki?

A

Tachycardia, myocarditis, pericarditis, coronary artery aneurysms

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14
Q

Which constellation of lab findings are seen with Kawasaki disease?

A

High ESR, CRP, WBC, left shift, platelets, transaminases, TG/LDL. low HDL, sterile pyuria

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15
Q

What is the treatment for Kawasaki?

A

IVIG and mega dose aspirin for 48hr, then go to 3/-5mg/kg/day. Can discontinue with all acute phase reactants return to normal

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16
Q

If cANA is high, which vasculites is it most likely to be?

A

Wegener’s; Churg-Strauss

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17
Q

If pANCA is seen, which vaculities can it be?

A

microscopic polyarteritis, Churg-Strauss, UC, sclerosing cholangitis, Crohn’s disease

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18
Q

Which labs indicate active disease in SLE?

A

Low complement and anti-ds DNA

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19
Q

Which autoantibody is sensitive and which is specific for SLE?

A

ANA-specific

Anti-dsDNA specific

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20
Q

Anti-ribosomal P is a test for what?

A

psychosis associated with autoimmune

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21
Q

How do you treat HSP?

A

supportive, Tylenol/NSAIDs for joint pain, steroids for severe abdominal pain, steroids and immunosuppression for renal involvement

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22
Q

Which of the three JIA typically has highest morbidity for uveitis?

A

oligoarticular/pauciarticular JIA

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23
Q

Which JIA has highest percentage of patient with ANA+

A

Oligo/pauci

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24
Q

What is the morbidity of most concern in polyarticular JIA?

A

unremitting arthritis

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25
What is the most concerning morbidity with systemic JIA?
The chronic systemic involvement. Uveitis is rare.
26
What complications can be seen in systemic JIA?
cardiac: pericarditis, myocarditis, endocarditis; hepatosplenomegaly, lymphadenopathy, pleuropulmonary disease, CNS disease, growth failure, osteoporosis
27
Pattern: unremitting fever, bruising purpura, mucosal bleeding, hepatomegaly, lymphadenopathy, liver dysfunction, CNS involvement, multiple organ failure. Labs - pancytopenia, falling ESR, liver derangement, coag abnormalities, increased ferritin, elevated TG
macrophage activating syndrome
28
Pattern: male with hip, knee, ankle pain, HLA-B27+
enthesitis related arthritis
29
Pattern: chronic inflammatory arthritis of axial and peripheral skeleton, frequent enthesitis, seronegative, HLA-B27, b/l sacroiliac joint inflammation
Juvenile ankylosing spondylitis
30
What is reactive arthritis?
Response ton an infectious agent in another part of the body
31
Postinfectious arthritis is what?
immune complexes containing non-viable components of an initiating infectious illness
32
What degree of extension or flexioun would classify as hypermobility?
>10 degrees
33
Criteria and associated symptoms for fibromyalgia
Generalized MSK at 3 or more sites for more than 3 months, 5+ tender points, difficulty sleeping
34
What is the weakness pattern for dermatomyositis?
Proximal muscle weakness
35
Pattern: 5-14yr old female with increased fatigue, had a cold 6 weeks ago, having trouble getting on the school bus. Parents noticed eyes loo puffy and red over the eyelids.
Dermatomyositis
36
Describe the rash of JDM
discoloration of the eyelids with periorbital edema; Gottron's papules, Erythematous, scaly rash over dorsal aspects of metacarpal and proximal interphalageal joints
37
What enzymes are elevated in JDM?
CK, AST, ALT, LDH, Aldolase
38
What type of disease is JDM?
Vasculitis of skin and muscle
39
Pattern: rash, dysphagia/dysphonia, dyspnea, GI (micro perforation), edema, joint contractures, cutaneous ulceration, calcinosis
JDM
40
What is the calcinosis in JDM?
healing that happens with calcium deposition, can become very skeletal
41
Treatment plan for JDM
Oral pred 2mg/kg daily until serum CK normalized, slowly taper over 24 months, hydroxychloroquine (Plaquenil), MTX, IVIG, TNF inhibitors
42
What tissues can scleroderma affect?
Skin, bone growth, joint
43
Pattern: calcinosis, Raynaud, esophageal dysmotility, sclerodactylyl, telangiectasia
limited cutaneous systemic scleroderma
44
Pattern: sclerodactylyl and tight face
system diffuse cutaneous scleroderma
45
What test for scleroderma?
ANA, Scl-70, anti-centromere Ab
46
Treatment for complications of scleroderma
Topical Vit D, MTX, calcium channel blocker (Raynaud's), ACE (renal)
47
What organ systems do you have to worry about with scleroderma?
skin, lungs, heart, renal
48
What gene is associated with familial sarcoidosis?
NOD2/CARD15 mutation
49
Pattern: polyarthritis, dermatitis, uveitis
sarcoidosis
50
What labs are useful for sarcoidosis?
Calcium and VitD; acute phase reactants, mild anemia, ACE
51
Trio of drugs for sarcoidosis
steroids, TNF inhibitors, methotrexate
52
Gene mutation in Ehlers Danlos
COL gene
53
What organ systems are affected in Ehlers Danlos?
osteopenia and cardiac
54
Gene mutation in Margan
AD FBN1 (fibrillin2)
55
Organ systems involved in Marfans
heart valves, aorta, lungs, dural sac of spine, skeleton, and eyes
56
Pattern: mutation of pyrin gene, amyloidosis that causes renal disease
familial Mediterranean fever
57
Pattern: period fever, apthathous ulcer, occurring every 28das
PFAPA
58
Which microorganisms can cause postinfections arthritis
parvovirus B19, influenze, hepatitis B, rubella, Epstein-barr
59
Which microorganisms can cause transient arthritis?
enterovirus, hepatitis B, rubella and mumps
60
Cause of chest pain in patient with JIA
pericarditis

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