Rheumatology Flashcards
(175 cards)
1
Q
back pain that’s worse @ night
A
Malignancy (mets)
2
Q
T/F: Ankylosing spondylithis, reactive arthritis, psoriac arthritis, and IBD display back pain that is better with exercise, not better with rest, and have gradual onset
A
True
3
Q
Pain and bilateral stiffness (esp in am) in shoulders and hips + Increased ESR + Normal CK. Age >50
A
Polymyalgia rheumatica –> ass. w/Temporal Arteritis
Tx= low dose steroids
4
Q
Rotator cuff tears: yes/no pain on active ROM, yes/no on passive ROM
A
yes on active
no on passive
5
Q
Antipyretic, analgesic, but not anti-inflammatory
A
Acetaminophen
6
Q
Antiplatelet, antipyretic, analgesic, anti-inflammatory
A
Aspirin
7
Q
Antipyretic, analgesic, anti-inflammatory
A
NSAIDs
8
Q
Acute monoarticular arthritis that quickly progresses to max intensity in 12-24 hours, relieved by OTC meds
A
Gout
9
Q
What precipitates gout attack?
A
- Meds: low-dose aspirin, diuretics
- Surgery, Trauma, Hospitalization
- Volume depletion
- Diet: high protein, high fat, sweetened drinks
- HTN/Obesity/CKD/Organ Transplant
10
Q
What decreases risk of gout attack?
A
Dairy product intake, Vitamin C, Coffee (>6 cups/day)
11
Q
wbc in joint aspiration of OA, RA, Septic Arthritis
A
OA: <2000
RA: 2,000 - 100,000
Septic: 50,000-150,000
12
Q
Initial DMARD agent of choice in RA
A
Methotrexate…start as soon as possible.
–>Nsaids only give sx relief (never monotherapy)
13
Q
Symmetric proximal mm weakness, elevated CK and aldolase (muscle enzymes)
A
Polymyositis. Dx w/muscle bx. Initial tx w/Prednisone.
14
Q
Symmetric proximal mm weakness + erythematous rash over dorsum of fingers and/or upper eyelids
A
Dermatomyositis. (Gottron’s papules/heliotrope eruption)
15
Q
Pt with back pain. Indications for xray vs MRI
A
Xray: Suspect malignancy; osteoporosis/compression fracture; ankylosing spondylitis
MRI: sensory/motor deficits; cauda equina syndrome; epidural abscess/infection;
–>you do bone scan if indication for MRI but can’t get MRI
16
Q
where do rheumatoid nodules form
A
over pressure points…elbow/extensor surface of promixal ulna. Are flesh colored
17
Q
Symmetrical progressive muscle weakness + rash (heliotrope, with periorbital edema)
A
Dermatomyositis (DONT THINK MG…ptosis/diplopia) #PEASANTRY)
18
Q
violaceous, scaly papules overlying joints + proximal muscle weakness
A
Gottrons papules –> Dermatomyositis
19
Q
Tx for Paget’s (mixed lytic and blastic bone lesions)
A
Bisphosphonate
20
Q
Erythema nodosum is associated with:
A
Sarcoid
Crohns/UC
Histo/Cocci/TB/Strep
21
Q
most common cause of asx elevated Alkaline Phosphatase in elderly
A
Paget dz (freq discovered incidentally)
22
Q
Best way to dx polymositis/dermatomyositis
A
Muscle bx –> mononuclear infiltrate surrounding necrotic and regenerating muscle fibers
23
Q
causes of gout (except for idiopathic which is most common)
A
Increased Urate Production:
- Tumor Lysis Syndrome
- Myeloproliferative disorders (i.e. PV…pruritis by hot baths, HA, hepatosplenomegaly)
- Tumor lysis syndrome
- HGPTT deficiency (Lesh-Nyhan…self-injurious behavor)
Decreased Uric Acid excretion
- CKD
- Thiazides/loops
24
Q
features of low back pain suggesting an inflammatory cause
A
- gradual onset
- age <40
- pain @ night that doesn’t improve w/rest
- improvement w/activity or exercise
25
T/F: Obesity, female, hypothyroidism = risk factors for carpal tunnel
True
26
T/F: Carpal tunnel = pain and paresthesias in first 3 fingers, typically worse at night, and is confirmed by nerve conduction studies
True
27
How do crystals appear in Pseudogout vs Gout
Pseudo: Calcium pyrophosphate (RHOMBOID, + birefringence)
Gout: Monsodium (NEEDLE-shaped, - birefringence)
28
T/F: Pseudogout often occurs in the setting of surgery or illness can result in chondrocalcinosis and classically affects the knee
True
| calcified articular cartilate, i.e meniscal calcification
29
osteoblast and clast activity in paget
increased osteoblast activity
| osteoclast dysfunction
30
Soft tissue swelling, small tibiotalar joint, chronic calcification of the articular cartilage
PSEUDOGOUT...chondrocalcinosis
31
Tx for Raynauds
CCB...Amlodipine or Nifedipine
32
What lab should you look at if you suspect Raynauds?
Autoantibodies and inflammatory markers, i.e. ANA, CRP, etc (NOT THYROID F(x) studies)
33
Pain with passive wrist flexion and/or pain with resisted wrist extension
Lateral epicondylitis (tennis elbow)
34
Can hypothyroid patients present with Raynauds?
Kind of...they can have cold-induced vasospasm but do NOT have sharply demarcated color like in Raynauds and do not have tissue ischemia...so if you suspect Raynaud's in someone you would NOT do thyroid studies (you do autoantibody and inflammatory marker instead)
35
Arthritis w/o rheumatoid factor
Seronegative spondyloarthropathies (PAIR = Psoriac Arthritis, Ankylosing Spondylitis, IBD, Reiters syndrome aka reactive arthritis)
36
How do you dx Ankylosing Spondylitis?
X-ray of the sacroiliac joint (NOT ordering HLA-B27, even though its highly associated...not specific).
37
Clinical features of ankylosing spondylitis?
Age <40
Chronic back pain that is relieved by w/exercise and NSAIDS but not with rest
tenderness at lumbosacral area
may have Uveitis, aortic regurg, dactylitis, IBD
38
rhomboid shaped crystals on arthrocentesis
Pseudogout
| gout = needle shaped
39
Pain/swelling of knee in patient with constipation, kidney stones, fatigue, Ca = 11
Pseudogout...this patient has hypercalcemia due to Primary Hyperparathyroidism (stones groans).
Pseudogout caused by Calcium Pyrophosphate Dihydrate (CPPD), common complication of HyperPTH
40
What will xray of pseudogout show?
Chondrocalcinosis (calcium deposition in the joint space)
41
Features consistent with osteoarthritis of the knee
```
Crepitus with movement
worse at end of day
small joint effusion w/o warmth/edema
popliteal (bakers) cyst behind knee
limited ROM
arthro shows clear fluid w/few inflam cells
```
42
Inflammation at sites of tendon and ligament attachment to bone (i.e at the HEEL, AC joint. etc)
Enthesitis --> common finding in ankylosing spondylitis/seronegative spondy's
43
Patient as pain at AC joint, heels, iliac crests, and tibial tuberosities. Low back that IMPROVES with movement
Enthesitis...Ankylosing spondylitis. Patient will have limited ROM spine
44
best long term tx for SLE
antimalarials --> Hydroxychloroquine
| ...need to do annual eye exams because of retinal toxicity
45
FP test for Syphilis
SLE (due to cardiolipin)
46
Most common causes of death in SLE
Renal failure, opportunisitic infections
47
Fatigue, malaise, fever, weight loss in a patient with joint pain and rash and photosensitivity
SLE constitutional sxs
48
T/F: A patient who develops Raynauds is unlikely to also have SLE
False. 20% of SLE patients develop Raynauds (exacerbated by smoking and exposure to cold)
49
Cardiac manifestations of SLE
Pericarditis, myocarditis, and Libman-Sacks endocarditis
50
most common pulmonary finding of SLE
Pleuritis
51
Do SLE patients exhibit GI sxs?
Yes, nausea and vomiting, dysphagia, PUD
52
Dx of SLE
ANA
Anti-dsDNA and anti-Sm Ab = diagnostic
Anti-ssDNA
Antihistone = drug-induced lupus
53
Lupus anticoagulant
Antiphospholipid syndrome
54
ESR vs CRP
ESR used to dx or r/o inflammtory process. Can also be up in infection/malignancy/rheum dz
CRP primary used for infection
55
Tx for SLE
1. Avoid sun exposure
2. nsaids
3. STEROIDS for ACUTE exacerbation
4. HYDROXYCHLOROQUINE (anti-malarial) = best long term therapy...need annual eye exams b/c retinal toxicity
56
When is hydroxychloroquine used in rheumatology?
This anti-malarial is the best long term therapy for SLE patients...need annual eye exams b/c retinal toxicity
57
What is the difference btwn SLE and drug-induced lupus
drug-induced lupus does NOT have CNS or Renal involvement...if there is, it is not drug-induced lupus. Will improve after withdrawal of drug. Antihistone antibodies +, and - for anti-dsDNA, anti-Sm
58
Drugs that caused drug-induced lupus
```
Hydralazine
Procainamide
Isoniazid
Methyldopa
Chlorpromazine (antipsychotic like haloperidol)
Quinidine (class IA antiarrythmic)
```
59
What is scleroderma?
Triad of autoimmunity, noninflammatory vasculopathy, and collagen deposition w/fibrosis
60
What is the pathophys in scleroderma?
Too much collagen deposition...the collagen is normal, but there is too much (from cytokines stimulating fibroblasts)
61
Clinical features of scleroderma
1. Raynauds (present in nearly all)
2. Sclerodactyly = tightening of skin on face/extremities...can lead to contractures
3. GI: Dysphagia/reflux b/c esophageal immbility
4. Pulm: Most common cause of death...fibrosis/pulm HTN
62
Dx of scleroderma
1. Elevated ANA
2. Anticentromere antibody (limited form. CREST)
3. Antitopoisomerase I (antiscleroderma-70) (diffuse)
4. Barium swallow (esophageal dysmotility) and PFTs
63
Tx of scleroderma
Sx mgmt!
- NSAIDS
- PPI or H2 for reflux
- CCB/avoid cold and smoking for Raynauds
- Bosentan for pum HTN; Cyclophosphamide for pulm fibrosis
- ACE-I
64
What is antiphospholipid syndrome?
hypercoagulable state commonly ass. w/ SLE
65
findings in antiphospholipid syndrome
- Recurrent arterial/venous thrombosis (risk of PE)
- Recurrent fetal loss (abortions)
- Thrombocytopenia
- Livedo reticularis
66
Lab findings in antiphospholipid syndrome
Lupus anticoagulant
Anticardiolipin (FP for syphilis)
Prolonged PTT/PT not corrected by adding normal plasma
67
What is Sjogrens?
Autoimmune dz commonly in women in which LYMPHOCYTES destroy Salivary/Lacrimal Glands
68
Clinical features of Sjogren?
-Dry eyes, dry mouth/tooth decay, swollen Parotid = KEY
- arthralgia/arthritis, fatigue, interstitial nephritis/vasculitis may be present
- 20% of scleroderma pts have Sjogren
69
What is the pathophysiological difference between dysphagia/reflux of Achalasia and Scleroderma (aka systemic sclerosis)?
Achalasia: Decreased peristalsis in distal esophagus, increased LES pressure and failure to relax (b/c no Auerbach myenteric plexus)
SS: Decreased peristalsis in distal esophagus, but decreased LES pressure/incompetence -->smooth muscle atrophy and fibrosis
both have esophageal immobility
70
If a woman comes in with dry eyes/dry mouth, what should you be evaluating for?
She has Sjogrens, which has increased risk of Non-hodgkin LYMPHOMA -->look for lymphadenopathy and hepatosplenomegaly
71
Lab dx for Sjogren
ANA+ in 95% pt
Rheumatoid Factor + in 50-75%% DONT BE A PEASANT
Anti-Ro (SS-A) and Anti-La (SS-B)
Schirmer test: filter paper inserted in eye to measure lacrimal gland output
72
Tx for Sjogren
Pilocarpine or Cevimeline -->enhance oral/ocular secretions via ACh
73
Pseudogout, Gout, Septic arthritis by wbc count
Pseudogout: 15000 - 30000, rhomboid shaped, + biref
Gout: <50,000, needle shaped, neg birefringence
Septic Arthritis: >50,000, visible organisms on gram stain/neutrophils
74
Causes of migratory arthritis
Lyme
Neisseria Gonorrhea (septic arthritis)
Crohns dz
Rheumatic Fever
75
Gonococcal arthritis
monoarthritis (septic)
or
triad of tenosynovitis, dermatitis, asymmetric migratory polyarthritis
76
What conditions are Pseudogout associated with
Hemochromatosis (look for patient with hx/fhx Diabetes)
-->need Iron studies to dx, then risk of HCC
Hyperparathyroidism
Hypothyroidism
77
Chondrocalcinosis is pathomneumonic for:
Pseudogout
78
anti-CCP (cyclic citrullinated peptide)
RA
79
Tx strategy for gout: Lifestyle, Acute flare, Prophylaxis
Lifestyle: Decrease alcohol, red meat, fructose, don't use thiazide
Acute Flare-up: Colchine or NSAIDS, steroids if desperate
Prophylaxis (against recurrent attacks): Allopurinol
-->you don't sue allopurinol for acute flare-up
80
which 3 patients are most likely to get gout ?
- drink alcohol
- CKD
- thiazide diuretic
81
tx for non-gonococcal (staph) septic arthritis (IVDU, Dialysis)
MSSA: Nafcillin
MRSA: Vancomycin, Linezolid (esp if theyre in a hospital setting)
82
best way to dx septic joint with gonorrhea
NAAT (culture won't show shit, Chocolate agar isnt a great test)
83
differences between diffuse and limited scleroderma
Limited: gradual onset Cutaneous to face/extremities only (won't have wrinkles). CREST syndrome. Very late visceral organ involvement, will really only see esophageal = reflux . Anti-centromere.
Diffuse: widespread cutaneous + rapid onset + visceral organ (lungs/heart/kidney), anti-topoisomerase/scl70,
-->do NOT give steroids for AKI...actually give them ACE-I (opposite of what you would normally do for AKI)
84
Pt with CKD gets gadolinium contast/MRI
Nephrogenic Systemic Sclerosis
-->may look like sclerodactyly because pt will have loss of wrinkles/tightening of face, so dont get confused...will be in a CKD pt with Gadalonium
85
Pulmonary arterial hypertension in scleroderma
Limited: lungs will look normal, no hypoxia
Diffuse: will occur after interstitial lung dz, will have hypoxia
86
if you dx polymyositis, dermatomyositis, or inclusion body myositis, what kind of screening is necessary?
Age-appropriate cancer screening...theres an association with occult malignancy
87
Proximal muscle weakness (can't get out of chair/go up stairs), Heliotrope rash (purple swelling of eyes), Gottron's papules, shawl sign (photosensitivity)
Dermatomyositis
| polymyositis has proximal muscle weakness, not really the other signs
88
Tx for poly/dermatomyositis
Steroids son
89
Who gets hydroxychloroquine (HCQ)?
ALL SLE PATIENTS.
HCQ for SLE
90
What do you tx RA w/?
Methotrexate
| NOT HCQ...which is for SLE
91
Tx for Lupus Nephritis
IV Cyclophosphamide or Oral Mycophenolate
| -->Cyclo increases risk for hemorrhagic cystitis/bladder carcinoma
92
how to do you tx acute SLE flare?
steroids, but get them off of them asap
93
What 2 complications of Lupus are we most worried about?
Lupus Nephritis is the big scary monster.
| Lupus cerebritis is also bad, will look like meningitis/encephalitis
94
Anti-dsDNA
Lupus nephritis
95
Pt has a fever, low complement levels (C3, C4)
SLE
96
how to do you dx lupus nephritis?
BIOPSY. typically don't do bx for renal conditions but you do for this.
Is ass with anti-dsDNA AB, but this is not how you dx
97
How does RA present with joint pain?
```
Lady >45 yo with predilection for small joints...hands and feet. symmetric. >3 joints. SPARES DIP.
Morning stiffness (>60 min, vs OA is <30).
Fingers may be bent.
```
Nodules: if bx, cholesterol
98
what are you looking for on xray in RA patient?
Erosions
| periarticular osteopenia
99
Tx for mild RA
NSAIDS (ibuprofen, meloxicon) -->but can NEVER be monotherapy
so ALL RA patients, no matter severity, get DMARDS (METHOTREXATE ALWAYS EVERY TIME SON)
100
how do you tx severe RA?
If severe, can add biologics = TNF alpha inhibitor = Infliximab, Rituximab, Etanercept
-->make sure theyre 1. Vaccinated 2. get TB test 3. travel to endemic Fungus area
(these ruin immune system)
101
Would you ever use hydroxycholoroquine (HCQ for SLE) for RA?
Rarely. Basically if they are pregnant, b/c then you can't use methotrexate or leflunomide (would use these before hcq normally)
102
Morning stiffness + spine
Mostly Ankylosing Spondylitis.
IF involves C1,C2 cervical spine...get Xray because this is now probably RA
103
Joint pain + cervical spine involvement
RA
104
wbc, rbc, platelet: which decreased in lupus
platelet, rbc
105
SLE patient has stroke. What should you consider?
Antiphospholipid...hypercoag state associated with SLE. Stroke = thrombotic event
106
Steroid use, joint pain/decreased ROM, normal xray
Osteonecrosis (avascular necrosis) --> disruption of bone vasculature
107
Link between osteoporosis and RA?
RA increases risk for osteopenia, osteoporosis, and bone fractures
108
T/F: Tx for fibromyalgia = low-dose steroids
FALSE AF BOY
- ->EXERCISE = PRIMARY TX
- ->can also use antidepressants, anti-convulsants
Low-dose steroids used for Polymyalgia rheumatica
109
what is Felty's syndrome?
RA + Neutropenia + Splenomegaly
| -->don't dx if RA and Spleno but not neutropenia! its rare af, low yield
110
adverse effects methotrexate (anti-metabolite drug)
Myelosuppression (need leucovorin rescue)
Hepatotoxicity
Mucositis (oral ulcers)
Pulmonary Fibrosis
111
Mgmt of acute/chronic low back pain
EXERCISE THERAPY
| -->NOT BED REST
112
Lab values in Paget
Normal Calcium, Phosphate, PTH
| Increased ALP, urine hydroxyproline
113
Why do patients with sarcoidosis have increased urination?
Hypercalcemia
| -->granuloma = 1 alpha hydroxylase activity = increased 1, 25 vit d = increased Ca absorption
114
Tx of sarcoidosis
Steroids son
115
T/F: Patients with sciatica typically need life-long therapy
False, typically self-resolves. Initial tx is just NSAIDS
116
Pain on hip abduction and internal rotation
Avascular necrosis (osteonecrosis). Steroid users, sickle cell, SLE, etc
117
Symmetric arthritis in patient exposed to young children. brief, self-limited course.
Viral arthritis --> Parvo
118
Vascular vs neurogenic claudication
Vascular: Relived with rest, pain with exertion
Neurogenic: Relieved by walking and leaning forward, not worse with rest
119
How do labs differentiate fibromyalgia and polymyalgia rheumatica?
Fibromyalgia: normal
PMR: elevated CRP, ESR
120
Joint pain + dactylitis (sausage fingers)
Psoriac Arthritis. classically involves DIP joint (which is spared in RA)
121
Fatigue + stiffness/pain in neck, shoulders, lower back, and hips. Has some point tenderness. Normal CRP and ESR.
Diffuse pain + fatigue + normal labs = Fibromyalgia
122
T/F: Initial tx for Fibromyalgia = exercise and NSAIDS
FALSE BITCH.
Initial: Exercise + Sleep Hygiene + TCA (AMITRYPTILINE, Imipramine). Can use SSRI/Pregabalin alternatively if not responding to TCA.
123
Why do RA patients develop macrocytic anemia?
They take methotrexate, which inhibits dihydrofolate reductase = Folate deficiency
124
Disseminated gonoccocal infection triad
Polyarthritis, Tenosynovitis (pain along tendon sheats), vesciopustular skin lesions
125
Rapid onset pain and swelling of knee while playing sports. Bloody fluid on joint aspiration (hemarthrosis). Unable to bear weight.
ACL injury
126
major risk factors for osteoporosis = advanced age, postmenopausal status, and obesity
false: advanced age, postmenopausal status, and LOW BODY WEIGHT
127
genu varum and costochondral enlargement in a baby who is black and breastfed
worried about Rickets (rachitic rosary). increased risk w/increased pigmentation and no vit d supplementation (formula or IU)
128
some features and risk factors of developmental dysplasia of the hip
- limited hip abduction, dislocated hip, +Ortolani
- Asymmetric gluteal/thigh/inguinal creases or skin folds
- leg length discrepancy
- RF: Breech, white, female, +FHx
129
Imaging for DDH
<4mo: US Hip
| >4mo: Xray Hip
130
slow-developing back pain
+Neuro dysf(x)..loss of perianal sensation/bladder f(x)
palpable step-off at lumbosacral area on exam
Spondylolisthesis -->developmental disorder with forward slip of a vertebrate (usually L5 over S1). Usually manifests in young kids ( so young kid with back pain, this is high on differential. Cancer wouldn't have chronic nature or step off; Ank spond wouldnt have neuro)
131
most common elbow fracture (FOOSH)
supracondylar humeral fracture. watch out for brachial a injury (look for loss of pulse, not so much increase in pain)
and compartment syndrome! (increasing pain, may have pulselessness, pallor, poikolothermia)
132
lytic bone lesion in kiddo, +/- skin rash, recurrent otitis media with mass involving mastoid bone. neoplastic. immature dendritic cells (no prolif) and immune cells. +S-100, birbeck granules on EM
Langerhans. Usually benign and self-resolves so don't need tx! LYTIC LESION IN BONE is the most important now
133
Arthritis + nail pitting/nail infection
Psoriac Arthritis. May look like onychomycosis or IDA.
134
Adverse effects methotrexate
- Pulmonary Fibrosis!
- Liver toxicity!
- Myelosuppression/cytopenia/megaloblastic anemia
- mucositis/stomatitis (mouth ulcers)
135
Temporal arteritis, a type of ____ _____ ____ (sxs = jaw claudication, HA, vision loss), is associated with this disease in >50 that is treated with low-dose steroids: ______
Giant cell arteritis
| Polymyalgia Rheumatica
136
what seperates limited cutaneous from diffuse scleroderma?
Limited cutaneous = CREST, anti-centromere. no visceral organ involvement, shit aint gonna kill you
Diffuse = anti-topoisomerase (Anti-Scl70). shit!
- ->Interstitial Lung Disease (lungs)
- ->Myocardial ischemia/fibrosis (heart)
- ->Scleroderma renal crisis (kidneys). give ACE-I and get bx
137
what does CREST stand for?
```
Calcinosis (skin pitting)
Raynauds. tx w/CCB
Esophageal dysmotility (GERD)
Sclerodactyly (tense fingers/thickening)
Telangiectasias (GI bleeds/IDA)
```
138
How do you make the dx of ank spond?
Xray of sacroiliac joints
139
progressive low back pain and stiffness, relief with activity, reduced spinal ROM, lumbosacral tenderness, young patient
ank spond
140
needle shaped crystals
gout. neg birefringence
141
T/F: seronegative spondys are more common in younger patients and present with pain at rest made better by movement
true
142
patient with erythema nodosum and no other sxs
get a CXR to r/o sarcoid
143
who gets the Seronegative spondys?
Men aged 15-35 = classic. Not gonna be someone >45. Pain is worse with rest and better with activity. Elevated CRP/ESR usually.
(vs fibromyalgia...female, pain is worse with activity, normal ESR, CRP)
144
long term complications in patients with ank spond
Osteoporosis/penia (so vertebral frac in a younger guy)
Aortic root dilation (AR murmur)
Cauda equina
145
most common extra skeletal manifestation of ank spond
Anterior uveitis (unilateral ocular pain/photophobia)
146
step up therapy for rheumatoid arthritis (methotrexate not controlling xs after 6 mo)
- add another nonbiologic (sulfasalazine, hydroxychloroquine, or alternate DMARD)
- can add a TNF alpha inhibitor (biologic like etanercept/infliximab/adalumab) if needed
- ->either way, continue methotrexate
147
what are the DMARDS (can be used in RA)
Nonbiologic: Methotrexate (obvi), Rituximab, Anakinra, Leflunomide, Tociluzumab
Biologics: Etanercept/Infliximab/Adalimubab)
148
multiple white nodules in the hands with a hx of arthritis in the fingers and feet
gout (tophi)
149
__________ can be a paraneoplastic syndrome associated with heliotrope rash (upper eyelids) and gottrons papules (erythematous rash on dorsum of fingers) in a patient with symmetric proximal mm weakness
Dermatomyositis (also shawl sign:back/shoulders)
Polymyositis also a paraneoplastic, without the skin findings
Confirm dx w/biopsy
150
some diseases that might be underlying reason for Gout
- Myeloproliferative disorder: 40% ppl w/ polycythemia vera have gout
- Lesch-Nyan
- Tumor lysis syndrome
- CKD
151
headache, blurred vision, splenomegaly, gout, pruritis after showers
Polycythemia vera (myeloproliferative disorder)
152
T/F: Surgery/trauma/hospitalization can be the precipitating factor for gout, and it can affect the knee or ankle as well as the toe (1st MTP)
TRUE AF HABIBI NIGGA
153
T/F: Gout = recurrent attacks that occur overnight/in the morning and maximum intensity in 12-24 hours
True
154
How do you dx and tx poly/dermatomyositis (proximal mm weakness and violaceous skin lesion)?
BIOPSY: shows mononuclear infiltrate surrounding necrotic/regenerating muscle fiber
Tx; Steroids
155
primary raynauds vs secondary
P: Female <30, no cause or precipitating factors, neg ANA/ESR
S: Men>40, connective tissue disorders, tissue injury etc, look for underlying disorder
156
What should you screen for in a patient with poly/dermatomyositis?
associated with Malignancy!
157
most common cause of hip pain in children
Transient Synovitis! follows viral infection or mild trauma. Supportive care and reassurance
158
Clavicular fracture (following FOOSH), patient holding the affected arm/side with the opposite, requires what kind of followup?
careful Neurovascular exam because brachial plexus and subclavian run right there. Do clinical exam (motor testing) of hand and arm, and angiogram for vessel.
159
factors that are more likely to be non-gonococcal septic arthritis than GSI
- not a young foxy lady
- single joint (not migratory)
- underlying joint disease (i.e. RA)
- immune suppression (i.e. diabetes)
- IVDU
160
clinical presentatiosn of disseminated gonococcal infection
- purulent monoarthritis OR
| - triad of tenosynovitis, dermatitis (pustules/papules), asymmetric migratory polyarthralgias
161
Carpal tunnel is caused by:
compression of carpal tunnel by flexor retinaculum
162
T/F: patients with rheumatoid arthritis have an increased risk of osteoporosis, osteopenia, and bone fractures
True
163
complications from Pagets dz
HA, frontal bossing, CN dysfx, Hearing Loss
164
hip pain worse with internal rotation
osteoarthritis
165
where do rheumatoid nodules forms?
elbow = classic site
166
what level of spine does rheumatoid affect?
cervical...can lead to subluxation and spinal cord compression
167
"spares the DIP joint"
rheumatoid arthritis
168
adult with arthritis after viral infx. which virus?
Parvo
169
Xray vs MRI in patient with back pain:
xray: risk of malignancy, infection or vertebral compression
MRI: neuro deficits, cauda equina, suspected epidural abscess
170
patient with Raynauds. What are some other things you're going to be on the lookout for?
```
GERD GERD GERD
skin thickening
arthritis
Intersitial lung disease, nephritis, pericarditis/myocardial fibrosis/pericardial effusion
SCLERODERMA/CREST aka systemic sclerosis
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171
T/F: Aortic aneurysm is a well known complication of giant cell arteritis (of which one subtype is temporal)
true --> thats why you follow them with serial CXRs
172
dysmotility in Achalasia vs systemic sclerosis
Achalasia: decreased peristalsis with increased LES pressure and incomplete LES relaxation due to loss of myenteric plexus
Scleroderma: decreased peristalsis and Decreased LES tone due to smooth muscle atrophy and fibrosis
173
young guy with chronic back pain that is worse at night but improves throughout the day with physical activity
Inflammatory --> mostly likely Ankylosing Spondy/PAIR
-->common in men <40
look for Enesthesis: inflammation at site of ligament insertion
174
symmetrical polyarthritis in a young woman married with kids
PARVO. Viral arthritis PEASANTRY (its not transient synovitis thats in a kid)
175
what's the presentation of patellofemoral syndrome?
woman with chronic anterior knee pain worse on extension (climbing stairs), squatting, running.
Dx: Extension of knee while compressing patella
Tx: stretch/strengthen thigh
