Rheumatology Flashcards
(111 cards)
1
Q
Features of prosthetic joint infection
A
Immunosuppressed + Elevated ESR + pain, warmth, effusion, fever
2
Q
Imaging finding for prosthetic joint infection
A
Periprosthetic lucency on radiograph
3
Q
Biopsy of microscopic polyangiitis (MPA)
A
- Nongranulomatous *necrotizing
* Pauci immune
4
Q
Clinical features of microscopic polyangiitis
A
*kidney involvement + palpable purpura
5
Q
Labs for microscopic polyangitis
A
Positive p-ANCA
6
Q
labs for GPA + biopsy
A
c-ANCA + granulomatous
7
Q
IgA vasculitis (HSP) biopsy
A
immune complexes identified on biopsy
8
Q
Thromboangiitis obliterans clinical features
A
Inflammation of vessels in upper and lower limbs, leading to reduced pulses and gangrenous ulcers + smoker
9
Q
Diffuse idiopathic skeletal hyperostosis on imaging
A
Bridging ossification of spinal ligaments
10
Q
Workup after radiologic diagnosis of AS
A
Don’t test for HLA-B27 antigen, low specificity and diagnosis is clinical + radiographic
11
Q
WBC count in septic arthritis
A
> 50K
12
Q
Treatment of severe tophaceous gout not responding to febuxostat
A
Pegloticase
13
Q
Workup of reactive arthritis
A
Chlamydia urine NAAT (most common agent causing urethritis)
14
Q
Ankylosing spondylitis diagnosis
A
- clinical + radiographic (inflammatory back pain + sacroillitis on imaging)
- Not HLA-B27
15
Q
Gastric antral vascular ectasia (GAVE) clinical features
A
- proliferation of blood vessels typically in antrum of stomach
- looks like watermelon stripes on endoscopy
16
Q
What is a dielafoy lesion?
A
Submucosal arterioles that protrude through the mucosa and cause hemorrhage
17
Q
Treatment of acute gout refractory to steroids
A
Il-1 inhibitors (Anakinra or canakinumab)
18
Q
Antisynthetase syndrome clinical features
A
ILD + Dermatomyositis or polymyositis
Raynaud’s
Inflammatory arthritis
19
Q
Positive antibody in anti-synthetase syndrome
A
anti-Jo-1 (an anti synthetase antibody)
20
Q
Cause of GI involvement in patients with systemic sclerosis
A
Small intestinal bacterial overgrowth (SIBO0
21
Q
Felty syndrome clinical features
A
long standing RA + neutropenia + splenomegaly
22
Q
Lyme arthritis clinical features
A
Large effusion + stiffness + minimal pain
23
Q
IgG4-related disease clinical features
A
- Organomegaly
- diffuse fibrosis
- Multiorgan failure
24
Q
Germ cell tumor presentation
A
- Bulky RP or mediastinal lymphadenopathy
- testicular mass may not always be present
25
Management of knee OA in patients with RA
- topical NSAIDs
26
Management of GCA
- high-dose prednisone BEFORE biopsy
27
Inclusion body myositis clinical features
- inflammatory myopathy involving proximal and distal muscles + symmetric + insidious onset
28
Initial management of sjogren syndrome
- artificial tears + sugar free candies
29
disseminated gonorrhea features
Tenosynovitis + dermatitis + polyarthralgia + fever/chills
30
Antibodies positive in GPA
Proteinase 3
31
Treatment of relapsed GPA
Rituximab
32
IMPT side effects to know with lyrica
- peripheral edema
- dizziness
- weight gain
33
Treatment of primary angiitis of the CNS
Cyclophosphamide
34
Primary angiitis clinical features
Vasculitis of CNS + granulomas
35
joint involvement in RA
symmetric involving small joints of hands and feet
36
Management of OA in patients with NSAID contraindications
Duloxetine
37
When topical NSAIDs are beneficial
patients with isolated joint involvement
38
Adult-onset Still disease clinical features
- spiking fever
- evanescent salmon-colored rash on the trunk and extremities
- arthritis
- lymphadenopathy
- HSM with elevated liver enzymes
39
Lab feature of adult still disease
Extremely high ferritin level
40
Long term treatment of IBD-associated arthritis
Adalimumab
| Infliximab
41
psoriatic arthritis clinical features
- psoriatic rash
| - nailbed pitting
42
antibody used to diagnose an SLE flare
dsDNA (also elevated ESR + low complement support)
43
Antibody associated with immune-mediated necrotizing myopathy
Anti-HMG Co-A reductase antibodies
44
Workup of suspected sjogren syndrome if serology is negative
Lip biopsy
45
Evaluation of acute monoarthritis
Always joint aspiration
46
When bisphosphonates need to be started for patients on chronic steroids
Moderate or high 10-year fracture risk according to FRAX calculator + at least 2.5 mg of prednisone daily for 3 months or more
47
relapsing polychondritis clinical features
- inflammation and damage of cartilaginous tissue (middle ear, nose, tracheobronchial tree, joints)
48
medications safe to use in pregnancy for RA patients
- plaquenil safe
| - MTX, leflunomide contraindicated
49
Gouty cellulitis clinical features
presents just like cellulitis during acute gout flair
50
Treatment of gouty cellulitis
prednisone
51
Second line for fibromyalgia
Duloxetine + lyrica
52
Treatment of ILD associated with systemic sclerosis
Mycophenolate
53
Most common side effect of topical NSAIDS
- skin irritation and rash
54
Acute calcium pyrophosphate crystal arthritis clinical features
- attacks longer than gout (weeks to months) (as opposed to gout attacks, which resolve with 1-2 weeks, typically)
- knees and wrists
- elderly patients
55
Pulmonary manifestation of RA
Rheumatoid pleuritis
56
Takayasu arteritis clinical features
young woman
granulomatous
aortic involvment
57
Medication patients on long term MTX need
Folic acid (reduces SE's of MTX) (MTX blocks cellular utilization of folic acid)
58
Lofgren syndrome clinical features
Acute arthritis + bilateral hilar lymphadenopathy + erythema nodosum
(Lofgren is a rheumatologic manifestation of sarcoidosis)
59
IgA vasculitis diagnosis
Skin biopsy with immunofluorescence (leukocytoclastic vasculitis with predominance of IgA deposits on immunoflueroscence)
60
How to evaluate for allopurinol hypersensitivity
HLA-B5801 allele testing
61
When to work patients up for allopurinol hypersensitivity
- Thai, Han Chinese, Korean
* CKD
* Diuretic use
62
Treatment of class V lupus nephritis
mycophenolate
63
First-line for ankylosing spondylitis
NSAIDs
64
Additional ankylosing spondylitis clinical features
- strong hereditary predilection
- highly correlated to HLA-B27
- male predominance
- may not show radiographic evidence early in course of disease
65
Acute cutaneous lupus erythematosus clinical features
- describes cutaneous manifestation of LSE
| - bright erythematous patches over both cheeks and the nasal bridge
66
Rosacea clinical features
- inflammatory papules, pstules, telangiectasias + involves nasolabial fodls
67
erysipelas clinical features
(superficial cellulitis involving the lymphatics)
- well demarcated plaque
- systemic symptoms (fever, malaise)
68
Kawasaki disease presentation
- fever, rash, cervical LAD, promoninent nonexudative conjunctivitis
69
Strongest modifiable RF for OA
obesity
70
Management of scleroderma renal crisis
Captopril (ACEi) (mitigates interstitial fibrosis and vascular dysfunction in glomerular arterial bed)
71
Features of scleroderma renal crisis
```
hypertensive emergency
headache
MAHA
thrombocytopenia
AKI
proteinuria
```
72
Initial evaluation of steroid-induced necrosis
Plain film
73
Management of inadequately controlled tophaceous gout
uptitrate allopurinol
74
Description of tophaceous gouts
- palpable masses, white nodules on joints
75
leading cause of mortality in mixed connective tissue disease
pulmonary arterial hypertension + ILD
76
rheum disorder I stored in TIm's basement
MCTD
77
MCTD overlap of what
SLE
systemic sclerosis
polymyositis
78
Management of refractory SLE
Belimumab
79
Diffuse idiopathic skeletal hyperostosis (DISH) clinical features
- similar to AS in radiography , don't confuse (*no SI joint involvement)
- noninflammatory condition involving ossification of spinal ligaments and entheses
- ossification of spinal ligaments (typically on right side) and enthesis
80
Colchicine toxicity
marrow suppression + kidney failure + rhabdo
81
Subacute cutaneous lupus erythematosus presentation
- annular rash with central clearing and plaques + scaling + SLE symptoms
82
Discoid lupus erythematosus (DLE) presentation
- scalp and face involvement
- hypo and/or hyperpigemented
- patches or plaques
83
Management of gout patient starting urate-lowering therapy
- should also receive prophylaxis
84
prophylactic agents for gout
colchicine
low dose steroids
low dose NSAIDS
85
meds to hold before testing for a pheo
TCAs (falsely elevates catecholamines or metanephrines)
SNRIs
Amphetamines
Decongestants
86
Duration of oral bisphosphonate therapy for osteoporotic women
5 years then stop
| Unless high risk (T less than negative 2.5), then 10 years
87
Evaluation of pituitary tumors
- evaluate for hypersecretion by measuring prolaction, IGF-1, cortisol, TSH/T4, FSH, testosterone
- evaluate for mass effect
88
management of patient prior to adrenalectomy for pheo
start phenoxybenzamine or another alpha-blocker (surgery can cause catecholaine release)
89
Initial workup of secondary amenorrhea
- rule out pregnancy
| - measure FSH, TSH, prolactin
90
Definition of secondary amenorrhea
Absence of menses for 3 or more months in patient who previously had normal cycle
91
primary amenorrhea definition
absence of menses by age 16 + normal sexual hair pattern and breast development
92
inpatient management of hyperglycemia in non-diabetic patient per boards
- basal insulin + sliding scale
93
Complications to be aware of following pituitary surgery
SIADH
| DI
94
Management of hyperprolactinemia causing hypogonadism
dopamine agonist therapy
95
most common pituitary abnormality in empty sella syndrome
hyperprolactinemia
96
MEN1 involves
pituitary
parathyroid
pancreas
97
What is vitamin D-dependent hypercalcemia
in granulomatous disease (sarcoidosis), macrophages convert 25-hydroxyvitamin D to 1,25-dihydroxyvitamin D without PTH regulation or renal conversion
98
vitamin D-dependent hypercalcemia lab features
high 1,25 dihydroxyvitamin D + suppressed PTH + high phosphorus (due to high vitamin D)
99
Tumors most commonly associated with hypercalcemia of malignancy
- Squamous cell carcinomas
- breast cancers
- renal cell carcinomas
100
mechanism of hypercalcemia in Hodgkin's and NHL
increased production of 1,25-dihydroxyvitamin D
101
Management of severe sjogren's
Rituxan
102
Morphea clinical features
- category of cutaneous sclerosis
- only skin involvement, no systemic sclerosis
- one or more discrete plaques
103
Morphea vs. limited cutaneous systemic sclerosis
Morphea = isolated skin lesions
limited cutaneous systemic sclerosis = skin disease that doesn't progress proximal to elbows or knees but may include face and neck and has extracutaneous involvement (limited just means limited areas of skin involvement)
104
Treatment of oral and genital ulcers in Behcet syndrome
Topical steroids
105
Behcet syndrome clinical features
- recurrent painful oral ulcers
- recurrent painful genital ulcers
- uveitis/eye involvement
- skin involvement (acneiform lesions)
- pathergy
106
What is pathergy?
Development of a pustule following a needle stick.
107
Maintenance therapy in Behcet's syndrome to prevent recurrent mucocutaneous lesions
Colchicine
108
Initial step in the management of recurrent tophaceous gout
```
Uptitrate allopurinol (even in stage 3 CKD) to a max of 800 mg/d in 100 mg increments
- (treating to a specific serum urate level is controversial, but you should still uptitrate)
```
109
Biggest risk allopurinol poses
DRESS syndrome
110
Use of pegloticase
Severe, refractory gout
111
Mechanism + Use of febuxostat
- lowers serum rate, similar to allopurinol
| - patients who are unresponsive to or can't tolerate allopurinol
