Rhuematology Flashcards
(155 cards)
1
Q
What is crest syndrome?
A
- LIMITED: CREST SYNDROME.
o CALCINOSIS. o RAYNAUD`S. o ESOPHAGEAL DYSFUNCTION.
o SCLERODACTYL.
o TELAGECTASIA
2
Q
Which disease is more common if males
A
Ankylosing
3
Q
HLA, associated with rheumatoid arthritis.
A
hladr1. Hladr4 hladrw 14.
4
Q
HLA ASS WITH SLE , ANKYLOSING AND SS
A
SLE:HLADR2,3
SS:HLADR3,5,8,52
ANK:HLAB27
5
Q
Disk for developing SLE associated with twins.
A
monozygotic twins 57. percent risk , dizygotic twins. 5% risk.
6
Q
What is the association of Estrogen and the increased risk of developing lupus.
A
Estradiol binds to T and B, lymphocytes, causing a prolonged antibody response.
7
Q
What are the drugs that are associated with increased risk of developing lupus?
A
HYDRLAZINE
METHYL DOPA
PROCAINAMDE
8
Q
Between rheumatoid arthritis systemic lupus systemic sclerosis and ankylosing spondylitis. Which environment risk factor is common between them?
A
viral infections
9
Q
SS enviromental risk factors
A
- Infection: VIRAL, BACTERIAL.
- Drug: cocaine, vit K, BLEOMYCIN, DPenicillamine, ergot & tryptans.
- Amino acids: L5HY DROXY TRYPTOPHAN.
- Silica, cosmetics (SILCON IMPLANT).
- Appetite suppressants (phenylethylamine).
- Epoxy resin(tires). 7. Trichloroethylene
(metal polishing)
10
Q
Which disease has IBDs as a risk factor
A
Ankylosing
- Changes in the bacteria in your colon; and bowel
inflammation.
11
Q
Which cytokines are responsible for the articular Manif in rheumatoid arthritis?
A
IL1
TNF
via pannus
12
Q
What is pannus
A
Inflammatory granulation tissue characterized by synovial cell proliferation plus inflammatory cells.
13
Q
patho of RA
A
citrullination of our. proteins will activate T and B lymphocytes, which will produce antibodies. These antibodies will form . antibody antigen complexes that will deposit itself in many tissues, making extra articular manifestations
14
Q
Patho of SLE
A
Exaggerated apoptosis that will leave intracellular remnants in the subcutaneous tissue that will activate T and B lymphocytes and make immune complexes.Failure to remove the complexes from the circulation
15
Q
Patho of ankylosing
A
Inflammation fibrosis and ossification. new bone formation.
16
Q
Patho of SS
A
Inflammation. activates T and B lymphocytes macrophages fibroblasts and mast cells release cytokines causing chronic inflammation . deposition of proteoglycans and collagen in skin and blood vessel wall. cellular apoptosis causing chronic inflammation and cancer . Deposition of vascular endothelial growth factor antibody on wall of blood vessels causing complete obstruction and gangrene.
17
Q
When do the RA deformities appear?
A
After 6 months.
18
Q
What causes the zigzag hand deformity
A
ulnar deviation of fingers at the metacarpal phalangel joints and radial deviation at. Radiocarpal joint.
19
Q
What are the Articular manif in systemic sclerosis as a bad progno?
A
palpable friction rub.
20
Q
How would joint deformity happen in SS
A
Either overlap syndrome with rheumatoid arthritis or skin. is stretched and causes a skin. caused deformity in the hand.
21
Q
What differentiates lower back pain in SPA from Myositis
A
MORE THAN 3 MONTHS
22
Q
When diffr ankylosing spondylitis, from sciatic disk.
A
The pain in the lower back radiates to the thigh, but not to the elbow and the knee.
23
Q
Enthesitis examples in spa
A
Planter faciitis
heel pain
24
Q
Which have insomnia and depression
A
SPA /SS
25
Anorexia in which disease
SS
26
Which disease has seveere fatigue
SPA
27
What is atalantoaxial subluxation in RA
SPINAL CORD COMPRESSION In rheumatoid arthritis, when Atlanta axial subulsation happens, the patient experiences hemoplegia, quadriplegia. syncopal attaxksattacks.
28
Mononeuritis multiplex ab in lupus
Anti neuronal antibody at. the active CNS lupus anti ribosomal antibody physcosis and depression. Anti phospholipid antibody thrombosis formation.
29
in which disease does trigeminal neuralgia happen
ss
30
What is cauda equina neuropathy? And what does it do?
cauda equina happens in ankylosing spondylitis when there is inflammation of the nerve roots in the lumbo sacrla region. This will lead to urine and fecal incontinence and severe neurotic pain.
31
in which diseases does CTS happpen
RA/SS
32
how to dd between scleritis and epi scleritis
Scleritis is painful episcleritis is painless.
33
M/c eye symptom in RA
keratoconjunctivitis
34
What is the cause of cardiomyopathy in patients with rheumatoid arthritis?
Rhuematoid nodules
35
Patho of neonatal lupus
anti ro go to child cause cong heart block
36
SS CAD description
Microvascular coronary artery disease 60% microvascular 25%. leading to areas of necrosis, patchy fibrosis, spasm that lead to diastolic heart failure.
37
What is the fatal lung condition in RA
bronchiolitis obliterrans
38
What is the pathogenesis of ARDS in lupus
Due to Pulmonary vasculitis which will lead to alverolar hemorrhages. And Pulmonary hypertension.
39
IN WHICH COND DOES APICAL ILF HAPPEN
ANKYLOSING SPONDYLITIS
40
Cause of pumonary HTN IN SS AND LUPUS
In Lupus, it's due to permanent VASCULITIS in SS . It is due to basal interstitial lung fibrosis.
41
First cause of death in SS
Pulmunary HTN
42
Felty syndrome
RA, neutropenia, and splenomegaly.
42
Which disease has reactive lymphadenopathy
SLE + splenomegaly / atrophied
43
drugs ass with GIT symptoms in Ra
MTX/NSAIDS
44
which disaese has GERD
ankylosing spondylitis
45
Which cond has the most gi symptoms
Systemic sclerosis associated with many git diseases, including GAVE, iron deficiency anemia due to chronic bleeding diverticulitis, diverticulosis of the small intestine, functional gastric outlet obstruction (post prandial fulness , early satiety) intestinal obstruction, small intestinal bacterial overgrowth, esophagitis and bleeding. gastroesophageal reflux disease and dysfunction of the lower two thirds of the esophagus
46
Location of ra nodules
Extensor surface of the forearm. sacrum toes, achillis tendon. They are usually soft or firm. fixed or mobile. Palisade or mononuclear with central fibrinoid.
47
Vasculitis symptoms in RA
Digital ulcerations pyoderma gangrenosum pigmentation palpable purpra . palmar erythema
48
Which disease doesnt have skin manif
Ankylosing spondylitis
49
Salt and pepper skin in ?
SS
50
livedo riticularis ass with
Anti phospo syndrome
51
Mnif of cutaneous lupus
Acute cutaneous lupus:
o Malar rash. o Bullous lupus. o TEN variants of SLE o Maculopapular rash. o Photosensitivity. Subacute: - Non indurated psoriatic form and/or
annular lesion polycyclic lesion resolve without scarring.
Chronic: 1. Discoid rash: localized (above neck) or generalized (above & below the neck).
2. Hypertrophic verrucous lupus.
3. Panniculitis (lupus profundus).
4. Erythematosus tumidus.
5. Chilblain lupus. 6. Discoid/ lichen planus overlap +* oral or ulcer, alopecia (nonscarring).
- Vasculitis: o Livedo reticularis(antiphosp holipid syndrome)
o Nail fold infarction.
Palpable purpura. o Digital ulcers. o Splinter Hge. Raynaud`s (uncommon).
52
Causes of muscle atrophy in RA and lupus
Disuse atrophy ,drug induced, associated myositis, vasculitis.
53
Osteo necrosis in which disease and due to what
Due to associated steroid therapy, or due to disease activity and is associated with systemic lupus.
54
SANTA symptoms of felty
Splenomegaly arthritis neutropenia thrombocytopenia anemia.
55
Stills disease
Young patients with rheumatoid arthritis presenting early on with extra articular manifestations and rheumatoid factor negative.
+rash and hepatosplenomegaly
56
In which case would RA present with rf-ve
STILLS DISEASE
57
In which diseases does amyloidosis happen, and what would it cause
RA/ankylosing spondylitis
NEPHROPATHY
58
how does ankylosing cause nephropathy
iga nephropathy
amyloidosis
59
Classes of lupus nephritis
Class one minimal mesengial lupus nephritis asymptomatic. Class 2 mesangial proliferative lupus nephritis(hematuria) class 3. focal lupus nephritis. (prot and hemat uria but not nephrotic range)Class 4 diffused lupus nephritis.(prot hemat uria RPGN) Class 5. membraneous lupus nephritis. (MASSIVE PROTEINURIA)Class 6. advanced Sclerosing lupus(ESRD)
60
In what lupus stage is there focal or global affection
Diffuse LN stage 4
61
In which class of lupus does RPGN manifest
Class 4
Diffuse lupus nephritis
62
2nd most common cause of deatyh in SS
SS renal crisis after pulmonary
63
in which type of ss does raynausd precede SS skin manif most of the time
When it is lmited type of SS and by upto 4 yrs
64
when is anti scleroderma positive
in diifffuse SS
65
When is anticentromeere positive
Limited SS
66
DIFF BETWEEN PRIIMARY AND SECOND RAYNAUDS
Primary begins at menarch usually. Encompassing all fingers, increases with emotion and cold . normal serology. Normal systemic symptoms. not associated with any antibody(ana 2ndary).no ulcers normal nail bed
67
Risk factors of ss renalcrisis
Risk factors: 1. Pericardial effusion. 2. Extensive skin lesion which is rapidly progressing within the first 2-3 years. 3. Steroid (prednisone > 15 mg). 4. Anti-polymerase III AB (bad prognosis). 5. Old age.
6. HTN.
68
What are the 3 complents that when low mean that SLE is active
CD3/4
CH50
69
In which disease does ALP increase in te serum
Ankylosing spondylitis
70
types of anemia in SS
NN
IDA
PERNICIOUS (MALABSORB)
71
which diseases have thrombocytopenia
SLE
FELTY
SS
72
What's the most specific antibody in rheumatoid arthritis?
ANTI CCP
73
What non rheumatological disease does rheumatoid factor increase in
Sarcoidosis
syphillis
74
Ab in RA
RF / CCB / ANTI KERATIN
75
ab in drug inducced lupus
ANTI HISTONE
76
markers of active lupus
C3/4
CH50
ANTIDS
ANA
77
ab specific to lupus
ANTI DS
ANTI SMITH
78
Which ab in lupus dec risk of nephritis
ANTO ROLA
79
Which ab in sle is ass with recurrent abortions
anti phospolipid ab
80
ALL ab in luous
Anti Smith antibody anti double stranded antibody rheumatoid factor anti neuronal antibody anti ribosome and antibody anti phospholipid antibody. anti ROLA antibody.
ANTI PLATELET/ERYTHROCYTE ANTI HISTONE
anti neuronal (not ANA)
81
AB inSS
Anti topoisomerase in diffuse type anti centromere in limited type rheumatoid factor. anti nuclear antibody . anti polymyositis in overlap syndrome
anti ds in overlap syndrome
82
Ab in ss overlaped with lupus
anti ds
83
ab in diffuse ss
anti topo/scl70
ana
84
RA in radiology early + late
early :swelling and juxta articular osteoporosis
late: Marginal erosion. narrowing of joint space.deformitites and subluxation
85
Radiology of choice for ddetection of early signs of infalmmation in AS
ct/mri
86
Xray findings in spine in AS
syndesmophytes bamboo sign. Railway sign. dt calcification of anterior lateral spinal ligaments . romanus sign.squaring of vertebrae
87
Xray findings in sacroilliac joint AS
bony bridging of joint
ounched out erosions
psuedo widening of the joint space
obliteratin of the joint space
88
Synovial fluid analysis +VE predominant neutrophils
AS
88
Synovial fluid analysis +VE predominant POLYMORPHS
ra
89
Synovial fluid analysis +VE predominant FIBRIN
ss
90
Which diseases will have severe synovitis
AS/RA (ss and sle mild)
91
According to luous criteria , in abscense of any lupus symptoms in a renal pt, what is the criteria of diagnosis for lupus
+ renal biopsy for lupus
+anti dna
+ ana
92
Anti polymerase in SS is :
(ik its a stupid question)
Bad prognosis
93
Heriditary type of muscle disorder
duchene
94
Groups of Inflammatory myositis
1:PM
2:DM
3:MALIGNANY MYOSITIS
4:JUVENILE
5:ASS WITH OTHER DISEASES
95
Characteristic points of all inflammatory myositis
Proximal muscle weakness and non suppurative inflammation of the muscles with predominant lymphocytes.
96
Which myositis types is common after the age of 50
IBM
Malignancy myositis
97
Complent and enviromental infections (EBV COXSACKIE RUBELLA) PLAY A ROLE IN THE ETIOLOGY OF WICH MYOSITITS
DM
98
M/C presentation of dm
Bilateral proximal muscle weakness with no pain.
99
What is an important cause of death in pm ptns
respiratory muscle weakness
intercostals and diapghram
also interstitial fibrosis
100
Which grp of muscles are never involved in pm
Ocular
101
Ab ass with interstitial fibrosis in pm
ANTI JO1 ab
Anti rna synthetase
102
Raynauds causes
SLE
SS
PM(also vasculitis will happen which would cause intestinal perforation)
DM(in 10 to 25% of ptns)
103
cause of acute renal failure in pm
myoglobinuria
104
what percentage of ptns have muscle manifestations in DM at presentation
50 to 60%
BUT juvenile type 90%
105
What is the most pathognomonic manifestation in DM and what is it ass with
Heliotrope rash
ass with peri orbital edema
106
Causes of livedo riticularis
SLE
DM
107
Dermal manif in DM
Heliotrope rash
SHAWL sign
Gotrronns sign
v sign
mechanics hand
VASCULITIS CAUSED THINGS :
nail fold infarction, peri angular erythema, telangiectasia, ulcer, Raynaud's, Livedo reticularis.
(all because of vasculitis) and calcinosis
108
Diagnosis of PM & DM (Bohan and Peter criteria)
1. Symmetric, progressive proximal muscle weakness. 2. Aldolase, LDH, and AST. 3. Typical electromyographic triad. 4. Evidence of chronic inflammation in muscle biopsy. 5. Characteristic rashes of dermatomyositis. - + To diagnose DM: Rash + any 3. - + To diagnose PM: first 4 criteria.
- Otherwise: probable.
109
Age range for apperance of childhood dm and pm
7-10 years
110
Cause of death in juvenile dm
GIT ULCERATIONS caused by diffuse necrotizing arteritis
111
Which between dm and pm has a higher ass with malignancy
DM
112
What percentages does myositis precede or follow malignancies
70% precedes it by avg 1-2 yrs
30% follows it
113
Diff of DM and IBM
* Differs from Polymyositis in that IBM:
o May include focal, distal, or asymmetric weakness.
o Only borderline elevation of enzymes. o Neurogenic or mixed neurogenic / myopathic changes on EMG and Poor
response to therapy.
114
Which diseases might have normal ESR
SS
Inflammatory myopathies
115
Which diseases have calcinosis
CREST SS
Juvenile DM/PM
116
Ptn presents with PM + high titer ANA
PM + overlap with another disease
117
Ptn presents with PM + LOW titer ANA
PM only
because ANA is +ve in over 50 % ptns in low titre in myopathies and is non specific
118
ALT to biopsy in IM
MRI
119
Muscle biopsy details in DM
1.cD4 +
B cells / macrophages
perifasicular atrophy
perivascular infiltrate
dec cappilaries
120
Muscle biopsy details in PM
CD8+
focal , patchy
Mononuclear cells
myo necrosis
endomysia infiltrate
121
Muscle biopsy details in IBM
Like pm +:
Eosinophillic cytoplasmic inclusions
rimmed vacoules
122
Which diseases will have cd8+ cells in the muscle biopsy
PM/IBM
123
Triad of musccle biopsy
Inflammatory cell infiltrate
fibro necrosis
regeneration
124
Ab ass with classical DM lesions
Anti mi2
125
Anti srp ass with what symptoms
Muscle weakness
cardiac involvement
myalgias
126
Tx for SERIOUS extra muscular manif in IIM
Immunosupressive drugs not CST
127
Dose of CST in IIM patients
1-2 mg /kg / day tapering
128
Drugs used for IIM tx
in order
CST
MTX
AZA
MTX+AZA
Cyclosporine
tacrolimus
IVIG
MMF
129
Pain in oseoarth vs porosis
Pororsis is painless
arth is painless
130
character of pain in osteoporosis
inc with movement
dec with rest
131
Triad of ostearth
PAIN
CREPITUS
EFFUSION
132
M/C site of osteoarth
Base of thumb
DIP
KNEE
HIP
OTHER
133
Which diseases might have normal ESR
SS
osteoarthritis
134
Why does genu vulgus happen in osteoarthritis
affection of
LATERAL tibial plateau
lateral femoral condyle
135
Which disease will have non inflammatory synovial fluid with less than 1000 WBC
OA
136
Criteria of OA
pain + 3
No palpable warmth
morning stiffness less than 30 minutes.
Bone tenderness.
Bone enlargement.
Crepitus
age more than 50
137
What risk factors inc risk of oa in the KNEE
obesity
female gender
138
What risk factors inc risk of oa in the hands and knee
Female gender
139
What risk factors inc risk of oa in any site
AGE
140
Names of nodeules in DIP AND PIP aff in oa
DIP:HEBERDEN
PIP:BOUCHARD
141
Causes of 2ry oa
2ry to any musculoskeletal disease: * Congenital disorder (hip): Legg-Calve-Perthes disease, Acetabular dysplasia, Slipped capital femoral epiphysis.
* Inborn error of connective tissue: Ehlers-Danlos syndrome, Marfan syndrome.
* Post traumatic (knee): Anterior cruciate ligament tear, Meniscus tear.
Metabolic disorders: Hemochromatosis, Wilson disease. * History of a septic joint: post-inflammatory.
* Underlying rheumatoid arthritis.
142
When do u avoid non selectieve nsaids in oa tx
IN high gi risk ptns
143
When do u avoid selective cox 2 in oa tx
CV risk
144
preffered tx for oa high cv risk
naproxen
145
Which drug of oa to avoid if on low dose asprin for high risk cv pptns
High dose diclo
ipubrofen
146
Most common type of juvenile arthritis
Oligo arthritis persistent
AN +ve
rf -ve
affect ankle + knee so one leg shorter
1-5yrs
147
Which type of Juvenile affects TMJ+SPINE
Poly rf -ve
148
Type of juvenile that may progress to AS
Poly with enthesopathy
149
Most common type of inflammatory arthritis in adults
Reiters
150
Pancet disease
arthritis dt tb
151
HLA B27 +ve in
AS
REITERS
PSOARITIC (AS SUBTYPE)
ACUTE ANTERIOR UVEITIS
152
M/C septic arthritis organism
gonoccoci
153
