3Rdyearclinmerhuem

Front 1

Uveitis caused by what rhematic diseases?

Back 1

HLAB27 disease, Behect's, JRA, Sarcoidosis

Front 2

_____ uveititis: Inflammatory cells in anterior chamber with minimal spillover into the retrolental space

Back 2

Anterior. Must ddx: hla27, behects, sarcoid, guchs, JRA, sphyilis, herpes, maduarede syndrome

Front 3

_____ uveitis: inflammatory cells in the vtreous

Back 3

intermediate

Front 4

_______ uveitis: inflammation of retin or choroid, with or without vitritis

Back 4

posterior

Front 5

panuveitis=

Back 5

inflammatory cells eveyrwhere

Front 6

if you classfy uveitiis as limited it means it occurred for

Back 6

less than 3 months

Front 7

If you classify uveitis as reucurrent that means there was

Back 7

greater than 3 months between episodes

Front 8

If you classify uveitis as chronic that means that

Back 8

the episodes are lessn tha 3 months apart, not including treatment time.

Front 9

Standard workup for a pt with uveitits:

Back 9

FTAABS, Lyme antibiody, chest x ray, cbc differentials. Also consider getting HLA-B27 and ANA (for kids with uveitis)

Front 10

HLA-B27 is associated with

Back 10

ankylosing spondylitis, reiters syndrome, psoriatic arthritis, IBS

Front 11

With anterior uveitis, 50% tend to be ____ positive

Back 11

HLAB27

Front 12

30-40% of pts with ankylosing spondylitis will have at least one episode of __________

Back 12

uveitis

Front 13

HLA-B27 is positive 71% in what kind of uveitis?

Back 13

unilateral and recurrent

Front 14

HLAB27 positive patients present __________% unilaterally or unilateral alternating

Back 14

93%

Front 15

Duration of treatment for anterior uveitis due to HLAB27? Number of attacks?

Back 15

4-9 weeks per attack. Median number of attacks is 3 (range 1-26)

Front 16

This syndrome involves urethritis, conj inflammation, polyarthritis, and possibly keratitis. It is triggered by diarrhea or dysentary.

Back 16

Reiters. Cant see, can't pee, can't climb a tree)

Front 17

IBS with uveitis is usually _________________. Wherease IBS wih sclerouveitis is usually _____________

Back 17

psoitive HBLAB27 with sacroilitis. Usually negative HLAB27 and have other RA type arthritis but NOT sacroilitis

Front 18

How do you treat anterior uveitis due to IBS?

Back 18

topcial corticosteroids, ALWAYS use pred forte. 58% require oral corticosteriods.

Front 19

How do you taper steriods?

Back 19

When there is a 2 step decrease in number of cells= 1 grade level decrease.

Front 20

For unilateral, intermittent uveitis you should use

Back 20

periocular steriod injectsion. Also, given for CME

Front 21

Oral cortiocsteriods are prescribed for

Back 21

bilateral, chronic, vision threatening diseaess

Front 22

After steriods hae been stoped in chronic uveitis, you shuold give

Back 22

immunosuppresive drugs

Front 23

If your pt is a steriod responsder ggive

Back 23

rimexolone, a mild steriod, and prssure lowering meds. MUST check IOP at every visit

Front 24

Differeneces between Episclertitis and Sclertitis 1. Symptoms? 2. Inflammation? 3.Systemic dsease? 4Treatment?

Back 24

Episcleritis: inrritation, superifical inflammation, uncommon to have systemic disease and you ise TOPICAL treatment. Scleritis: you have pain, deep inflammation, commonly involving systemic diseases, and treatment is SYSTEMIC

Front 25

_____% of Sceritis cases are associated with systemic disease

Back 25

48%

Front 26

You can get necrotizing scleritis in pts with

Back 26

Wegener;s granuomatosis!!!! A vasculitis. See inflammation of small and medium sized blood vessels. Look for scleral thinning, peripheral ulcervative keratitis and painful red eye

Front 27

_______% of RA pts get sclertisi

Back 27

18

Front 28

4% of pts with _______ get scleritis

Back 28

Lupus

Front 29

Treatment of Scleritis:

Back 29

(90% of cases are inflammatory and are either given oral NSAIDS, oral Predniosone, or immunosuppressive therapy) (!0% are infectiosu and reuire antibiotics)

Front 30

If your pt presents with scleritis what must you do?

Back 30

ALWAYS DDX for syphilis and sarcoids (FTAABS, chest x tray), ANCA C and P (WEGENER'S test), urinalysis, chest x ray, lyme antibody, and RF and ANA

Front 31

Dr. N's favorite food?

Back 31

ice cream

Front 32

Dr. N's favorite mode of transportation?

Back 32

trains

Front 33

What tests for Wegener's?

Back 33

ANCA

Front 34

Age,Race,and Sex of a typeical SLE pt?

Back 34

9x more common in women, aged 20-30, more common in AF, Hispanics, and Asians.

Front 35

clinical manifestations of lupus

“DOPAMINe RASH”

Back 35

Discoid rash
Oral ulcers (+)
photosensitivity
Arthritis/Arthralgias (+)
Malar rash: Redness on cheeks and bridge of nose (“butterfly” rash); photosensitive
Immunological: Decreased WBC count
Neurological
Renal disorders (+)
Anti-nuclear antibody (ANA +)
Serositis (+): Inflammation of serous areas of the body, e.g. pleural cavity (pleuritis)
Hematological (+): Anemia, thrombocytopenia

Front 36

3 antibody Lupus blood testing

Back 36

Auto-antibodies (ANA, Anti-dsDNA, Anti-Smith, APLA)
i. Anti-dsDNA: Antibodies to own DNA that is very specific for Lupus
ii. Anti-Smith: Specific for Lupus **important
iii. APLA (Anti-phospholipid antibody): Antibodies directed to the phospholipids

Front 37

What does the anti-smith Ab test specific for?

Back 37

lupus

Front 38

__________;Heterogeneous group of conditions linked by the presence of thickened, sclerotic skin lesions
Manifestations are diverse and include abnormalities of the vasculature and involvement of multiple organ systems. **mixed CT diseases often affect kidneys

Back 38

Sclerodera

Front 39

90% of pts with Scleroderma have what condition, as well?

Back 39

>90% of patients have antecedent Raynaud’s phenomenon
i. If have Raynaud’s, then will be diagnosed with scleroderma at some point

Front 40

localized scleroderma characteristics;
CREST

Back 40

i. Calcinosis: Ca2+ deposits in skin, nodules
ii. Raynaud’s phenomenon
iii. Esophageal dysmotility: Trouble swallowing, and acid reflux
iv. Sclerodactyly: Fibrosis of skin on fingers, long tapering fingers, thin, long pointed fingers
v. Telangiectasia: Small, red blood vessels all over the body

Front 41

_______________:
Chronic inflammatory disorder caused by a lymphocytic infiltrate that destroys the lacrimal and salivary glands
Characterized by a particular form of dry eyes (keratoconjunctivitis sicca, KCS) and dry mouth (xerostomia)

Back 41

Sjogren’s Syndrome

Front 42

___________________: is an overlap syndrome that embraces features of several connective tissue/rheumatic diseases such as SLE, scleroderma, and polymyositis

Back 42

Mixed Connective Tissue Disease (MCTD)


Patients appear to have a lupus-like disease or myositis, and over time develop scleroderma-like manifestations

Front 43

what is the antibody used to test Mixed Connective Tissue Disease (MCTD)

Back 43

Characteristic antibody: Anti-RNP (ribonucleoprotein antibody)


Usually responsive to steroids

Front 44

a. Reiter’s syndrome: Usually follows a________
b. Reactive arthritis: Usually follows gastrointestinal problems___________-

Back 44

STD



gastrointestinal problems

Front 45

what is Enthesitis?

Back 45

a. Inflammation at sites where tendons, ligaments, and joint capsules attach to bone

Front 46

what is Sacroiliitis?

Back 46

a. Inflammation of sacro-iliac joints

Front 47

What is Dactylitis ?

Back 47

a. Inflammation of 1 or more fingers; sweating and pain in fingers

Front 48

what isSpondylitis ?

Back 48

a. Inflammation of 1 or more vertebrae

Front 49

T/F . The Seronegative Spondyloarthropathies affect MEN more than women

Back 49

T!!!!

Front 50

What Disease has
Musculoskeletal manifestations
a. Transient (50%) or permanent (25%) peripheral arthritis
b. Enthesopathy (Achilles tendonitis, Plantar fasciitis): Pain in soles of feet
c. Predilection for sacro-iliac joints and spine; bilateral sacroilitis-fusing of bones in area of joints, where there should normally be a space
d. Decreased range of motion of lumbar spine: Cannot bend over and touch toes
e. Limitation of chest expansion
f. Limited lumbar flexion

Back 50

Ankylosing Spondylitis

Front 51

dIAGNOSIS of Ankylosing Spondylitis made with?

Back 51

Diagnostic X-ray changes in sacro-iliac joints and squaring of vertebrae (“bamboo” spine), which causes the limitation of movement
b. HLA-B27 (+) in 90%
c. Rheumatoid factor (-)
d. Anemia
e. Elevated erythrocyte sedimentation rate (ESR)

Front 52

Post-Infectious Arthritis: “Reactive Arthritis” (old terminology: Reiter’s Syndrome)
1. Classic triad

Back 52

a. Urethritis
b. Conjunctivitis
c. Arthritis

Front 53

Psoriatic Arthritis affects men and women _________

Back 53

equally

Front 54

Psoriatic Arthritis clinical manifestations

Back 54

a. Arthritis: Usually upper extremity, asymmetric, and oligoarticular (involves many joints), often distal interphalangeal (DIP) joints with nail pitting, “sausage” digits (dactylitis)
b. Sacroiliac joint involvement can have joint destruction
c. Can turn into arthritis mutilans, where psoriatic arthritis becomes so severe that the joints are mutilated
d. Often HLA-B27 (+): Axial disease
e. Extensive skin manifestations (scaly)

Front 55

Treatment of psoriatic arthritis

Back 55

a. Symptomatic, NSAIDs, Methotrexate, or Cyclosporine
b. Newer agents (Biologics): Etanercept, Infliximab (TNF-alpha inhibitors)
c. Efalizumab, Alefacept: T-cell inhibitors

Front 56

Most patients with _______present with:
i. Oligoarthritis predominantly involving the lower extremities
ii. Episodes of peripheral arthritis
Extra-articular manifestations: Uveitis, erythema nodosum, pyoderma gangrenosum (spontaneous gangrene of the skin), etc.

Back 56

Inflammatory Bowel Disease-Associated Spondyloarthropathy

Front 57

clinical manifestations of UVEITIS CAUSE BY AS?

Back 57

AS
Ankylosing Spondylitits
Acute, unilateral, recurrent,
rarely involves posterior elements

Front 58

clinical manifestations of UVEITIS CAUSE BY ReA?

Back 58

Rheumatoid Arthritis Acute, unilateral, recurrent,
rarely involves posterior elements

Front 59

clinical manifestations of UVEITIS CAUSE BY PsA?

Back 59

Psoriatic Arthritis Chronic, bilateral,
more often involves posterior elements

Front 60

clinical manifestations of UVEITIS CAUSE BY IBD-SpA?

Back 60

Inflammatory Bowel Disease Chronic, bilateral,
more often involves posterior elements

Front 61

clinical manifestations of UVEITIS CAUSE BY USpA?

Back 61

Uncommon, usually acute, unilateral, recurrent

Front 62

2 bilateral causes of uveitis/

Back 62

Psoriatic Arthritis

IBD

Front 63

______________:
1. Can involve small, medium or large blood vessels
2. Most common in people from the “Old Silk Route” (China, Japan, Korea etc.)
3. Associated with HLA-B51

Back 63

Behcet’s Disease

Front 64

Most characteristic features (triad): of Behcet's Disease

Back 64

know**
a. Oral and genital ulcers
b. Uveitis
c. Arthritis

Front 65

Diagnosis and Treatment og Behcet's

Back 65

a. Diagnosis: Pathergy test (needle prick test - causes non-specific inflammation from prick alone)
b. Treatment: Topical steroids, Colchicine, Thalidomide for resistant oral and genital ulcers which is also used for some cancers, can’t use if pregnant b/c has caused severe birth defects (child born w/o limbs)

Front 66

Polyarteritis Nodosa
affects _____________ vessel vasculitis (

Back 66

Medium-sized


vessels to heart, therefore can get MI)

Front 67

______________:Granulomatous vasculitis of small arteries, arterioles and capillaries

Back 67

Wegener’s Granulomatosis

Front 68

Wegener’s Granulomatosis triad

Back 68

a.Upper respiratory tract:
i. Sinusitis, otitis media, epistaxis, saddle-nose deformity where nasal septum collapses (also seen in syphilis)
b.. Lungs: Symptoms include hemoptysis
i. Pulmonary nodules, alveolar hemorrhages
c. Kidney:
i. Rapidly progressive glomerulonephritis (RPGN) –inflammation in
glomerulus that suddenly activates and kidney fxn completely shuts down within hours

Front 69

Gold standard diagnosising technique for Wegener’s Granulomatosis

Back 69

Tissue diagnosis: Biopsy (sinuses or lung)

Front 70

_______________:. Definition: A metabolic bone disorder characterized by decreased bone mass per unit volume (density) of normally mineralized bone.

Most common skeletal disorder in the world

Back 70

Osteoporosis (common in elderly men with Vit D defic or post-menopausal women)

Front 71

____________:Bone mass value 1 to 2.5 SD below young adult mean values

_____________: Bone mass value > 2.5 SD below young adult mean values (with or without a fracture)

Back 71

“Osteopenia”:


Osteoporosis”:

Front 72

What doe DEXA scans test for?

Back 72

Osteoporosis


DEXA Scans (DEXA = Dual Energy X-ray Absorptiometry)
i. Bone mineral density is essential for diagnosis and management of osteopenia and osteoporosis
ii. A decrease in BMD parallels fracture risk
iii. Reported as a “T” or a “Z” score
1) T score: Normal bone density for young and healthy
2) Z score: Normal/average bone density for age-matched
iv. Dx osteoporosis: 2.5 or more standard deviations below Dexa Z score

Front 73

___________ means joint pain without inflammation

Back 73

Arthralgia:.

Front 74

________: Inflammation of the joints.

Back 74

Arthritis:

Front 75

____________:: 1 joint involved.

Back 75

Monoarthritis

Front 76

_________: 2-3 joints involved.

Back 76

Oligoarthritis:

Front 77

_____________:4 or more joints involved

Back 77

Polyarthritis:

Front 78

Axial arthritis:

Back 78

affecting the spine.

Front 79

Para-axial arthritis:

Back 79

affecting the shoulders and/or hips.

Front 80

T/F Osteoarthritis is due to infammation

Back 80

FALSE

Most common joint disease; normal “degenerative wear and tear,” not inflammation

Front 81

T/F One of the causes of osteoarthritis is obesity

Back 81

T

Front 82

Primary Osteoarthritis is caused by:

Back 82

1. Obesity.
2. Contact sports.
3. Old age.

Front 83

Secondary Osteoarthritis is caused by:

Back 83

1. Fracture.
2. Inflammation (septic arthritis).

Front 84

Three characteristics of osteoarthritis (KNOW)

Back 84

1. narrowing of joint space.
2. osteophytes.
3. bony cysts.

Front 85

Crystal deposition diseases:

Back 85

Crystalline Arthropathy (crystal deposits in joints incite inflammation, recruiting macrophages and neutrophils

Front 86

Gout characteristics

Back 86

1. Often familial.
2. Hyperuricemia (high uric acid levels):
a. Only 10% of people with hyperuricemia get gout.
b. Present in all patients who get gout.
3. Episodic or constant.

Front 87

2 causes of Hyperuricemia:

Back 87

a. Under-excretion (90%):
i. Renal failure.
ii. Alcohol, Medications (ASA, HCTZ, etc.).
b. Overproduction (10%):
i. Primary (Purine synthesis enzymes).
ii. Increased uric acid consumption.
iii. Increased uric acid production.
iv. Alcohol.

Front 88

What occurs during an acute gout attack?

Back 88

Acute gout attack:
i. Podagra (50% of initial presentations):big red inflammation of the big toe.
ii. Polyarticular: involve multiple joints.

Front 89

What changes in treatment if a person with gout is either an under or over excretor?

Back 89

Determine if the patient is an underexcretor or overproducer of uric acid:
i. Overproduction: Treat with Allopurinol (inhibits uric acid formation)
Allopurinol is never given during acute attack of gout because it will make worse (KNOW).
ii. Underexcretion: Treat with Probenecid (increases secretion of uric acid).
c. Renal calculi (kidney stones) are common.

Front 90

What causes Pseudogout?

Back 90

Calcium Pyrophosphate Dihydrate Deposition (CPPD): NOT uric acid

Front 91

What are the differences between the crystals in gout versus psuedogout?

Back 91

a. Pseudogout: Crystals are rounded, oval, rhomboid shape and blue in color.
b. Gout: Crystals are needle-shaped and yellow in color

Front 92

__________Arthritis
1. Very rare, very destructive, and very painful.
2. Severe destructive arthritis with erosions.
3. Periarticular ligamentous instability.
4. Knees and shoulders.
5. Usually in older females.

Back 92

Hydroxyapatite

Front 93

Infectious arthritis: Septic Arthritis (infection in joints) often caused by

Back 93

1. Neisseria gonorrhea *** (young, STI).
2. Staphylococcus sp. ***

Front 94

What is the most important aspect of diagnosising Septic Arthritis?

Back 94

Septic Arthritis: Diagnosis
Arthrocentesis: important to culture, because if there is an infection, steroids are contraindicated!

Front 95

Rhuematoid Arthritis life expectency?

Back 95

Life expectancy is reduced by 3 to 18 years because of the disease and also the treatment.

Front 96

Rhuematoid Arthitis affects who more?

Back 96

women

Front 97

Hallmark of Rhuematodi arthritis?`

Back 97

Pathological hallmark: pannus (inflammation of the tissues lining joints and is a systemic dx)-vs osteoarthritis which is not inflammatory and is limited to the joints.
1. Inflammatory, proliferative synovial membrane.

Front 98

most common complication of rhuematoid arthritis?

Back 98

Coronary Artery Disease: leading cause of death due to inflammation of blood vessels.

Front 99

what are DMARDS?

Back 99

treatment for rheumatoid arthritis
DMARDs (disease-modifying anti-rheumatic drugs): Immunomodulators that target pathophysiology by suppressing inflammatory cells (e.g. macrophages)

Front 100

Polymyositis and dermatomyositis is diagnosed by how?

Back 100

Muscle biopsy: Gold standard.

inflammation of muscles, with skin changes.

Front 101

most common areas of body affected by Paget's disease?

Back 101

Most commonly involved sites: (important)
1. Sacrum.
2. Spine.
3. Femur.
4. Tibia.
5. Skull.
6. Pelvis.

Front 102

__________________:Most common cause of musculoskeletal pain in US in women 20-55 y.o.

Back 102

Fibromyalgia


Disturbed sleep.
5. Profound fatigue.
6. Multiple tender points (‘everywhere hurts’).
7. Women > Men (10 : 1).

Front 103

______:Most common presenting symptom everywhere (in MD office/ER).

Back 103

Acute Back Pain

Front 104

In pts with acute back pain:
_________%better in 1 week.
___% better in 2 months.

Back 104

40%

90%

Front 105

Carpal Tunnel Syndrome is most common in

Back 105

More common in: (KNOW)
1. Pregnancy, and women using oral contraceptives.
2. Hypothyroidism.
3. Diabetes.
4. Dialysis patients.

Front 106

______________: “tennis elbow”, involves extensor muscles of forearm and lateral epicondyle

Back 106

Lateral epicondylitis

Front 107

_____________-: “golfer elbow”, involves flexor muscles of forearm and medial epicondyle.

Back 107

Medial epicondylitis

Front 108

___________-: Inserts into calcaneus bone (heel).
1. Largest tendon in the body.
2. Most commonly ruptured tendon.

Back 108

Achilles Tendon