Clin Med- Rheumatology

Front 1

What is the main function of the immune system?

Back 1

protection from foreign substances & organisms

Front 2

What is the key strategy of the immune system?

Back 2

differentiate between self & non-self

Front 3

What is complement and where is it produced?

Back 3

*series of proteins that are enzyme precursors
*liver

Front 4

What are the 3 fxns of complement?

Back 4

1- opsonization
2- inflammatory
3- lysis

Front 5

What are the two types of defense mechanism of the immune system?

Back 5

1- natural immunity
2- adaptive immunity

Front 6

What is the most important cell of natural immunity?

Back 6

macrophage!!

Front 7

What is the main cell of adaptive immunity? What does it produce?

Back 7

*lymphocyte
*produces B & T cells

Front 8

What is the disadvantage of the adaptive immune system?

Back 8

it is slow!!

Front 9

What does interferon do?

What do mast cells do?

Back 9

Interferon kills things.

Mast cells release histamine

Front 10

_____ is a circulatory condition associated w/spasms in the blood vessels of the fingers & toes, causing them to change color. After exposure to cold, these initial areas turn white, then blue, & finally red.

Back 10

Raynaud's phenomenon

Front 11

_____ syndrome is manifested by dry eyes & dry mouth.

Back 11

Sicca

Front 12

Re: rheumatologic diseases, what is more important than any lab test?

Back 12

hx & physical exam

Front 13

What are the only 2 rheumatological emergencies?

Back 13

*Infective arthritis

*Lyme disease

Front 14

What is migratory polyarthritis caused by?

Back 14

Gonorrhea

Front 15

What is the most common cause of non-inflammatory joint pain?

Back 15

osteoarthritis

Front 16

The cause of monoarthritis is limited to which two major categories? Given an example of each.

Back 16

1- infection (septic arthritis, lyme disease)
2- crystalline arthritis (gout or pseudogout)

Front 17

What accounts for the majority of acute monoarthritis?

Back 17

crystalline disorders (80%)

Front 18

Examination of ______ is crucial in determining the cause of monoarthritis.

Back 18

synovial fluid

Front 19

What is the presentation of an acute gout attack?

Back 19

*severe pain & swelling of one joint, classically the great toe

Front 20

Who does gout occur more commonly in?

Back 20

*men or postmenopausal women
*hospitalized pts (as a result of dehydration, changes in meds, stress)

Front 21

What conditions may pseudogout be associated with?

Back 21

*hyperparathyroidism
*hypothyroidism
*hemochromatosis
*hypercalcemia
*illness
*trauma

Front 22

What joint is affected in pseudogout in 50% of cases?

Back 22

knee

Front 23

How does infectious arthritis present? What could happen if medical attn is not immediate?

Back 23

*acute swelling, pain, erythema
*merits immediate med attn!
*jt can be destroyed in 24-48 hrs if left untreated

Front 24

80-90% of acute nongonococcal bacterial arthritis is _______. Which joints are most commonly affected? Infection usually due to what kind of spread?

Back 24

*monoarticular
*large joints -- hip, knee
*hematogenous spread

Front 25

What conditions is HLA-B27 associated with?

Back 25

*ankylosing spondylitis
*Reiter's disease
*psoriatic arthritis
*enteropathic arthritis

Front 26

Chronic pseudogout tends to involve the wrists, knees, & shoulders and may be initially misdiagnosed as _______.

Back 26

RA

Front 27

What are some causes of symmetric polyarthritis?

Back 27

*RA
*SLE
*vasculitides

Front 28

RA generally affects which joints?

Back 28

*MCPs
*PIPs
*wrists

Front 29

c-ANCA is very specific for which disorder?

Back 29

Wegener's

Front 30

What antibody is found in Sjogren's disease? Systemic sclerosis? CREST syndrome?

Back 30

*SSA/Ro
*Scl 70
*Centromere

Front 31

How sensitive is the Rf in RA?

Back 31

80% sensitivity

Front 32

What is CREST syndrome?

Back 32

C- calcinosis
R- reynaud's phenomenon
E- esophageal dysmotility
S- sclerodactyly
T- telangiectasia

Front 33

______ can be dx by the presence of needle-shaped, highly birefringent urate crystals that are yellow when parallel to polarized light.

Back 33

GOUT

Front 34

Fewer than ____ WBCs in the synovial fluid are generally considered to be non-inflammatory.

Back 34

200 WBCs/ml

Front 35

More than _____ WBCs/ml is consistent with an inflammatory effusion.

Back 35

2000

Front 36

Septic arthritis is generally associated with >_____ WBCs, with >______ being dx.

Back 36

*>50,000
*>100,000

Front 37

What is seen on radiographs of osteoarthritis?

Back 37

*osteophytes
*subchondral cysts
*joint sclerosis
*asymmetric joint space narrowing

Front 38

What is an MRI useful for in joint problems?

Back 38

*confirm presence of a lesion not apparent on plain films such as torn meniscus or small fx; also good for tendinous lesions

Front 39

For acute crystalline arthritis, ______ are the tx of choice.

Back 39

NSAIDs

Front 40

Chronically, ________ is the most common prophylactic agent used in gout.

Back 40

allopurinol

Front 41

What is allopurinol hypersensitivity syndrome classified as? What is the tx?

Back 41

*fever, rash, eosinophilia, hepatic & renal dysfunction
*immediate cessation of the drug

Front 42

What is classified as pain worst at the end of the day, weight-bearing jts affected such as hips, DIP jts can be affected, & joint space narrowing is seen on x-ray.

Back 42

Osteoarthritis

Front 43

What is the most common rheumatic disease?

Back 43

osteoarthritis

Front 44

What does incidence of OA increase with?

Back 44

*age
*wear & tear
*obesity

Front 45

T or F: the synovium is affected in OA.

Back 45

FALSE-- is NOT affected

Front 46

What are some causes of secondary OA?

Back 46

*previous trauma
*congenital hip dysplasia
*avascular necrosis of the capital femoral epiphyses
*obesity
*metabolic disorders

Front 47

If you suspect OA, what labs should be ordered?

Back 47

NONE

Front 48

What other condition can cause avascular necrosis of the femoral head?

Back 48

sickle cell anemia

Front 49

Herberden nodes are found on which joints? Bouchard's?

Back 49

*DIP
*PIP

Front 50

What are the symptoms of OA?

Back 50

*gradual onset of deep pain
*pain worsens with activity
*pain worst at end of the day
*pain relieved by rest
*AM stiffness <30 minutes
*painful ROM

Front 51

Late findings of OA... ?

Back 51

*tenderness
*crepitus
*joint deformity

Front 52

Unlike RA, OA affects the _____.

Back 52

DIPs

Front 53

What is the BEST FIRST Tx for OA (unless pt is an athlete).

Back 53

weight reduction

Front 54

What is Hakemi's DOC for the Tx of OA?

Back 54

tylenol

Front 55

Bone mass measurement should be considered in all women by what age?

Back 55

60

Front 56

What is the BEST 1st TX for osteoporosis?

Back 56

Bisphosphonates (i.e. boniva, fosamax)

Front 57

Femoral neck fx specifically in osteoporosis can lead to ... ?

Back 57

Avascular necrosis

Front 58

What is an alternative to bisphosphonates for pain relief of osteoporosis?

Back 58

calcitonin nasal spray

Front 59

Re: RA, what enzymes cause the inflammation?

Back 59

IL-1

Front 60

Felty's syndrome is an extra-articular manifestation of RA. What is it characterized by?

Back 60

*increased spleen
*neutropenia
*lymphadenopathy

Front 61

RA usually spares the _____ (part of the joint).

Back 61

*cartilage

Front 62

What are some clinical features of RA?

Back 62

*symmetrical jt involvement
*fatigue
*swanlike deformities
*morning stiffness >30 min
*pericarditis, pleuritis
*rheumatoid nodules in lung

Front 63

The release of ______ cause fatigue.

Back 63

cytokines

Front 64

RA leads to cellular & autoantibody attack of the ____ membranes. Give some examples.

Back 64

serosal -->
*joints
*bursae
*tendon sheaths
*pericardium
*pleura

Front 65

RA occurs more commonly in ... ?

Back 65

women during their childbearing years

Front 66

What may occur with the eyes of the pt with RA?

Back 66

episcleritis

Front 67

RA involves inflammation and hypertrophy of the _______.

Back 67

synovium

Front 68

______ deformities are hyperextension of PIP & flexion of DIP.

Back 68

swan-neck

Front 69

______ deformities are flexion of PIP & extension of DIP, which occur later in the disease process.

Back 69

boutonniere

Front 70

What type of cyst is common in pts with RA?

Back 70

Baker's cyst

Front 71

______ are found at the elbows, occiput, & sacrum in 25% of pts with RA.

Back 71

subcutaneous nodules

Front 72

What is usually the most specific test for RA?

Back 72

radiography

Front 73

What is the Tx of RA?

Back 73

1- NSAIDs to decrease inflammation
2- DMARDS (i.e. sulfasalazine or methotrexate)

Front 74

As soon as the dx of RA is made, what should the pt be started on?

Back 74

DMARD!!

Front 75

What are three side effects of methotrexate?

Back 75

*liver failure
*stomatitis
*marrow suppression

Front 76

What needs to be done before starting a pt on an anti-TNF agent?

Back 76

*CXR & PPD to test for TB b/c these agents can reactivate TB

Front 77

What are some s/e of chloroquine?

Back 77

*retinopathy
*tinnitus

Front 78

_____ occurs secondary to a disorder of purine metabolism that leads to hyperuricemia and, hence, intra-articular and extra-articular urate deposition.

Back 78

Gout

Front 79

______ causes crystals to be deposited in the synovium.

Back 79

hyperuricemia

Front 80

___% of gout pts are underexcretors of uric acid.

Back 80

90

Front 81

Who does Gout commonly affect?

Back 81

middle-aged men

Front 82

What are the two clinical stages of Gout?

Back 82

1- asymptomatic hyperuricemia

2- acute gouty arthritis

Front 83

Pts on _____ will have increased uric acid levels.

Back 83

HCTZ

Front 84

Describe asymptomatic hyperuricemia.

Back 84

urate deposition is absent, but increased serum uric acid concentration puts the pt at risk for acute gouty arthritis

Front 85

Describe acute gouty arthritis.

Back 85

LE, monoarticular arthritis produces sudden tenderness, erythema, warmth, & swelling that resolves in a few days

Front 86

What is a common complication of gout and what does it lead to?

Back 86

*acute obstructive uropathy, leading to ARF

Front 87

What is the BEST INITIAL TX of an acute attack of gout? What drug can be used for pts in which the first line is contraindicated?

Back 87

*NSAIDs such as indomethacin
*Colchicine

Front 88

T or F: it is ok to use uric acid-lowering agents such as allopurinol during an acute attack of gout.

Back 88

FALSE!! Do NOT use during an acute attack b/c it will prolong the duration of the attack

Front 89

The inflammatory component is so intense, an acute attack of gout is often mistaken for ______.

Back 89

bacterial cellulitis

Front 90

Which joint is the first joint affected in 50% of cases of gout?

Back 90

first MTP (podagra)

Front 91

______ is sterile arthritis occurring after an infection.

Back 91

Reiter's syndrome

Front 92

What is the cause of Reiter's syndrome?

Back 92

*GI tract & chlamydia infections

Front 93

T or F: Reiter's syndrome is associated with HLA-B27

Back 93

True

Front 94

What is seen on examination of Reiter's syndrome?

Back 94

*sausage-shaped digits
*oral ulceration
*circinate balanitis
*keratoderma blenorrhagica

Front 95

What is the management of Reiter's syndrome?

Back 95

NSAIDs

Front 96

What is keratoderma blenorrhagica?

Back 96

brownish-red macules, vesicopapules, scales on palms & soles of the pts with Reiter's syndrome

Front 97

What conditions are enteropathic arthropathies associated with?

Back 97

UC or Crohn's disease... peripheral arthritis tends to exacerbate with flare-ups of the bowel disease

Front 98

How should Crohn's + Arthritis be managed?

Back 98

Anti-TNF such as Remicaide

Front 99

Who is SLE most common in?

Back 99

women during their reproductive years; especially AA women

Front 100

What two medications may cause drug-induced SLE?

Back 100

*hydralazine
*procainamide

Front 101

What is the prognosis of drug-induced SLE?

Back 101

GOOD! Stop the drug & it will be reversible

Front 102

What is the INITIAL SCREENING test for SLE?

Back 102

ANA; but NOT specific

Front 103

What test is SPECIFIC to SLE, but not sensitive?

Back 103

Anti-Sm

Front 104

What is highly suggestive of the dx of lupus?

Back 104

Hypocomplementemia (C3 & C4)

Front 105

_______ antibodies may be detected in up to 1/3 of pts with SLE.

Back 105

antiphospholipid

Front 106

What is the big fuss about antiphospholipid syndrome?

Back 106

Causes hypercoaguable states; prone to DVTs, etc. If pregnant, prone to miscarriages

Front 107

Pts with lupus anticoagulant factor will have a false + ____.

Back 107

PTT

Front 108

Pts with SLE will have a biological false test for ____.

Back 108

syphilis

Front 109

What is the FIRST-LINE INITIAL TX of SLE? What are some S/E of the drug?

Back 109

*Hydroxychloroquine
*neuropathy
*impaired night vision

Front 110

What are some other agents for Tx of SLE?

Back 110

*NSAIDs
*corticosteroids

Front 111

HSP is commonly found where? Uncommon on the _____.

Back 111

*buttocks & LE
*upper extremities

Front 112

HSP is also known as a ______ or allergic purpura.

Back 112

anaphylactoid

Front 113

Who does HSP typically occur in? Secondary to... ?

Back 113

*children or young adults
*secondary to strep infections, insect stings, administration of drugs

Front 114

What is the hallmark of the vasculitis HSP?

Back 114

palpable purpura

Front 115

What are the clinical features of HSP?

Back 115

*palpable purpura
*abdominal pain, GI bleed
*arthritis
*renal involvement

Front 116

What confirms the dx of HSP with appropriate symptomology?

Back 116

presence of IgA in tissue bx

Front 117

What are some of the lab findings of HSP?

Back 117

*mild anemia
*leukocytosis
*elevated ESR
*UA -- hematuria, proteinuria, RBC casts

Front 118

What is the Tx of HSP?

Back 118

*supportive
*corticosteroids
*otherwise self-limiting

Front 119

HSP is characterized by what 4 clinical syndromes? (PAAR)

Back 119

*palpable purpura
*arthritis/arthralgia
*abd pain
*renal disease

Front 120

What does a + ASO-titer mean?

Back 120

past strep infection

Front 121

What is the cause of rheumatic fever?

Back 121

an auto-immune mediated inflammation of heart & big joints following on strep pharyngitis

Front 122

What are the S&S of rheumatic fever?

Back 122

*myocarditis- dilated heart with S3 ventricular gallop
*endocarditis- MR murmur
*pericarditis- central CP, pericardial friction rub

Front 123

How is rheumatic fever dx?

Back 123

Jones Criteria; ASO titer, C&S

Front 124

What is the Tx of rheumatic fever?

Back 124

*high dose NSAIDs
*PCN
*steroids

Front 125

For rheumatic fever, what is dx using the Jones Criteria?

Back 125

Need 2 major & 1 minor & previous strep infxn

Front 126

What are the 5 major manifestations of rheumatic fever?

Back 126

*Pancarditis (50%)
*Polyarthritis (80%)
*Sydenharn's chorea (10%)
*Erythema marginatum (<5%)
*subcutaneous nodules (rare)

Front 127

Minor manifestations of rheumatic fever?

Back 127

*fever
*polyarthralgia
*hx of rheumatic fever
*raised acute phase reactants: ESR, CRP, leucocytosis
*prolonged PR interval on ECG

Front 128

What are some hypercoagulable states? Which is the most common?

Back 128

*Factor V Leiden-- MC
*Protein S def
*Protein C def
*anti-thrombin III def
*antiphospholipid syndrome

Front 129

Behcet's disease is classically characterized by what triad of symptoms?

Back 129

*aphthous ulcers
*genital ulcers
*uveitis

Front 130

Who is Behcet's disease common in?

Back 130

Mediterranean & Asia

Front 131

What is pathergy & what condition is it associated with?

Back 131

A measure of the increased sensitivity of the skin which occurs in Behcet's syndrome

Front 132

What is the Tx of Behcet's syndrome?

Back 132

steroids

Front 133

What is "heliotrope" & what is it characteristic of?

Back 133

*violacious color of upper eyelids produced by telangectasia
*dermatomyositis

Front 134

What do the hands look like in dermatomyositis? What are Gottron's papules?

Back 134

*dusky red plaques
*infiltrated plaques over bony prominences

Front 135

What serological markers are found in dermatomyositis? How is the dx confirmed?

Back 135

*Anti-Jo-1, anti-Mi-2
*elevated CK
*dx confirmed by muscle bx

Front 136

What is the Tx of dermatomyositis?

Back 136

steroids & other immunosuppressives

Front 137

_______ is characterized by pulmonary, arthritis, lymphadenopathy, & raised serum ACE. _____ are found on bx.

Back 137

*sarcoidosis
*granulomas

Front 138

What is the tx of sarcoidosis?

Back 138

steroids

Front 139

What is generally the first symptoms of scleroderma?

Back 139

Reynaud's phenomenon