Final Review For Medicine

Front 1

What is inclusion body myositis? x4

Back 1

oddball: i)men ii)distal muscles iii)no autoIgs iv)low elevated CK

Front 2

What is inclusion body myositis? x4

Back 2

oddball: i)men ii)distal muscles iii)no autoIgs iv)low elevated CK

Front 3

What are 3 ass'd findings in both poly and dermato?

Back 3

i)arthralgias ii)interstitial lung dz (rare) iii)CHF and conduction defects (rare)

Front 4

What is tx for Ankylosing spondy? x4

Back 4

i)NSAID for sympto relief ii)PT iii)SX for severe spinal deformity iv)strictly immobilize if neck or back pain and have trauma until image it

Front 5

What is Ig for MCTD? What are clinical findings?

Back 5

i)Anti-U1 RNP Igs ii)overlap syndrome for SLE, RA, SS, polymyositis. Can have pulm dz, raynaud, eso dysfcn, etc

Front 6

What are 7 conditions where ANAs are elevated?

Back 6

i)SLE ii)RA iii)Scleroderma iv)Sjogrens v)MCTD vi)polymyositis and dermatomyositis vii)drug induced lupus

Front 7

What is life threatening complication of RA? If pt w/RA and needs sx, what should be done? Why?

Back 7

i)Instability of cervical spine (C1-2 subluxation) ii)spine radiograph b/c neurologic injury possible during intubation

Front 8

How long does polymyalgia rheumatica last for? What are clinical features x3? what is tx?

Back 8

i)self limited in 1-2 yrs (diff from RA). ii)a)constitutional sxs b)hip and shoulder stiffness that is b/l; morning stiffness c)jt swelling in knees, wrists, hands possible. iii)Elevated ESR. iv)treat w/steroids to suppress inflammation till dz resolves

Front 9

What is Reactive arthritis pattern of arthritis? Wen does it occur? What are the organisms? x4

Back 9

i)assymetric oligoarthritis of lower extremities that progresses sequentially from one jt to another, preceded by infectious process that is remote from site of arthritis (1-4 wks prior), usually after enteric or urogenital infections. ii)shigella, campy, chlam, salmon, NOT gonococcal urethritis

Front 10

Which joints are affected in psoriatic arthritis? What is initial tx?

Back 10

i)upper ext ii)NSAIDs, may need same drugs as RA

Front 11

What are Ro and La + in? x5

Back 11

i)complement deficiency (C2/C4) ii)Sjogren's iii)SLE iv)ANA neg lupus v)neonatal lupus

Front 12

What is used for symptomatic tx in RA? x2

Back 12

i)NSAID: best for pain ii)steroids: if nsaid no good; low dose long term may be Dz modifying (decr radiographic progression)

Front 13

What is Felty's syndrome?

Back 13

variant of RA: anemia, splenomegaly, RA; also thrombocytopenia, lymphadenopathy; high titers of RF w/extraarticular dz

Front 14

What are the symptoms of lupus?

Back 14

constitutional sxs and SOAPBRAIN MD: Serositis; Oral ulcers; Arthritis; Photosensitivity; Blood (hemolytic anemia, lymphopenia, thrombocytopenia); Renal: GN or nephrotic; ANA; Immuno d/o: Anti-Sm, Ro-La, DsDNA, APLS; Neuro; Malar rash; Discoid rash

Front 15

What are clinical features of fibromyalgia? x3

Back 15

i)stiffness, body aches, fatigue aggravated by weather changes, stress, sleep deprivation ii)sleep patterns fucked and unrefreshing iii)depression and anxiety common

Front 16

What are 4 poor prognostic indicators in RA?

Back 16

i)High RF titers ii)subQ nodules (ass'd w/high RF) iii)erosive arthritis iv)autoIgs to RF

Front 17

What is diff b/w PAN and weg? what systems does PAN hit x2. What are its assn's? x3 What is the WBC type that is responsible?

Back 17

i)no pulm involvement in PAN. ii)a)nervous system and GI tract iii)a)Hep B, HIV, drug rxns iv)PMN invade all layers and fibrinoid necrosis+intimal proliferation leads to reduced luminal area. v)PMN

Front 18

What are the lab tests for Lupus? x9

Back 18

i)ANA ii)Anti-Sm iii)Anti-dsDNA iv)Anti ssDNA v)Anti-histone (drug induced) vi)VDRL+ vii)Lupus anticoag and APLS viii)Anti-Ro and La ix)complement levels are decreased

Front 19

What is APLS? What are the findings x5? What are labs? x3 What is treat?

Back 19

i)hypercoag state that can be ass'd w/SLE or other collagen vasc dz. ii)a)livedo b)venous thrombus c)arterial thrombus d)abortions e)thrombocytopenia iii)a)lupus anticoag b)anticardiolipin Ig c)prolonged PTT/PT not corrected w/added normal plasma iv)long term anti-coag

Front 20

What is CRP elevated in? x3 What is it used for? If >15, what does it mean?

Back 20

i)a)inflamm states and infection b)misc conditions: MI, vasculitis, trauma, malig, panc ii)For infection: more sens and sp than ESR iii)>15=bacterial infection probably present

Front 21

How to DX Weg's? what confirms dx?

Back 21

i)cxr w/nodules or infiltrates ii)labs: incr ESR; anemia; hematuria; pos c-ANCA, possible thrombocytopenia iii)open lung bx

Front 22

What is Takayasu's vessel involvement? How to DX? What triad do you think of for Takayasu's?

Back 22

i)aortic arch and its major branches: get narrowed vessels. ii)arteriogram iii)a)decr/absent peripheral pulse b)discrepancies of BP (arm vs leg) c)arterial bruits.

Front 23

What are serology is found in ANA neg lupus (x2)? What are the symptoms? x3 What does it cause incr risk for?

Back 23

i)a)Ro+ (SS-A) b)ANA-neg. ii)a)arthritis b)cutaneous lupus c)raynaud's. iii)neonatal lupus in infants

Front 24

What is the diagnostic criteria of polymyositis?

Back 24

all four means definite, 3 is probable.i)symmetric prox muscle weakness ii)elevated CK iii)EMG findings of myopathy iv)biopsy evidence of myositis

Front 25

What causes the pathologic changes in muscle for poly vs dermatomyositis?

Back 25

i)dermato: humoral immune mech ii)poly and inclusion body: cell mediated process

Front 26

What other arteries can be involved w/temporal arteritis? What is it ass'd w/incr risk of? x2

Back 26

i)aorta or carotids ii)a)aortic dissection b)aortic aneurysm

Front 27

What is Sjogrens caused by? What is primary Sjogren's? What is secondary? What do pts have incr risk of getting? What is most common cause of death?

Back 27

i)lymphocytes infiltrate and destroy lacrimal and salivary glands. ii)primary: dry eyes and dry mouth only iii)2/2: 1/1 + CT dz (RA, SS, SLE, polymyositis). iv)NHL v)malignancy is most common cause

Front 28

What is dx criteria for fibromyalgia? x2 How to treat x3?

Back 28

i)tender points at 11/18 places ii)widespread pain including axial pain for 3 mths. iii)a)stay active and productive b)SSRI and TCAs, no narcotics c)CBT, exercise, psych eval

Front 29

What is 1st line in RA and what are 3 s/e?; what is alternate 1st lines (x2) and what do you need to do?

Back 29

i)MTX: a)GI upset; oral ulcers; BM suppression ii)a)hydroxychloroquine: eye exams b/c can get retinopathy iii)sulfasalazine

Front 30

What is ESR seen in? x4 Wat is the use of it? x2

Back 30

i)a)infection (acute or chronic) b)malig c)rheumatologic dz ii)a)dx or r/o inflam process and monitor course of inflamm process

Front 31

What is most common cause of death in Lupus? x2

Back 31

OI and renal failure

Front 32

What are features unique to dermatomyositis? x5

Back 32

i)heliotrope rash (butterfly) ii)Gottron's papules: papular, erythematous, scaly lesions over knuckles. iii)V sign: rash on face, chest iv)shawl sign: rash on shoulders, upper back, elbows. v)periungual erythema w/telangiectasias

Front 33

What drugs should you avoid in gout? x2

Back 33

i)ASA: makes gout worse ii)acetaminophen (no anti-inflamm)

Front 34

What is pseudogout? What does deposition increase w/? x2 What are 3 dz's that incr crystal deposition?

Back 34

i)Ca-PP crystals in jt cause inflammation ii)a)age b)OA iii)a)hemochromatosis b)HPTH c)hypothyroidism.

Front 35

What is tx for Sjogren's? For 2/2?

Back 35

i)pilocarpine: incr secretions ii)eye drops iii)NSAIDs/steroids for joints iv)therapy for CT dz

Front 36

What are the 4 parts to the pathophysiology of SLE?

Back 36

i)autoantibodies ii)complement activation iii)deposition of immune complexes iv)accompanying tissue destruction/vasculitis

Front 37

What dz manifestations are not seen in drug induced lupus? x5 What are 3 agents causing it? What are lab findings in drug induced and what isn't present? x2

Back 37

i)a)CNS dz b)renal dz c)no butterfly rash d)alopecia e)ulcers ii)a)hydralazine b)procainamide c)INH iii)anti-histone Igs present but no anti-dsDNA or Anti-Sm Ab

Front 38

How to DX reactive arthritis? What is TX? x2

Back 38

i)synovial fluid analysis (r/o infection or crystals) ii)a)NSAIDs are 1st line b)immunosuppressive: sulfasalazine, azathioprine. NO ABX!