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30 Cards in this Set

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What is Rheumatoid Arthritis?
1) Autoimmune, HLA-DR4
2) Symmetric inflammatory arthritis: knees, feet, MCP, PIP
What is the pathology of RA?
Leukocyte infiltration into joint. Synovium hypertrophies into joint, eroding cartilage and bone.
What are the si/sx of RA?
1) Symmetric arthritis in > 3 joint areas
2) SubQ nodules
3) Fever & wt. loss
4) Serositis
5) Anemia of chronic disease
6) Elevated ESR
What is Rheumatoid Factor?
IgM anti-IgG, not specific but present in > 70% of RA patients
What is the treatment for RA?
Methotrexate, NSAIDs, TNF antagonists
How do you Dx SLE?
D= discoid macular rash
O= oral ulcers
P= photosensitivity
A= arthritis
M= malar rash
I= immunologic criteria
N= neurologic
E= ESR high
R= renal disease
A= ANA +
S= serositis
H= hematologic problems
How do you Tx SLE?
NSAIDs, prednisone, cyclophosphamide
What is the classic triad of Sjogren's syndrome?
1) Dry eyes
2) Dry mouth
3) Inflammatory arthritis
What is Behcet's syndrome?
Multisystem inflammatory disorder that chronically recurs. Painful genital and oral ulcers, can also see vasculitis and arthritis.
What are the Seronegative Spondyloarthropathies?
1) Osteoarthritis
2) Ankylosing spondylitis
3) Reiter's syndrome
4) Psoriatic arthritis
How is Osteoarthritis different from Rheumatoid Arthritis?
1) Caused by wear & tear, not autoimmune/inflammation
2) See osteophytes (Heberden's nodes, Bouchard's nodes)
3) Asymmetric joint involvement
4) Affects older patient population
What do you find in Ankylosing Spondylitis?
1) HLA-B27
2) Sacroiliitis
3) "Bamboo spine"
What do you find in Reiter's Syndrome?
1) Uveitis, conjunctivitis
2) Urtethritis
3) Arthritis
4) also HLA-B27
What do you find in Psoriatic Arthritis?
1) Nail-pitting
2) DIP involvement
3) Occurs in 10% of patients with psoriasis

*recall psoriasis is epidermal hyperplasia with red plaques and white scaling
What is the CREST syndrome in Scleroderma?
C= calcinosis
R= Raynaud's
E= esophagitis
S= sclerodactyly
T= telangiectasis
What do you see in Sarcoidosis?
1) Diffuse systemic disorder which might be infectious or autoimmune
2) Fevers, chills, night sweats, wt. loss, cough, dyspnea, arthralgia, blurry vision (uveitis)
3) BILATERAL HILAR adenopathy on chest x-ray
How do you Dx Sarcoidosis?
Clinical, but if find noncaseating granulomas on Bx is highly suggestive if nothing else explains it
Why are patients with Sarcoidosis often have nephrolithiasis?
Granulomas secrete 1-a-hydroxylase which inc. production of VitD --> hypercalcemia
How do you Tx Sarcoidosis?
Prednisone (1st line), but 50% patients remit so only Tx if in danger
What is Gout?
Monoarticular arthritis due to uric acid crystal deposits in joint
What do you see in Sarcoidosis?
1) Diffuse systemic disorder which might be infectious or autoimmune
2) Fevers, chills, night sweats, wt. loss, cough, dyspnea, arthralgia, blurry vision (uveitis)
3) BILATERAL HILAR adenopathy on chest x-ray
How do you Dx Sarcoidosis?
Clinical, but if find noncaseating granulomas on Bx is highly suggestive if nothing else explains it
Why are patients with Sarcoidosis often have nephrolithiasis?
Granulomas secrete 1-a-hydroxylase which inc. production of VitD --> hypercalcemia
How do you Tx Sarcoidosis?
Prednisone (1st line), but 50% patients remit so only Tx if in danger
What is Gout?
Monoarticular arthritis due to uric acid crystal deposits in joint
What are si/sx of Gout?
Often podagra (big toe), overlying skin erythema can mimic cellulitis. NEEDLE-SHAPED negatively birefringentcrstals!
What are some causes of urate overproduction in Gout?
1) PRPP synthetase hyperactivity: make a lot of purines --> lots of urate
2) HGPRTase deficiency (aka Lesch Nyan): no salvage purines --> lots of urate
What are some causes of urate underexcretion in Gout?
1) Renal disease
2) Drugs: low-dose aspirin, diuretics, alcohol
Acute Tx and Maintenance Tx of Gout?
Acute: colchicine, NSAIDs (but not aspirin)
Long term: allopurinol (for overproducers), probenecid (for underexcreters)
What is Pseudogout?
Calcium pyrophosphate dihydrate crystals in joints, also in old ppl. Can be secondary to hyperparathyroid, Wilson's, diabetes, hemochromatosis. Positively birefringent rhomboid crystals!