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53 Cards in this Set

  • Front
  • Back
X-ray findings in osteoarthritis (4)
Narrow joint space
Osteophytes
Dense subchondral bone
Bone cysts
Causes of gout (5)
Overproduction of uric acid:
- Increased cell turnover (cancer, hemolysis)
- Enzyme deficiency (Lesch-nyhan)

Underexcretion:
- Renal insufficiency
- Ketoacidosis, lactic acidosis
- Thiazides and aspirin
What are 2 consequences of chronic gout
1. Tophi: Urate crystal deposits anywhere in the body

2. Uric acid kidney stones
Diagnostic tests for gout
Joint aspiration showing needle shaped, negatively birefringent crystals

Elevated ESR and leukocytosis

Normal X-ray early, later cortical bone erosion
Treatment of gout - acute (3) and chronic (5)
Acute:
1. NSAIDs
2. Colchicine
3. Corticosteroids (triamcinolone) if needed or in renal insufficiency


Long-term:
1. Diet
2. Avoid thiazides, aspirin, and niacin
3. Colchicine
4. Allopurinol or feboxustat
5. Pegloticase
Which anti-hypertensive is used in patients with gout?
Losartan
Adverse effects of allopurinol and colchicine?
Allopurinol
1. Hypersensitivity reaction (rash, hemolysis, allergic interstitial nephritis)
2. Toxic epidermal necrosis/stevens-johnson syndrome

Colchicine: Neutropenia
Treatment for fibromyalgia
Amitryptiline*
Milnacipran
Pregabalin
Trigger point injections
What are physical exam tests for carpal tunnel syndrome? What are the most accurate diagnostic tests?
Tinel sign: Pain/tingling when you tap median nerve
Phalen sign: Pain/tingling with wrist flexion

Most accurate tests: EMG and NCS
What is the presentation of plantar fascitis?
Very severe pain on the bottom of the foot that improves with taking a few steps
Criteria for diagnosing rheumatoid arthritis
6 points:

Joint involvement (up to 5 points)
Elevated ESR or CRP (1 point)
Longer than 6 weeks duration (1 point)
Positive RF or anti-CCP (1 point)
Treatment for rheumatoid arthritis
DMARDs
Best initial DMARD- Methotrexate

NSAIDs or steroids for symptomatic relief (do not slow progression)
Presentation of juvenile rheumatoid arthritis
Spiking fever
Salmon colored rash on chest/abdomen

May have:
Splenomegaly
Pericardial effusion
Mild joint symptoms
Which organs are spared by drug induced lupus?
Brain and kidney
Which antibody is seen in:
drug induced lupus
CREST syndrome
Sjogrens
Drug induced lupus: Anti-histone
CREST syndrome: Anti-centromere
Sjogrens: Anti-Ro (ssB) and anti-La (ssA)
Most specific antibody in lupus?
Anti-ds DNA
Unique lab findings in antiphospholipid syndrome (3)
Elevated PTT, normal PT
False positive VDRL/RPR
Initial and most accurate tests for antiphospholipid syndrome
Initial: plasma mixing study (PTT remains prolonged)

Most accurate: Russel viper venom (PTT remains prolonged despite mixing)
Treatment to prevent recurrence of spontaneous abortion
Heparin and aspirin
Treatments for CREST syndrome:
Overall slowing progression
Renal (hypertensive) crisis
Esophageal dysmotility
Pulmonary fibrosis
Raynauds
Overall slowing progression: Methotrexate
Renal (hypertensive) crisis: ACE inhibitor
Esophageal dysmotility: PPIs
Pulmonary fibrosis: Cyclophosphamide
Raynauds: CCB
Hematologic manifestations of lupus (2)
Hemolytic anemia
Anemia of chronic disease
Eye manifestations of lupus (3)
Photophobia
Retinal lesions (cotton wool spots)
Vision loss
Skin findings in dermatomyositis
Shawl sign: Erythema of face, upper back, shoulders
Heliotrope rash: Edema and purplish eyelids
Gottron papules: Scaly patches on the backs of hands
Best initial and most accurate test for polymyositis and dermatomyositis
Initial: CPK and aldolase

Accurate: Muscle biopsy
What disease does dermatomyositis increase the risk for?
Cancer
Best initial (2) and most accurate test for sjogren's syndrome?
Initial:
1. Schirmer test (filter paper on eye doesn't produce tears)
2. Anti-ssA and ssB (Ro and la)

Accurate: Lip or parotid gland biopsy (shows lymphocytic infiltrates)
What disease is the risk increased for in sjogren's syndrome?
Lymphoma
Which complement is decreased in SLE and Hep C
SLE - C3
Hep C - C4
Presentation of bechet's syndrome
Painful oral and genital ulcers
Eye lesions (uveitis, blindness)
Erythema nodosum
Arthritis
CNS lesions (MS, dementia)
*Pathergy - sterile skin pustules from minor trauma
Diagnostic test and treatment for Bechet's syndrome
Diagnostic: No specific test

Treatment: Steroids
Anti-TNF drugs
Infliximab
Adalimumab
Etaneracept
Best initial and most accurate test for ankylosing spondylitis
Initial: X-ray of sacroilliac joint (applies to all seronegative spondylarthropathies)

Accurate: MRI
Presentation of psoriatic arthritis
Arthritis (especially SI join)
Sausage digits (from enthesopathy)
Nail pitting
Best initial test for psoriatic arthritis
X ray of joint = pencil in cup deformity
Treatment for psoriatic arthritis
NSAIDs
Then methotrexate
Then anti-TNF drug
Causes of reactive arthritis (3)
IBD
STD
GI infection (yersinia, c diff, campylobacter, shigella, salmonella)
Triad of reactive arthritis
Joint pain
Eye findings (uveitis, conjunctivitis)
Genital abnormalities (urethritis, balantitis)
Diagnostic testing/treatment for reactive arthritis
No specific test; tap joint to r/o septic arthritis

Treatment: Antibiotics for infection
Symptom relief - NSAIDs, sulfasalazine
Best empiric therapy for osteomyelitis?
Vancomycin and ceftriaxone

(if recently placed artificial joint, it must be removed and replaced after antibiotics)
Most common organism groups to cause septic arthritis
Staphylococcus
Streptococcus
Gram negative rods
What test should you do in a patient with recurrent gonorrhea infections?
Terminal complement deficiency
Unique history for gonococcal arthritis as opposed to septic arthritis (3)? What tests should you do if these features are present?
Gonoccal arthritis:

Multiple joints
Tenosynovitis
Petichial rash

Testing:
Must culture from multiple sites
Diagnostic testing for osteomyelitis
Initial - Xray
If normal X-ray --> MRI

Accurate: Biopsy and culture
What is Felty syndrome?
Rheumatoid arthritis w/ splenomegaly
PLUS
Granulocytopenia (neutrophils <2000)

Occurs after many years of RA
Paget's disease
Osteoclast hyperfunction --> increased bone breakdown and compensatory bone formation --> Mosaic lamellar bone

Most commonly affects pelvis, spine, skull, long bones

Femoral bowing, increased ALP

Symptoms: Bone and joint pain, hearing loss, skeletal deformities
Presentation of parvovirus B19 in adults
Arthritis/arthralgia in distal joints
Variable systemic symptoms
Chronic malabsorptive diarrhea
Weight loss
Migratory non-deforming arthritis
Lymphadenopathy
Low grade fever
Whipple's disease (trophyrema whipelli)
Criteria for diagnosis of polymyalgia rheumatica (4)
>50 years old
Aching neck, shoulders and pelvic girdle for at least a month
Morning stiffness lasting at least 1 hour
Elevated ESR
Treatment of polymyalgia rheumatica
Low dose steroids
Xray findings:
Pencil in cup deformity

Osteophyte formation, narrow joint space
Pencil in cup: Psoriatic arthritis

OA

Punched out lesions with a rim of cortical bone - Gout

Periarticular osteopenia and joint margin erosion - RA

Normal joint space with soft tissue swelling - Septic arthrtitis

Chondrocalcinosis - Pseudogout
Cough and dyspnea
Fever
Weight loss
Erythema nodosum
Uveitis
Hilar adenopathy and reticular opacities on CXR
Sarcoidosis
Risk factors for aseptic avascular necrosis
Chronic steroids
Alcoholism
Hemoglobinopathies
Sudden onset joint pain with clubbing in a chronic smoker
Hypertrophic osteoarthropy