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53 Cards in this Set
- Front
- Back
X-ray findings in osteoarthritis (4)
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Narrow joint space
Osteophytes Dense subchondral bone Bone cysts |
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Causes of gout (5)
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Overproduction of uric acid:
- Increased cell turnover (cancer, hemolysis) - Enzyme deficiency (Lesch-nyhan) Underexcretion: - Renal insufficiency - Ketoacidosis, lactic acidosis - Thiazides and aspirin |
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What are 2 consequences of chronic gout
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1. Tophi: Urate crystal deposits anywhere in the body
2. Uric acid kidney stones |
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Diagnostic tests for gout
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Joint aspiration showing needle shaped, negatively birefringent crystals
Elevated ESR and leukocytosis Normal X-ray early, later cortical bone erosion |
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Treatment of gout - acute (3) and chronic (5)
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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 |
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Which anti-hypertensive is used in patients with gout?
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Losartan
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Adverse effects of allopurinol and colchicine?
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Allopurinol
1. Hypersensitivity reaction (rash, hemolysis, allergic interstitial nephritis) 2. Toxic epidermal necrosis/stevens-johnson syndrome Colchicine: Neutropenia |
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Treatment for fibromyalgia
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Amitryptiline*
Milnacipran Pregabalin Trigger point injections |
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What are physical exam tests for carpal tunnel syndrome? What are the most accurate diagnostic tests?
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Tinel sign: Pain/tingling when you tap median nerve
Phalen sign: Pain/tingling with wrist flexion Most accurate tests: EMG and NCS |
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What is the presentation of plantar fascitis?
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Very severe pain on the bottom of the foot that improves with taking a few steps
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Criteria for diagnosing rheumatoid arthritis
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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) |
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Treatment for rheumatoid arthritis
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DMARDs
Best initial DMARD- Methotrexate NSAIDs or steroids for symptomatic relief (do not slow progression) |
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Presentation of juvenile rheumatoid arthritis
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Spiking fever
Salmon colored rash on chest/abdomen May have: Splenomegaly Pericardial effusion Mild joint symptoms |
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Which organs are spared by drug induced lupus?
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Brain and kidney
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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) |
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Most specific antibody in lupus?
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Anti-ds DNA
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Unique lab findings in antiphospholipid syndrome (3)
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Elevated PTT, normal PT
False positive VDRL/RPR |
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Initial and most accurate tests for antiphospholipid syndrome
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Initial: plasma mixing study (PTT remains prolonged)
Most accurate: Russel viper venom (PTT remains prolonged despite mixing) |
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Treatment to prevent recurrence of spontaneous abortion
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Heparin and aspirin
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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 |
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Hematologic manifestations of lupus (2)
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Hemolytic anemia
Anemia of chronic disease |
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Eye manifestations of lupus (3)
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Photophobia
Retinal lesions (cotton wool spots) Vision loss |
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Skin findings in dermatomyositis
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Shawl sign: Erythema of face, upper back, shoulders
Heliotrope rash: Edema and purplish eyelids Gottron papules: Scaly patches on the backs of hands |
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Best initial and most accurate test for polymyositis and dermatomyositis
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Initial: CPK and aldolase
Accurate: Muscle biopsy |
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What disease does dermatomyositis increase the risk for?
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Cancer
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Best initial (2) and most accurate test for sjogren's syndrome?
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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) |
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What disease is the risk increased for in sjogren's syndrome?
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Lymphoma
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Which complement is decreased in SLE and Hep C
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SLE - C3
Hep C - C4 |
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Presentation of bechet's syndrome
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Painful oral and genital ulcers
Eye lesions (uveitis, blindness) Erythema nodosum Arthritis CNS lesions (MS, dementia) *Pathergy - sterile skin pustules from minor trauma |
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Diagnostic test and treatment for Bechet's syndrome
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Diagnostic: No specific test
Treatment: Steroids |
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Anti-TNF drugs
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Infliximab
Adalimumab Etaneracept |
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Best initial and most accurate test for ankylosing spondylitis
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Initial: X-ray of sacroilliac joint (applies to all seronegative spondylarthropathies)
Accurate: MRI |
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Presentation of psoriatic arthritis
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Arthritis (especially SI join)
Sausage digits (from enthesopathy) Nail pitting |
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Best initial test for psoriatic arthritis
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X ray of joint = pencil in cup deformity
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Treatment for psoriatic arthritis
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NSAIDs
Then methotrexate Then anti-TNF drug |
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Causes of reactive arthritis (3)
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IBD
STD GI infection (yersinia, c diff, campylobacter, shigella, salmonella) |
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Triad of reactive arthritis
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Joint pain
Eye findings (uveitis, conjunctivitis) Genital abnormalities (urethritis, balantitis) |
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Diagnostic testing/treatment for reactive arthritis
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No specific test; tap joint to r/o septic arthritis
Treatment: Antibiotics for infection Symptom relief - NSAIDs, sulfasalazine |
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Best empiric therapy for osteomyelitis?
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Vancomycin and ceftriaxone
(if recently placed artificial joint, it must be removed and replaced after antibiotics) |
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Most common organism groups to cause septic arthritis
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Staphylococcus
Streptococcus Gram negative rods |
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What test should you do in a patient with recurrent gonorrhea infections?
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Terminal complement deficiency
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Unique history for gonococcal arthritis as opposed to septic arthritis (3)? What tests should you do if these features are present?
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Gonoccal arthritis:
Multiple joints Tenosynovitis Petichial rash Testing: Must culture from multiple sites |
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Diagnostic testing for osteomyelitis
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Initial - Xray
If normal X-ray --> MRI Accurate: Biopsy and culture |
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What is Felty syndrome?
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Rheumatoid arthritis w/ splenomegaly
PLUS Granulocytopenia (neutrophils <2000) Occurs after many years of RA |
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Paget's disease
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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 |
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Presentation of parvovirus B19 in adults
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Arthritis/arthralgia in distal joints
Variable systemic symptoms |
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Chronic malabsorptive diarrhea
Weight loss Migratory non-deforming arthritis Lymphadenopathy Low grade fever |
Whipple's disease (trophyrema whipelli)
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Criteria for diagnosis of polymyalgia rheumatica (4)
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>50 years old
Aching neck, shoulders and pelvic girdle for at least a month Morning stiffness lasting at least 1 hour Elevated ESR |
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Treatment of polymyalgia rheumatica
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Low dose steroids
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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 |
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Cough and dyspnea
Fever Weight loss Erythema nodosum Uveitis Hilar adenopathy and reticular opacities on CXR |
Sarcoidosis
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Risk factors for aseptic avascular necrosis
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Chronic steroids
Alcoholism Hemoglobinopathies |
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Sudden onset joint pain with clubbing in a chronic smoker
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Hypertrophic osteoarthropy
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