Rheumatology Weak Points #1

Front 1

Migrating arthritis etiologies?

Back 1

N Gonorrhea

SLE

Front 2

Pathophysiology of Lupus

Back 2

Autoimmune antibody

Front 3

Antibodies in SLE

Back 3

anti-ANA (not necessary)

anti-Ro(SSA)

anti-DS DNA (40%)

anti-Smith (30%, most specific)

*These two are diagnostic of SLE

Front 4

Who gets SLE?

Back 4

WOMEN (90%)

African american

Front 5

Chondrocalcinosis

Back 5

Hemochromatosis

Hyperparathyroidism

Hypomagnesemia

Hypophosphatemia

*radiographs have linear radiodense deposits in menisci or articular cartilage

Front 6

What cardiac complications are SLE patients at risk for?

Back 6

Libman Sacks endocarditis

Pericarditis

Front 7

Gonococcal arthritis aspiration will yield what?

Back 7

Culture of aspirate only positive in 50% of cases.

First step is still joint aspirate, but also do serum cultures.

Front 8

Drug Induced Lupus - what antibodies are present?

Which drugs?

Back 8

Anti Histone

Hydralazine and procainamide, isoniazid, methyldopa

If Renal or CNS involvement, NOT drug induced

Front 9

What do ANA's represent?

Back 9

Connective tissue disease:

SLE

RA

Scleroderma

Mixed connective tissue disease

Polymyositis, Dermatomyositis

Drug induced

Front 10

How does neonatal lupus present?

Back 10

Skin lesions

Cardiac abnormalities (transposition, AV Block)

Valvular and septal defects

Front 11

Rheumatoid Factor found in what condition?

Back 11

Rheumatoid Arthritis (but not sensitive or specific)

Front 12

C-ANCA found in?

Back 12

Wegener's Granulomatosis

Front 13

P-ANCA found in?

Back 13

Polyarteritis Nodosa

Front 14

Two Spontaneous Abortions in healthy young woman - what do you think of?

Back 14

anti phospholipid syndrome

Front 15

Lupus Anticoagulant (Ab) found in?

Back 15

Antiphospholipid Syndrome

Front 16

What are the two major acute reactant markers?

Back 16

ESR, CRP

Front 17

Anti CCP is most specific for what?

Back 17

Rheumatoid Arthritis

Most specific

Front 18

HLA DR2 and HLA DR3 associated with?

Back 18

SLE

Front 19

Sjogren's associated with which HLA?

Back 19

HLA DR3

Front 20

RA associated with which HLA?

Back 20

DR4

Front 21

What HLA in seronegative spondyloarthropathies?

Back 21

Psoriatic arthritis

Ankylosing spondylitis

I

Reiter's syndrome

Front 22

Treatment of SLE?

Back 22

NSAIDs

Steroids

Cytotoxic agents - cyclophosphamide for renal involvement

Best long term is anti malarials, hydroxychloroquine for constitutional, cutaneous and articular

Front 23

Methotrexate flares up what in RA?

Back 23

Rheumatoid nodules

Front 24

Rheumatoid Arthritis plus pneumoconiosis is?

Back 24

Caplan's Syndrome

Front 25

Felty's Syndrome

Back 25

RA with splenomegaly and neutropenia (or a predisposition to infection)

May experience fever, weight loss, fatigue

Anemia, thrombocytopenia

Front 26

What is the prognosis of joint pain in SLE?

Back 26

Full recovery

Front 27

Hydroxychloroquine s/e?

Back 27

Optic retinopathy - requires regular eye exams

Front 28

Who is the typical RA patient?

Back 28

Middle age woman

Women 3:1

Age 2-40

Front 29

How does arthritis progress in patients with RA throughout the day?

Back 29

Morning stiffness that improves as day progresses

Front 30

Cardiac manifestations in RA

Back 30

Rheumatoid nodules (can lead to heart block)

Pericarditis

Effusion

Front 31

What anemia is found in RA?

Back 31

Anemia of chronic disease

Front 32

Mechanism/Pathology in atlanto-occipital involvement of RA?

Back 32

Pannus formation

Presents with neck pain, parasthesias, radiculopathy

Work up with Xray first, then CT/MRI

Front 33

What is the involved structure in a Baker's cyst?

Back 33

Inflammed, enlarged synovium

Front 34

Poor prognosis markers in Rheumatoid Arthritis?

Back 34

High titers of rheumatoid factor

Rheumatoid subcutaneous nodules

Erosive arthritis

Front 35

Sun causes what in SLE?

Back 35

Flare ups (photosensitivity)

Front 36

RA drug of choice

Back 36

NSAIDs first line

DMARDs

add corticosteroids if insufficient for short term relief

Front 37

Juvenile RA and Still's Disease

Back 37

Juvenile - starts before age 18

Still's - non articular disease predominates

Front 38

DMARD's first line?

S/E?

Other DMARDs

Back 38

Methotrexate best initial

S/E: GI upset, hepatocellular injury

*Supplement with folate. Monitor liver and renal

Leflunomide (alternative to methotrexate)

Hydroxychloroquine

Anti TNF agents - etanercept, infliximab (added if methotrexate is not sufficient)

Front 39

Belimumab does what?

Back 39

Inhibits B Cell activation

Front 40

Colchicine in pericarditis?

Back 40

Prevents recurrence of pericarditis.

Given after/addition to therapy for underlying disease

Front 41

Synovial fluid in normal state?

Back 41

Clear

WBC <200

PMN <25%

Front 42

Synovial fluid in noninflammatory conditions ?(OA/trauma)

Back 42

Clear or yellow

WBC <2000

PMN<25%

RBCs for trauma

Front 43

Synovial fluid in septic arthritis?

Back 43

Turbid, purulent

WBC >50,000

PMN>70%

Synovial culture positive except gonococcus

Front 44

Synovial fluid with inflammatory conditions?

Back 44

Cloud yellow

WBC>5000

PMN 50-70%

Crystal findings (pseudogout or gout)

Front 45

If pregnant woman has anti RO (SSA), next best step in management of fetus?

Back 45

Fetal echocardiogram for heart wall abnormalities