Step 2 Rheumatology

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Granulomatosis with Polyangitis

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the term they use to trick you out of Wegener's Dz
Wegener's: systemic vaculitis + Upper + Lower Airway granulomatous inflammation + flomerulonephritis.
Onset 40 yo
C-ANCA positive vs protease-3
tx: cyclophosphamide

Front 2

ankylosing spondylitis pt w/ minimal trauma

Back 2

--> vertebral fx; high index of suspicion

Front 3

Immune thrombocytopenia

Back 3

pre-schooler antibovies vs platelets
self limited, spontaneous recovery
observe & corticosterois if <30k
more platelets --> more destrx, do not unless active bleeding/ intracranial bleeding
life saving heroic measure: splenectomy

Front 4

Methotrexate side effects

Back 4

side effects can be alleviated by folate supplementation without changing the efficacy (crazy)
MTX: macrocytic anemai, nausea, stomatitis, rash, hepatoticity, itnerstitial lung disease, alopecia, fever

Front 5

Hydroxychloroquin

Back 5

Gi distress, visual distrubances, hemolysis in G6DP deficient

Front 6

Cyclosporin main toxicities

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virla infx, lymphoma, nephrotoxic

Front 7

Azathirprine

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pancreatitis, liver toxicity dose dpt BM suppression

Front 8

Cyclophosphamide main toxicities:

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hemorrhagic cystitis, bladder carcinoma, sterility, meylosuppression
In SLE reserved for pts with renal or CNS problems

Front 9

best test to confirm dermatitis herpetiformis:

Back 9

anti-endomysial IgA antibodies assay
also sometimes they'll try to trick you by asking you to confirm celiac with this and not offering anti-gliadin

Front 10

Initial therapy for rosacea

Back 10

topical metronidazole to prevent papules & pustules

Front 11

painless blisters /skin fragility on hand dorsum + hyperpigmentation or hypertrichosis on face

dz, tx

Back 11

porphyrea cutanea tardis, exacerbated by alcohol & estrogens so stop those
tx: phlebotomy, hydroxychloroquin

Front 12

Mouth Ulcers + MCP/PIP Pain

Back 12

SLE

Front 13

3 classic signs of psoriatic arthritis:

Back 13

DIP involvement
dactylitis "sausage digits"
onycholysis - pitting/separation of nailbed

Front 14

DIP involvement
dactylitis "sausage digits"
onycholysis - pitting/separation of nailbed

Back 14

3 classic signs of psoriatic arthritis:

Front 15

Diagonostic testing of Ankylosing Spondylitis

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AP XR of SI Joint
Fusion/Bamboo spine is diagnostic
--> equivocal --> MRI
NB: 90% of AS pts have HLA B27, but only 5% of HLAB27 pts have AS --> not a diagnostic test.

Front 16

SLE & blood

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warm iGG antibodies against everythihng

Front 17

hydroxychloroquine & SLE

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hydroxychloroquine is good for SLE with only eye and skin manifestations, but it can cause eye damage, need eye exam q6mo

Front 18

SLE with eye & skin manifestations

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hydroxychloroquine is good for SLE with only eye and skin manifestations, but it can cause eye damage, need eye exam q6mo

Front 19

Eosinophiluria with Drug use

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Drug Induced Interstitial nephritis

Front 20

Tx: Seborrheic dermatitis

Back 20

moiturizers, topical antifungals, antidandruff shampoo, topical steroids
severe cases suggest immunodeficiency

Front 21

pain and stiffness in neck, shoulders, & hips
pain is not in joint, no limitation of passive/active motion

Dz, Dx, Tx

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Polymyalgia Rheumatica:
pain and stiffness in neck, shoulders, & hips
pain is not in joint, no limitation of passive/active motion
Req for Dx: pain as above ESR >40, age >50, morning stiffness >1h, no other dzs causing
Tx: low dose prednisone
Do not order ANA /Rh titers

Front 22

symmetrical muscle weak with pain.

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Polymyositis: symmetrical muscle weak with pain. From inflammed muscle fibers, CK is elevated. Dx: Bx,
NB: polymyalgia rheumatica = PAIN and weakness, DErmatomyositis: skin manifestations

Front 23

Myopathy with sluggish achilles DTR:

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think hypothyroid
hypothyroidism can be coordinated with proximal myopathy, rhabdo;

Front 24

6 Diagnostic features of osteoarthritis:

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>50yo
minimal/no morning stiffness
boney tenderness
boney enlargement
creiptus on motion
no warmth
3 make the dx

Front 25

Dematomyositis

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is a muscle/skin paraneopalstic ondition
looks like eaton lambert but with cutaneous manifestations

Front 26

Fibromyalgia txs

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amytriptaline & cyclobenzaprine

Front 27

Pt dxd with aSx giant cell arteritis fu:

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serial CXR's for known complixn: Aortic Anuerysm

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Complixn from well controlled RA

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pts with RA get osteoporosis from meds & the fact that pts are usually women & 2/2 arthritis do not perform weight bearing

Front 29

osteitis deformans

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is from pagets loss of lamellar bone

Front 30

Erythema Nodosum Acronym

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SORE SHINS - not fully inclusive
Streptococci, OCP, Rickettsia, Eponymous (Bechet), Sulfonamides, Hansen's Leporsy, IBD, NHL, Sarcoid

always fu with CXR

Front 31

ANA

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anti-ncuelar sensative for SLE anti-smith is specific

Front 32

anti-smith

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anti-ncuelar sensative for SLE anti-smith is specific

Front 33

MCP + PIP
no joint swelling, no systemic sx, stiffness <30d even s tx

Back 33

"Viral arthritis"
Parvovirus B19:

Front 34

child:
rash, arthralgia, abdominal pain/vomiting, renal dz

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= HS purpura IgA vasculitis

Front 35

Strawberry vs Cherry Hemangiomas:

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Strawberry: infantile, common & benign grow rapidly until age 2, regress by age 8
Cherry: adults, small, do nt regress

Front 36

Rheumatic Fever:

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antibody cross reactivity
heart, joints, skin, brain (carditis, polyarthritis, erythema marginatum (central clearing/pink border)/subcu nodules, chorea

Front 37

DDX: Widened Gamma Gap:

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MM, Amyloidosis, Waldenstrom's macroglobulinemia, MGUS

Front 38

Definitive Dx of Amyloidosis is

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Abdominal Fat Pad Bx
Consider when M spike + some organ failure (heart, liver, kidney)

Front 39

Toxic Epidermal Necrolysis vs SJS

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SJS <10% of body surface
TEN >30%
same spectrum

Front 40

pt with temporal arteritis later complains of muscle pains

Back 40

could be polymyalgia rheumatica, ESR would be elevated
could also be treatment induced steroid --> muscle degredation, dc steroids

Front 41

hypercalcemia, elevated ACE levels in middle aged African American women

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Sarcoidosis usually causes--> hypercalcemia, elevated ACE levels
typical pt: middle aged African American women
progressive dry cough, interstitial infiltrates --> pulmonary fibrosis --> dry rales.
uveitis, acute polyarthritis, or erythema nodosum
non caseatin ggranulomas
asx --> no tx, follow often remits
sx dz --> glucocorticoids
hypercalcemia is from increased conversion of 25OHVitD to 1,25OHVitD

Front 42

Most Common Organ involved in Graft vs Host Disease

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: Skin; Skin rash is almost always seen.

Front 43

achalasia vs scleroderma

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achalasia: lost esophageal tone + increased LES tone
scleroderma: lost ET + decreased LES tone

Front 44

cyclosprin toxicities

Back 44

nephrotoxicity, hyperkalemia, hypertension, gum hertertophy, hirsutism, tremor

Front 45

Pt with RA controlled the pain with indomethacin

Back 45

still use Methotrexate; pain isn't the only problem;

Front 46

DOC for relapsing-remitting MS:

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Interferon Beta

Front 47

pseudogout crystals

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= calcium pyrophosphate dihydrate cyrstals = rhomboid with postive birefringence

Front 48

Pt has persistent nasal congestion & postnasal drip, no eye sx, no triggers, no help from loratidine

course of action

Back 48

Non-Allergic Rhinitis
some help from 1st gen antihistamines, no help from 2nd gen (no anticholinergic properties)
Tx: topical antihistamine or topical glucocorticoid intranasallly, both if necessary

Front 49

Inflammatory Arthritis <2 mo

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: likely infectious
weakly postiive ANA normal in 5% of adults
Tx: NSAIDs

Front 50

azithropine

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diarhrhea, leukopenia, hepatotoxicity

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Mycophenolate

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Marrow suppression

Front 52

Diagnostic Test for Ankylosing Spondylitis

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plain film demonstrating sacroilitis
NB: 1/2 dvlp anterior uveitis: monocular pain, blurring photophobia

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herberden vs Bouchard nodes

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distal & proximal IPJs respectively, boht arte osteoarthritis
Not the Middle

Front 54

sausage digits

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psoriatic arthritis =

Front 55

which chronic hepatitis has arthralgias

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C

Front 56

DOC's for RA:

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Infliximab (Remicade) - TNF inhibitor
Etanercept (Enbrel) - TNF inhibitor
MTX
Hydroxychloroquine

Front 57

Celiac Sprue --> Dermatitis Herpetiformis
DOC

Back 57

DOC: Dapsone; improvement with dapsone is considered diagnostic feature of condition.

Front 58

bullous pemphigoid vs pemphigus vulgaris

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bullous: tense blisters not in mouth; IgG & C3; benign, pruritic
pemphigus vulgaris: flaccid bullae, happen first in mouth; IgG deposidts; autoantibodies vs desmoglein; tx: steroids, immunosuppressants;

Front 59

Late Middle Aged Female w/ Dry mouth & Dry Eyes

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--> Sjogren
Dx: Anti-Ro/SSA Abs or SSB (La)