Step 2 Rheumatology

Front 1

Ankylosing spondylitis

Back 1

seronegative inflammatory arthritis; axial skeleton fusion and SI involvement; forward stooped posture with increased thoracic kyphosis and loss of lumbar lordosis

Front 2

Schober test

Back 2

used to test ROM of lower spine by measuring degree of forward flexion using 2 landmarks on patients back; positive in ankylosing spondylitis

Front 3

Diffuse idiopathic spinal hyperostosis (DISH)

Back 3

calcification on spinal ligaments due to abnormal osteoblastic activity; most common in thoracic spine (linear calcifications and ossification across at least 4 contiguous vertebral bodies)

Front 4

Scheuermann kyphosis

Back 4

idiopathic anterior wedging of vertebral body; thoracic and thoracolumbar spines=rigid kyphosis; wedging of >5 degrees and at least 3 adjacent vertebrae; pain worse after activity, better with rest

Front 5

Stork test

Back 5

stand on one leg and hyperextend back; pain elicited in spondylolisthesis

Front 6

anti-cyclic citrullinated peptide antibodies

Back 6

75% sensitivity and 90% specificity for RA

Front 7

Rheumatoid factor

Back 7

IgG autoantibodies against Fc portion; found in RA, SLE, Sjogren's, hepC

Front 8

Discoid lesions

Back 8

erythematous raised patches with adherent keratosis scaling-extend into dilated hair follicles; occur in 25% SLE on face, neck and scalp-slowly expand with active inflammation on periphery

Front 9

histology of Rheumatoid nodule

Back 9

central necrosis surrounding by pallisading macrophages and lymphocytes; test positive for RF

Front 10

Gottron's papules

Back 10

erythematous to violaceous papules that occur symmetrically over exstensor aspect of metacarpophalangeal and interphalangeal joints; may scale and ulcerate; hallmark of dermatomyositis

Front 11

heliotrope eruption

Back 11

erythematous eruption located on upper eyelids with edema; found in dermatomyositis

Front 12

anti-smith antibodies

Back 12

55-100% specific for SLE; non-histone proteins that interact with RNA; detected in 10-50% SLE; do not correlate with extent of disease (like anti-dsDNA)

Front 13

anti-phospholipid antibodies

Back 13

100% specific for SLE; present in ~1/3 SLE

Front 14

Anti-Jo-1 antibody

Back 14

specific in inflammatory myopathies (polymyositis and dermatomyositis)

Front 15

Anti-Ro antibodies

Back 15

Sjogren's 57%; also seen in SLE, systemic sclerosis, RA, and primary biliary sclerosis

Front 16

anticentromere antibodies

Back 16

CREST/scleroderma

Front 17

anti-Scl-70 (antitopoisomerase I)

Back 17

96% specific for scleroderma (associated with diffuse form=high risk of lung disease)

Front 18

limited scleroderma (CREST syndrome)

Back 18

affects hands, arm, and face; calcinosis, Raynaud's phenomenon, esophageal dysmotility, sclerodactyly, and telangectasia

Front 19

diffuse scleroderma

Back 19

organ involvement plus skin; 90% Raynaud's

Front 20

iron studies in thalassemia

Back 20

normal to high ferritin and normal to low TIBC; target cells

Front 21

kidney in SLE

Back 21

thickened capillary walls (tram-track, then wire-loop)=membranous glomerulonephritis; cortical surface looks flea-bitten

Front 22

T-score osteopenia and osteoporosis

Back 22

T-score of -1 to -2.5 and <-2.5 respecitively

Front 23

fibromyalgia dx

Back 23

pain in all 4 quadrants of body for >3 months and at least 11 of 18 tenderpoints

Front 24

polymyalgia rheumatica

Back 24

severe aching and stiffness in neck, shoulders, and pelvis; no loss of strength; association with temporal arteritis

Front 25

elevated enzymes in dermatomyositis

Back 25

CK and aldolase; associated w/ malignancy

Front 26

Tx sicca syndrome

Back 26

pilocarpine=muscarinic agonist that stimulates all 3 muscarinic receptors and enhances oral/ocular secretions; lacks arthritis (unlike Sjogren)

Front 27

xerostomia and xerophthalmia

Back 27

dry eyes and dry mouth

Front 28

Complex regional pain syndrome

Back 28

pain, swelling, limited ROM, vasomotor instability, skin changes, patchy bone demineralization; often begins after injury

Front 29

Complex regional pain syndrome stage 1

Back 29

dvlp pain in limb; burning/throbbing, sensitivity to touch/cold, localized edema; vasomotor disturbances; x-ray normal, possible patchy bone demineralization

Front 30

Complex regional pain syndrome stage 2

Back 30

progression of soft tissue edema, thickening of skin, muscle wasting; 3-6 months

Front 31

Complex regional pain syndrome stage 3

Back 31

decreased ROM, contractures, waxy trophic skin, brittle ridged nails, severe bone demineralization

Front 32

Complex regional pain syndrome type 1 vs 2

Back 32

1=no definable nerve lesion; 2=definite peripheral nerve injury present

Front 33

Reactive arthritis (aka Reiter disease)

Back 33

aseptic inflammatory polyarthritis; mostly young males; urethritis, conjuntivitis, and arthritis; usually follows STD or enteric infection=Shigella, Campylobacter, salmonella, chlamydia

Front 34

enthesitis

Back 34

inflammation around the bone where ligaments, tendons, and joint capsules insert (especially achilles tendon area)

Front 35

Rx C trachomatis

Back 35

macrolide or tetracycline (doxy)

Front 36

Raloxifene specs

Back 36

mixed agonist (bone)/antagonist (breast/vaginal tissues); increases risk of thromboembolism, breast cancer risk decreases, no effect on endometrial cancer (like tamoxifen)

Front 37

Chronic fatigue

Back 37

persistent/relapsing fatigue>6 months unexplained and not alleviated by rest

Front 38

hydralazine

Back 38

first line anti-hypertensive in pregnancy; causes drug induced lupus

Front 39

causes of drug induced lupus

Back 39

hydralazine, procainamide, quinidine, isoniazid, diltiazem, minocyline

Front 40

syndesmophytes

Back 40

bony growths inside ligaments; seen in ankylosing spodylitis

Front 41

enthesophytes

Back 41

bony projections forming at attachment site for tendons or ligaments formed in response to repetitive stress

Front 42

Whipple's disease

Back 42

gram-pos bacteria; fevers, GI symptoms, joint pains (malabsorption, foul-stools, GI bleeding); tropical

Front 43

porphyria cutanea tarda

Back 43

deficient uroporphyrinogen decarboxylase; blistering of hands, forearms and face-worse in sunlight

Front 44

what precipitates gouty attacks

Back 44

purine-rich substances: alcohol, high protein meals (fish, mussels, meats (organ meats more so)), medicines (thiazide diuretics)

Front 45

osteopetrosis

Back 45

marble bone disease; failure of bone resorption leading to thickening, dense bones prone to fracture-secondary to abnormal osteoclast fxn; serum Ca, phosphate, and ALP normal; erlenmeyer flask deformity on xray

Front 46

polymyositis

Back 46

progressive, systemic CT disorder; 50-70 yo females; increased CK, aldolase, and positive anti-Jo-1-antibodies; Rx high dose corticosteroids or azathioprine and/or methotrexate

Front 47

Felty's syndrome

Back 47

rare, severe subset of RA=RA, splenomegaly, granulocytopenia

Front 48

Caplan syndrome

Back 48

combo of RA and pneumoconiosis that manifests as intrapulmonary nodules

Front 49

neonatal exposure to anti-Ro/SSA or Anti-La/SSB antibodies

Back 49

increases risk of neonatal SLE and causes 60-90% cases of congenital complete heart block=bradycardia, intermittent cannon waves in neck and gallops/murmurs; highest prevalence in Sjogrens