Skin Muscle and Bone > SMB Week 4 > Flashcards

SMB Week 4 Flashcards

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1
Q

Things to ask in a history for arthritic pain, in addition to LOCATES questions:

A
  • Swelling, heat, redness, trauma

- Morning stiffness

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2
Q

Sources of joint pain that are not “true arthritis”:

A
  • referred pain: visceral, neurologic
  • non-articular: muscle bone
  • periarticular: muscle, tendon, tenosynovium, bursa, enthuses, bursa, ligament
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3
Q

Signs of true arthritis:

A
  • swelling/tenderness of entire joint line
  • limited ROM in all directions
  • pain with AROM = PROM
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4
Q

Signs of periarticular pain:

A
  • swelling/tenderness in area around joint
  • limited ROM in some directions
  • pain with AROM > PROM
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5
Q

What factor reliably distinguishes inflammatory vs. non-inflammatory arthritis?

A

Synovial fluid analysis

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6
Q

What do you look for in a synovial fluid analysis?

A
  • volume/appearance/viscosity
  • cell count/differential
  • crystal examination
  • stains/cultures
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7
Q

WBC seen in inflammatory arthritis

A
  • Inflammatory:
    2000 - 75000/mL
    % PMN > 75%
  • Septic:
    > 50000/mL
    % PMN > 90%
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8
Q

Crystals in gout and pseudo gout :

A
  • Yellow “needles” parallel to polarization, blue needles perpendicular = GOUT
  • “rhomboid” blue crystals parallel to polarization, yellow perpendicular = PSEUDO GOUT
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9
Q

What is the most common spondyloarthritis?

A

Ankylosing spondylitis

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10
Q

Which joints are commonly affected in RA?

A
  • MCPs and PIPs

- DIPs not usually affected

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11
Q

Which joints are commonly affected in osteoarthritis of the hands?

A
  • DIPs and PIPs

- MCPs not usually affected

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12
Q

How sensitive and specific is an RF test for RA?

A
  • sensitivity 70 - 85%

- specificity 48 - 92%

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13
Q

“Bamboo spine”

A
  • Ossification of outer fibrous ring of intervertebral disks, seen in severe cases of ankylosing spondylitis
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14
Q

Radiographic findings with advanced gout:

A
  • extra-articular erosions
  • sclerosis
  • “overhanging edge”
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15
Q

Rheumatoid factor:

A
  • Antibody against the Fc portion of IgG antibodies.

- RF/IgG complexes lead to disease

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16
Q

True or false: both rheumatic and non-rheumatic diseases (other than RA) can cause a positive RF test

A

True: numerous infections and non-rheumatic diseases, as well as SLE, Sjogrens and other connective tissue diseases can cause a + RF test.

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17
Q

True or false: a + ANA test is specific to SLE

A

False: although 99% of SLE pts will have a + ANA, many other rheumatic and non-rheumatic diseases will cause it (i.e., it’s sensitive but not specific).

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18
Q

Two tests used with ANA to rule in SLE:

A
  • anti-ds DNA

- anti-Sm

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19
Q

What is HLAB27 used for?

A

Used to help rule out ankylosing spondylitis

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20
Q

How sensitive is the HLAB27 test?

A

95%

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21
Q

True or false: SLE occurs more commonly in Caucasians than in Blacks, hispanics and asians.

A

False

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22
Q

Mnemonic for clinical features of lupus:

A

MD SOAP BRAIN

Malar rash, Discoid rash, Serositis, Oral ulcers, Arthritis, Photosensitivity, Blood Dyscrasias, Renal, ANA +, Immunologic, Neurologic

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23
Q

Musculoskeletal manifestations of SLE:

A
  • Polyarthralgias/polyarthritis
  • Soft tissue pain
  • Myositis
  • Osteonecrosis
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24
Q

What % of SLE patients have renal involvement?

A
  • 100% on biopsy

- 50-65% clinically

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25
Manifestations of SLE serositis:
- Pericarditis - Pleurisy, effusions - Peritonitis
26
Which antibody is seen in almost 100% of patients with drug-induced lupus?
Anti-histone antibody
27
What are the 3 phases of scleroderma?
- Inflammatory edematous phase (few months: non-pitting edema, mistaken for RA) - Fibrotic phase (few years: tightening/thickening/salt & pepper skin, lower oil, sweat production) - Atrophic phase (skin thinning, contractures)
28
Leading cause of death in scleroderma:
Pulmonary hypertension
29
GI Sx in scleroderma:
- esophageal hypomotility (reflux, dysphagia) - bloating, diarrhea & constipation - malabsorption, weight loss - GI bleed due to telangiectasias
30
Another name for GAVE (gastric antral vascular ectasia):
Watermelon stomach
31
Treatment for renal disease in scleroderma:
ACE inhibitors
32
Tx for pulmonary hypertension in patients with scleroderma:
- Parenteral epoprostanol - Bosanten - Iloprost - Sildenafil
33
CREST Syndrome in scleroderma:
``` C: calcinosis R: Raynaud's phenomenon E: Esophageal dysmotility S: Sclerodactyly T: Telangiectasias ```
34
Sjogren's syndrome:
- Inflammatory d/o of the exocrine glands - Lymphocytic infiltration of salivary and lacrimal glands - progressive glandular destruction
35
Antibodies seen in Sjogren's syndrome:
SSA and SSB
36
Acute vs. chronic arthritis:
37
Mono vs. oligo vs. polyarthritis:
- Mono = 1 joint - Oligo = 2 - 4 joints - Poly = > 4 joints
38
Polymyalgia rheumatica:
- Proximal muscles (shoulders, hips, neck, thighs) - fever, weight loss, malaise - profound morning stiffness - almost exclusively in whites > 50 - ESR > 50 mm/hr.
39
Treatment for polymyalgia rheumatica:
- Prednisone 7.5 - 20 mg/day - Start low, increase dose until Sx controlled, then maintain 2 - 4 weeks - Reduce dose 10% q 2 - 4 weeks - Once below 10 mg/day, reduce max 1%/month - May use MTX as well
40
What serologic test is used for vasculitis, especially small vessel vasculitis?
ANCA
41
Clinical features suggesting vasculitis:
General: - multiple organ dysfunction - constitutional Sx - high ESR - Ischemia Organ Specific: - Rapidly progressing organ dysfunction - Skin: palpable purpura/hemorrhage - Neurologic change: foot drop, mono neuritis multiplex - ENT/lung: chronic inflammation
42
Manifestations of AAV:
- constitutional Sx - migratory arthritis/arthralgia - GI: bowel infarction, bleeding, perforation - skin: leukocytoclastic vasculitis et al. - neurologic: mononeuritis multiplex - glomulonephritis - granulomatous inflammation of respiratory tract - ocular Sx
43
Mononeuritis multiplex:
Loss of both sensory and motor function in a major nerve/plexus/root.
44
Tests suggesting immune complex formation/deposition:
- RF - ANA - Low C3, C4
45
Tests suggesting vasculitis without immune complex deposition:
ANCA - c-ANCA: Granulomatosis with polyangitis, AKA Wegener's - p-ANCA: Churg-Strauss and microscopic polyangitis
46
Tests suggesting systemic inflammation:
- CRP | - ESR
47
True or false: most patients with clinical signs and symptoms of vasculitis DO NOT have vasculitis
True: vasculitis is rare
48
Red flags suggesting vasculitis mimics:
- heart murmur - lower extremity digit necrosis - splinter hemorrhages - liver dysfunction - sexual activity/drug use - high fevers - prior cancer Hx
49
Viral infections that mimic rheumatic and vasculitic syndromes:
- HCV: cryoglobulinemia - HBV: polyarteritis nodosa - HIV: seronegative rheumatic syndromes
50
Drugs that can cause hyperuricemia:
- Thiazide diuretics - Ethambutol (TB) - Nicotinic acid (niacin) - alcohol - others (salicylates, cyclosporines, et al.)
51
Clinical diagnosis of gout:
Combination of crystals, tophi and/or 6 or more criteria.
52
1st line treatment for gout:
- NSAIDS - Systemic corticosteroids - Colchicine
53
When is colchicine the 1st line Tx for gout?
- Onset no greater than 36 hours prior to treatment | - Unable to take NSAIDS
54
MOA for colchicine:
- decreases leukocytes mobility | - reduces deposition of uric acid crystals
55
Side effects of colchicine:
- NVD very common (50 - 80%) - bone marrow toxicity - contraindicated in patients with: hepatobiliary dysfunction, hemodialysis, blood dyscrasias
56
Drug interactions with colchicine:
- CYP3A4 inhibitors - clarithromycin - cyclosporine - statins - others
57
Which combination treatment should you NOT use for gout?
NSAIDS + systemic corticosteroids
58
1st line treatment for prophylaxis of gout:
allopurinol
59
MOA of allopurinol:
- xanthine oxidase inhibitor | - blocks last 2 steps of uric acid synthesis
60
Axial vs. peripheral spondyloarthritis
Axial: - predominantly involves the spine +/- peripheral joints Peripheral: - predominantly involves the peripheral large joints
61
5 diseases of spondyloarthritis:
- ankylosing spondylitis (spine is a must, often peripheral as well) - psoriatic arthritis (mostly peripheral) - reactive arthritis (mostly peripheral) - IBD related arthritis (mostly peripheral) - uveitis related arthritis (mostly peripheral)
62
Spondyloarthritis is defined by the inflammation of which joints?
Sacroiliac
63
What is the hallmark of spondyloarthritis?
Enthesitis/tendinitis
64
What is radionuclide scintigraphy used for?
- Detecting inflammatory or metabolic alterations in bone or periarticular soft tissue structures. - Works by using radioactive molecules, which are preferentially taken up by certain inflammatory or pathological cells.
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