Term
| Rupture of the central slip of a digital extensor tendon at the middle phalanx, marked by extension of the MCP and DIP joints and flexion of the PIP joints. Seen in what dz? |
|
Definition
|
|
Term
| 4 classic signs of inflammation |
|
Definition
Calor - heat
Dolor - pain
Rubor - redness
tumor - swelling |
|
|
Term
| Small nodules located at the DIP joint, is a calcified spur of the joint cartilage associated with OA. |
|
Definition
|
|
Term
| Bony outgrowths, usually found around a joint. it is commonly seen in DJD |
|
Definition
|
|
Term
| Disorder characterized by episodic digital ischemia, manifested clinically by the sequential development of digital blanching, cyanosis, and rubor of the fingers or toes following cold exposure and subsequent rewarming |
|
Definition
|
|
Term
| The connective tissue membrane that lines the cavity of a synovial joint and produces the synovial fluid. it lines all internal surfaces of the cavity except for the articular cartilage of the bones. Inflammation of this lining called ____ is the major manifestation of RA. |
|
Definition
|
|
Term
| A characteristic hand deformity seen in ___ that involves hyperextension of the PIP and hyperflexion of the DIP |
|
Definition
|
|
Term
A nodular deposit of monosodium urate monohydrate crystals wtih an associated foreign body reaction. associatd wtih gout. often seen in fingers, eyelids, and ears.
must be differentiated from bursitis and rheumatoid arthritis |
|
Definition
|
|
Term
| bony inflammation on the PIP, characteristic of OA |
|
Definition
|
|
Term
| What are some radiographic findings of OA |
|
Definition
bony sclerosis
loss of cartilage
osteophytes
|
|
|
Term
What dz? Radiographic findings:
Not helpful early in dz
tends to be symmetric involvement
loss of bone (juxta-articular erosion)
Joint space narrowing, loss of cartilage after months |
|
Definition
|
|
Term
| What is the purpose of doing radiographs for RA? |
|
Definition
| to evaluate the extent of damage so we know what treatment approach we need to take |
|
|
Term
What dz? Radiographic findings:
Calcinosis - subcutaneous deposit
pulmonary fibrosis
upper esophageal and GI issues - small bowel obstruction, esophageal dismotility |
|
Definition
| limited scleroderma (CREST) |
|
|
Term
What dz? Radiographic findings:
Pulmonary fibrosis |
|
Definition
|
|
Term
What dz? Radiographic findings:
asymmetrical joint swelling
subcortical cysts w/o erosions
juxta-articular erosions
spicules
soft tissue masses |
|
Definition
|
|
Term
What dz? Radiographic findings:
chondrocalcinosis (halo-looking in joint space), often in wrists, shoulders, and knees. |
|
Definition
|
|
Term
What dz? Radiographic findings:
lung involvement:
- infiltrates that may be cavitating
- nodules
- pleuritis
- obstruction with atelectasis from fibrous scarring
angiogram abnormality:
- the "skipping" look of narrowing and widening |
|
Definition
|
|
Term
What dz? Radiographic findings:
- Bamboo spine with syndesmophytes
- sclerosis of SI joints - sacroilitis |
|
Definition
|
|
Term
| What are some indications for screening for rheumatoid factor? |
|
Definition
RA and Sjogren's syndrome
Screens for inflammatory disease but is not specific |
|
|
Term
| What are some conditions that could show positive Rh factor? |
|
Definition
RA
Sjogren's
COPD
HCV
lupus
elderly
Hep C |
|
|
Term
____ is the initial screening for inflammation. It is a measure of how far the top of the RBC layer has fallen in a tube of blood in one hour. When inflammation is present the high proportion of fibrinogen in the blood causes RBCs to stick to each other and form stacks that settle faster.
In what diseases would this be elevated?
If this is >100, think what dzs?
If this is markedly decreased, think what dzs? |
|
Definition
sed rate
temporal arteritis
polymyalgia rheumatica
giant cell arteritis
SLE
RA
Chronic kidney dz
>100:
PMR/GCA
Wegener's
Leukemia
lymphoma
renal insufficiency
cacner
decreased:
polycythemia
sickle cell
hereditary spherocytosis
chf |
|
|
Term
| How do you determine the normal sed rate for a pt? |
|
Definition
| divide their age by 2 - will be the upper limit of their ESR |
|
|
Term
Joint fluid analysis:
Fluid color:
Transparent = ?
Translucent = ?
Opaque = ? |
|
Definition
transparent = noninflammatory
translucent = mild inflammation
opaque = purulent effusion |
|
|
Term
Joint fluid analysis:
White cell count:
<2,000 = ?
2,000-75,000 = ?
>100,000 = ? |
|
Definition
<2000 = non-inflammatory
2000-75000 = inflammatory
>100,000 = purulent |
|
|
Term
| How can you tell the difference between gout and pseudogout? |
|
Definition
On microscopic exam:
Gout - negative birefringent monosodium urate crystals
psuedogout - positive birefringent calcium pyrophosphate crystals |
|
|
Term
| When would you do a serum uric acid test? |
|
Definition
screening for gout
following uric acid levels of pts on allopurinol (uloric) or probenecid |
|
|
Term
| when would you do a urine uric acid test? |
|
Definition
| to determine if the pt has under or over secretion of uric acid |
|
|
Term
| What are some causes of uric acid level elevation/ |
|
Definition
gout (although 25% of gout pts do not have elevated levels)
diuretics
low dose aspirin
alcohol |
|
|
Term
What test?
measures proteins that help fight infection but measuring how the compliment system (C3 & C4) are functioning.
Used to screen for autoimmune diseases, especially lupus.
Helps to distinguish chronic dz from more acute processes |
|
Definition
|
|
Term
| Pt presents with joint pain, skin rash, fatigue. You suspect lupus. What drug would you prescribe to prevent flare ups and major organ involvement? |
|
Definition
| hydroxychloroquine (plaquenil) |
|
|
Term
| Severe lupus (CNS involvement, significant arthritis, major organ invovlement). What therapy? What are some considerations of this treatment? |
|
Definition
Steroids (prednisone, methotrexate, leflunomide)
Methotrexate: must be off for 3 mos before pregnancy
Leflunomide: long half life, persists in pts for years. must be off drug for 2 years or be detoxed before pregnancy. |
|
|
Term
| What is the first FDA approved drug for SLE in 56 years? |
|
Definition
|
|
Term
What dz?
spontaneous abortions
thromboses
thrombocytopenia
livedo reticularis (lacy veins underneath skin, usually around arms, elbows, knees)
hypercoagulability
Often associated with Lupus
If thrombosis is present in this dz, what treatment? |
|
Definition
APA syndrome
coumadin with INR between 3&4, as long as platelets are >50,000 |
|
|
Term
| If a pt is in catastrophic APA syndrome, what should be done? |
|
Definition
Treat with pulse solumedrol, IV cytoxan, and rituxan
Tx must begin immediately as death or loss of limbs/organs can occur |
|
|
Term
1. Inflammation in muscles
2. inflammation in muscles + skin involvement
3. Pt with connective tissue disease (CTD) and myositis
4. Muscle inflammation that is not responsible to treatment |
|
Definition
polymyositis
dermatomyositis
myositis associated with CTD
inclusion body myositis |
|
|
Term
| Pt with symmetric proximal muscle weakness (no pain). May have fever, chills, sweat, fatigue, dysphagia, pulmonary and cardiac symptoms and periorbital edema. Dx? |
|
Definition
|
|
Term
| Pt with proximal muscle weakness and a heliotrope rash |
|
Definition
|
|
Term
| Typical rahses of myositis. |
|
Definition
heliotrope
gottron's papules (on knuckles)
sun-sensitive rash |
|
|
Term
| What's the biggest difference between the skin rash of lupus v. myositis? |
|
Definition
myositis (gottron's papules or heliotrope rash) tend to appear on knucles or around eyes
|
|
|
Term
Pt presents with muscle weakness & rash.
EMG shows abnormalities
Muscle enzymes: elevated CPK (18,000), serum aldolase, SGOT
Muscle biopsy: perivascular infiltrate of inflammatory cells (lymphocytes)
Dx? What dz should definitely be ruled out?
Tx? |
|
Definition
myositis
R/O inclusion body myositis
Tx: steroids (immediate relief), methotrexate & azathiprime (long term). Rituximab if methotrexate and azo fail
sgot & AST are liver enzymes |
|
|
Term
| Components of a normal joint |
|
Definition
Water (70%)
Cartilage (70% water)
Type II collagen
Proteoglycans (nutrients of cartilage = glucosamine, chondroitin)
Chondrocytes (make proteoglycans. rarely regnerate after injury)
synovium & synovial fluid (lubrication and blood supply) |
|
|
Term
| Changes of synovium in RA? |
|
Definition
| becomes very much thicker |
|
|
Term
| Where are two places where RA could definitely not occur? |
|
Definition
| DIPs and back (no synovium) |
|
|
Term
| classic systemic symptoms of rheumatoid dz |
|
Definition
fever/chills
rash/photosensitivity
dry eyes/mouth
stomatitis
raynaud's
pleuropericardial |
|
|
Term
| Possible ddx if one joint is involved |
|
Definition
septic arthritis (worst case scenario - think of this first)
crystal dz
DJD
traumatic effusion (injury) |
|
|
Term
|
Definition
RA (most common)
spondyloarthropathies (ankylosing spondylitis, reiters)
undifferentiated CTD (lupus, sjogrens)
DJD
crystal dz (less likely than monoarticular) |
|
|
Term
|
Definition
back strain (most common)
Lumbar disc herniation (radiant, pos straight leg raise)
scoliosis (young women)
spinal stenosis (pseudoclaudication)
OA |
|
|
Term
|
Definition
subacromial bursitis (tender on raising arm)
Adhesive capsulitis (AROM & PROM limitation)
OA
rotator cuff
bicipital tendonitis (tender in front, on resisted rotation) |
|
|
Term
|
Definition
anserine bursitis
prepatellar bursitis
baker's cyst (OA and RA)
chondromalacia patella
OA of knee |
|
|
Term
|
Definition
OA
trochanteric bursitis (classically hurts at night)
referred pain from back |
|
|
Term
| Primary v. secondary sjogren's |
|
Definition
Primary: dry eyes/dry mouth, common in older women
secondary: associated wtih another CTD |
|
|
Term
| What dz? common in older women and often seen with other autoimmune conditions. Characterized by an infiltration of lymphoid cells in the lacrimal & salivary glands |
|
Definition
|
|
Term
| Pt wtih pos schirmer test, rose bengel staining, lymphocyte infiltration in salivary glands, and pos SSA/SSB (or RA or ANA) test. Dx? |
|
Definition
|
|
Term
| extraglandular symptoms of ____ include fatigue, synovitis, rashes, vasculitis, biliary cirrhosis, renal tubular acidosis, pancreatic insufficiency |
|
Definition
|
|
Term
Tx for what dz?
salagen/evoxac
tear duct ablation
plaquenil
nsaids |
|
Definition
|
|
Term
| Sjogren's pts are at risk for what serious disease? |
|
Definition
|
|
Term
What dz?
chronic multi-system disease involving the skin, lungs, and GI tract as well as the renal system. Widespread small vessel vasculopathy (vessel scarring) and fibrosis are present. |
|
Definition
|
|
Term
Possible environmental causes or triggers for ____:
bleomycin
vinyl chloride
contaiminated tryptophan
trichloroethylene
silicone
epoxy resins |
|
Definition
|
|
Term
| ___ is typically seen 5-10 years before the other symptoms of CREST |
|
Definition
|
|
Term
|
Definition
Calcinosis (subq calcium deposit)
Raynaud's
Esophageal dysmotility
Sclerodactyly
Telangiectasias |
|
|
Term
What dz?
40% 10 year survival
Anti-SCL 70 antibody
diffuse skin involvment (swelling and stiffnes of fingers and skin above wirst)
major organ invovlemnt (renal vasospasm, CHF and arrythmias, pulmonary fibrosis)
raynauds
polyarthralgias common
flexion contractures common
friction rubs = poor prognosis
upper and lower GI dysmotility
Labs: SCL70 antibody, RA factor +, ESR normal, mild increase in IgG |
|
Definition
|
|
Term
What dz?
70% 10 year survival
anticentromere antibody
raynauds
sclerodactyly to wrists
scleroderma on hands and mouth ('pursed mouth')
telangiectasias
pulmonary htn (late in dz)
esophageal dysmotility |
|
Definition
| CREST (limited scleroderma) |
|
|
Term
|
Definition
calcium channel blocker for raynaud's
ACE inhibitors for renal crisis
steroids for myositis
NSAIDS or plaquenil for synovitis
cyclophosphamide for pulmonary fibrosis
viagra, iloprost, tracleer for pulmonary htn |
|
|
Term
|
Definition
|
|
Term
| Why is it bad to do a skin biopsy of scleroderma? |
|
Definition
| skin won't heal from where biopsy was taken |
|
|
Term
| Heberden's and bouchard's nodes are seen in what dz? |
|
Definition
|
|
Term
___ arthritis affects upper neck (C1-3)
___ arthritis affects lower neck (C5-7) |
|
Definition
|
|
Term
|
Definition
exercise!
lose weight
glucosamine/chondroitin
NSAIDS
joint injections (G-F 20, steroids, hylan products)
|
|
|
Term
| two biggest complications of NSAIDS |
|
Definition
|
|
Term
| what are some ways to protect the GI tract while taking NSAIDs |
|
Definition
Cox-2 NSAIDs (celebrex)
NSAID + PPI (prilosec, prevacid)
NSAID + misoprostol
NSAID + H-2 blocker (pepsid) |
|
|
Term
|
Definition
| something about checking for organ fxn/GI bleed in pts taking NSAIDs |
|
|
Term
| Elevated CRP & ESR, leukocytosis, pos rheum factor, neg CCP. Artery biopsy shows acute infiltration with polymorphonuclear leukocytes and fibroid necrosis. Angiogram reveals areas of tapering with areas of occlusion and aneurysm. What dz? |
|
Definition
|
|
Term
| in what diseases is there an HLA-B27 association/ |
|
Definition
ankylosing spondylitis (mainly)
reiters syndrome
acute anterior uveitis
reactive arthritis
psoriatic spondylitis
7% of dz-free people |
|
|
Term
| ____ is a disease-specific autoantibody marker for RA (98% specific). It can be detected before the onset of the disease and the higher it is, the more aggressive the dz. |
|
Definition
|
|
Term
| What are some risk factors for gout? |
|
Definition
men
>50
Post-menopausal women
DM
Htn
Hyperlipidemia
g |
|
|
Term
| 90% of gout is due to ____. 10% is due to ____. |
|
Definition
undersecretion of uric acid
overproduction of uric acid
determined by 24 hour urine test: Low levels of uric acid in urine = undersecreter
high levels = overproducer |
|
|
Term
| 36 y/o female pt presents wtih fatigue, fever, cutaneous rash, synovitis, joint swelling, oral ulcerations and pleuritis/pericarditis. Dx? |
|
Definition
|
|
Term
| Pts with gout caused by overproduction absolutely require ___ long term |
|
Definition
|
|
Term
| what are two drugs to treat gout that block uric acid synthesis? |
|
Definition
|
|
Term
| What is lesh-neheim syndrome? |
|
Definition
| a congenital condition in which the pt is missing an enzyme higher up in the uric acid chain so that they cannot make uric acid |
|
|
Term
| what drug can be given to pts with gout and pseudogout to paralyze microtubules of WBCs so that they can't migrate to the site of infection and cause pain? |
|
Definition
colchicine
pts with gout respond more quickly than pt with pseudogout |
|
|
Term
| excessive Th cell activity with low Tc cell activity that results in B cell proliferation and autoantibody production. Which dz? |
|
Definition
|
|
Term
| Chondrocalcinosis, positively birefringent rod-shaped crystals, occuring in a knee with OA. What dz? |
|
Definition
|
|
Term
| in what dz may the pt complain of "walking on rocks" because the MTP has dropped? |
|
Definition
|
|
Term
| what disease could present with a saddlenose deformity? |
|
Definition
|
|
Term
| CBC results; low WBC, RBC, and platelets. Hypergammaglobulinemia on quantitative Ig count. High ANA. What dz is most likely? |
|
Definition
|
|
Term
| Pt presents with localized skin rxn mainly on face, scalp, arms, and upper anterior chest (sun-exposed areas). ANA negative. May present as serpiginous or malar rash. What dx? How would you treat it? |
|
Definition
cutaneous (discoid) lupus
topical steroids first
plaquenil, thalidomide, leflunomide (DMARD) |
|
|
Term
| A baby is born with leukopenia, skin rash, thrombocytopenia, and congenital heart block. What would you expect the mother's blood to be positive for? |
|
Definition
SSA
(baby has neonatal lupus) |
|
|
Term
| what drugs are responsible for drug-induced lupus |
|
Definition
| hydralazine, phenytoid, isoniazid, and TNF blockers. sulfa drugs will exacerbate it. |
|
|
Term
| Wht are some systemic complications of lupus? |
|
Definition
| renal dz, neurological dz (stroke, depression, CNS vasculitis), hematologic dz (hemolytic anemia, leukopenia, thrombocytopenia) |
|
|
Term
| 58 y/o pt presents with a 5 day hx of temporal headaches, scalp tenderness, jaw claudication, visual impairment, and arm claudication. ESR = 104, CRP is elevated, LFT elevated. Temporal artery biopsy abnormal. Dx? Tx? |
|
Definition
giant cell arteritis
high dose steroids for at least a month
immunosuppression (azathioprine, methotrexate) |
|
|
Term
| Pt with lupus develops proteinuria and low serum albumin. What dx? |
|
Definition
| membranous glomerulonephritis |
|
|
Term
| What drug should all lupus pts be on? |
|
Definition
|
|
Term
| What are some ddx if a pt thinks they have fibromyalgia? |
|
Definition
vit d deficiency
hypothyroidism
polymyalgia rheumatica |
|
|
Term
| nutritional advice for fibromyalgia pts |
|
Definition
eat at least 3 meals/day with protein
avoid caffeine
avoid nutrasweet
drink 6-8 glasses/day
lose weight
exercise |
|
|
Term
| Drugs for fibromyalgia pts |
|
Definition
tricyclics
SNRIs
SSRIs
NSAIDS
muscle relaxants |
|
|
Term
| Average age of onset for RA |
|
Definition
|
|
Term
|
Definition
four or more of the following:
morning stiffness >1 hour
arthritis of at least 3 joints
arthritis of hands (mcp, pip, wrist)
symptomatic swelling
serum rheumatoid factor +
rheumatoid nodules
radiographi cchanges |
|
|
Term
| Extra articular involvement in RA |
|
Definition
Eye involvement (dry eye, vision loss due to scleritis)
pulmonary involvement (pleuritis, pleural effusion, RA nodules in lungs)
Vasculitis
Subcutaneous nodules
felty's syndrome (splneomegaly, low platelet cout, low WBC count) |
|
|
Term
Hyperflexed PIP and hyperextended DIP
Hyperextended PIP and hyperflexed DIP |
|
Definition
|
|
Term
| if you suspect RA, what are the first 3 tests you shuld get? |
|
Definition
|
|
Term
| A 67 y/o pt presents after waking up this morning and being so stiff he couldn't move his hip or shoulder. Pt has pain and systemic symptoms. Labs: elevated ESR and CRP. Dz? Tx? |
|
Definition
polymyalgia rheumatica
low dose steroids initially, then plaquenil
usually resolves in 6 mos to 32 years |
|
|
Term
| What dz may preent with a sed-rate >100? |
|
Definition
polymyalgia rheumatica
giant cell arteritis
wegener's granulomatosus
leukemia
lymphoma
renal insufficiency
mes in bone |
|
|
Term
| 10-15% of the time, polymyalgia rheumatica progresses to ____ |
|
Definition
|
|
Term
| 36 y/o male presents wtih frequent sinus infections, interstitial pneumonitis, and glomerulonephritis. Pulmonary biopsy reveals langerhaus cells. What dz? What is the first test you would do to confirm the dx? what tx? |
|
Definition
| Wegener's granulomatosus (classic triad of upper resp tract involvment, lower resp tract involvment, and renal involvement). Do serum ANCA (antineutrophil cytoplasmic antibody test). Steroids first, then cyclophospamide, methotrexate, or azathiprine |
|
|
Term
| serious and usually fatal dz that can involve any organ except the skin (and not usually the lungs) |
|
Definition
|
|
Term
Pt with pos rheumatoid factor and neg CCP, think what dz?
pt wtih pos rheumatoid factor and pos CCP, think waht dz? |
|
Definition
|
|
Term
| What is the first choice drug for RA? what other substances should it always be used wtih? |
|
Definition
methotrexate
always use with folic acid
while on methotrexate, get CBC every 4-8 weeks, liver enzymes every 4-8 weeks, and renal fxn every 6 mos - due to its many sometimes serious effects |
|
|
Term
| What is a good choice for mild RA? |
|
Definition
|
|
Term
| what are these drugss? etanercept, infliximab, adalimumab, anakinra |
|
Definition
| biologic dmards (TNF or IL inhibitors). most of them work well when combined with methotrexate but they are very expensive and have possible serious side effects like reactivation of latent TB |
|
|
Term
|
Definition
| measure of fxn in pts wtih RA |
|
|
Term
|
Definition
|
|
Term
|
Definition
| inflammation where the tendons and ligaments attach |
|
|
Term
| definite or probable AS in a pt negative for HLAB27 & neg for psoriasis: think what dz? |
|
Definition
| spondyloarthropathy associated with IBD |
|
|
