Term
| What is the classic triad of disseminated gonococcal polyarthritis? |
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Definition
1. polyarthralgia
2. tenosynovitis
3. painless vesiculopustular skin lesions. |
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Term
| What does methotrexate inhibit? |
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Definition
| - dihydrofolate reductase |
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Term
| Pt presents with lower back pain that is worse with walking, and relieved by sitting. In addition, it is easier to walk uphil than downhill. Dx? |
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Definition
- lumbar spinal stenosis
- LSS is MC caused by degenerative joint disease. |
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Term
| Inflammatory symmetric arthritis that resolves within 2 months is due to: |
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Definition
- viral infection
- MCC: parvovirus, hepatitis, HIV, mumps, and rubella. |
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Term
| What is first line treatment for a disk herniation? |
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Definition
| - early mobilization and NSAIDs. |
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Term
| Tennis player presents unable to lift his arm over his head due to pain. It is worse with internal rotation and flexion, and he is without other abnormalities. Dx? |
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Definition
| - Subacromial bursitis. This is the result of repeated overhead motions. The supraspinatus tendon is compressed between the acromion and the humoral head. |
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Term
| AA woman presents with blurred vision, cough, and SOB. For a few days she has had mild fevers, malaise, and easy fatigability. On exam her right eye is red and slit lamp shows leukocytes in the anterior chamber. CXR shows bilateral hilar infiltrates. Dx? |
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Definition
- Sarcoidosis.
- Think AA woman in 3rd and 4th decades. Lungs are MCly involved, but when symptomatic, cough, erythema nodosum, anterior uveitis, and arthritis may be seen.
- Hilar adenopathy, of course. |
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Term
| Degenerative joint disease = |
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Definition
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Term
| What are classic findings of OA on x-ray? |
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Definition
- joint space narrowing
- subchonral sclerosis
- osteophytes |
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Term
| Does enoxaparin prolong the PTT? |
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Definition
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Term
| What is long term use of cyclophosphamide a/w? |
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Definition
| - bladder carcinoma and hemorrhagic cystitis |
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Term
| Pt presents with pain on the medial tibia just below the knee. There is a well-defined area of tenderness, and no redness, warmth, swelling, pain on valgus stress test, or x-ray findings. Dx? |
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Definition
- anderine bursitis.
- The anserine bursa is located anteromedially over the tibial plateau, just below the joint line of the knee.
- May result from abnormal gait, overuse, or trauma.
- Tx: rest, ice, reduced pressure on the bursa. Corticosteroids may help. |
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Term
| I say anti-SSA(Ro) and anti-SSB(La) and you say: |
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Definition
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Term
| Pt presents with dry eyes and dental caries. You think? |
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Definition
| - Sjogren's, and evaluate for Ro and La antiboies. |
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Term
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Definition
= neurogenic arthropathy
- a complication of neuropathy and repeated joint trauma. It affects weight bearing joints and manifests with functional limitation, deformity, DJD and loose bodies on joint imaging. |
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Term
| Pt presents with progressive low back pain and spinal stiffness > 3 months |
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Definition
- investigate for ankylosing spondylitis with an AP x-ray of the sacroiliac joints.
- Fusion of the sacroiliac joints and/or bamboo spine is diagnostic |
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Term
| Why do you follow patients with giant cell arteritis with serial x-rays? |
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Definition
| - Because aortic aneurysms are a major complication. |
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Term
| What is polymyalgia rheumatica? |
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Definition
- PMR is characterized by pain and stiffness in the neck, shoulders, and pelvic girdle in a patient over 50 years with an elevated ESR and morning stiffness lasting over 1 hour.
- The TOC is low dose prednisone.
- NB: PMR commonly occurs in a/w giant cell arteritis. |
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Term
| ________ is required in all patients with new onset lupus nephritis. |
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Definition
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Term
| What is the classical antibody finding in dermatomyositis? |
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Definition
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Term
| Over 10% of patients with DM will develop a __________, most likely ____________. |
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Definition
| - malignancy, ovarian cancer. |
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Term
| Is an acute presentation typical in polymyositis? |
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Definition
| - no, this diesease usually has an insidious onset over years. |
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Term
| What is the best diagnostic study for polymyositis? |
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Definition
- muscle biopsy. This will show a mononuclear infiltrate surrounding necrotic and regenerating muscle fibers.
- In more advanced cases, there may be replacement of muscle with fibrotic tissue. |
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Term
| What disease affecting multiple organ systems can cause proximal muscle weakness? |
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Definition
| - Hyperthyroid/hypothyroid |
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Term
| If the patient is stable, do you ever give hypertonic saline? |
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Definition
| - no. Reserve hypertonic saline for the patient who is seizing, obtunded, or grossly unstable. |
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Term
| What is the first line DMARD in RA? |
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Definition
- methotrexate.
- others include hydroxychloroquine, sulfasalazine, leflunomide, etanercept, infliximab, and azathioprine |
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Term
| Patients with hyperparathyroidism are at increased risk of developing which crystal arthropathy? Why? |
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Definition
- pseudogout, because pseudogout is a deposition of calcium pyrophosphate dehydrate.
- Look for rhomboid shaped, positively birefringent crystals. |
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Term
| Pt presents with recurrent oral ulcers, recurrent genital ulcers, and anterior uveitis. Dx? |
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Definition
- Behcet's syndrome. This is a multi-system inflammatory condition characterized by recurrent oral and genital ulcers, and skin lesions.
- It is seen most commonly in the Turkish, Asian, and middle Eastern population. |
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Term
| Patient who was recently treated for urethral discharge presents with oligoarthritis, and conjunctivitis. Dx? |
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Definition
- Reactive arthritis. This is a seronegative spondyloarthropathy resulting from enteric or GU infection. Findings in reactive arthritis may also include urethritis.
- NSAIDs are the firs line. |
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Term
| Up to 40% of patients with polycythemia vera suffer from _______. |
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Definition
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Term
| Pt presents with months of oligoarthritis, and new onset diarrhea and weight loss. He has generalized lymphadenopathy and non-deforming arthritis. Small bowel biopsy shows PAS positive macrophages. Dx? |
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Definition
- Wipple's disease
- This is a multi-systme d/o characterized by malabsorptive diarrhea, weight loss, migratory non-deforming arthirtis, lymphadenopathy, and low-grade fever.
- Dx made by PAS positive macrophages in the lamina propria.
- T. whippelii is a gram + bacteria. |
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Term
| What two drugs are used in the prevention of gout? |
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Definition
| - Allopurinol and probenecid |
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Term
| What drugs are used during acute attacks of gout? |
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Definition
| - colchicine, NSAIDs, and steroids |
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Term
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Definition
- excessive fluid produciton by inflammed synovium.
- This presents as a tender mass |
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Term
| New mother presents with pain on her radial wrist: |
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Definition
- De Quervain tenosynovitis. This is caused by inflammation of the abductor pollicis longus and extensor pollicis brevis tendons as the pass thorugh a fibrous sheath at the radial styloid process.
- Passive stretching elicits pain (+ Finkelstein). |
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Term
| What does CREST stand for? |
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Definition
Calcinosis cutis
Raynaud's
Esophageal dysmotility
Sclerodactyly
Telangiectasias |
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Term
| What is a leukamoid reaction? |
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Definition
- a marked increase in leukocytes due to a severe infection or inflammation.
- an increased leukocyte alkaline phosphatase (LAP) scoare is typical. |
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Term
| What laboratory vals are elevated in polymyosistis? |
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Definition
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Term
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Definition
| - Inflammation and pain at sites where tendons and ligaments attach to bone. This is most commonly seen in HLA-B27 arthropathies sucha s ankylosing spondylitis, psoriatic arthritis, and reactive arthritis. |
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Term
| What antibodies are seen in primary biliary cirrhosis? |
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Definition
| - anti-mitochondrial antibodies |
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