Reading...
Play button
Play button
Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
96 Cards in this Set
- Front
- Back
|
Inflammatory joint patterns (3)
|
RA
SLE Gout |
|
|
Noninflammatory joint patterns (1)
|
OA
|
|
|
Monoarticular joint patterns (3)
|
Gout
Septic arthritis Lyme |
|
|
2-4 joints affected (3)
|
Reiter's
Psoriatic IBD |
|
|
>5 joints affected (2)
|
SLE
RA |
|
|
DIPs affected (1)
|
OA
|
|
|
MCPs/Wrists affected (2)
|
RA
SLE |
|
|
1st MTP affected (1)
|
Gout
|
|
|
RA Dx test (2)
|
CCP
RF |
|
|
Normal color of synovial fluid
|
Straw colored
|
|
|
What does a very high LDH indicate?
|
Tumors
Cell membranes are being lysed |
|
|
Infection indicated by synovial fluid
|
Gonorrhea
|
|
|
Inflammatory response indicated by synovial fluid
|
RA
|
|
|
Acute onset, typically nocturnal
Hyperuricemia Tophi |
Gout
|
|
|
Calcium pyrophosphate
Large joints, such as knees and wrists, affected |
Pseudogout
|
|
|
Pseudogout Crystals (3 Ps)
|
Calcium Pyrophosphate
Prism shaped crystals Positive birefringence |
|
|
Gout Crystals
|
Uric acid crystals
Needle shaped crystals Negative birefringence |
|
|
Hyperuricemia treatment
|
Allopurinol
|
|
|
Pneumonic for Allopurinol v. Colchicine
|
Patients with gout take Allopurinol ALL the time (prevents attacks)
Colchicine is for acute treatment |
|
|
Acute Treatment of Gout
|
NSAIDs: Indomethacin 25-50mgm every 8 hours (any Cox 1 or Cox 2)
Colchicine Corticosteroids for pts unable to take NSAIDs |
|
|
Management of Gout (4)
|
Low-purine diet
Manage obesity Decrease ETOH Stop offending meds |
|
|
Medications that aggrevate gout (4)
|
Thiazides
Loops INCREASE low dose ASA Niacin |
|
|
Drugs used to prevent gouty attacks (2)
|
Probenicid
Allopurinol |
|
|
Probenicid Contraindications
|
Pts must have urinary output >2 liters/day
Avoid in pts with uric acid lithiasis |
|
|
Allopurinol Contraindications
|
May cause rash with toxic epidermal necrolysis
Can kill kidney and liver |
|
|
Major SE of Colchicine
|
Gastro problems (diarrhea)
|
|
|
Symmetric joint swelling with redness, warmth, tenderness and pain with movement
|
RA
|
|
|
Joints affected by RA (5)
|
PIPs
MCPs Knees Ankles Toes |
|
|
3 RA deformaties
|
Ulnar deviation
Boutonnaire's Swan neck |
|
|
RA X-ray changes
|
Earliest changes in wrists or feet
Juxta-articular demineralization Erosions |
|
|
RA Tx Options (2)
|
NSAIDs
DMARDs |
|
|
Types of DMARDs (4)
|
Methotrexate
Tumor necrosis factor inhibitors Corticosteroids Azathioprine |
|
|
Treatment of choice for RA after NSAIDs
|
Methotrexate
|
|
|
4 SEs of Methotrexate
|
Gastritis
Stomatitis Interstitial pneumonitis Folate antagonis (not for pregnancy) |
|
|
Use after failure of or in combo with Methotrexate in treatment of RA
|
Tumor necrosis factor inhibitors
|
|
|
2 types of Tumor necrosis factor inhibitors
|
Etanercept (only one that doesn't end in -imab)
Infliximab |
|
|
Tumor necrosis factor inhibitor SEs (2)
|
Leukopenia
Reactivation of latent TB |
|
|
SEs of longterm corticosteroid use (6)
|
Avascular necrosis
Gastritis/ulcers Cataracts Immunosuppression Cushing's syndrome Osteoporosis |
|
|
Discoid skin lesions
Pericarditis, pleuritis Renal disease Neurologic disease Joint pain, swelling Malar rash |
SLE
|
|
|
Best SLE lab
|
ANA
|
|
|
SLE management
|
Antimalarials (hydroxychloroquine)
Prednisone |
|
|
Mainstay of SLE therapy
|
Prednisone
|
|
|
Antimalarial used to treat SLE
|
Hydroxychloroquine
|
|
|
SE of Hydroxychloroquine
|
Pigmentary retinitis (opth exam every 6-12 months)
|
|
|
3 drugs that induce SLE
|
Procainamide
Hydralazine Isoniazid |
|
|
SLE + anemia
|
Anemia of chronic disease
|
|
|
SLE + VDRL
|
May be false positive
|
|
|
Usually associated with RA, SLE, or other connective tissue disease
|
Sjogren's
|
|
|
4 positive lab tests in Sjogren's syndrome
|
ANA
RF AntiSSA AntiSSB |
|
|
Dry eyes, burning, and dryness of the mouth
|
Sjogren's
|
|
|
Lymphocytic invasion of lacrimal and salvary glands
increased incidence of lymphoma |
Sjogren's
|
|
|
Systemic sclerosis
|
Scleroderma
|
|
|
Autoimmune squamous cell destruction
|
Scleroderma
|
|
|
Skin becomes so thick pt cannot close eyes
|
Scleroderma
|
|
|
Scleroderma of face and hands only
|
CREST:
Calcinosis Raynaud's phenomenon Esophageal dysmotility Sclerydactyly Telangiectasias |
|
|
RF negative
ANA negaitive HLA-B27 positive |
Seronegative Spondyloarthropathies
|
|
|
Seronegative Spondyloarthropathies (4)
|
Ankylosing spondylitis
Reiter's syndrome Psoriatic arthritis Colitic arthritis |
|
|
Reiter's syndrome pneumonic
|
Can't sleep
Can't see Can't pee Can't sleep with me |
|
|
Urethritis
Conjunctivitis/uveitis Arthritis Follows GI infection or Chlamydia |
Reiter's syndrome
|
|
|
Assymmetric, sausage appearance of fingers and toes
SI joint disease common |
Psoriatic arthritis
|
|
|
RF negative
ESR elevated |
Psoriatic arthritis
|
|
|
Common in patients with IBD
|
Colitic arthritis
|
|
|
Most common extra-intestinal manifestation of IBD after anemia
|
Colitic arthritis
|
|
|
Colitic arthritis Tx
|
Treat intestinal inflammation to help control arthritis pain
|
|
|
Large artery syndromes (temporal arteries, aorta)
|
Giant cell/temporal artritis
Takyasu's |
|
|
Medium artery syndromes (not lungs)
|
Polyarteritis nodosa
Kawasaki's disease |
|
|
Small artery syndromes (kindeys and lungs)
|
Wegener's
Microscopic polyangitis Behcet's syndrome |
|
|
Fever, malaise, anorexia, HA, jaw claudication, scalp tenderness
|
Termporal arteritis/giant cell arteritis
|
|
|
Temporal arteritis/giant cell arteritis associated with
|
Polymyalgia rheumatica
|
|
|
Tender, inflamed, cordlike temporal arteries
Absent pulse Optic neuropathy (monocular blindness) |
Temporal arteritis
|
|
|
Temporal arteritis Dx
|
Temporal artery biopsy
|
|
|
Temporal arteritis Tx
|
Prednisone 60-120 mgm PO QD
Do not delay for biopsy |
|
|
17x more common in patients with history of temporal arteritis
|
Thoracic aneurysm
|
|
|
Young women whose arteries become mush
|
Takyasu's arteritis
|
|
|
Aortic arch and abdominal aorta (including renal arteries) affected
Fever, malaise, weight loss, arthralgias, erythema multiforme Pulseless disease |
Takyasu's arteritis
|
|
|
Takyasu's arteritis Tx
|
Steroids
|
|
|
Medium sized muscular vessels (not lungs) imflamed
Common in middle aged men with Hep B |
Polyarteritis Nodosa
|
|
|
Meds that can cause Polyarteritis nodosa (3)
|
Sulfa
Gold Peniciamine |
|
|
All organ systems but lungs inflammed
Acute MI, HTN, abdominal pain, GI hemorrhage/infarct Elevated ESR Normochromic, normocytic anemia |
Polyarteritis nodosa
|
|
|
Polyarteritis nodosa Dx
|
Biopsy specimen
|
|
|
c-ANCA positive
|
Wegener's granulomatosis
|
|
|
Middle aged caucasian with necrotizing granulomatous vasculitis of small arterioles and capillaries
|
Wegener's granulomatosis
|
|
|
Wegener's granulomatosis Triad
|
Upper respiratory symptoms
Lower respiratory symptoms Focal segmental glomerulonephritis |
|
|
Epistaxis
Recurrent sinusitis Rhinorrhea refractory to treatment Crusting ulcerceration of nasal mucosa Granulomas on CXR |
Wegener's granulomatosis
|
|
|
Saddle nose deformity
|
Wegener's granulomatosis
|
|
|
Iritis v. optic neuritis
|
Autoimmune disease = iritis
MS = optic neuritis |
|
|
Oral and genital ulcers
Iritis Polyarthralgias Dementia, parkinsonism |
Behcet's Disease
|
|
|
Behcet's disease Tx
|
Prednisone
|
|
|
Elder with pain and stiffness of shoulder and pelvic girdle but no weakness
|
Polymalgia rheumatica
|
|
|
Disease associated with Polymyalgia rheumatica
|
Giant cell arteritis
|
|
|
Inflammatory myopathies (dermopathies)
Heliotrope rash (purple rash over eyelids and chest) Proximal muscle weakness Elevated CK Increased risk of malignancy |
Polymyositis/dermatomyositis
|
|
|
Purple rash over eyelids and chest
|
Heliotrope rash
|
|
|
Heliotrope rash
|
Polymyositis/Dermatomyositis
|
|
|
Polymyositis/Dermatomyositis Tx
|
Steroids
|
|
|
Chronic, widespread muscular pain in 11 of 18 documented sites
|
Fibromyalgia
|
|
|
Fibromyalgia Tx (3)
|
Exercise
Pregabalin (Lyrica) Duloxetine HCl (Cymbalta) |
