Rheumatology Ck

mikenakhla's version from 2016-05-19 21:39


Question Answer
• Treatment of fibromyalgia if exercise fails?duloxetine and TCAs
• 5 clinical manifestations of HSP? Treatment?palpable purpura, arthralgia, abdominal pain/intussusception, renal disease similar to IgA nephropathy, scrotal swelling. Treat with hydration/NSAIDs for most patients, steroids if severe
• Common complication of lupus that increases with risk of chronic steroid use? Causes pain in groin, thigh, or butt that's worse with activity. What is this and how do you diagnose it?avascular necrosis, get MRI b/c x ray might be normal
• Systemic sclerosis pulmonary complicationinterstitial fibrosis
• Oral/genital ulcers that are recurrent and painful. Uveitis common with this disease as wellBehcet disease
• Advanced rheumatoid arthritis associated with splenomegaly and neutropenia?Felty syndrome
• Temporal arteritis patient, treated then has muscle weakness, more prominent in lower extremitiessteroid induced myositis
• Inflammation of one eye after penetrating injury to the other eye?sympathetic opthalmia aka "spared eye injury". Characterized as anterior uveitis usually. Due to "uncovering of hidden antigens".
• Sarcoid cutaneous findings?erythema nodosum
• Chondrocalcinosis, commonly with liver disease and diabeteshereditary hemochromatosis, with calcium pyrophsophate dihydrate crystal deposition in joints, causing pseudogout.
• Rheumatoid arthritis patient with pain and soft tender mass in popliteal fossa?Baker cyst - excessive fluid production by inflammed synovium
• TIA, stroke, DVT and recurrent miscarriages or pregnancy complications, what do you think this is?antiphospholipid syndrome ,treat with anticoagulation
• Scleroderma renal crisis? What peripheral blood smear findings do you get?systemic sclerosis plus AKI, schistocytes because of microangiopathic hemolytic anemia.
• Why do patients with temporal arteritis get serial chest x-rays?because of possible aortic aneurysm
• Nasal discharge, glomerulonephritis, and possibly weird skin lesions that don't heal. What is this and what are common lab findings?think wegener's granulomatosis aka "granulomatosis with polyangitis". C ANCA positive and proteinase-3 antibodies. Elevate CRp as well
• How do you treat wegener's?cytotoxic agents eg cyclophosphamide
• Rheumatoid arthritis patients are at increased risk of developingosteoporosis and fractures and shit.
• Cause of type I hypersensitivity reactions?preformed IgE antibodies. Examples include anaphylaxis, hives etc
• Deficiency of c1 esterase inhibitor and C4 complement levels is the underlying cause to this disease. What are the symptoms?hereditary angioedema. Swelling of lips, eyelids, airway, unrelated to allergen exposure. Autosomal dominant.
• Acute treatment for hereditary angioedema? Chronic?acute is same as anaphylaxis, chronic is androgens because it stimulates the liver to make C1 esterase inhibitor
• Pathophys behind type II hypersensitivity reactions?preformed IgG and IgM antibodies that react with an antigen and cause secondary inflammation
• Transfusion reactions, goodpasture syndrome, myasthenia, are all examples of what type of hypersensitivity reaction?type II
• Serum sickness, lupus, rheumatoid arthritis, polarteritis nodosa are all types of what hypersensitivity reactiontype III, antigen-antibody complex deposition
• What is a Type IV hypersensitivity reaction?cell mediated/delayed. Sensitized T cells release inflammatory mediators.
• Contact dermatitis, chronic transplant rejection, granulomas, TB test, all examples of what type of hypersensitivity reaction?type IV
• Recurrent respiratory and GI infectionsIgA deficiency
• Low or absent B cells, with infections starting at 6 months of age, more common in males. What is this? Recurrent infectious agents?bruton agammaglobulinemia. X linked. Reurrent lung and sinus infections with streptococcus and haemophilus
• Cause of SCID? Findings?adenosine deaminase deficiency. B and T cell defects and severe infections within first few months of life
• Eczema, thrombocytopenia (bleeding), and recurrent infections in a baby.wiskott-Aldrich
• Giant granules in neutrophils, infections, albinism. What is this and what causes itthis is chediak higashi syndrome, caused by microtuble polymerization defect
• Decreased activity of nicotinamide adenine dinucleotide phosphate oxidase and recurrent catalase positive organism infection (eg staph aureus and pseudomonas). What is this? How do you diagnose it?this is chronic granulomatous disease (CGD). Impaired intracellular killing by phagocytes., can't make H2O2 in their lysosomes. Diagnose with nitroblue tetrazolium dye (NBT) or dihydrohodamine 123 test, which are neutrophil FUNCTION tests. Measures respiratory bursts, which these patients lack.
• Recurrent neisseria infections, what deficiency do you have?compliement C5-C9
• Thrush and candidal infetion in scalp, skin, nails. Often associated with hypothyroidismchronic mucocutaneous candidiasis
• Recurrent staph infections, especially of the skin, and very high IgE levels. Have fair skin, are usually gingers, and have eczemathis is Hyper IgE syndrome aka Job Buckley syndrome
• Stroke symptoms, positive RPR, positive ANA, thrombocytopeniaantiphospholipid syndrome. Lab findings include anticardiolipin antibody and anti beta 2 glycoprotein I antibody
• Recurrent oral and genital ulcers and possible skin/eye involvement. This is a multisystem inflammatory conditionbehcet syndrome. Thrombosis is a major cause of morbidity
• Rheumatoid arthritis affects which part of the spine?cervical spine
• Treatment for ALL patients with rheumatoid arthritis?start DMARDs as early as possible to limit joint degeneration. Use NSAIDs or steroids initially for symptom relief until you get a response with DMARDs (methotrexate most commonly)
• What should you test patients for before starting DMARD therapy for rheumatoid arthritis for example?hepatitis B and C and TB
• Recurring catalase positive infections in a little kid?CGD, chronic granulomatous disease
• Patients with ankylosing spondylitis can develop restrictive lung disease, why?diminished chest wall and spinal mobility.
• Symmetric small joint inflammatory arthritis, then resolves within two months. Can be RF or ANA positiveviral arthritis
• What causes pancytopenia in lupus patients?peripheral immune destruction of all three cell lines
• Systemic scleroderma antibody? CREST syndrome?anti topoisomerase I, anti centromere
• Anti smooth muscle antibodies?autoimmune hepatitis
• C1 inhibitor? C1q? C4 levels depressed in both forms of this conditionC1 inhibitor decreased in hereditary angioedema, C1q is decreased in acquired angioedema seen over 30. C4 levels low in both
• Reactive arthritisurethritis (chlamydial infection), conjunctivitis, and arthritis. Diagnose and treat STD and treat partners, use NSAIDs for arthritis
• Screening test for lupus? Confirmatory test?ANA titer, then anti smith or anti DS-DNA
• Sx of lupuspericarditis, pleuritis, discoid rash, malar rash, photosensitivity, kidney damage, arthritis, blood counts low,
• Heliotrope around eyes with periorbital edema and weaknessdermatomyositis
• Polyarteritis nodosa is associated withHep B infection and cyroglobulinemia.
• Sx of PAN (polyarteritis nodosa)? Lab tests? Diagnosis?fever, abdominal pain, weight loss, kidney issues, peripheral neuropathy. Positive ANCA usually. Gold standard for diagnosis is biopsy of affected end organ
• Child with heart attack?think kawasaki, treat with aspirin and IVIG to reduce coronary aneurysms.
• Pulseless disease?takayasu arteritis. Vasculitis affecting aortic arch and branches. If carotids involved can cause neuro signs or stroke. Treat with steroids
• Painful oral and genital lesions with uveitis, arthritis and possibly other skin lesions.behcet syndrome, treat with steroids
• Normal calcium and phosphorus, but high alk phospaget's
• Raynaud symptoms in a young male smokerbuerger disease. Stop smoking and stops the development of the disease
• Cyclophosphamide side effect? Risks with long term use?Acute hemorrhagic cystitis and bladder cancer long term
• Familial dysaautonomia, gross dysfunction of autonomic nervous system and severe orthostatic hypotensionriley day syndrome
• Elevated ACE levelsSarcoidosis
• Extrapulmonay sx of sarcoidosisuveitis, arthritis, erythema nodosum
• Prolonged use of hydroxychloroquine (usually for lupus) can have this side effectretinal toxicity. Patients need baseline and periodic reassessment of eyes.
• What does lupus anticoagulant (anti phospholipid antibody) do to PT?prolongs it in vitro b/c it is a pro thrombotic immunoglobulin
• This predisposes to amyloidosisrheumatoid arthritis
• RA, enlarged kidneys, hepatomegaly, what is this and how do you see it with biopsy?amyloidosis, congo red stain.
• Most common cause of AL (light chain) amyloidosis? What about AA (abnormal proteins)?myeloma, RA
• Hyalinosis on kidney biopsydiabetic nephropathy
• Looks like marfan's but have fair skin, ntellectual disability and hypercoagulablehomocystinuria. Downward lens dislocation, where marfan's is upward