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Flashcards in rheumatology Deck (65)
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0
Q

What do you expect the ANA, RF and ESR to be in patients with ankylosing spondylitis ?

A

Normal ANA and RF

Normal or mildly elevated ESR

1
Q

What diagnosis presents with leg and back pain which is worse in the mornings and bending over but is relieved by exercise ? What are two other conditions associated with this disease?

A

Ankylosing spondylitis - uveitis and IBD

2
Q

How should you treat a patient with ankylosing spondylitis ?

A

NSAIDs . Sulfadiazine and methotrexate

3
Q

What diagnosis presents with ulcers in the mouth and genitals as well as uveitis and arthritis? How would you treat?

A

Behcet syndrome - steroids

4
Q

What would you expect the following lab results to be in a patient with behcet syndrome: ANA, RF, ESR and CRP?

A

ANA and RF normal

Elevated ESR and CRP

5
Q

What diagnosis would you suspect in a patient with clumsiness, shiny scaly skin on extensor surfaces, periungal lesions and difficulty swallowing ?

A

Dermatomyositis

6
Q

What is the most appropriate initial step in the diagnosis of dermatomyositis? How would you treat?

A

Creatine kinase level

High dose steroids, immunosuppressives and IVIG
Avoid sunlight
Antimalarials sometimes used

7
Q

Other than hypermobility of joints, what are 2 other findings associated with ehlers danlos syndrome ?

A

Poor wound healing and easy bruising

8
Q

How can you distinguish Lowe’s syndrome from ehlers danlos syndrome?

A

Lowe’s also has hypermobile joints but also has blindness, intellectual disability and hypotonia

9
Q

What diagnosis presents as blanching purpura on legs, crampy abdominal pain and blood in urine and stool? What lab findings do u expect to be abnormal?

A

Henoch schonlein purpura - elevated BUN/creatinine, urinalysis with protein and blood and normal platelet count!

10
Q

What should be suspected when patients with HSP present with abdominal pain?

A

Ileoileal intussusception

11
Q

What is the underlying cause/pathology of HSP?

A

Vasculitis of skin, GI Tract, joints and kidneys - usually after bacterial or viral infection

12
Q

How can you distinguish the joint manifestations present in HSP from those seen in rheumatic fever ?

A

HSP involves periarticular disease with the soft tissues around the joints involved (vs articular disease in rheumatic fever)

13
Q

What are the 8 main causes of polyarticular arthritis ?

A
Fabry disease
Infection
Reactive arthritis
Rheumatic fever
Serum sickness 
Connective tissue disease 
iBD
Malignancy
14
Q

What two criteria must be met in order to diagnose JIA?

A

Age of onset <16

Symptoms >6 weeks

15
Q

What diagnosis should you suspect in a female with pain and swelling in >5 joints?

A

Polyarthritis JIA (type 1)

16
Q

What diagnosis should you suspect in a child who presents with pain and swelling of 3 joints and uveitis?

A

Oligoarthritis JIA

17
Q

What can an ANA and RF indicate in JIA?

A

Most patients are ANA positive and those with positive RF typically have worse disease
Both ANA and RF are usually negative in systemic JIA

18
Q

What is the term used to describe systemic JIA which presents with extra-articular involvement?

A

Stills disease

19
Q

What are 6 main extra-articular manifestations of systemic JIA?

A
High fever
Leukocytosis
Rash (red macules with central clearing that coalesce)
Hepatosplenomegaly 
Lymphadenopathy 
Pleuritis/pericarditis
20
Q

What is the first line treatment for a patient with morning stiffness & joint pain x 6 weeks, fevers and lymphadenopathy with symptoms that wax and wane? Second line treatment?

A

NSAIDs (1st line)

steroids and immunosuppressives (2nd line)

21
Q

What are the abnormal lab findings common in Kawasaki?

A
Thrombocytosis
Leukocytosis
Normocytic anemia
Elevated CRP/ESR
Negative ANA/RF
22
Q

When should cardiac ECHO be performed in patients suspected of having Kawasaki disease?

A

At time of diagnosis
2-3 weeks later
6-8 weeks after onset of illness

23
Q

What is the appropriate treatment for Kawasaki disease ?

A

IVIG 2g/kg

Aspirin 80mg/kg for 48hr then 5mg/kg for 2 months

24
Q

What is the difference between measles and Kawasaki disease?

A

Measles has exudative conjunctivitis and rash typically is descending

25
Q

What is the cause of Lyme disease?

A

Immunologic response to borrelia burgdorferi

26
Q

What are the common symptoms in the first two weeks of Lyme disease?

A

Erythema chronicum migrans rash (in 75% of cases) and vague flu like symptoms with arthralgia

27
Q

What is the appropriate method of testing and confirmation of Lyme disease?

A

Lyme antibody titer (takes 4-6 weeks to become positive) then western blot to confirm

28
Q

What diseases cause false positive Lyme testing?

A

Lupus
Dermatomyositis
ricketsia

29
Q

What is the treatment for Lyme disease ?

A

Doxycycline 14-21 days (amoxicillin or cefuroxime if younger than 8 y/o)

30
Q

What causes chills, fever and hypotension in a patient treated for Lyme disease?

A

Jarisch Herxheimer reaction due to lysis and endotoxin release

31
Q

What diagnosis should you consider in a tall patient with high arched palate, hyperextensible joints and pectus? What could a murmur be due to in these patients?

A

Marfan - aortic or mitral valve regurgitation

32
Q

What are the major criteria for diagnosis of Marfan syndrome ?

A

Dilatation/dissection of ascending aorta or aorta root
Ectopia lensis
Lumbosacral dural ectasia
Skeletal manifestations (4)

33
Q

What is the inheritance of Marfan syndrome and where is the mutation located?

A

Autosomal dominant - chromosome 15 (fibrillin gene)

34
Q

What two types of specialists should closely follow patients with Marfan?

A

Cardiology

Ophthalmology (serial slit lamp exams)

35
Q

What is the likely diagnosis in a patient with vague joint pains who recently received 4 y/o vaccinations?

A

Post infectious arthritis from live MMR vaccine

36
Q

What diagnosis should you consider in a patient who presents with swollen tender joints and conjunctivitis after an episode of diarrhea? What other symptom should you expect?

A

Reactive arthritis following salmonella, shigella or yersinia
Pt would also present with nongonococcal urethritis

37
Q

What is a common cause of reactive arthritis in a sexually active teen?

A

Chlamydia

38
Q

What would you expect the ANA and HLA-B27 results to be in a patient with reactive arthritis?

A

Normal ANA

Positive HLA-B27

39
Q

How would you treat a patient suspected of having reactive arthritis?

A

NSAIDs and antibiotics

40
Q

What heart problem is likely in a patient with rheumatic fever with persistent new murmur and mild CHF?

A

Aortic regurgitation

41
Q

What heart problem is likely in a patient with rheumatic fever and a murmur at the apex?

A

Mitral valve regurgitation

42
Q

What is the criteria for diagnosis of rheumatic fever?

A

Recent Group A strep infection plus:
2 major symptoms
or
1 major and 2 minor criteria

43
Q

What are the 5 major jones criteria to diagnosis rheumatic fever ?

A
Polyarthritis (not arthralgia)
Carditis
Subcutaneous nodules (painless)
Erythema marginatum
Sydenham chorea
44
Q

What are the 4 minor criteria to diagnose rheumatic fever?

A

Fever
Arthralgia (not arthritis)
Elevated acute phase reactants
Prolonged PR interval

45
Q

What treatment would you use for the following rheumatic fever symptoms: arthritis, carditis, chorea and heart failure ?

A

Arthritis - aspirin
Carditis - steroids
Chorea - haldol
Heart failure - digoxin

46
Q

What are two methods of definitive documentation of recent strep infection ?

A

ASO titers

Positive streptozyme

47
Q

What diagnosis should you consider in a patient with chronic cough and easy fatigue as well as weight loss…chest X-ray shows hilar adenopathy?

A

Sarcoidosis

48
Q

What is secreted from the non-caseating granulomas found in sarcoidosis ? What end organs are affected by this?

A

Vitamin D - this leads to hypercalcemia and hypercalciuria which causes renal and eye disease

49
Q

What diagnosis presents as a linear hyperpigmented patch of skin that is painful and becomes more fibrotic over time? What are 5 treatment options ?

A

Scleroderma - lubricants, photochemotherapy, steroids, anti malarials and immunosuppressives

50
Q

What are 4 symptoms of systemic scleroderma and how can you prevent progression from local scleroderma?

A
Raynauds
Sclerodactyly
Pulmonary fibrosis
LES incompetence 
*there is no treatment to prevent "progression" to systemic scleroderma
51
Q

What diagnosis should you consider in a patient who presents with fever, urticaria and arthralgia a few weeks after exposure to an antigen? What is the treatment?

A

Serum sickness - antihistamines and steroids

52
Q

What happens to complement levels in patients with lupus?

A

C3/C4 levels go down during more active disease states

53
Q

What are the diagnostic criteria for lupus?

A

4 or more of the following features:

  • malar rash of discoid lesions
  • photosensitivity
  • oral ulcers
  • arthritis
  • low WBC/platelets /hemolytic anemia
  • anti dsDNA or anti-SM antibodies
  • cellular casts in urine
  • pleuritis/pericarditis
  • neurologic problems
54
Q

What is the possible diagnosis In an adolescent female who presents with fever, joint pain and oral ulcers who has a problem with chronic ITP?

A

Lupus

55
Q

What should you be concerned about in a patient with lupus who presents with respiratory distress and lower leg pain?

A

Thromboembolus/PE

56
Q

What 6 drugs can cause drug induced lupus?

A
Procainamide
Hydralazine
Quinidine
Sulfonamides 
Lithium
Anticonvulsants
57
Q

What diagnosis should you consider in a newborn with bradycardia, thrombocytopenia and red scaly rash on face? What is the most serious potential complication in these patients?

A

Neonatal lupus - 3rd degree heart block or hydrops fetalis

58
Q

What antibody is found to be high in patients with neonatal lupus?

A

Anti SSA

59
Q

What are side effects with use of hydroxychloroquine?

A

Retinal damage and ototoxicity

60
Q

What is the likely cause of high blood pressure and visual changes in patients with lupus?

A

Chronic steroid use!

61
Q

What is the likely diagnosis in a patient with chronic sinusitis, joint pain and fever with a positive c-ANCA?

A

Wegener granulomatosis

62
Q

What is the appropriate treatment for wegener?

A

Cyclophosphamide and steroids

63
Q

What diagnosis should you consider in a synovial fluid analysis with decreased viscosity and 15-20,000 WBCs?

A

JIA or reactive arthritis

64
Q

What diagnosis should you suspect when synovial fluid shows WBC 5,000 and normal viscosity ? What if the viscosity is decreased?

A

Lupus – Rheumatic fever