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Flashcards in rheumatology Deck (65)
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0

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?

Ankylosing spondylitis - uveitis and IBD

1

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

Normal ANA and RF
Normal or mildly elevated ESR

2

How should you treat a patient with ankylosing spondylitis ?

NSAIDs . Sulfadiazine and methotrexate

3

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

Behcet syndrome - steroids

4

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

ANA and RF normal
Elevated ESR and CRP

5

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

Dermatomyositis

6

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

Creatine kinase level

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

7

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

Poor wound healing and easy bruising

8

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

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

9

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?

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

10

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

Ileoileal intussusception

11

What is the underlying cause/pathology of HSP?

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

12

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

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

13

What are the 8 main causes of polyarticular arthritis ?

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

14

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

Age of onset <16
Symptoms >6 weeks

15

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

Polyarthritis JIA (type 1)

16

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

Oligoarthritis JIA

17

What can an ANA and RF indicate in JIA?

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

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

Stills disease

19

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

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

20

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?

NSAIDs (1st line)
steroids and immunosuppressives (2nd line)

21

What are the abnormal lab findings common in Kawasaki?

Thrombocytosis
Leukocytosis
Normocytic anemia
Elevated CRP/ESR
Negative ANA/RF

22

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

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

23

What is the appropriate treatment for Kawasaki disease ?

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

24

What is the difference between measles and Kawasaki disease?

Measles has exudative conjunctivitis and rash typically is descending

25

What is the cause of Lyme disease?

Immunologic response to borrelia burgdorferi

26

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

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

27

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

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

28

What diseases cause false positive Lyme testing?

Lupus
Dermatomyositis
ricketsia

29

What is the treatment for Lyme disease ?

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