1-uWorld

Question 1

New onset headaches and intermittent vision changes, think this disorder

Answer 1

Giant Cell arteritis

Question 2

First-line for med symptomatic ankylosing spondylitis

After how long of duration on this with no relief would be considered therapeutic failure?

Answer 2

NSAIDs

Therapeutic failure after 4 weeks

Question 3

Second line for med ankylosing spondylitis

Answer 3

Tissue necrosis factor alpha, check for active or latent TB before use

Question 4

You have started patient on bisphosphonate for osteoporosis, now 2 years later that her osteoporosis has gotten worse, What is the next step?

Answer 4

Stop bisphosphonate, start Teriparatide i.e. PTH analog

Look for undiagnosed conditions that may be contributing to the osteoporosis: Hyperthyroidism, hyperparathyroidism, multiple myeloma, malabsorption, CKD

teriperatide used for severe osteoporosis who failed first-line treatment’

Treat with teriparatide for 2 years, then resume bisphosphonate

Question 5

How long does it take for bisphosphonates therapeutic effect to kick in

Answer 5

Typically 6 to 12 months

Question 6

After initiating methotrexate, you can have manifestations of___dermatological and___infectious appearing

Answer 6

Macular rash affecting his extremities and sparing the trunk

Fever

Question 7

What life-threatening complications can occur as a result of methotrexate and what labs or imaging need to be done before or after initiating methotrexate?

Answer 7

Hepatic fibrosis/hepatotoxicity
Due viral hepatitis panel prior to MTX therapy
Obviously treated viral hepatitis prior to initiation
LFTs Periodically

Pulmonary damage
Get chest x-ray prior to initiation

Myelosuppression
Get CBC periodically

Nephrotoxicity
Creatinine periodically

Question 8

Psoriatic arthritis involves PIP or DIP

Answer 8

DIP

Question 9

What are the features of seronegative arthritis?

Answer 9

Enthesitis
Dactylitis(Sausage fingers)
Uveitis
IBD risk/Psoriasis
Arthritis with pencil in cup destruction

Question 10

What is the antibody for mixed connective tissue disease ?

Answer 10

Ribonucleoprotein
Also known as
Anti-U1 RNP

Question 11

Systemic sclerosis versus limited scleroderma antibodies

Answer 11

RNA polymerase 2 and 3
Scleroderma 70/antitopoisomerases type I

Anti-centromere

Question 12

Polymyositis and dermatomyositis antibodies

Answer 12

Anti-Jo1
aminoacyl transfer RNA(tRNA) synthetase

Question 13

Antimyeloperoxidase antibody is for this disease

Answer 13

Microscopic polyangiitis

p-anca

Question 14

Antibody for Wegener’s granulomatosis

Also known as granulomatosis with polyangiitis

Answer 14

anti-Proteinase 3 AKA PR-3

Question 15

What is a most common cause of death in mixed connective tissue disease?

Answer 15

Pulmonary hypertension

Question 16

What is the diagnosis criteria for mixed connective tissue disease?

Answer 16

Antibody/serology with positive U1-antiribonucleoprotein protein antibody

PLUS Have to have AT LEAST 3 of the following

• Swollen hands/fingers-
• Myositis/myalgias
• Synovitis
• Raynaud’s phenomenon

Question 17

Creatinine kinase is___in dermatomyositis polymyositis and___in polymyalgia rheumatica

Answer 17

Elevated
Within normal limits

Question 18

Psoriatic arthritis is more aggressive and associated with this infection

Answer 18

HIV

Question 19

What is the treatment for psoriatic arthritis, what medications are typically used?

Answer 19

Methotrexate
Sulfasalazine
TNF alpha inhibitors

Question 20

Gonococcal infection can cause this kind of arthritis

Answer 20

Septic arthritis

Question 21

Hepatitis C infection can appear similar to rheumatoid arthritis due to immune complex deposition resulting in___

Answer 21

Mixed cryoglobulinemia With arthritis
(Abnormal proteins i.e. cryoglobulins in blood that precipitate or clump together in cold temperatures)

Glomerulonephritis

Vasculitis

Question 22

A rash that is salmon-colored occurs in this disease

Which lab abnormality is classic for this disease?

Answer 22

Stills disease juvenile arthritis

Marked ferritin elevations are classic

Question 23

Complement levels in drug-induced lupus versus systemic lupus

Answer 23

Normal, SLE reduced

Question 24

Medications that cause drug-induced lupus

Answer 24

Procainamide
Hydralazine
TNF alpha
Minocycline

Question 25

Target uric acid level to reduce tophi burden and joint destruction

Answer 25

<6

Question 26

Alternative xanthine oxidase inhibitor outside of allopurinol And what to take precaution of

Answer 26

Febuxostat-take precaution with LFTs

Question 27

Should serum uric acid levels to be used to confirm diagnosis of gout ?

Answer 27

No, levels can be normal and extensive tophaceous gout

Question 28

___Is used for mild RA ___Is used for moderate to severe RA

Answer 28

Non Biologics like sulfasalazine, hydroxychloroquine Methotrexate alone or in combination with other DMARDs

Question 29

What can happen after joint inflammation and RA?As a complication

Answer 29

Irreversible joint destruction

Question 30

What is primary Raynaud's phenomenon What is secondary Raynaud's phenomena How do you tell them apart?

Answer 30

Primary-**Idiopathic… Thought to be a response to cold or stress** Risk factor of cardiovascular disease, Smoking Secondary-**Vasoconstriction from vascular pathology** Autoimmune sclerosis Frostbite Drug-induced i.e. methamphetamine Nasal capillary refill test: Place oil on nailbed and look under ophthalmoscope-if normal architecture of capillary then secondary

Question 31

Meds for primary Raynaud's phenomenon For secondary

Answer 31

BOTH: 1st line:Calcium channel blocker next-Phosphodiesterase inhibitor

Question 32

Patient has a history of diabetes, bumped her foot on the table the other day, now the foot is red and swollen but she does not feel pain, x-ray unremarkable, what is the diagnosis? What is the pathogenesis of this diagnosis?

Answer 32

Neuropathic arthropathy AKA Charcot's arthropathy Pathogenesis: Patient has diabetic Neuropathy or posterior column disorder Minor trauma to foot(Repetitive)-->Acute inflammation/vascular changes-->Osteoclast activity induced/resorption of bone-->Bone ligament destruction-->Abnormal weightbearing--->foot ulcers--->cellulitis/osteomyelitis/ amputation

Question 33

What is the treatment to neuropathic arthropathy, AKA Charcot's arthropathy

Answer 33

Casting of foot, To avoid weightbearing

Question 34

Reviewed complex regional pain syndrome********