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MKSAP KEY POINTS > Rheum KPs > Flashcards

Rheum KPs Flashcards

1
Q

Pain with both passive and active range of motion implies?

pain with only active range of motion is likely due to?

A

an intrinsic joint condition,

a periarticular condition.

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2
Q

Synovial fluid leukocyte counts - normal? non-inflammatory conditions? inflammatory states?

A

<200

200-2000

> 2000

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3
Q

Meds that provide similar pain relief for inflammatory conditions as oral NSAIDs with fewer gastrointestinal effects and are preferred for patients 75 years or older

A

topical NSAIDs

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4
Q

When should patients on steroids get bisphosphonate therapy?

A

> 4 weeks at doses >5 mg prednisone

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5
Q

Non-Biologic DMARDs?

A

Chasm Clam

Cyclophosphamide
Hydroxychloroquine
Azathioprine
Sulfasalazine
Methotrexate

Cyclosporine
Leflunomide
Apremilast
Mycophenolate

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6
Q

recommended initial disease-modifying antirheumatic drug for most patients?

A

Methotrexate

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7
Q

Cyclophosphamide is used to treat?

A

severe and/or life-threatening manifestations SLE

systemic sclerosis, the inflammatory myopathies, interstitial lung disease, and vasculitis

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8
Q

Perk of mycophenolate mofetil?

A

at least as effective as cyclophosphamide for systemic lupus erythematosus but with fewer, and milder, side effects.

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9
Q

If non-biologics fail, first choice of biologics?

A

TNF-a inhibitors

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10
Q

vaccines are currently contraindicated for patients on biologic therapies? When should they be given?

A

Live attenuated

4 weeks before starting

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11
Q

Allopurinol MoA? Avoid in which patients?

A

purine analogue that inhibits xanthine oxidase; other purine analogues (azathioprine or 6MP)

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12
Q

Feboxustat MoA? Benefit over allopurinol? Avoid in which patients?

A

non-purine, non-competitive xanthine oxidase inhibitor; less likely to cause hypersensitivity

other purine analogues (azathioprine or 6MP)

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13
Q

Probenecif MoA? Avoid in patients with?

A

promotes kidney uric acid excretion (uricosuric effect)

CrCl<50

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14
Q

Imaging used to follow course of RA?

Imaging that should not be routinely preformed?

A

Plain radiography of the hands, wrists, and/or feet

MRI of peripheral joints

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15
Q

Felty Syndrome?

A

Neutropenia, splenomegaly, and RA

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16
Q

recommended initial disease-modifying antirheumatic drug for most patients with rheumatoid arthritis?

A

Methotrexate

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17
Q

Benefits of TNF-a inhibitor in psoriatic arthritis?

A

remission, reduces radiographic progression, nromalizes acute phase reactants, reduce cardiovascular risk

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18
Q

RA drugs contraindicated in pregnancy? Safe in pregnancy?

A

Methotrexate and leflunomide are absolutely contraindicated in pregnancy

Both hydroxychloroquine and sulfasalazine

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19
Q

radiographic hallmarks of osteoarthritis?

In contrast, radiographic findings seen in RA (which are absent in OA)?

A

Joint-space narrowing, subchondral sclerosis, and marginal osteophyte formation

periarticular osteopenia and marginal erosions

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20
Q

Intra-articular glucocorticoids reduce osteoarthritis knee pain within?

A

days to weeks

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21
Q

The most effective surgical intervention for knee or hip osteoarthritis?

A

total joint arthroplasty

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22
Q

Fibromyalgia is a clinical diagnosis characterized by?

A
  • chronic widespread pain,
  • tenderness of the skin and muscles to pressure,
  • fatigue,
  • sleep disturbance, and
  • exercise intolerance.
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23
Q

Initial laboratory evaluation of fibromyalgia?

Tests that should be avoided?

A

BMP, CBC TSH, ESR, CRP

ANA, RF, anti-CCP, CK

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24
Q

For patients with fibromyalgia, this is critical for functional improvement.

A

aerobic exercise

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25
Q

FDA approved and modestly effective for fibromyalgia? (3)

A

Pregabalin, duloxetine, and milnacipran

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26
Q

Severe presentations of reactive arthritis or psoriatic arthritis should raise concern for?

A

HIV

27
Q

Arthritis of varying patterns may occur in patients with IBD, but this type parallels IBD activity?

A

oligoarticular peripheral arthritis

28
Q

spondyloarthritis - 1st line imaging?

Role of MRI?

Role of CT?

A

XR

only if conventional radiographs are negative and strong suspicion

only for identifying occult spine fractures and bony erosions.

29
Q

first-line therapy for ankylosing spondylitis? If inadequate?

A

NSAIDs

TNF-a inhibitors

30
Q

first-line therapy for psoriatic arthritis? If inadequate?

A

NSAIDs for inflammation; non-biologic DMARDs for arthritis and enthesitis

biologics

31
Q

first-line therapy for inflammatory bowel disease–associated arthritis? If inadequate?

A

Methotrexate or sulfasalazine

TNF-a

32
Q

All patients with systemic lupus erythematosus should be evaluated for nephritis with?

A

Cr, Urine protein-creatinine ratio, urinalysis

33
Q

Most common cause of death for older patients with SLE?

A

ischemic heart disease

34
Q

Anti-U1? (3)

A

Associated with Raynaud phenomenon and esophageal dysmotility; also seen in MCTD

35
Q

Antiribosomal P?

A

Associated with CNS lupus and lupus hepatitis

36
Q

Med that should be initiated in every patient with systemic lupus erythematosus who can tolerate?

A

Hydroxychloroquine

37
Q

initial therapy for acute manifestations of systemic lupus erythematosus?

A

Steroids

38
Q

Maternal antibodies associated with neonatal lupus erythematosus?

A

anti-Ro/SSA or anti-La/SSB

39
Q

Patients with Sjögren syndrome have a ~30-fold increased risk for? (most common type?)

A

lymphoma (DLBCL and MALT)

40
Q

If diagosis of Sjögren syndrome is unclear, can biopsy?

A

lip biopsy demonstrating minor salivary gland inflammation

41
Q

Prognosis of MCTD v SLE? Why?

A

Increased. PAH more common in MCTD

42
Q

“treat-to-target” approach for gout - targets?

A

<6.0 in patients without tophi

<5.0 in patients with tophi

43
Q

Gout flare prophylaxis?

A

colchicine and NSAIDs

44
Q

Calcium pyrophosphate deposition is associated with these diseases?

A

hyperparathyroidism, hemochromatosis, hypomagnesemia, and hypothyroidism

45
Q

Management of symptomatic basic calcium phosphate deposition (Milwaukee shoulder syndrome?)

A

NSAIDS, joint aspiration adn tidal lavage, and intra-articular steroids

46
Q

disseminated gonococcal infection present with these two syndromes

A

1) arthritis, tenosynovitis, and dermatitis

2) purulent monoarthritis or oligoarthritis.

47
Q

Musculoskeletal Mycobacterium tuberculosis typically presents as?

A

spondylitis, vertebral osteomyelitis, or hip or knee arthritis. - NO CONSTITUTIONAL SYMPTOMS

48
Q

nterstitial lung disease in patients with dermatomyositis or polymyositis is associated with these antibodies?

A

with antisynthetase antibodies, including anti–Jo-1

49
Q

pt with dermatomyositis or polymyositis - cancer screening?

A

age-appropriate + ovarian (no CT or PET unless additional risk factors)

50
Q

Treatment of polyarteritis nodosa includes?

A

high-dose prednisone and cyclophosphamide.

51
Q

Primary angiitis of the central nervous system presents with?

A

recurrent headaches and progressive encephalopathy

52
Q

Kawasaki disease symptoms?

A

high spiking fevers, conjunctivitis, rash, and mucositis of the lips and oral cavity.

53
Q

Microscopic polyangiitis typically involves? patients classically express?

A

the kidneys and lungs

p-ANCA and antimyeloperoxidase (MPO)

54
Q

Remission induction of both granulomatosis with polyangiitis and microscopic polyangiitis consists of?

A

high-dose glucocorticoids plus cyclophosphamide or rituximab, followed by maintenance therapy

55
Q

characteristic rash in type II cryoglobulinemia? Other organs involved?

A

Palpable purpura; Peripheral nerves and kidneys

56
Q

Diffuse cutaneous systemic sclerosis is characterized by?

A

extensive distal and proximal skin thickening (chest, abdomen, and arms proximal to wrists) and is commonly accompanied by internal organ fibrosis.

57
Q

Limited cutaneous systemic sclerosis is characterized by ?

A

distal (face, neck, and hands), but not proximal, skin thickening; it is usually unaccompanied by internal organ fibrosis but is more likely to be associated with pulmonary arterial hypertension.

58
Q

autoantibody testing for systemic sclerosis?

A

antinuclear, anti–Scl-70, anticentromere, and anti-RNA polymerase III

59
Q

How to distinguish secondary Raynaud phenomenon associated with systemic sclerosis from primary Raynaud phenomenon?

A

Nailfold capillarioscopy (abnormal in systemic sclerosis)

60
Q

Med that decreases mortality among patients with scleroderma renal crisis

A

ACE inhibitor

61
Q

annual monitoring of this is recommended for all patients with systemic sclerosis?

A

PAH

62
Q

Relapsing polychondritis is characterized by? (4)

A
  • chondritis of the ears, nose, and/or respiratory tract;
  • nonerosive inflammatory polyarthritis;
  • ocular inflammation;
  • cochlear and/or vestibular dysfunction.
63
Q

Relapsing polychondritis - ear findings?

A

Spares earlobe

MKSAP KEY POINTS (19 decks)

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