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ABIM IM Recert > Board Vitals Rheumatology > Flashcards

Board Vitals Rheumatology Flashcards

1
Q

What is the treatment of fibromyalgia?

A

Tricyclic antidepressant

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2
Q

What are second line drugs for fibromyalgia?

A

SNRIs (selective serotonin reuptake inhibitors)

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3
Q

Which SNRI is not preferred for fibromyalgia?

A

Venlafaxine

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4
Q

What is the treatment for fibromyalgia associated with anxiety or depression?

A

SNRIs (selective serotonin reuptake inhibitors)

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5
Q

What is the second line medication for fibromyalgia associated with sleep disturbances?

A

Pregabalin

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6
Q

Which antibodies need to be checked as part of the initial evaluation in all patients with polyarticular joint pain lasting for more than 6 weeks?

A
  • Anti-nuclear Antibody (ANA)
  • Rheumatoid Factor (RF)
  • Anti-citrulline peptide antibody (ACPA)
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7
Q

What is the most specific marker of rheumatoid arthritis?

A

Anti-citrulline peptide antibody (ACPA)

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8
Q

What is the initial treatment for symptomatic sarcoidosis?

A

Steroids

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9
Q

Can methotrexate be used to treat steroid refractory sarcoidosis?

A

Yes

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10
Q

Can infliximab be used to treat steroid refractory sarcoidosis?

A

Yes

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11
Q

Patients presents with upper respiratory symptoms, nasal ulcers, signs of sinusitis, purpura, and bilateral nodular opacities on X-ray.

Diagnosis?

A

Granulomatosis with polyangitis (Wegner’s granulomatosis)

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12
Q

Patient has a vasculitis together with asthma and/or nasal sinus polyps and eosinophilia.

Diagnosis?

A

Eosinophilic granulomatosis with polyangitis (Churg-Strauss disease)

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13
Q

Do patients with IgA nephropathy have pulmonary findings?

A

No

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14
Q

A malar rash is typical of which disease?

A

SLE (systemic lupus erythematosus)

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15
Q

Which disease are Anti-Ro antibodies associated with?

A

Sjogren’s syndrome

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16
Q

What is HLA-B27 test used for?

A

When seronegative spondylarthrosis is suspected e.g. ankylosing spondylitis or psoriatic arthritis.

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17
Q

What is the anti-RNA polymerase III test used for?

A

Diffuse scleroderma

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18
Q

What is the initial treatment of lupus nephritis?

A

Glucocorticoid (methylprednisolone) plus either mycophenolate mofetil or cyclophosphamide

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19
Q

Should glucocorticoid monotherapy be used for treating lupus nephritis?

A

No

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20
Q

What happens when you use glucocorticoid monotherapy for treating lupus nephritis?

A

Increased progression to end stage renal disease and increased mortality.

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21
Q

Which antibodies are present in granulomatosis with polyangiitis?

A

c-ANCA

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22
Q

Which antibodies are present in Goodpasture syndrome?

A

Anti-GBM

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23
Q

Which autoimmune disease is characterized by glomerulonephritis and pulmonary hemorrhage?

A

Goodpasture syndrome

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24
Q

PR3-antineutrophil antibody is positive in what condition?

A

Granulomatosis with polyangiitis (Wegener’s granulomatosis)

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25
Q

If patients are going to get high dose steroids, then what prophylaxis do they need?

A

Trimethoprim-sulfamethoxazole (for PJP)

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26
Q

What dosage of steroids requires prophylaxis against PJP?

A

Prednisone 30 mg or more (or equivalent) for 4 weeks or more.

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27
Q

What drug classes are used in severe psoriasis?

A

TNF inhibitors
IL-17 inhibitors

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28
Q

What is the preferred initial pharmacotherapy in patients with osteoarthritis in the hands?

A

Topical NSAIDS

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29
Q

Can intra-articular corticosteroid injections accelerate the progression of osteoarthritis?

A

Yes

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30
Q

What can cervical spine involvement in rheumatoid arthritis lead to?

A

Atlantoaxial subluxation

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31
Q

HLA-B27 Class I MHC is associated with what condition?

A

Ankylosing spondylitis

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32
Q

What is the initial treatment of polymyalgia rheumatica?

A

Glucocorticoids

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33
Q

What is the treatment of dermatomyositis?

A

Prednisone + methotrexate or azathioprine

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34
Q

Which drug can you use instead of methotrexate in patients with alcohol use disorder who are unwilling/unable to limit their alcohol intake?

A

Azathioprine

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35
Q

In addition to prednisone, which drug is recommended for the treatment of dermatomyositis in patients who also have interstitial lung disease?

A

Azathioprine

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36
Q

What tests are recommended in fibromyalgia to rule out underlying systemic inflammatory conditions?

A
  • CBC
  • CRP
  • ESR
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37
Q

Are there any diagnostic tests to confirm fibromyalgia?

A

No (clinical diagnosis)

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38
Q

Is fibromyalgia an inflammatory condition?

A

No

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39
Q

Glomerulonephritis and pulmonary disease, including cavitating pulmonary nodules.

Diagnosis?

A

Granulomatosis with polyangiitis (Wegener’s granulomatosis)

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40
Q

Patient presents with recurrent oral ulcers, genital ulcers, anterior uveitis, and erythema nodosum.

Diagnosis?

A

Behcet syndrome

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41
Q

Is polyarteritis nodosa ANCA-positive or ANCA-negative?

A

ANCA-negative

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42
Q

Are serum IgA levels typically elevated in IgA vasculitis?

A

Yes

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43
Q

Is microscopic polyangiitis ANCA-positive or ANCA-negative?

A

ANCA-positive

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44
Q

Is granulomatosis with polyangiitis ANCA-positive or ANCA-negative?

A

ANCA-positive

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45
Q

Do you have to check HLA B27 in patients who otherwise clearly have ankylosing spondylitis?

A

No

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46
Q

Patient presents with pain on impact, with knee bending inward, no swelling and positive valgus stress test.

What is the injury?

A

Medial collateral ligament (MCL) tear

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47
Q

What is “tennis elbow”?

A

Lateral epicondylitis

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48
Q

What is “golfer’s elbow”?

A

Medial epicondylitis

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49
Q

What is “runner’s knee”?

A

Patellofemoral pain syndrome

50
Q

Is an MRI required to diagnose patellofemoral pain syndrome?

A

No

51
Q

How much alcohol do people need to drink to adversely affect bone density?

A

More than 2 drinks per day

52
Q

Is drinking less than one drink of alcohol a day a risk factor for low bone density?

A

No

53
Q

Is smoking a risk factor for low bone density?

A

Yes

54
Q

What outpatient study needs to be done after a low impact fragility fracture?

A

DXA

55
Q

What are anti-double-stranded DNA antibodies specific for?

A

SLE (systemic lupus erythematosus)

56
Q

What are anti-Smith antibodies specific for?

A

SLE (systemic lupus erythematosus)

57
Q

Are anti-double-stranded DNA antibodies or anti-nuclear antibodies more specific for SLE (systemic lupus erythematosus)?

A

Anti-double-stranded DNA antibodies

58
Q

What are anti-Ro and anti-La antibodies associated with?

A

Sjogren’s syndrome

59
Q

Which antibodies are present in CREST syndrome?

A

Anti-centromere antibodies

60
Q

Does hypothyroidism increase risk of gout flares?

A

Yes

61
Q

Does furosemide increase risk of gout flares?

A

Yes

62
Q

Does losartan increase risk of gout flares?

A

No

63
Q

Does alcohol use increase risk of gout flares?

A

Yes

64
Q

What is the first line treatment of osteoarthritis?

A

Aerobic and strengthening exercises

65
Q

Should the initial dose of steroids be lower or higher in polymyalgia rheumatica?

A

Lower (15 mg per day)

66
Q

Patient presents with arthritis along with conjunctivitis, uveitis and urethritis.

Diagnosis?

A

Reiters syndrome (reactive arthritis)

67
Q

What is the initial treatment of Reiters syndrome?

A

NSAIDS

68
Q

What does linear calcification of the joint on X-ray imaging suggest?

A

Pseudogout

69
Q

What shape are calcium pyrophosphate crystals in pseudogout?

A

Rhomboid crystals

70
Q

What shape and type are monosodium urate crystals in gout?

A

Needle-shaped negatively birefringent crystals

71
Q

What is the initial treatment of monoarticular pseudogout?

A

Intra-articular glucocorticoid injection

72
Q

Which other condition is polymyalgia rheumatica commonly associated with?

A

Giant cell arteritis

73
Q

What is the treatment of scleroderma renal crisis?

A

ACE inhibitors

74
Q

Should ARBs be used as first line in the treatment of scleroderma renal crisis?

A

No (efficacy not established)

75
Q

What does RS3PE stand for?

A

Remitting seronegative symmetrical synovitis with pitting edema

76
Q

RS3PE is a paraneoplastic condition associated with underlying malignancy in up to 30% of cases.

True or false?

A

True

77
Q

Which paraneoplastic rheumatologic condition is associated with cutaneous small-vessel vasculitis?

A

Leukocytoclastic vasculitis

78
Q

Does RS3PE syndrome have tenosynovitis of the flexor or the extensor tendons of the hands and forearms?

A

Extensor

79
Q

What is the first line treatment of acute gout in a patient with renal failure?

A

Prednisone (glucocorticoids)

80
Q

Should colchicine be used in patients with ESRD on hemodialysis?

A

No (not easily removed by dialysis)

81
Q

Should NSAIDS be used in renal failure?

A

No

82
Q

What is the first line treatment of acute gout in a patient with no other issues?

A

NSAIDS

83
Q

Is Sjogren syndrome associated with gastroesophageal reflux disease?

A

Yes

84
Q

What is a clue in the history that suggests a cough is due to aspiration rather than GERD?

A

If it occurs when eating and drinking

85
Q

Lytic bone lesions with intralesional ringed calcifications which can give a “popcorn pattern” appearance.

Diagnosis?

A

Chondrosarcomas

86
Q

Imaging show layering near the periosteum with splitting of the cortex; classically described as “onion skin”.

Diagnosis?

A

Ewing sarcoma

87
Q

Imaging findings of either “Codman triangle” i.e. tumor breaking through cortex and lifting periosteum or “sunburst” appearance i.e. formation of tiny bone fibers in the periosteum.

Diagnosis?

A

Osteosarcoma

88
Q

Imaging findings of a small central lucency with a sclerotic margin and cortical thickening.

Diagnosis?

A

Osteoid osteomas

89
Q

What’s the most common thyroid manifestation of Sjogren’s disease?

A

Hypothyroidism

90
Q

Should steroids administered for acute gout be given systemically or intraarticularly in patients with diabetes mellitus?

A

Intraarticularly

91
Q

Which disease is marked by an autoimmune response to cartilaginous structures?

A

Relapsing polychondritis

92
Q

Is laryngotracheobronchial disease associated with relapsing polychondritis?

A

Yes

93
Q

What is often seen on pulmonary function testing in laryngotracheobronchial disease?

A

Decreased expiratory flow

94
Q

What is often seen on pulmonary function testing in relapsing polychondritis?

A

Decreased expiratory flow

95
Q

What is the most frequent injured ligament in an ankle sprain?

A

Anterior talofibular ligament tear

96
Q

Which test can demonstrate anterior talofibular ligament tear?

A

Anterior drawer test of the ankle

97
Q

What is the treatment of esophageal dysmotility (nutcracker)?

A

Diltiazem (calcium channel blocker)

98
Q

What is the treatment of achalasia?

A

Peroral endoscopic myotomy

99
Q

Is Paget’s disease a disease of osteoclasts or osteoblasts?

A

Osteoclasts

100
Q

What is the treatment of choice for Paget’s disease?

A

Bisphosphonates

101
Q

What is the first line treatment of rheumatoid arthritis?

A

Prednisone plus methotrexate

102
Q

Which antibodies reliably indicate active SLE and correlate with renal involvement?

A

Anti double stranded DNA antibodies

103
Q

Within what timeframe can colchicine be administered for acute gout?

A

Within 24 hours of symptom onset

104
Q

What is the preferred treatment of acute pseudogout?

A

Intra-articular steroid injection

105
Q

Can Pegloticase be used to treat gout in chronic kidney disease?

A

Yes

106
Q

What is the treatment of granulomatosis with polyangitis?

A

Rituximab plus methylprednisone

107
Q

Which infection is cryoglobulinemic vasculitis associated with?

A

Hepatitis C

108
Q

What is the treatment of drug-induced lupus?

A

NSAIDS

109
Q

Colchicine suppresses inflammation by interfering with neutrophil microtubules.

True or false?

A

True

110
Q

Are patients with granulomatosis with polyangitis positive for c-ANCA or p-ANCA?

A

c-ANCA

111
Q

Patient presents with pain at the metatarsal heads that that results in tenderness over the ball of the foot and sometimes the toes.

Diagnosis?

A

Metatarsalgia

112
Q

Is diagnostic imaging needed to confirm diagnosis of frozen shoulder?

A

No

113
Q

Are rheumatoid arthritis effusions exudative or transudative?

A

Exudative

114
Q

Which gout medication has potential severe cutaneous reaction in Asians?

A

Allopurinol

115
Q

Is hydroxychloroquine safe to use in pregnancy?

A

Yes

116
Q

Does Raynaud phenomenon get better or worse during pregnancy?

A

Better

117
Q

What is the next step when the creatinine is worsening in an SLE patient?

A

Renal biopsy

118
Q

What is the treatment of interstitial lung disease associated with systemic sclerosis?

A

Mycophenolate mofetil
Cyclophosphamide

119
Q

Which has more toxicity, mycophenolate mofetil or cyclophosphamide?

A

Cyclophosphamide

120
Q

What the preferred first line management of osteoarthritis?

A

Topical NSAIDS

ABIM IM Recert (42 decks)

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