Board Vitals Rheumatology Flashcards
(120 cards)
1
Q
What is the treatment of fibromyalgia?
A
Tricyclic antidepressant
2
Q
What are second line drugs for fibromyalgia?
A
SNRIs (selective serotonin reuptake inhibitors)
3
Q
Which SNRI is not preferred for fibromyalgia?
A
Venlafaxine
4
Q
What is the treatment for fibromyalgia associated with anxiety or depression?
A
SNRIs (selective serotonin reuptake inhibitors)
5
Q
What is the second line medication for fibromyalgia associated with sleep disturbances?
A
Pregabalin
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)
7
Q
What is the most specific marker of rheumatoid arthritis?
A
Anti-citrulline peptide antibody (ACPA)
8
Q
What is the initial treatment for symptomatic sarcoidosis?
A
Steroids
9
Q
Can methotrexate be used to treat steroid refractory sarcoidosis?
A
Yes
10
Q
Can infliximab be used to treat steroid refractory sarcoidosis?
A
Yes
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)
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)
13
Q
Do patients with IgA nephropathy have pulmonary findings?
A
No
14
Q
A malar rash is typical of which disease?
A
SLE (systemic lupus erythematosus)
15
Q
Which disease are Anti-Ro antibodies associated with?
A
Sjogren’s syndrome
16
Q
What is HLA-B27 test used for?
A
When seronegative spondylarthrosis is suspected e.g. ankylosing spondylitis or psoriatic arthritis.
17
Q
What is the anti-RNA polymerase III test used for?
A
Diffuse scleroderma
18
Q
What is the initial treatment of lupus nephritis?
A
Glucocorticoid (methylprednisolone) plus either mycophenolate mofetil or cyclophosphamide
19
Q
Should glucocorticoid monotherapy be used for treating lupus nephritis?
A
No
20
Q
What happens when you use glucocorticoid monotherapy for treating lupus nephritis?
A
Increased progression to end stage renal disease and increased mortality.
21
Q
Which antibodies are present in granulomatosis with polyangiitis?
A
c-ANCA
22
Q
Which antibodies are present in Goodpasture syndrome?
A
Anti-GBM
23
Q
Which autoimmune disease is characterized by glomerulonephritis and pulmonary hemorrhage?
A
Goodpasture syndrome
24
Q
PR3-antineutrophil antibody is positive in what condition?
A
Granulomatosis with polyangiitis (Wegener’s granulomatosis)
25
If patients are going to get high dose steroids, then what prophylaxis do they need?
Trimethoprim-sulfamethoxazole (for PJP)
26
What dosage of steroids requires prophylaxis against PJP?
Prednisone 30 mg or more (or equivalent) for 4 weeks or more.
27
What drug classes are used in severe psoriasis?
TNF inhibitors
IL-17 inhibitors
28
What is the preferred initial pharmacotherapy in patients with osteoarthritis in the hands?
Topical NSAIDS
29
Can intra-articular corticosteroid injections accelerate the progression of osteoarthritis?
Yes
30
What can cervical spine involvement in rheumatoid arthritis lead to?
Atlantoaxial subluxation
31
HLA-B27 Class I MHC is associated with what condition?
Ankylosing spondylitis
32
What is the initial treatment of polymyalgia rheumatica?
Glucocorticoids
33
What is the treatment of dermatomyositis?
Prednisone + methotrexate or azathioprine
34
Which drug can you use instead of methotrexate in patients with alcohol use disorder who are unwilling/unable to limit their alcohol intake?
Azathioprine
35
In addition to prednisone, which drug is recommended for the treatment of dermatomyositis in patients who also have interstitial lung disease?
Azathioprine
36
What tests are recommended in fibromyalgia to rule out underlying systemic inflammatory conditions?
- CBC
- CRP
- ESR
37
Are there any diagnostic tests to confirm fibromyalgia?
No (clinical diagnosis)
38
Is fibromyalgia an inflammatory condition?
No
39
Glomerulonephritis and pulmonary disease, including cavitating pulmonary nodules.
Diagnosis?
Granulomatosis with polyangiitis (Wegener's granulomatosis)
40
Patient presents with recurrent oral ulcers, genital ulcers, anterior uveitis, and erythema nodosum.
Diagnosis?
Behcet syndrome
41
Is polyarteritis nodosa ANCA-positive or ANCA-negative?
ANCA-negative
42
Are serum IgA levels typically elevated in IgA vasculitis?
Yes
43
Is microscopic polyangiitis ANCA-positive or ANCA-negative?
ANCA-positive
44
Is granulomatosis with polyangiitis ANCA-positive or ANCA-negative?
ANCA-positive
45
Do you have to check HLA B27 in patients who otherwise clearly have ankylosing spondylitis?
No
46
Patient presents with pain on impact, with knee bending inward, no swelling and positive valgus stress test.
What is the injury?
Medial collateral ligament (MCL) tear
47
What is "tennis elbow"?
Lateral epicondylitis
48
What is "golfer's elbow"?
Medial epicondylitis
49
What is "runner's knee"?
Patellofemoral pain syndrome
50
Is an MRI required to diagnose patellofemoral pain syndrome?
No
51
How much alcohol do people need to drink to adversely affect bone density?
More than 2 drinks per day
52
Is drinking less than one drink of alcohol a day a risk factor for low bone density?
No
53
Is smoking a risk factor for low bone density?
Yes
54
What outpatient study needs to be done after a low impact fragility fracture?
DXA
55
What are anti-double-stranded DNA antibodies specific for?
SLE (systemic lupus erythematosus)
56
What are anti-Smith antibodies specific for?
SLE (systemic lupus erythematosus)
57
Are anti-double-stranded DNA antibodies or anti-nuclear antibodies more specific for SLE (systemic lupus erythematosus)?
Anti-double-stranded DNA antibodies
58
What are anti-Ro and anti-La antibodies associated with?
Sjogren's syndrome
59
Which antibodies are present in CREST syndrome?
Anti-centromere antibodies
60
Does hypothyroidism increase risk of gout flares?
Yes
61
Does furosemide increase risk of gout flares?
Yes
62
Does losartan increase risk of gout flares?
No
63
Does alcohol use increase risk of gout flares?
Yes
64
What is the first line treatment of osteoarthritis?
Aerobic and strengthening exercises
65
Should the initial dose of steroids be lower or higher in polymyalgia rheumatica?
Lower (15 mg per day)
66
Patient presents with arthritis along with conjunctivitis, uveitis and urethritis.
Diagnosis?
Reiters syndrome (reactive arthritis)
67
What is the initial treatment of Reiters syndrome?
NSAIDS
68
What does linear calcification of the joint on X-ray imaging suggest?
Pseudogout
69
What shape are calcium pyrophosphate crystals in pseudogout?
Rhomboid crystals
70
What shape and type are monosodium urate crystals in gout?
Needle-shaped negatively birefringent crystals
71
What is the initial treatment of monoarticular pseudogout?
Intra-articular glucocorticoid injection
72
Which other condition is polymyalgia rheumatica commonly associated with?
Giant cell arteritis
73
What is the treatment of scleroderma renal crisis?
ACE inhibitors
74
Should ARBs be used as first line in the treatment of scleroderma renal crisis?
No (efficacy not established)
75
What does RS3PE stand for?
Remitting seronegative symmetrical synovitis with pitting edema
76
RS3PE is a paraneoplastic condition associated with underlying malignancy in up to 30% of cases.
True or false?
True
77
Which paraneoplastic rheumatologic condition is associated with cutaneous small-vessel vasculitis?
Leukocytoclastic vasculitis
78
Does RS3PE syndrome have tenosynovitis of the flexor or the extensor tendons of the hands and forearms?
Extensor
79
What is the first line treatment of acute gout in a patient with renal failure?
Prednisone (glucocorticoids)
80
Should colchicine be used in patients with ESRD on hemodialysis?
No (not easily removed by dialysis)
81
Should NSAIDS be used in renal failure?
No
82
What is the first line treatment of acute gout in a patient with no other issues?
NSAIDS
83
Is Sjogren syndrome associated with gastroesophageal reflux disease?
Yes
84
What is a clue in the history that suggests a cough is due to aspiration rather than GERD?
If it occurs when eating and drinking
85
Lytic bone lesions with intralesional ringed calcifications which can give a "popcorn pattern" appearance.
Diagnosis?
Chondrosarcomas
86
Imaging show layering near the periosteum with splitting of the cortex; classically described as "onion skin".
Diagnosis?
Ewing sarcoma
87
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?
Osteosarcoma
88
Imaging findings of a small central lucency with a sclerotic margin and cortical thickening.
Diagnosis?
Osteoid osteomas
89
What's the most common thyroid manifestation of Sjogren's disease?
Hypothyroidism
90
Should steroids administered for acute gout be given systemically or intraarticularly in patients with diabetes mellitus?
Intraarticularly
91
Which disease is marked by an autoimmune response to cartilaginous structures?
Relapsing polychondritis
92
Is laryngotracheobronchial disease associated with relapsing polychondritis?
Yes
93
What is often seen on pulmonary function testing in laryngotracheobronchial disease?
Decreased expiratory flow
94
What is often seen on pulmonary function testing in relapsing polychondritis?
Decreased expiratory flow
95
What is the most frequent injured ligament in an ankle sprain?
Anterior talofibular ligament tear
96
Which test can demonstrate anterior talofibular ligament tear?
Anterior drawer test of the ankle
97
What is the treatment of esophageal dysmotility (nutcracker)?
Diltiazem (calcium channel blocker)
98
What is the treatment of achalasia?
Peroral endoscopic myotomy
99
Is Paget's disease a disease of osteoclasts or osteoblasts?
Osteoclasts
100
What is the treatment of choice for Paget's disease?
Bisphosphonates
101
What is the first line treatment of rheumatoid arthritis?
Prednisone plus methotrexate
102
Which antibodies reliably indicate active SLE and correlate with renal involvement?
Anti double stranded DNA antibodies
103
Within what timeframe can colchicine be administered for acute gout?
Within 24 hours of symptom onset
104
What is the preferred treatment of acute pseudogout?
Intra-articular steroid injection
105
Can Pegloticase be used to treat gout in chronic kidney disease?
Yes
106
What is the treatment of granulomatosis with polyangitis?
Rituximab plus methylprednisone
107
Which infection is cryoglobulinemic vasculitis associated with?
Hepatitis C
108
What is the treatment of drug-induced lupus?
NSAIDS
109
Colchicine suppresses inflammation by interfering with neutrophil microtubules.
True or false?
True
110
Are patients with granulomatosis with polyangitis positive for c-ANCA or p-ANCA?
c-ANCA
111
Patient presents with pain at the metatarsal heads that that results in tenderness over the ball of the foot and sometimes the toes.
Diagnosis?
Metatarsalgia
112
Is diagnostic imaging needed to confirm diagnosis of frozen shoulder?
No
113
Are rheumatoid arthritis effusions exudative or transudative?
Exudative
114
Which gout medication has potential severe cutaneous reaction in Asians?
Allopurinol
115
Is hydroxychloroquine safe to use in pregnancy?
Yes
116
Does Raynaud phenomenon get better or worse during pregnancy?
Better
117
What is the next step when the creatinine is worsening in an SLE patient?
Renal biopsy
118
What is the treatment of interstitial lung disease associated with systemic sclerosis?
Mycophenolate mofetil
Cyclophosphamide
119
Which has more toxicity, mycophenolate mofetil or cyclophosphamide?
Cyclophosphamide
120
What the preferred first line management of osteoarthritis?
Topical NSAIDS
