Exam 1 -- Rheumatology #1

Question 1

How much of the primary care workload is rheumatology?

Answer 1

20-30%

Question 2

What is another term for rheumatology?

Answer 2

Collagen vascular diseases

Question 3

Does a ligament connect bone to bone or muscle to bone?

Answer 3

LBB (Ligament connects bone to bone)

Question 4

Does a tendon connect bone to bone or muscle to bone?

Answer 4

TMB (Tendon connects muscle to bone)

Question 5

How does the enthesis (end of a bone) differ from the shaft of the bone?

Answer 5

The enthesis is more porous and is vascularized; the shaft is denser and avascular

Question 6

Articular cartilage is a specific type of what cartilage?

Answer 6

Hyaline

Question 7

Is articular cartilage vascular or avascular?

Answer 7

Avascular

Question 8

Articular cartilage is made of what type of collagen?

Answer 8

Type 2

Question 9

Where can type 2 collagen be found?

Answer 9

Articular cartilage and the vitreous humor of the eye

Question 10

Extracellular fluid is made of what components?

Answer 10

Collagens, elastins, glycoproteins, proteoglycans, and cells

Question 11

Collagens make up how much of the synovial fluid?

Answer 11

90%

Question 12

What role do glycoproteins have in joints?

Answer 12

Tissue remodeling (they are also known as fibronectin)

Question 13

True or false: cytokines stimulate fibronectin

Answer 13

False; they inhibit fibronectin, decreasing tissue rebuilding

Question 14

What purpose do proteoglycans have in the extracellular fluid?

Answer 14

They are GAG chains that bind the fluid together and retain nutrients

Question 15

What is the name for nutrient rich fluid that is secreted by cells in the ECM?

Answer 15

Hyaluronan

Question 16

Matrix Metalloproteinases (MMPs) 2 and 9 degrade CT. What specific portions of the ECM do they degrade?

Answer 16

Collagen, proteoglycans, and fibronectin

Question 17

True or false: MMPs are upregulated during inflamation

Answer 17

True.

Question 18

What is a common drug used to decrease MMP activity?

Answer 18

Doxycycline

Question 19

Are bursitis, carpal tunnel syndrome, and tenosynovitis rheumatologic in nature?

Answer 19

No, but they are dealt with by rheumatologists often

Question 20

What can cause bursitis?

Answer 20

Repetitive motion, pressure, RA, gout, trauma

Question 21

True or false: bursitis normally presents bilaterally and symmetrically

Answer 21

False; it presents unilaterally and asymmetrically

Question 22

In what way (relating to activity and rest) does bursitis differ from reheumatoid arthritis?

Answer 22

Bursitis is exacerbated by activity and improved by rest; RA is the opposite.

Question 23

True or false: bursitis is more common than RA and lupus

Answer 23

True.

Question 24

What is a good way to treat buritis?

Answer 24

PRICE (Protect, Rest with a little activity, Ice, Compress, Elevate); NSAIDs (higher doses); massage; corticosteroid (only if not bacterial in nature); possibly antibiotics; surgery in extreme cases

Question 25

True or false: carpal tunnel syndrome is the most common entrapment neuopathy

Answer 25

True.

Question 26

What causes carpal tunnel syndrome?

Answer 26

Prolonged pressure and/or use, arthritis, pregnancy

Question 27

How would you treat carpal tunnel syndrome?

Answer 27

Splint at night, corticosteroid injection, surgery

Question 28

What is tenosynovitis?

Answer 28

Inflammation of the synovium around a tendon (not inflammation of the tendon itself

Question 29

What is another name for tenosynovitis?

Answer 29

Trigger finger

Question 30

What causes tenosynovitis?

Answer 30

Repetitive use, RA, injury, genetics

Question 31

How would you treat tenosynovitis?

Answer 31

Split, corticosteroid injection, surgery

Question 32

True or false: tenosynovitis is more common in diabetics

Answer 32

True.

Question 33

What treatment strategies can be employed for not only bursitis, carpal tunnel syndrome, and tenosynovitis, but also for RA?

Answer 33

Rest and light exercise, physical therapy, smoking cessation, alcohol reduction, weight loss, Omega-3, fish oil supplements, medications

Question 34

What role do omega-3 and fish oil supplements play in treating RA or other conditions that involve the joints?

Answer 34

They inhibit MMPs

Question 35

Treatment of conditions involving the joints can consist of different classes of drugs. Which classes are meant to relieve the pain?

Answer 35

NSAIDs, corticosteroids, analgesics

Question 36

Treatment of conditions involving the joints can consist of different classes of drugs. What class is meant to treat the actual condition, not just relieve the pain?

Answer 36

DMARDs (including biologics and tetracyclines)

Question 37

What enzyme do corticosteroids target?

Answer 37

Phospholipase A2 (releases arachidonic acid from the cell membrane--AA is the precursor molecule for thromboxanes, protacyclins, and prostaglandins

Question 38

The COX-1 pathway leads to what kind of prostaglandins?

Answer 38

Cytoprotective--protection of gastric mucosa; also aid in platelet aggregation

Question 39

What are some side effects that can arise from COX-1 inhibition?

Answer 39

GI upset, GI bleeding, nausea

Question 40

The COX-2 pathway leads to what kind of prostaglandins?

Answer 40

Inflammatory--recruitment of inflammatory cells, sensitization of skin pain receptors.

Question 41

The COX-2 pathway is active in the kidneys. What is its result in the kidney?

Answer 41

Regulation of BP

Question 42

The COX-2 pathway results in prostacyclins. What is the role of prostacyclins?

Answer 42

They cause vasodilation and keep thromboxanes in check. Hence, inhibition of COX-2 results in vasoconstriction (an increase in BP) and an increase in clot formation due to the thromboxanes.

Question 43

What are the 4 benefits of NSAIDs?

Answer 43

Anti-pyresis (fever-reducing); anti-platelet (clot reduction); analgesic (pain-reducing); anti-inflammatory (in higher doses)

Question 44

True or false: NSAIDs can damage the liver

Answer 44

True.

Question 45

Which NSAIDs are very COX-1 selective? Which are COX-2 selective?

Answer 45

Aspirin and piroxicam are very COX-1 selective; celecoxib and meloxicam are COX-2 selective

Question 46

Patients with what type of allergy should not be given celecoxib?

Answer 46

Sulfa

Question 47

Which NSAIDs are used as topical agents to reduce macular swelling after cataract surgery (and prophylactically, too)?

Answer 47

Ketorolac, diclofenac

Question 48

What are some side effects that can arise from corticosteroid use?

Answer 48

Osteoporosis, diabetes, HTN, weight gain, infections, Cushing's syndrome (not disease), cataracts, glaucoma

Question 49

Corticosteroid use is contraindicated in what common condition?

Answer 49

Pregnancy

Question 50

What is the upper limit of how long a corticosteroid should be used?

Answer 50

About 3 months

Question 51

How long do DMARDs take for their full effect?

Answer 51

6 weeks to 6 months

Question 52

What type of infection can be reactivated with DMARD use?

Answer 52

Usually TB

Question 53

Methotrexate causes a decrease in what cellular substance?

Answer 53

Folic acid, decreasing the ability of the cell to contribute to the inflammatory response. This leads to apoptosis.

Question 54

True or false: methotrexate is safe to take during pregnancy

Answer 54

False.

Question 55

What are some of the side effects of methotrexate use?

Answer 55

Nausea, liver damage*, pulmonary toxicity*, mouth ulcers, alopecia, infections

Question 56

Which DMARDs act as folic acid inhibitors?

Answer 56

Methotrexate and sulfasalazine

Question 57

How long do patients take to respond to sulfasalazine treatment?

Answer 57

3-6 months

Question 58

True or false: sulfasalazine is safe to take during pregnancy

Answer 58

True.

Question 59

What are some of the side effects of sulfasalazine use?

Answer 59

Nausea, rash, reversible infertility in males

Question 60

How does hydroxychloroquine work?

Answer 60

It impairs the cytokine response

Question 61

How long do patients take to respond to hydroxychloroquine treatment?

Answer 61

3-6 months

Question 62

What is a normal dose of hydroxychloroquine for RA?

Answer 62

200-400mg (usually 200mg) bid

Question 63

Hydroxycloroquine binds to melanin, making it especially toxic for what part of the eye?

Answer 63

The macula

Question 64

What are some of the side effects of hydroxychloroquine use?

Answer 64

Irreversible retinopathy (bull's eye retinopathy) 1 in 2000; GI upset, nightmares, psychosis

Question 65

True or false: hydroxychloroquine is safe to take during pregnancy

Answer 65

True.

Question 66

True or false: azathioprine and leflunomide (DMARDs) are safe to take during pregnancy

Answer 66

False.

Question 67

Which DMARD might be used if previous DMARDs haven't been working?

Answer 67

Cyclophosphamide

Question 68

How does cyclophosphamide work?

Answer 68

Suppresses B and T cell function by 30-40%

Question 69

How long can cyclophosphamide be used for?

Answer 69

3-6 months

Question 70

What are some of the side effects of cyclophosphamide use?

Answer 70

Herpes zoster, alopecia, nausea/vomiting, infertility in males and females

Question 71

True or false: cyclophosphamide is safe to take during pregnancy

Answer 71

False.

Question 72

How does cyclosporine work?

Answer 72

It inhibits IL-1 and IL-2 and T cells

Question 73

What ophthalmic solution contains cyclosporine?

Answer 73

Restasis (for dry eye)

Question 74

What are some of the side effects of cyclosporine use?

Answer 74

HTN, kidney problems (in 50%), infection

Question 75

True or false: cyclosporine is safe to take during pregnancy

Answer 75

False.

Question 76

Which DMARDs are tetracyclines?

Answer 76

Minocycline and doxycycline

Question 77

True or false: doxycycline has both antibiotic and anti-inflammatory effects

Answer 77

True.

Question 78

How does doxycycline work?

Answer 78

It inhibits MMPs, TNF, T cells, and cytokines

Question 79

What are some of the side effects of doxycycline use?

Answer 79

Skin rash, GI upset, sensitivity to sun*, dizziness, decreases effectiveness of birth control*, increases potency of blood thinners*, causes teeth and bone deformity* in children (CI pregnancy and breast feeding)

Question 80

Use of doxycycline is contraindicated in what populations?

Answer 80

Pregnant, breast-feeding, or kids (causes bone and teeth deformity)

Question 81

True or false: all biologic drugs for RA are injections

Answer 81

True.

Question 82

If a biologic drug is used to treat RA, it is usually given with what other DMARD?

Answer 82

Methotrexate

Question 83

What are the side effects of biologic drugs?

Answer 83

Infection risk, TB activation, increased risk of malignancy, demyelination

Question 84

Use of biologic drugs for a patient with RA is contraindicated if the patient has what other condition?

Answer 84

MS

Question 85

The biologic drugs have what type of suffix?

Answer 85

"-mab"

Question 86

True or false: all biologic drugs for RA are safe to use in pregnancy

Answer 86

False; none of them are safe to use during pregnancy

Question 87

Which biologic drug for RA is approved for children?

Answer 87

Tocilizumab

Question 88

True or false: using two biologic drugs is completely safe for treatment of RA

Answer 88

False; it decreases the immune response too much