ICM - Rheum 1

Question 1

uric acid level for hyperuricemia (doesn’t always lead to gout…most asymptomatic)

Answer 1

>6.8 mg/dL

Question 2

uric acid is end product of this process

Answer 2

purine metabolism

Question 3

these dietary excesses increase risk for gout

Answer 3

meat, seafood, alcohol

Question 4

cytokine that is important in pathogenesis of acute gout flare (after crystals released into joint/bursae)

Answer 4

IL-1

Question 5

normal urine uric acid excretion amount in 24 hours

Answer 5

250-75 mg

Question 6

these can cause primary overproduction of uric acid

Answer 6

deficient HGPRT (salvage pathway), overactive PRPP, G6PD deficiency, F1P aldolase deficiency

Question 7

normal amount of filtered load of uric acid that is excreted

Answer 7

10%

Question 8

primary causes of renal underexcretion

Answer 8

deficiency in urate exporter, medullary cystic kidney disease (kids)

Question 9

normal time it takes for acute gouty arthritis to resolve

Answer 9

3-10 days

Question 10

80% of initial acute gouty arthritis attacks will be this

Answer 10

monoarticular

Question 11

crystal in gout joint aspiration

Answer 11

monosodium urate monohydrate

Question 12

crystal in pseudogout joint aspiration

Answer 12

calcium pyrophosphate dihydrate

Question 13

perdiod after 1st gout attack…additional acute attacks (usually within 2 years), shorter asymptomatic periods, sever, prolonged polyarticular flares

Answer 13

intercritical gout

Question 14

solid urate deposits in chronic gout

Answer 14

tophi

Question 15

to prevent gout progression, want to lower serum urate to below this level (deplete total body urate pool)

Answer 15

6 mg/dL

Question 16

typical drug of choice to treat gout

Answer 16

NSAIDs

Question 17

alternative to NSAID treatment for gout, but has more side effects (*diarrhea*)

Answer 17

colchicine

Question 18

typical length of corticosteroid treatment for gout

Answer 18

5-7 days

Question 19

allopurinol inhibits this enzyme in purine metabolism (to reduce uric acid levels)

Answer 19

xanthine oxidase

Question 20

this is overproduced in CPPD

Answer 20

cartilage pyrophosphate

Question 21

where cartilage pyrophosphate crystals deposit

Answer 21

joint articular cartilage (hyaline), fibrocartilage, ligaments

Question 22

x-ray showing calcification of cartilage and fibrocartilage

Answer 22

chondrocalcinosis

Question 23

where are gout crystals mostly located?

Answer 23

synovium (versus CPPD in cartilage)

Question 24

recessive renal tubular disorder –> older child/adult with hypokalemia, metabolic alklaosis, hypomagnesium, hypocalcuria, leg/arm cramps, weakness, polyuria, nocturia, chondrocalciosis

Answer 24

Gitelman syndrome

Question 25

acute CPP crystal arthritis --\> lasts 1-3 weeks, flares after parathyroidectomy, mono or oligo-articular arthritis

Answer 25

pseudogout

Question 26

where CPP crystal arthritis most commonly affects

Answer 26

knee (50%), wrist, shoulder, ankle

Question 27

chronic CPP crystal inflammatory arthritis --\> CPPD crystals demonstrable in joint fluid of RA clinical joints, radiographic changes like OA

Answer 27

pseduo-RA

Question 28

possible treatments for BCP crystal deposition arthropathy

Answer 28

NSAIDs, COX-2 inhibitors, steroid injection, irrigation (ultrasound to degrade and lowering serum phosphate also)

Question 29

stain for calcium oxalate crystal test (appear bipyramidal)

Answer 29

alizarin red

Question 30

where are calcium oxalate depositions found? (crystals can break off, causing acute synovitis stimulating synovial cell proliferation and enzyme release--\> articular destruction)

Answer 30

bone, articular cartilage, synovium, periarticular tissue

Question 31

bone that is lost in osteoporosis

Answer 31

trabecular (cortical also in type II)

Question 32

common fractures in type I osteoporosis (postmenopausal women mostly, lost of trabecular bone)

Answer 32

compression fractures and Colles fracture

Question 33

most common fractures in type II osteoporosis

Answer 33

femoral neck, proximal humerus, pelvis

Question 34

risk factors for osteoporosis

Answer 34

female, estrogen depletion, Ca/VitD deficiency, low peak bone mass, decreased physical activity, hypogonadism, hyperthyroidism, smoking, corticosteroids

Question 35

most common clinical finding of osteoporosis

Answer 35

vertebral body compression factors

Question 36

gold standard for diagnosis of osteoporosis (measures bone density and compares to young adult)

Answer 36

DEXA

Question 37

DEXA score in this range is osteopenia

Answer 37

1-2.5 below

Question 38

DEXA score in this range is osteoporosis

Answer 38

less than 2.5

Question 39

who should get DEXA screening?

Answer 39

women\>65, postmenopausal50 with fracture

Question 40

first line pharmacologic treatment for osteoporosis; how do these work?

Answer 40

bisphosphonates; inhibit osteoclast function

Question 41

osteoporosis therapy that helps build bone --\> must limit treatment for 2 years due to increased risk of osteosarcoma

Answer 41

PTH

Question 42

possible treatment for osteoporosis....can decrease pain of vertebral fractures (not used as much anymore)

Answer 42

calcitonin

Question 43

formation of new bone at joint surfaces

Answer 43

eburnation

Question 44

formation of new bone in periarticular tissues

Answer 44

osteophyte formation

Question 45

greatest modifiable risk factor for OA

Answer 45

obesity

Question 46

gene that may be mutated to increase risk of OA

Answer 46

COL2A1

Question 47

radiographic evidence of OA

Answer 47

joint space narrowing, osteophytes, subchondral cysts and sclerosis

Question 48

nodal generalized OA has predisposition to affect these joints

Answer 48

knee, hip and spine

Question 49

first line pharmacological treatment for OA; what is just as effective but has possible GI side effect?

Answer 49

acetaminophen; NSAIDs

Question 50

DDX for OA

Answer 50

Ca pyrophosphate deposition disease, RA, infectious monoarticular disease, psoriatic arthritis

Question 51

chronic inflammatory arthritis that affects the \*synovium\*

Answer 51

RA

Question 52

how do joints feel in RA?

Answer 52

soft and squishy (warm, boggy)

Question 53

cardiac manifestations of RA

Answer 53

pericarditis, myocarditis, CVD

Question 54

pulmonary manifestations of RA

Answer 54

pleural effusion (low glucose and low complement), interstitial fibrosis

Question 55

ocular manifestations of RA

Answer 55

Sjogrens, corneal inflammation, scleritis

Question 56

these are pathognomonic for RA

Answer 56

rheumatoid nodules

Question 57

seropositive RA, neutropenia, splenomegaly, occasional leg ulcers (hematological manifesation of RA)

Answer 57

Felty's syndrome

Question 58

these titer levels are good for prognosis of RA (higher=more severe)

Answer 58

RF

Question 59

very specific test for RA (96%) --\> helpful in diagnosis and prognosis

Answer 59

ACCP

Question 60

anemia seen in RA

Answer 60

normocytic normochromic

Question 61

diagnostic criteria for RA (from step up)

Answer 61

inflammatory arthritis more than 3 joints, \>6 weeks, elevated CRP/ESR, + RF/ACPA, radiographic changes

Question 62

drug of choice for pain control in RA

Answer 62

NSAIDs

Question 63

best initial DMARD for RA

Answer 63

methotrexate

Question 64

first line agent DMARDS for RA

Answer 64

methotrexate, leflunomide, hydroxychloroquine, sulfasalazine