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MKSAP Flashcards

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1
Q

Typical clinical presentation of Behcet syndrome

A

Young Male from the Mediterranean region with recurrent painful oral and scrotal/vulvar ulcers and eye inflammation (panuveitis, retinal vasculitis, optic neuritis). They can also have neurological symptoms, GI symptoms, and arthralgia.

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2
Q

How do you establish the diagnosis of Behchets

A

International scorch guidelines:
1. Recurrent oral, genital or ocular inflammation
2. Pathergy

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3
Q

Pharmacological management of Behchets

A
  1. Colchicine (first line for muco-cutaneous manifestations)
  2. Apremilast (PDE-4 inhibitor) for recurrent oral lesions
  3. Glucocorticoids
  4. Azathioprine and thalidomide
  5. TNF-alpha agents
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4
Q

Inflammatory arthritis with DIP involvement

A

PsA

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5
Q

Steroids in PsA can ppt ____ psoriasis

A

Erythrodermic

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6
Q

2 drugs associated with ANCA vasculitis

A

PTU and levamisole

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7
Q

Monoclonal antibody FDA approved for EGPA

A

Mepolizumabable Mugratory Eosinophilic Granulomatosis with Polyangitis —> treated with IL-5 inhibition

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8
Q

The test I need before doing anything else for inflammatory back pain is __

A

HLA-B27

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9
Q

What does seronegativity imply?

A

RF, ANA, and CCP are negative

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10
Q

Initiating pregablin for fibromyalgia

A

Start at low doses at night and titrate to max of 225 mg daily

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11
Q

2 SNRIs approved by FDA for fibromyalgia

A

Milnacipran

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12
Q

Characteristic finding of CPPD synovial fluid analysis

A

Positively birefringent rhomboid shaped crystals

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13
Q

Timeline for temporal artery biopsy in GCA

A

2 weeks within intubation of steroids

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14
Q

Preferred first like therapy for GCA

A

High dose prednisone + tocilizumab

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15
Q

Imaging modality for Gout if arthrocentesis cannot be performed?

A

Dual energy CT and double contour sign in US

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16
Q

IL-1BC

A

Anakinra and Canakinumab

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17
Q

Allele associated with hypersensitivity to allopurinol

A

HLA-B*58:01

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18
Q

Cholenergic agonists used for treatment of sicca symptoms when behavioral management fails

A

Cevemiline and pilocarpine

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19
Q

Patients with sjogrens and lupus are at increased risk of this malignancy

A

NHL

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20
Q

Characteristic radio graphic feature of CCPD in MCP joints

A

Hooked osteophytes

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21
Q

4 conditions associated with CCPP

A

Hyper PTH
Hemochromatosis
Hypo PO4
Hypo Mg

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22
Q

DDx of sjogrens

A

Sarcoidosis
IgG4 related diseases
GPA
HIV
Hep C
Lymphoma

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23
Q

What is the timeline for development of Reactive arthritis

A

2-3 weeks

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24
Q

Cutaneous manifestations of reactive arthritis

A

Keratoderma blenorrhagicum and circinate Balanitis

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25
Least common SpA
Reactive arthritis
26
Joint distribution for reactive arthritis
Asymmetric pauci arthritis involving the lower extremities
27
Treatment of reactive arthritis
NSAID x 2 weeks —> persistent —> steroids —> persistent for 3-6 months —> DMARDs for RA —> continued therapy for 3-6 months post disease resolution
28
Rx of IgG4 related disease
Long taper of steroids —> can add rituximab since disease recurs with discontinuation/taper of steroids
29
Rx of idiopathic RP fibrosis
MTX
30
Organisms implicated in post prosthetic join replacement infection: 1. Early <3 months 2. Late > 12 months 3. Intermediate (3-12 months)
1. Early and late - S. Aureus 3. Intermediate - CONS
31
What is FABER test
Flexion Abduction External rotation
32
Which joints are involved in AS
SI and synovial facet joints of the vertebrae
33
What is the 40% rule in AS
Patients are most comfortable when then are in 40% flexi on of the spine. Even AG night they use 3-4 pillows to prop to that position. Finally fibrosis and ossification ensue leading to kyphosis
34
What are the three stages of AS
Inflammation —> fibrosis —> ossification
35
Patient with AS has chest pain at night and at rest that improved with activity
Enthesitis of the Costco vertebral joints
36
Which peripheral joints are most commonly involved in AS
Hip and knee
37
2 DDx for renal disease in AS
1. Amyloidosis - more common 2. IgA nephropathy
38
Cause equina in AS. Culprit?
Arachnoid diverticula
39
HRCT finding in AS
Upper lobe fibrosis
40
What are the three patterns of joint involvement in IBD associated SpA and which ones correlate with IBD activity
1. Isolated SI or with AS 2. Type I peripheral: asymmetric oligo articular in BL LE —> correlate with add activity 3. Type 2 peripheral: symmetric poly arthritis in UE with wide range join involvement —> independent of IBD activity
41
Which ass of biologics cause IBD flare
IL-17
42
Meds for lupus in pregnant
Azathioprine and HCQS
43
Most dramatic presentation of relapsing oolychomdritis requiring extensive workup and urgent attention
Tracheobronchial involvement
44
Relapsing polychondritis presentation
Ear, middle ear (hearing loss), eye, modals bridge, trachea and bronchi, articular cartilages (inflammatory arthritis), heart valves, and the dons
45
Condition associated with relapsing polychondritis in 30% patients
ANCA vasculitis
46
What is MAGIC syndrome?
Mouth and Genital ulcers with Inflamed Cartilage (MAGIC) - Behchets + relapsing PC
47
Rx of RPC - mild and severe disease
Mild : NSAID + dapsone Severe: steroids, MTX, TNF agents, and tocilizumab
48
Classic manifestation of SIBO
Explosive diarrhea following a meal.
49
Rx of SIBO antibiotics
Ciprofloxacin, doxycycline, amoxi/clav, and rifaximin
50
Labs that can help differentiate lupus flare from pre-eclampsia
Complements, ds-DNA, and irate levels (elevated in pre eclampsia)
51
Life threatening Pulmonary manifestations of SLE
1. Acute lupus pneumonitis —> difficult to differentiate from infection —> Rx with Ab and steroids 2. DAH —> urgent bronch
52
CV manifestations of lupus (valve)
Aortic and mitral thickening, regurgitation, and LSE
53
GI manifestations of lupus
1. Abdominal pain that correlates with disease activity and resolves with improvement 2. Mesenteric vasculitis 3. Non infectious hepatitis with anti ribosomal P antibody
54
Alopecia is in lupus
Non-scarring
55
How is DILE different from normal SLE
Less organ involvement and more constitutional with skin, joint, and fatigue
56
Protein dysfunction in SpA
Fibrillar 1–> destruction of articular cartilages —> acetabular destruction
57
MOA of mepolizumab
IL-5 inhibitor
58
Rx of IGG4 related Ds
1. High dose steroids x 4 weeks —> slow taper over 1 years. 2. Steroids sparing agents: Azathioprine and Rituximab
59
Two rheum medications that can cause serum sickness like reaction
Infliximab and rituximab
60
Typical location of rheumatoid modules in the lung
Sub plural and around the interlobar septum
61
Characteristic finding of DISH in C, L, And T spine
Cervical: downward pointing spurs Thoracic: ligamental calcification Lumbar: upward pointing spurs
62
OA at MCP
Hemochromatosis
63
RA pattern but not RA
Chronic CPPD
64
4 DDx of dactylitis (S3T)
SpA Sarcoidosis Sickle cell TB
65
Medical condition mimicking scleroderma in hands
Diabetic stuff hands
66
Dorsal pitiing edema if hands
RS3PE
67
OA joints in feet
Mid foot and 1st MTP
68
How many toes should you normally see when looking for behind
1-1.5
69
Toe splaying is a finding in
RA
70
What is haglund deformity
Bony hypertrophy at the back of the heel die to chronic pressure from tight shoes
71
Coxalgic gait
Leaning over arthritic hip when that hip bears weight, pelvis remains level
72
Normal elbow valgus make and female
Make 5 Female 10-15

Rheumatology (2 decks)

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