MKSAP STOCK5

Question 1

What are the two most common peripheral nerve manifestations of polyarteritis nodosa?

Answer 1

Mononeuropathy, Mononeuritis multiplex

Question 2

What is the expected physiologic changes in plasma osmolality and serum sodium during pregnancy?

Answer 2

Decrease in BOTH osmolality and sodium with normalization after delivery

Question 3

What is the most common mechanism of cardiac involvement in patients with systemic sclerosis and cardiomyopathy?

Answer 3

Microvascular disease (leads to patchy myocardial fibrosis)

Question 4

What kidney disease is associated with mesalamine therapy?

Answer 4

Interstitial nephritis

Question 5

What are four indications to start urate-lowering therapy for gout?

Answer 5

Two or more attacks within 1 year period; one attack in the setting of CKD (at least stage II), one attack and the presence of tophi, one attack and a Hx of nephrolithiasis

Question 6

What is the definitive diagnostic intervention for primary angiitis of the central nervous system?

Answer 6

Intracerebral angiography with brain biopsy

Question 7

What is a long term complication of meniscectomy?

Answer 7

Early onset knee OA

Question 8

What is the diagnostic imaging test for knee osteoarthritis?

Answer 8

STANDING plain radiograph of the knee

Question 9

What is the treatment of rheumatoid arthritis that is inadequately controlled with methotrexate?

Answer 9

Addition of tumor necrosis factor alpha inhibitior (adalimumab, golimumab, certolizumab, infliximab, or etanercept)

Question 10

Cause of persistent urogenital infection associated with reactive arthritis

Answer 10

Chlamydia trachomatis

Question 11

What is the management of methotrexate therapy before conception?

Answer 11

Must be discontinued

Question 12

What nonpharmacologic therapy is indicated for all patients with fibromyalgia?

Answer 12

Regular aerobic exercise

Question 13

What are two common causes of hypersensitivity vasculitis

Answer 13

Drugs and Infection

Question 14

What is the most likely cause of progressive weight loss, abdominal cramping, and loose stools in a patient with diffuse cutaneous systemic sclerosis?

Answer 14

Bacterial Overgrowth Syndrome

Question 15

What is the treatment of polymyalgia rheumatica?

Answer 15

Low-Dose Prednisone i.e. 10-20 mg –expect rapid improvement

Question 16

What is the recommended pharmacologic therapy for knee osteoarthritis in patients with inadequate response to acetaminophen

Answer 16

NSAIDs systemic or topical

Question 17

What is the diagnosis for insidiously progressive shoulder pain, stiffness, and swelling following either trauma or overuse in older women?

Answer 17

Basic Calcium Phosphate Deposition (Milwaukee Shoulder Syndrome)

Question 18

What are two antihypertensive medications that lower the risk of an acute flare in patients with gout?

Answer 18

Losartan (but NOT other ARBs) and CCBs

Question 19

What is the urine study useful for determining the cause of a metabolic alkalosis?

Answer 19

Urine chloride levels

Question 20

What is the confirmation for a diagnosis of drug-induced lupus?

Answer 20

Aside from the anti-histone Ab, cessation of sx when drug is stopped

Question 21

What agents are recommended by JNC 8 for initial tx of stage I HTN in blacks?

Answer 21

Thiazide or CCB

Question 22

What imaging is required for patients with clinically diagnosed hand osteoarthritis?

Answer 22

NONE- woooh tricked ya!

Question 23

What is the recommended initial pharmacologic therapy for knee osteoarthritis

Answer 23

Acetaminophen

Question 24

What is the initial treatment of new-onset, rapidly progressive, or erosive rheumatoid arthritis?

Answer 24

Methotrexate (some form of DMARD)

Question 25

What are the complement levels in cyroglobulinemic vasculitis?

Answer 25

Low C4, normal C3

Question 26

What are three findings predictive of diffuse alveolar hemorrhage in a patient with systemic lupus erythematosis?

Answer 26

Hypoxemia, New pulmonary infiltrates on chest radiograph, decreasing hematocrit

Question 27

Cultures of these two body fluids should be obtained before initiating empiric antibiotics for suspected prosthetic joint infection

Answer 27

Blood and synovial fluid

Question 28

What is the formula for estimating the maximal expected ESR based on age?

Answer 28

(Age in years + 10) /2

Question 29

What are four clinical findings highly suggestive of cryoglobulinemic vasculitis?

Answer 29

Multisystem vasculitis, Low C4, normal C3, and a positive rheumatoid factor

Question 30

What is the preferred type of vascular access in patients with ESRD requiring HD

Answer 30

AV fistula

Question 31

What endocrine disorder is associated with acquired hypokalemic periodic paralysis?

Answer 31

Thyrotoxicosis

Question 32

What is the diagnosis for erosive arthritis involving the distal interphalangeal and carpometacarpal joints NOT associated with elevation of inflammatory markers?

Answer 32

Erosive Osteoarthritis

Question 33

This is a disease characterized by eosinophilia, migratory pulmonary infiltrates, purpuric skin rash, and mononeuritis multiplex

Answer 33

Eosinophilic Granulomatosis with polyangiitis

Question 34

What is the indicated therapy for the treatment of a scleroderma renal crisis?

Answer 34

Captopril

Question 35

What ist he recommended manipulation of NSAID therapy in older patients to decrease the risk of gastrointestinal toxicity?

Answer 35

Switch from oral to topical

Question 36

What serum antibody levels correlate with disease activity in SLE (esp. kidney involvement)

Answer 36

Anti-Double Stranded DNA ab

Question 37

What is the initial treatment of polymyositis or dermatomyositis with muscle involvement?

Answer 37

Glucocorticoids (high dose)

Question 38

What routine lab monitoring is required q8-12 weeks in patients treated with leflunomide?

Answer 38

Liver enzymes

Question 39

Reactive arthritis and psoriatic arthritis are more common and more severe in patients with this systemic infection

Answer 39

HIV infection

Question 40

What antibody is often associated with mixted connective tissue disease?

Answer 40

Anti-U1 ribonucleoprotein

Question 41

What is the initial treatment of mild systemic lupus erythematosis

Answer 41

Hydroxychloroquine

Question 42

What is the most overrepresented cancer in women with dermatomyositis compared with women without it

Answer 42

Ovarian CA

Question 43

What is the recommended mgmt of secondary hyperparathyroidism in patients with CKD?

Answer 43

Normalization of calcium, phosphorus, and vitamin D levels with active vitamin D (i.e. Calcitriol)

Question 44

What is the diagnosis associated with distal skin thickening and features of CREST syndrome?

Answer 44

Limited Cutaneous Systemic Sclerosis

Question 45

What is pegloticase?

Answer 45

Infusional uric acid specific drug used for gout refractory to xanthine oxidase inhibitors

Question 46

What is the name of the neuropathy characterized by abnormal findings in the territory of two or more nerves in separate parts of the body?

Answer 46

Mononeuritis multiplex

Question 47

Testing for this infection is indicated before initiating treatment with a biologic agent

Answer 47

Mycobacterium tuberculosis

Question 48

What is the form of osteoarthritis affecting non weight bearing joints such as the shoulders or wrists?

Answer 48

Osteoarthritis with calcium pyrophosphate deposition

Question 49

What is the primary therapy for parvovirus B19 associated arthritis?

Answer 49

NSAIDs

Question 50

What are the four clinical findings of which TWO are required to make a diagnosis of Behcet syndrome in addtion to recurrent painful oral ulcers?

Answer 50

Recurrent painful genital ulcers, eye involvment, skin involvement, and pathergy

Question 51

What is the recommended initial therapy for minimal change disease in adults?

Answer 51

High dose steroids

Question 52

What rheumatologic disorder is characterized by high spiking fevers, arthritis, rash, high neutrophil counts, and markedly elevated serum ferritin?

Answer 52

Adult Onset Still Disease

Question 53

What are two clinical criteria to diagnose preeclampsia in a patient without proteinuria?

Answer 53

New onset HTN after 20 weeks of pregnancy or evidence of end-organ damage i.e. thrombocytopenia, kidney dysfxn, liver dysfxn, pulm edema etc)

Question 54

What are three indications for kidney biopsy in patients with suspected lupus nephritis?

Answer 54

Increasing serum creatinine without explanation, proteinuria \>1 g / 24h; and proteinuria with cellular casts or hematuria

Question 55

What are four synovial fluid studies indicated when evaluating probable crystal related arthritis?

Answer 55

Leukocyte count, crystal analysis, gram stain, and culture

Question 56

What are the three cardinal findings of Lofgren syndrome?

Answer 56

Acute arthritis, Bilateral Hilar lymphadenopathy, and erythema nodosum

Question 57

What is the clinical diagnosis in a patient with findings consistent with rheumatoid arthritis but negative rheumatoid factor of anti-cyclic citrullinated peptides?

Answer 57

Seronegative Rheumatoid Arthritis

Question 58

What is the diagnosis of a lymphoplasmacytic infiltration and enlargement of pancreas, lymph nodes, salivary glands, kidneys, or skin?

Answer 58

IgG4-Related Disease

Question 59

Name four autoimmune diseases associated with scleritis?

Answer 59

Rheumatoid Arthritis, Relapsing Polychondritis, Inflammatory Bowel Disease, and Vasculitis

Question 60

What is the most common inherited kidney disorder?

Answer 60

Autosomal Dominant Polycystic Kidney Disorder

Question 61

What is the kidney disease causing marked proteinuria without apparent systemic disease that may occur in extremely obese patients?

Answer 61

Secondary focal segmental glomerulosclerosis (FSGS)

Question 62

What is the serum bicarbonate level for which oral alkali therapy is indicated in patients with CKD?

Answer 62

If it is \<23

Question 63

What are two coexisting conditions that may present as acute monoarthritis?

Answer 63

Gout and Septic Arthritis

Question 64

What is an indication for gouty flare prophylaxis when treating tophaceous gout?

Answer 64

Any sign of active disease including flares of acute gout or tophi

Question 65

What is the diagnostic criteria for preeclampsia

Answer 65

New onset hypertension after 20 weeks of pregnancy with proteinuria (\>300 mg or urine prot/cr ratio \>300)

Question 66

What is the recommended method to monitor ankylosing spondylitis disease activity in patients responding to Tx?

Answer 66

A good physical exam

Question 67

What are four factors associated with a worse clinical outcome in patients with IgA nephropathy?

Answer 67

HTN, Kidney dysfunction, Persistent proteinuria \>1g, and tubulointerstitial damage seen on kidney bx

Question 68

What are the two most common causes of pseudohyponatremia?

Answer 68

Hyperglycemia, significantly elevated serum lipid levels, and abnormal serum paraproteins

Question 69

What is a cause of acute kidney injury associated with peripheral eosinophilia, hypocomplementemia, and eosinophiluria?

Answer 69

Cholesterol embolization

Question 70

What is the likely diagnosis in a patient younger than 40 with signs and symptoms of large vessel stenosis and evidence of systemic inflammation?

Answer 70

Takayasu arteritis

Question 71

What is the imaging study indicated for all patients with Marfan syndrome?

Answer 71

Transthoracic Echocardiography

Question 72

Patients who are treated with cyclophosphamide are at increased risk for developing what malignancy?

Answer 72

Bladder CA

Question 73

What are three culture sites for suspected disseminated gonococcal infection?

Answer 73

Blood, GU tract, or pharynx

Question 74

What is the potential rheumatologic prodrome of acute hepatitis B infection?

Answer 74

Rapid Onset Symmetric Polyarthritis

Question 75

What is the diagnosis for the syndrome that includes features of systemic lupus erythematosis, systemic sclerosis, and/or polymyositis and positive anti-U1 Ribonucleoprotein antibodies?

Answer 75

Mixed Connective Tissue Disease

Question 76

What is the immunosuppressant treatment for dry eyes associated with Sjogren syndrome?

Answer 76

Topical Cyclosporine

Question 77

What is the imaging study for suspected osteonecrosis if plain radiographs are normal?

Answer 77

MRI

Question 78

What are four clinical features characteristic of reactive arthritis?

Answer 78

Asymmetric monoarthritis or oligoarthritis of the lower extremities, enthesopathy, dactylitis, and sacroiliitis

Question 79

What condition is defined by flowing osteophytes involving contiguous vertebrae in the thoracic spine with preservation of disk space in the absence of inflammatory change?

Answer 79

Diffuse Idiopathic Skeletal Hyperostosis (DISH)

Question 80

What are the two most common causes of death in patients with ESRD?

Answer 80

Cardiovascular disease and infection

Question 81

What is an inflammatory myopathy characterized by insidious onset, slow progression, and weakness of both distal and proximal muscles?

Answer 81

Inclusion Body Myositis

Question 82

What are four clinical features in patients with Raynaud phenomenon indicating and increased risk for developing an associated connective tissue disease?

Answer 82

Severe and prolonged episodes of vasospasm, asymmetric involvement of digits, abnormal nailfold capillary exam, and digital pitting

Question 83

What is the recommended tx for patients with CKD and hyperphosphatemia after following low phosphate (renal) diet?

Answer 83

Oral Phosphate Binders

Question 84

What acid-base disorder is associated with anxiety disorder and panic episodes

Answer 84

Respiratory alkalosis

Question 85

What is the recommended treatment of acute ethylene glycol poisoning?

Answer 85

IV hydration, fomepizole (competes for EtOH dehydrogenase) and HD

Question 86

What is the initial diagnostic study for evaluating possible diabetes insipidus?

Answer 86

Water Restriction test

Question 87

What are three drugs that may be safely continued during pregnancy in women with SLE requiring immunosuppression?

Answer 87

Azathioprine, hydroxychloroquine, and prednisone

Question 88

What is the most common cause of hyporesponsiveness to EPO in patients with CKD related anemia?

Answer 88

Iron deficiency

Question 89

What is the recommended BP goal by JNC8 for pt aged 60 and over

Answer 89

Less than 150/90

Question 90

What is the sequence of the two serologic tests for a diagnosis of Lyme arthritis?

Answer 90

ELISA followed by B. borgdurferii Western Blot

Question 91

Increasing the dietary intake of this type of food may help decrease risk of gout flares?

Answer 91

Low-Fat dairy products

Question 92

What is the diagnostic laboratory study for suspected granulomatosis with polyangiitis?

Answer 92

Antiproteinase 3 antibodies (C-ANCA)

Question 93

What is the first line treatment of ankylosing spondylitis when NSAIDs are inadequate?

Answer 93

tumor necrosis factor alpha inhibitor therapy

Question 94

What medication is indicated to lower serum urate levels in pt with gout who do not respond to xanthine oxidase inhibitors?

Answer 94

Pegloticase (this is infusional therapy)

Question 95

What is the most common cardiac manifestation of rheumatoid arthritis?

Answer 95

Pericarditis

Question 96

What are four potential causes of secondary membranous glomerulopathy?

Answer 96

Malginancies (solid organ), Autoimmune diseases (lupus or MCTD), HBV/HCV, and medications like Gold, NSAIDs and penicillamine

Question 97

What urate-lowering agent is contraindicated in patients being treated with azathioprine?

Answer 97

Febuxostat (allpurinol requires dose reduction)

Question 98

What is the agent used in tumor lysis syndrome to rapidly decrease serum urate levels?

Answer 98

Rasburicase (urate oxidase)

Question 99

What is the initial therapy to rapidly lower serum potassium levels in severe hyperkalemia?

Answer 99

IV insulin and glucose

Question 100

Three classes of antihypertensive medication that is ABSOLUTELY contraindicated in pregnancy

Answer 100

ACE, ARBs, and direct renin inhibitors (aliskerin)