MSK/Rheum

Question 1

Gout dx test?

Acute tx?

Answer 1

Negative bifringence TAP

NSAIDS –> Steroids –> Colchicine

Question 2

Best HTN tx w/ gout?

worst?

Answer 2

Best: Losartan

Worst: Thiazide

Question 3

Allopurinol s/e?

Answer 3

Hypersensitivity

TEN/SJS

Question 4

Causes of pseudogout?

Answer 4

Hemochromatosis
Hyperparathryoid
DM
Hypothyroid
Wilson disease

Question 5

Tx for pseudogout?

Answer 5

NSAIDs –> Steroids

Chronic prevention: Colchicine

Question 6

Most common cause of epidural abscess, how get there?

Answer 6

S aureus from hematogenous spread

Question 7

LBP worse at rest?

Answer 7

Ank Spond

Question 8

Tx for cord compression (no matter what cancer causes)?

Answer 8

Steroids first

Question 9

LBP worse when walking up stairs, better when down?

Answer 9

Spinal Stneosis

Question 10

Duptryen contracture tx?

Answer 10

Collagenase injections

Question 11

Viral arthritis vs. Rheumatoid?

Answer 11

Viral = +RF, -CCP
Rheum = +RF, +CCP

Question 12

Felty syndrome?

Answer 12

RA + Splenomegaly + Neutropenia

Question 13

Caplan syndrome?

Answer 13

RA + pneumoconiosis + Lung nodules

Question 14

Sicca syndrome?

Answer 14

RA + dry eyes/MM

Question 15

1 tx for RA?

Answer 15

DMARDS!
- MTX
- Inflixumab
Hydroxycloroquine
Sulfasalazine

Question 16

DMARDs safe in preg?

Answer 16

Sulfasalazine

Hydroxychloroquine

Question 17

MTX
Inflixumab
Hydroxycloroquine
Sulfasalazine s/e?

Answer 17

• Liver, BM, Lung
• TB
• retinal tox
• Rash, BM

Question 18

Salmon colored rash
Spiking high fever
joint effusion?

Answer 18

JRA (elevated ferritin ONLY)

Question 19

Joint XR in SLE?

Answer 19

NORMAL (still joint pain in 90% of cases)

Question 20

SLE acute tx?

Answer 20

high dose steroids

Question 21

Coagulation labs in anti-phospholipid syndome?

Answer 21

ELEVATED aptt (doesn’t correct)

Normal INR/PT

Question 22

Tests for scleroderma?

Answer 22

BEST: Anti-centromere

Scl-70 = anti topo

Question 23

Best initial test for polymyositis/dermatomyositis?

Answer 23

CPK/Aldolase (elevated)

Muscle bx = most accurate

Anti-Jo = Pulm involvement

Question 24

Worst complication of sjogrens?

Answer 24

Lymphoma

Question 25

First test for sjogrens?

Answer 25

Eye-filter paper, SSA/SSB Most accurate = Lip or parotid gland bx

Question 26

PAN organs?

Answer 26

Renal GI Neuro (mononeuritis muliplex) Hep B/C

Question 27

Best bx for wegeners?

Answer 27

Lung > renal >sinus

Question 28

Pencil in a cup on finger XR?

Answer 28

Psoriatic arthritis

Question 29

Work up for suspected pseudogout?

Answer 29

``` Ca studies (hyperparathyroid) Fe studies (hemochromatosis) ```

Question 30

PMR vs. RA. vs. Myositis?

Answer 30

PMR = Stiffness w/o swelling (+ESR) RA = Stiffness + swelling (+RF, +ESR) Myositis = weakness (+ESR, +CK)

Question 31

LBP that improves with use (worst at night)>

Answer 31

Ank spond Inflammation at joint/ligament insertion

Question 32

Baker's cyst associated with which joint disease?

Answer 32

OA

Question 33

CREST vs. Scleroderma on exam?

Answer 33

CREST = limited thickening (hands, head, neck) Systemic = Anywhere else (+Interstitial fibrosis)

Question 34

Anti-centromere ab?

Answer 34

CREST

Question 35

Anti-histone?

Answer 35

Drug SLE

Question 36

AMA ab?

Answer 36

PBC

Question 37

Gonnococcal vs. reactive arthritis?

Answer 37

GC = Fever, active purulent urethritis, migratory polyarhtirits Reactive = Afebrile, back pain, mouth ulcers, non-purulent urethritis

Question 38

Asymptomatic erythema nodosum work up?

Answer 38

``` CBC LFT Anti-streptolysin Tb test (rare) CXR (sarcoid) ``` Colonoscopy if GI symptoms

Question 39

Migratory arthritis Chronic diarrhea lymphatenopathy PAS+ biopsy of SI?

Answer 39

Whipple disease

Question 40

Thumb pain when holding baby

Answer 40

Dequervain Tenosynovitis

Question 41

Behcet vs. reactive arthritis?

Answer 41

Both = Uveitis, urethritis, oral ulcers Behcet = More skin, less joint, no preceeding GI disease, subacute but constant presentation Reactive = More joint, less skin, GI infx starts, relapsing remitting course

Question 42

Cyclosporine tox? (IL2 inhibitor)

Answer 42

``` Gingival hyperplasia Hirsutism Transient HTN (NA retention) Reversible neuro Glucose intolerance SCC Lymphoproliferative disease ```

Question 43

Tacrolimus tox (similar ot cyclosporine)

Answer 43

NOT Gingiva/hirsutism More GI, glucose, neuro

Question 44

Mycophenalate tox? (reversible inosine monophosphate inhibitor)

Answer 44

BM supp

Question 45

Azathioprine tox?

Answer 45

Dose dep diarrhea HEPATOTOX Leukopenia