RA and Gouty arthritis

Question 1

Biomarkers for RA diagnosis

Answer 1

Anti-CCPs and RF

Question 2

Which of the ff is TRUE about RA?

A. Result from inflammation of the joints, tendons, and bursae.
B. Early morning joint stiffness lasting less than 1 hr
C. Earliest involved joints are small joints of hands and feet
D. Two of the options
E. All of the options

Answer 2

D. Two of the options

Early morning joint stiffness lasting MORE THAN 1HR

Question 3

Frequent hallmark of RA

Answer 3

Flexor tendon tenosynovitis

Question 4

Hyperextension of the PIP joint with flexion of the DIP joint

Answer 4

Swan-neck deformity

Question 5

Flexion of the PIP joint with hyperextension of the DIP joint

Answer 5

Boutonniere deformity

Question 6

Subluxation of MCP joint with hyperextension of the first IP

Answer 6

Z-line deformity

Question 7

Subluxation of the distal ulna

Answer 7

Piano-key movement

Question 8

The most frequent site of cardiac involvement in RA is the __________

A. Endocardium
B. Myocardium
C. Pericardium
D. Any of the options

Answer 8

C. Pericardium

Question 9

Cardiomyopathy, a clinically important manifestation of RA can only be identified by which of the ff?

A. Echocardiography
B. CT scan
C. MRI
D. Any of the options

Answer 9

D. Any of the options

Echocardiography and MRI

Question 10

The most common valvular abnormality in RA is ________

A. Aortic stenosis
B. Mitral regurgitation
C. Tricuspid regurgitation
D. Any of the options

Answer 10

B. Mitral regurgitation

Question 11

The most common pulmonary manifestation of RA is ________

A. interstitial lung disease
B. pulmonary vasculitis
C. pleuritis
D. pleural effusion

Answer 11

C. Pleuritis

Question 12

The most common hematologic abnormality in RA is _________

A. Anemia
B. Neutropenia
C. Leukemia
D. Lymphoma

Answer 12

A. Anemia

Question 13

The most common cause of death in RA patients is ________

A. Pulmonary disease
B. Hematologic disease
C. Cardiovascular disease
D. Two of the options
E. All of the options

Answer 13

C. Cardiovascular disease

Question 14

The gene to confer the greatest risk of RA is _________

Answer 14

HLA-DRB1 gene

Question 15

The most reproducible environmental factor linked to RA is _________

Answer 15

Cigarette smoking

Question 16

Citrullination involves the conversion of citrulline from what amino acid?

A. Arginine
B. Alanine
C. Tryptophan
D. Valine

Answer 16

A. Arginine

Question 17

What are the pathologic hallmarks of RA?

Answer 17

Synovial inflammation and proliferation, focal bone erosions, and thinning of articular cartilage.

Question 18

Chronic inflammation leads to ___________

A. Synovial lining hyperplasia
B. Formation of pannus
C. Nephritis
D. Two of the options
E. All of the options

Answer 18

D. Two of the options

Synovial lining hyperplasia
Formation of PANNUS - thickened cellular membrane containing fibroblast-like synoviocytes and granulation-reactive fibrovascular tissuie

Question 19

The structural damage to the mineralized cartilage and subchondral bone is mediated by the _______

A. Osteoclast
B. Osteoblast
C. Osteocytes
D. Any of the options

Answer 19

A. Osteoclast

-multinucleated giant cells, identified by expression of CD68, and appear at the pannus-bone interface where they form resorption lacunae

Question 20

Immunoglobulin which is most frequently measured by laboratories and found in 75-80% of the patients

Answer 20

IgM

Question 21

Synovial fluid WBC count in RA

Answer 21

5000 - 50,000

2000 - noninflammatory (OA)

Question 22

Most useful confirmatory lab test for inflammatory arthritis such as RA

Answer 22

Synovial fluid analysis

Question 23

In plain radiography, the initial finding is ___________

A. Periarticular osteopenia
B. Soft tissue swelling
C. Symmetric joint space loss
D. Subchondral erosions

Answer 23

A. Periartricular osteopenia

Question 24

What part of the feet is often targeted first in RA?

A. 1st MTP
B. 2nd MTP
C. 3rd MTP
D. 4th MTP
E. 5th MTP

Answer 24

A. 1st MTP

Question 25

What imaging technique offers the greatest sensitivity for detecting synovitis and joint effusions, as well as early bone and bone marrow changes?

Answer 25

MRI

Question 26

What is the most common cause of death in RA patients? ``` A. Infection B. MI C. Ischemic heart disease D. Pneumonia E. Any of the options ```

Answer 26

C. Ischemic heart disease

Question 27

DMARD of first choice for the treatment of RA

Answer 27

Methotrexate

Question 28

Osteoporosis ranks as an important long-term complication of chronic use of what drug?

Answer 28

Prednisone

Question 29

Which of the following is/are used to reduce the signs and symptoms of RA, slow radiographic progression of joint damage, and improve physical function and quality of life? ``` A. Infliximab B. Adalimumab C. Etanercept D. Two of the options E. All of the above ```

Answer 29

E. All of the above

Question 30

This drug is a chimeric monoclonal antibody directed against CD20, a molecule expressed by most mature B lymphocytes

Answer 30

Rituximab

Question 31

What drugs are considered as oral triple therapy for RA? A. Methotrexate + Leflunomide + Tofacitinib B. Methotrexate + Sulfasalazine + Hydroxychloroquine C. Methotrexate + Anankira + Infliximab D. Methotrexate + Abatacept + Rituximab

Answer 31

B. Methotrexate, Sulfasalazine, and hydroxychloroquine (oral triple therapy)

Question 32

Which of the following is TRUE about Gout? A. Affects middle-aged man and postmenopausal women B. Results from increased body pool of calcium pyrophosphate with hyperuricemia C. Characterized by episodic acute or chronic arthritis D. Two of the options E. All of the options

Answer 32

D. Two of the options Results from increase body pool of urate with hyperuricemia

Question 33

Most common early clinical manifestation of gout.

Answer 33

Acute arthritis

Question 34

Which of the following may precipitate acute gouty arthritis? ``` A. Dietary excess B. Surgery C. Excessive ethanol ingestion D. Two of the options E. All of the options ```

Answer 34

E. All of the options Several events may precipitate acute gouty arthritis: dietary excess, trauma, surgery, excessive ethanol ingestion, hypouricemic therapy, and serious medical illnesses such as myocardial infarction and stroke.

Question 35

Best drug to lower serum urate in overproducers, urate stone formers, and patients with renal disease.

Answer 35

Allopurinol

Question 36

This drug reduces neutrophil mediated inflammatory | response by blocking the beta tubulin polymerization→ prevents the migration of neutrophils into the inflamed area

Answer 36

Colchicine

Question 37

This drug is a urate oxidase enzyme, third-line and newest urate-lowering therapy to be approved for the treatment of refractory chronic gout. A. Febuxostat B. Colchicine C. Pegloticase D. Any of the options

Answer 37

C. Pegloticase

Question 38

This drug is a potent and selective inhibitor of xanthine oxidase, thereby reducing the formation of xanthine and uric acid without affecting other enzymes in the purine or pyrimidine metabolic pathway. A. Allopurinol B. Febuxostat C. Probenecid D. Any of the options

Answer 38

B. Febuxostat

Question 39

This uricosuric drug/s are employed to decrease the body pool of urate in patients with tophaceous gout or in those with increasingly frequent gouty attacks. ``` A. Probenecid B. Sulfinpyrazone C. Allopurinol D. Colchicine E. Any of the options ```

Answer 39

E. Any of the options Probenecid and Sulfinpyrazone

Question 40

This stage of gout presents an imaging which shows characteristic juxta articular bone and loss of joint space

Answer 40

Chronic tophaceous gout