Rhem Qs

Question 1

Henoch-Schönlein purpura - affects? Caused by? Lab findings? What comfirms the diagnosis?

Answer 1

skin, joints, kidneys, and gastrointestinal tract

Immune complex disease

Active Urine sedimentl C4 low, IgA elevated

Deposition of IgA on a skin
biopsy

Question 2

Hemochromatosis - affect on joints?

Answer 2

OA-like arthropathy BUT affects second and third metacarpophalangeal (MCP) or wrist joints.

Question 3

Anti-synthase syndrome?

If suspected on PE, should get what imaging test?

Answer 3

anti–Jo-1 plus two of the following clinical features:

myositis, interstitial lung disease, Raynaud phenomenon, nonerosive inflammatory arthritis, and mechanic’s hands.

CXR

Question 4

Tofacitinib - used to treat? Will cause what lab abnormality?

Answer 4

RA; elevation of all components of lipid panel

Question 5

Patients with Sjögren syndrome are at risk of developing what cancer?

Answer 5

Lymphoma (B-cell and MALT)

Question 6

Long term consequence of FMF?

Answer 6

AA amylodosis

Question 7

Pt with interstitial lung disease from diffuse cutaneous systemic sclerosis - start this medication?

Answer 7

cyclophosphamide

Question 8

Eosinophilic granulomatosis with polyangiitis is characterized by? (4)

Answer 8

eosinophilia,
migratory pulmonary infiltrates,
purpuric skin rash,
mononeuritis multiplex in the setting of antecedent atopy.

Question 9

immunosuppressant agent that preferentially targets T cells?

Answer 9

Cyclosporine

Question 10

Diffuse idiopathic skeletal hyperostosis?

Answer 10

noninflammatory condition defined by the presence of flowing osteophytes involving the anterolateral aspect of the thoracic spine at four or more contiguous vertebre

Question 11

prodromal stage of hepatitis B virus infection?

Answer 11

rapid-onset symmetric polyarthritis, (present before frank jaundice)

Question 12

inclusion body myositis - age of onset? muscles involved? symmetry?

Usual CK level?

Answer 12

> 50, distal and proximal, mostly symmetric

<1000

Question 13

This improves the symptoms of dry eyes in patients with primary Sjögren syndrome?

Answer 13

Topical cyclosporine

Question 14

used to treat allergic conjunctivitis?

Answer 14

Olopatadine drops

Question 15

Hydroxycloroquine - benefit in SLE? (4)

Answer 15

Reduces disease activity
improves survival
reduces risk of SLE-related thrombosis
Reduses risk of MI

Question 16

When to start urate lowering therapy for you? (4)

Answer 16

• 2+ attacks within a year
• An attack + CKD
• An attack tophi
• An attack with a history of urolithiasis

Question 17

Treatment of polymyalgia rheumatica?

Answer 17

Low dose (10-20mg) prednisone

Question 18

Anyone with reactive athritis should be tested for?

Answer 18

Chlamydia

Question 19

Milwaukee shoulder syndrome - age/sex? caused by? Charaterized by? Historical clues?

Answer 19

Women 70+

calcium phosphate deposition

pain, stiffness, and swelling that occurs gradually.

preceding trauma or history of overuse on the affected side

Question 20

IgG4-related disease is characterized by (histologically)?

Answer 20

lymphoplasmacytic infiltration

Question 21

Eosinophilia myalgia syndrome - presents with? Caused by?

Answer 21

• fasciitis and dermal induration
• neuropathy
• myopathy

linked to consuming contaminated L-tryptophan

Question 22

Morphea is characterized by ?

Answer 22

ocalized area of skin thickening

Question 23

initial treatment of choice for patients with new-onset, rapidly progressive, or erosive rheumatoid arthritis?

For non-erosive disease?

Answer 23

Methotrexate

Hydroxychloroquine

Question 24

anti-U1-RNP antibodies suggest?

Also must have 3/5?

Answer 24

• Raynaud phenomenon,
• edema of the hands,
• sclerodactyly,
• synovitis, and
• myositis

Question 25

Triad for DAH?

Answer 25

hypoxemia, new infiltrates found on chest radiograph, and decreasing hematocrit

Question 26

Löfgren syndrome? Characterized by? Treat with?

Answer 26

self-limited sarcoidosis acute arthritis, bilateral hilar lymphadenopathy, and erythema nodosum NSAIDs or low-dose prednisone

Question 27

Nonbiologic disease-modifying antirheumatic drugs (DMARDs) such as methotrexate and sulfasalazine - role in axial disease? in peripheral arthritis?

Answer 27

Not efficacious may be considered

Question 28

Women with dermatomyositis may have an increased risk of?

Answer 28

Ovarian cancer

Question 29

Strong risk factor for PAN?

Answer 29

HBV

Question 30

Diagnosis of PAN is best established by demonstrating what on biopsy? Or this on imaging findings?

Answer 30

necrotizing arteritis characteristic medium-sized artery aneurysms and stenoses on imaging studies of the mesenteric or renal arteries

Question 31

People with gout should eat MORE of this?

Answer 31

Low-fat dairy

Question 32

Study that could be appropriate if thromboangiitis obliterans (“Buerger disease”) were suspected?

Answer 32

Digital arteriography

Question 33

U1-ribonucleoprotein antibodies are associated with?

Answer 33

Mixed Connective tissue disease

Question 34

primary angiitis of the central nervous system (PACNS). Diagnosis and treatment?

Answer 34

Brain biopsy; glucocorticoids and cyclophosphamide

Question 35

Test to confirm Takayasu arteritis?

Answer 35

arteriography of the aorta and its branches

Question 36

SLE treatment that needs to be stopped during pregnancy? That do not need to be stopped?

Answer 36

Mycophenolate mofetil Prednisone and hydroxychloroquine

Question 37

The presence of these antibodies is sufficient to establish a diagnosis of granulomatosis with polyangiitis in patients with these 3 findings?

Answer 37

antiproteinase 3 antibodies classic upper airway manifestations, pulmonary infiltrates/nodules, and glomerulonephritis

Question 38

Antimyeloperoxidase antibodies are associated with? (3)

Answer 38

microscopic polyangiitis, eosinophilic granulomatosis with polyangiitis (formerly known as Churg-Strauss syndrome), and rapidly progressive glomerulonephritis.

Question 39

Blood pressure medications that lower uric acid levels?

Answer 39

losartan and calcium channel blockers

Question 40

Pt with severe tophaceous gout and persistent hyperuricemia and has not responded to oral urate-lowering therapy, including the xanthine oxidase inhibitors allopurinol and febuxostat. Next Med?

Answer 40

pegloticase

Question 41

Scleroderma renal crisis presents with? (organ affected, vitals, labs) Treatment?

Answer 41

Acute onset of oliguric kidney disease and severe hypertension, mild proteinuria, urinalysis with few cells or casts, microangiopathic hemolytic anemia, and thrombocytopenia. ACE inhibitor

Question 42

In patients with systemic sclerosis, malabsorption is often due to? Test?

Answer 42

bacterial overgrowth. glucose hydrogen breath test.

Question 43

Treatment for high-risk polymyalgia rheumatica?

Answer 43

Methotrexate+ prednisone