Rheum

Question 1

What’s the first choice medication for RA?

Answer 1

Mtx

Question 2

What’s the mechanism of action for methotrexate? Supplement with what medication?

Answer 2

Dihydrofolate reductase inhibitor; folate

Question 3

What organ toxicity (3) is there for methotrexate?

Answer 3

Marrow suppression, pneumonitis, and hepatotoxicity

Question 4

Avoid rx methotrexate In conjunction with what medication?

Answer 4

Trimethoprim-sulfamethoxazole

Question 5

Which 2 RA meds can be used in pregnancy?

Answer 5

Hydroxychloroquine and sulfasalazine

Question 6

Sulfasalazine causes what side effect in men?

Answer 6

Decreased sperm count

Question 7

Which gene test should be checked before administering azathioprine to prevent dangerous bone marrow suppression?

Answer 7

TPMT gene test (thiopurine S-methyltransferase)

Question 8

With osteoarthritis, what would you expect the ESR and CRP levels to be?

Answer 8

Normal (versus elevated in rheumatoid arthritis)

Question 9

Needle-shaped, (-) birefringent crystals Dx of?

Answer 9

Gout (monosodium urate crystals)

Question 10

What’s the mechanism of action for methotrexate? Supplement with what medication?

Answer 10

Dihydrofolate reductase inhibitor; folate

Question 11

What is the most sensitive method of diagnosing avascular necrosis?

Answer 11

MRI

Question 12

With systemic lupus erythematosus exacerbation, what would you expect the complement (high/low), anti-dsDNA (pos/neg) and ESR (high/low) levels to be?

Answer 12

Low complement, pos anti-dsDNA, high ESR

Question 13

Rapid fire assoc:Rhomboid crystals, (+) birefringent

Answer 13

Pseudogout (calcium pyrophosphate dihydrate crystals)

Question 14

Which agent used in the treatment of rheumatoid arthritis requires frequent eye exams?

Answer 14

Hydroxychloroquine

Question 15

Rapid fire assoc:Polished, “ivory-like” appearance of bone at cartilage erosion

Answer 15

Eburnation (osteoarthritis resulting in bony sclerosis)

Question 16

What is the most specific test for diagnosing rheumatoid arthritis?

Answer 16

Anti-citrullinated protein(anti-CCP) antibody

Question 17

What is the leading cause of death inpatients with systemic lupus erythematosus?

Answer 17

Cardiovascular disease

Question 18

Painful fingers/toes changing color from blue to white to red with cold or stress

Answer 18

Raynaud phenomenon (vasospasm in extremities)

Question 19

What would you expect pleural effusion glucose level to be in individuals with rheumatoid arthritis?

Answer 19

Less than 30 mg/dl

Question 20

Dry eyes, dry mouth, arthritis Dx?

Answer 20

Sjogren syndrome (autoimmune destruction or exocrine glands)

Question 21

What rheumatological condition can often be associated with temporal arteritis?

Answer 21

Polymyalgia rheumatica(PMR)

Question 22

What is the most common extra-articular manifestation of rheumatoid arthritis?

Answer 22

Subcutaneous Rheumatoid nodules

Question 23

Rapid fire assoc: Anticentromere antibodies

Answer 23

Scleroderma (CREST)

Question 24

Rapid fire assoc: Anti-topoisomerase antibodies

Answer 24

Diffuse systemic scleroderma

Question 25

Urethritis, conjunctivitis, arthritis in a male

Answer 25

Reactive arthritis associated with HLA-B27

Question 26

Rapid fire assoc:"Bamboo spine" on x-ray

Answer 26

Ankylosing spondylitis (chronic inflammatory arthritis: HLA-B27)

Question 27

What is the initial diagnostic test to check in an individual you suspect to have temporal arteritis?

Answer 27

ESR

Question 28

What is the goal uric acid level to prevent further attacks in patients with gout? Goal w/tophi?

Answer 28

Less than 6mg/dl, less than 5

Question 29

Rapid fire assoc:Antineutrophil cytoplasmic antibodies (ANCAs)

Answer 29

Microscopic polyangiitis and eosinophilic granulomatosis with polyangiitis (Churg-Strauss syndrome) (MPO-ANCA/p-ANCA); granulomatosis with polyangiitis (Wegener; PR3-ANCA/c-ANCA)

Question 30

What is the initial diagnostic test to check of an individual you suspect of having polymyositis?

Answer 30

Creatine phosphokinase (CPK)or Creatinine kinase (CK)

Question 31

Rapid fire assoc:Antihistone antibodies

Answer 31

Drug-induced SLE (eg, hydralazine, isoniazid, phenytoin, procainamide)

Question 32

Rapid fire assoc:Anti-IgG antibodies

Answer 32

Rheumatoid arthritis (systemic inflammation, joint pannus, boutonniére deformity)

Question 33

Rapid fire txt: Kawasaki disease

Answer 33

IVIG, high-dose aspirin

Question 34

What class of medication is the first-line treatment of renal crisis in scleroderma?

Answer 34

ACE inhibitors

Question 35

What HLA marker can often be associated with ankylosing spondylitis?

Answer 35

HLA-B27

Question 36

Patient who uses cocaine and has a weak handshake. What is the likely diagnosis?

Answer 36

Inclusion body myositis

Question 37

Rapid fire txt: Chronic gout

Answer 37

Xanthine oxidase inhibitors (eg, allopurinol, febuxostat); pegloticase; probenecid

Question 38

Patient with rheumatoid arthritis on leflunomide decides she wants to get pregnant. What is the best next step in management?

Answer 38

Give cholestyramine for 9-11 d for leflunomide wash out

Question 39

Rapid fire txt: Acute gout attack

Answer 39

NSAIDs, colchicine, glucocorticoids

Question 40

Patient with polymyositis is on high dose steroids. CPK levels are improving but weakness worsening. What to do?

Answer 40

Taper down on the steroids

Question 41

If pts with osteoarthritis present with morning stiffness, what length of time should it not exceed?

Answer 41

30 minutes

Question 42

Of the MCP, PIP, and DIP joint, which of the following is least likely to be involved with rheumatoid arthritis?

Answer 42

DIP joint

Question 43

Greater than what value is the WBC count expected to be in cases of septic arthritis?

Answer 43

More than 50,000/uL

Question 44

what is the Initial step for a patient symptomatic for Atlanto-odontoid subluxation?

Answer 44

Cervical spine X Ray with flexion and extension views.

Question 45

Antibody in diffuse systemic sclerosis?

Answer 45

Anti SCL 70. AntiTopoisomerase.

Question 46

Cytoplasmic vacuolization in muscle is Seen with what dz that also has elevated CK?

Answer 46

Chronic accumulation of colchicine in ckd patients

Question 47

What are the components of felty syndrome?

Answer 47

Rheumatoid arthritis, neutropenia, splenomegaly

Question 48

What dz is suggested by aggressive destruction of the glenohumeral joint & rotator cuff and has a hemorrhagic effusion?

Answer 48

Basic calcium phosphate deposition dz, Milwaukee shoulder