Rheumatology

Question 1

To diagnose RA, symptoms have to occur for _____ weeks

Extra Joint Symptoms

1) Lungs: Pleural effusion, lung nodules
2) Heart: Pericarditis, auto-immune valvopathy
3) Neuro: Mononeuritis multiplex
4) Joint: Boutanierre, Swan Neck

Answer 1

6

Question 2

RA + Splenomegaly + pancytopenia = _______

Answer 2

Felty Syndrome

Question 3

______ is a backbone DMARD for RA. Other therapies: Anakinra (Anti IL-1), Tocilizumab, sarilumab (anti IL-6), Adalimumab (TNF)

Severe : Tofacitinib : Janus Kinase inhibitor

Answer 3

Methotextrate

Question 4

____ condition has the lowest glucose on pleural effusion

Answer 4

RA

Question 5

Heberden (Distal), Bouchard (Proximal) nodes are features of ______. Best initial test _____

Answer 5

Osteoartheritis

CXR

Question 6

Joint Fluid, OA leukocyte count

Answer 6

2000

Question 7

____ is a flavor of arthritis resulting in spinal fusion, but not degenerative disk changes

Answer 7

DISH (Diffuse Idiopathic Spontaneous Hyperostosis)

Question 8

Seronegative Spondyloarthropathies

1) Ankylosing Spondylitis
2) _______
3) Psoriatic Artheritis
4) Stills Disease

Answer 8

Reactive Artheritis (Reiters Syndrome)

Question 9

_____ occurs among males<40, AM pain at the SA joints, with most common extra joint reaction: Uveitis

Answer 9

Ankylosing Spondylitis

Testing: X-ray –> MRI —> HLA-B27 ; in this case serum testing is not done first

Tx: NSAIDS, Adalimumab ; MTX does not work on the spine —> Secukinumab (IL-17)

Question 10

____ characterized post GI/GU infection with monocular/polyarthicular arthritis, conjunctivitis, genital lesion, psoriasis looking lesion feet . Treated with _____

Answer 10

Reactive Artheritis , NSAIDS

Question 11

Psoriasis Treatment

1) NSAIDS
2) Infliximab
3) _______
4) Ustekinumab (IL 12/23)
5) Orencia: Abatacept (T cell), also for RA

Answer 11

Sekukinumab (IL 17)

Question 12

Salmon rash, polyartheritis, myalgia, lymphadenopathy, hepatosplenomegaly, high Ferritin

Answer 12

Juvenile idiopathic arthritis, Stills disease

Tx: NSAIDS, Anakinra

Question 13

Joint pain + diarrhea + weight loss, PAS (+) bowel stain

Tx:_____

Answer 13

Whipple Disease

Bacterim

Question 14

___ of 11 criteria are needed to diagnose Lupus.

Answer 14

4

All you need is rash (photosensitive, malar discoid), joint pain and ANA/dsDNA to get the diagnosis

Lupus leads to complement consumption, low complement is suggestive

Question 15

____ marker is used to test for CNS lupus

Answer 15

Ribosomal P

Question 16

RA, like downs syndrome, may be associated with _______, need to be careful with intubation

Answer 16

C1/C2 cervical spine subluxation

Question 17

_____ RA drug for mild RA, associated with retinopathy

Answer 17

Hydroxychloroquine

Question 18

Diagnosis of Ankylosing Spondylitis

1) _____ –> MRI –> HLA-b27

Answer 18

X-ray

Question 19

Ankylosing Spondylitis associated with : ____, uveitis

Treatment: NSAID, _____

Answer 19

Aortitis

TNF agent, steroids not useful

Question 20

___ characterized by negative ANA, negative RF, high ferritin, arthritis, fever, myalgia, lymphadenopathy, hepatosplenomegaly, salmon rash

Answer 20

Still Disease, adult onset juvenile artheritis

Tx: NSAID –> Steroid –> Anakinra

Question 21

Drugs that cause drug induced lupus ___, ____, ____

Answer 21

hydralazine, procainamide, isoniazid

Question 22

Treatment for mild lupus _____

Answer 22

Hydroxychloroquine —> steroids –> DMARD off flare –> B cell inhibitor (Belimumab)

Question 23

Most accurate test for Sjogrens ____

Answer 23

Lip biopsy, Ro/La antibody is suggestive

A subset of people with lupus can have Ro/La, useful for ANA negative lupus

Question 24

Exception to using ACE during pregancy____

Answer 24

Schleroderma, very good for HTN/Renal effects, risk outweighs benefits

Question 25

Difference between CREST (Limited Schleroderma vs Systemic Schleroderma) CREST Antibody____ Systemic Antibody_____

Answer 25

Anticentromere Anti SCL(70): But not reliable, only positive 30% of the time Systemic disease: Renal hypertension, proteinuria, pulm htn, restrictive cardiomyopathy,

Question 26

Thick orange skin syndrome, eosinophilia, worse when working out ______

Answer 26

Eosinophilic Fasciitis Tx: Steroids

Question 27

Myositis with Jo+ are increased risk of ______

Answer 27

Interstitial lung disease

Question 28

Both distal/proximal muscle weakness, elevated CK____

Answer 28

Inclusion body myositis No Treatment

Question 29

_____ is a mixture of SLE, scleroderma, polymyositis, with antibody____ positive

Answer 29

Mixed connective tissue disorder Anti U1 ribonucleoprotein Tx: Steroid, AZT, MTX,

Question 30

Treatment of fibromyalgia______

Answer 30

Duloxetine, CBT, aerobic exercise, NOT NSAID

Question 31

Polymyalgia reumatica vs myositis

Answer 31

ESR vs CK , normal electromyogram Tx: Steroids

Question 32

Best initial test for PAN_____

Answer 32

CT Angio Abdomen

Question 33

_____ medication can induce a Churg Struss flare

Answer 33

Montelukast (Leukotriene inhibitors)

Question 34

A specific therapy for giant cell arteritis apart from steroids_____

Answer 34

Tocilizumab (IL-6 inhibitor)

Question 35

____ is a large vessel vasculitis, famous for causing loss of pulses, increased stroke risk Most accurate test _____

Answer 35

Takayasu MRA, aortography not biopsy

Question 36

Cryglobinemia associated with vasculitis and _______

Answer 36

Hep C Tx: Rituximab, cyclophosphamide

Question 37

oral/genital ulcers, uveitis, sterile skin abscess, pulmonary artery aneurysm _______

Answer 37

Behcet Steroid /Cyclophosphamide

Question 38

recurrent abdominal pain, tenderness, fever, episodes of joint and chest pain, elevated ESR with history of multiple negative CT scans/Colonoscopy_______

Answer 38

Familial Mediterranean Fever Dx: MEFV gene Tx: Colchicine, Cx: Amyloidosis

Question 39

Gout can be induced by this medication_____

Answer 39

Thiazide, Nicotinic acid

Question 40

Gout | - Acute Treatment _____

Answer 40

NSAID/Colchicine --> Steroids

Question 41

Gout (Chronic Treatments) Mechanisms - Allopurinol: _______ - Febuxistate_______ - Rasburicase______ - Probenecid _______

Answer 41

Xanthine oxidase inhibitor (reduces uric acid production) Xanthine oxidase inhibitor Converts uric acid to allantois Urinary excretion of uric acid (not for renal failure)

Question 42

__________are disease associated with pseudo gout (calcium pyrophosphate)

Answer 42

hemochromatosis, hyperparathyroidism, acromegaly, hypothyroidism NSAID, colchicine --> steroids

Question 43

You have to stop bisphosponates _____ weeks before dental surgery

Answer 43

6

Question 44

``` Osteoporosis Treatment 1) Bisphosphonates + VitaminD/Calcium 2) Denosumab 3) SERM 4) PTH analogs (Teriparatide) 5_________ ```

Answer 44

Calcitonin

Question 45

Pagets disease: high ALP with normal Ca2+/PO43-, urine hydroxyproline - Most accurate test_____ - Treatment____

Answer 45

Nuclear bone scan Bisphosphonates