Rheumatology

Question 1

Management for scleroderma renal crisis (Hypertensive emergency, headache, MAHA, Thrombocytopenia, elevated serum creatinine levels, and proteinuria)

Answer 1

ACE inhibitors, typically captopril

Question 2

Most common side effect of topical NSAID

Answer 2

Skin irritation/rash

Question 3

Autoimmune disease that has clinical manifestations of other specific connective tissue diseases, but not enough positive features to satisfy diagnostic or classification criteria for any one disease

it’s appropriate treatment

Answer 3

Undifferentiated connective tissue disease; hydroxychloroquine

Question 4

Nongranulomatous necrotizing pauci-immune vasculitis of small vessels or pauci-immune necrotizing crescenteric glomerulonephritis in the kidney

Answer 4

Microscopic polyangiitis

Question 5

Strongest modifiable risk factor for osteoarthritis

Answer 5

Obesity

Question 6

Non-inflammatory condition that involves ossification of spinal ligaments and entheses and usually presents as back pain and stiffness; characteristic radiographic changes include confluent ossification of at least for continuous vertebral levels, usually on the right side of the spine

Answer 6

Diffuse idiopathic skeletal hyperostosis

Question 7

Recommended agent for patients with severe recurrent and/or tophaceous gout that is intolerant or resistant to standard therapies

Answer 7

Pegloticase

Question 8

Appropriate diagnostic test for suspected chlamydial reactive arthritis

Answer 8

Nucleic acid amplification urine testing

Question 9

Inflammatory back pain for 3 months or more and bilateral sacroiliitis on imaging

Answer 9

Ankylosing spondylitis

Question 10

Secondary cause of acute and chronic GI bleeding in patients with diffuse cutaneous systemic sclerosis (*hint: watermelon sign)

Answer 10

Gastric antral vascular ectasia

Question 11

Treatment for severe and refractory gout attacks or with contraindications to other treatments

Answer 11

Anakinra

Question 12

Treatment for refractory undifferentiated connective tissue disease

Answer 12

Hydroxychloroquine

Question 13

Combination of this medication and methotrexate has shown efficacy in managing joint symptoms and slowing the progression of radiographic damage, including joint space narrowing and erosion in recalcitrant/uncontrolled psoriatic arthritis

Answer 13

TNFa inhibitor (I.e. Abatacept)

Question 14

Three drugs FDA approved for fibromyalgia

Answer 14

Pregabalin, duloxetine, milnacipran

Question 15

Interstitial lung disease, myositis, Raynaud phenomenon, nonerosive inflammatory arthritis, constitutional findings such as low-grade fever and mechanics hands; anti-Jo-1 antibody positive

Answer 15

Antisynthetase syndrome

+anti-aminoacyl-tRNA synthetases antibodies, I.e. anti-Jo-1

Question 16

Rare but severe presentation of SLE characterized by shortness of breath, hypoxia, and diffuse pulmonary infiltrates

Answer 16

Lupus pneumonitis

Question 17

Long-standing aggressive rheumatoid arthritis, neutropenia, and splenomegaly with the risk for serious infections, lower extremity ulcers, lymphoma, and vasculitis

Answer 17

Felty syndrome

Question 18

Vasculitis affecting medium sized arteries and is characterized by constitutional and neurologic symptoms, skin rashes, and kidney involvement that is renovascular rather than glomerular in origin

Answer 18

Polyarthritis nodosa

Question 19

Inflammatory myopathy that can involve both the proximal and distal muscles with typically symmetric muscle distribution

Answer 19

Inclusion body myositis

Question 20

Initial management of Sjogren syndrome

Answer 20

Restoring moisture of the eyes and mouth (I.e. artificial tears and sugar-free candies)

Question 21

Eye pain, pain with gentle palpation of the globe, photophobia, vision-threatening in a patient with RA

Answer 21

Scleritis

Question 22

Triad of tenosynovitis, dermatitis (usually painless pustular or vesiculopustular lesions), and polyarthralgia without frank arthritis

Answer 22

Arthritis-dermatitis syndrome of disseminated gonococcal infection due to neisseria gonorrhea

Question 23

Appropriate treatment for patients who experience a relapse of GPA

Answer 23

Rituximab

Question 24

Appropriate treatment for primary angiitis of the CNS

Answer 24

Cyclophosphamide + high-dose glucocorticoid

Question 25

Acute onset of small-joint symmetric Polyarthritis following a febrile illness with a rash, in those with exposure to children

Answer 25

Parvovirus B19 infection

Question 26

Spiking fever, and evanescent salmon-colored rash on the trunk and extremities that occurs in conjunction with fever, arthritis, LAD, leukocytosis, and high serum ferritin level

Answer 26

Adult-onset Stills disease

Question 27

Most appropriate test to perform to diagnose chronic inflammatory monoarthritis

Answer 27

Synovial biopsy

Question 28

Myopathy associated with Anti-HMG Co-A reductase antibodies

Answer 28

Immune-mediated necrotizing myopathy

Question 29

Most appropriate diagnostic test to confirm suspected Sjögren syndrome in a patient with uninformative serologic evaluation

Answer 29

Lip biopsy

Question 30

Inflammatory condition affecting the bursa at the insertion of the conjoined medial knee tendons into the anteromedial proximal tibia

Answer 30

Pes anserine bursitis

Question 31

Inflammation and damage of cartilaginous tissues (i.e. external and middle ear, nose, tracheobronchial tree, and joints)

Answer 31

Relapsing polychondritis

Question 32

Appropriate treatment for gouty cellulitis accompanying an attack of acute gouty arthritis

Answer 32

Prednisone

Question 33

Set an onset of pain, warmth, tenderness, and swelling of the affected joint, usually a knee or wrist, + chondrocalcinosis

Answer 33

Acute calcium pyrophosphate crystal arthritis (pseudogout)

Question 34

Systemic sclerosis + AKI and severe hypertension, mild proteinuria, UA with few cells or casts, MAHA, thrombocytopenia

Answer 34

Scleroderma renal crisis

Question 35

Recurrent painful oral and genital mucosal ulcerations, inflammatory eye disease, pathergy

Answer 35

Bechet Syndrome

Question 36

Acute arthritis, bilateral hilar LAD, erythema nodosum

Answer 36

Lofgren syndrome

Question 37

Diagnosing IgA vasculitis

Answer 37

Biopsy of affected organ (Biopsy will demonstrate leukocytoclastic vasculitis with predominance of IgA deposits on immunofluorescence

Question 38

Most appropriate initial immunosuppressive therapy in the treatment of isolated class V lupus nephritis, especially without kidney dysfunction

Answer 38

Mycophenolate mofetil

Question 39

Diagnostic test of choice to assess and categorize kidney disease in patients with SLE

Answer 39

Kidney biopsy

Question 40

Causes of premature mortality in patients with mixed connective tissue disease

Answer 40

Pulmonary arterial hypertension and interstitial lung disease

Question 41

FDA approved as an addition to standard therapy in patients who have SLE with persistent mild to moderately active disease

Answer 41

Belimumab

Question 42

Confluent ossification of at least 4 contiguous vertebral levels, usually on the right side of the spine

Answer 42

Diffuse idiopathic skeletal hyperostosis (DISH)

Question 43

Alternative to colchicine for recurrent oral ulcers in Bechet syndrome

Answer 43

Aprelimast

Question 44

First-line treatment of familial Mediterranean fever

Answer 44

Lifelong daily prophylaxis with colchicine

Question 45

Recommended management for urate-lowering therapy in patients who have contraindications to allopurinol

Answer 45

Febuxostat

Question 46

Pharmacological management for oral dryness in Skogren syndrome not relieved with non-pharmacological therapy

Answer 46

Cevimeline or pilocarpine

Question 47

Annular and polycyclic photosensitive plaques on the back, chest, extremities, or psoriasiform scaly plaques in a similar distribution

Answer 47

Subacute cutaneous lupus erythematosus

Question 48

Main state of therapy for ILD in systemic sclerosis

Answer 48

Mycophenolate mofetil

Question 49

Treatment for IgG4 related disease

Answer 49

High-dose glucocorticoids and rituximab

Question 50

First line treatment for new diagnosis of Rheumatoid arthritis

Answer 50

Methotrexate