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Flashcards in rheumatology Deck (331):
1

Positive straight leg test

disk herniation

2

Rx of acute back pain with no neurologic deficit(4)

NSAIDS
Early mobilisation
Mx relaxants
rx dure 4 a 6 semaines

3

Clue for whipple disease (3)

Joint pain
Malabsorption
PAS

4

Dx of Whipple(2)

Biopsy small intestine
PCR

5

quid of tropherima whippeli

Gram positive bacteria

6

xray in osteoarthritis(3)

subchondral sclerosis
joint space narrowing
ostophytes

7

joint hand involved in osteoarthritis

DIP

8

joint hand involved in RA(2)

MCP
PIP

9

Marker of systemic sclerosis

antitopoisomerase-I

10

digestive complication of systemic sclerosis(2)

GERD
esophageal dismotility

11

Most common cause of death in past from systemic sclerosis and why(2)

renal failure
because no ACE inbitor at this time

12

why people with multiple sclerosis can develop right failure

because of increase pulmonary artery pressure

13

risk of patient taking chemo in rhumatology

gout

14

prophylactic measure to prevent gout in patient taking chemo(2)

allopurinol
and
probenicid

15

most common presentation of goutty attack

podagra

16

quid of podagra

first metatarsophalangeal gouty arthritis

17

characteristic of urate crystals in gout induced by chemo(2)

negative birefringent
needled shaped

18

Wbc count in gout arthrocentesis

2000-50000

19

what's allopurinol

xanthine oxydase inhibitor

20

Meds used to treat acute attack of gout(3)

colchicine
NSAIDS
Steroids

21

Triad of Bechet(3)

reccurent painful ulcers
erythema nodosum
ant uveitis

22

localisation of reccurrent ulcers in behcet(2)

mouth
penis

23

population touched by Behcet(3)

turkish
asian
Middle eastern population

24

clue for compression vertebral fractures

local tenderness upon percussion of vertebrae

25

cause of compression fractures(2)

Bone demineralisation
low bone densitiy

26

cause of osteomalacia(3)

low calcium
low vit D
low phosphore

27

clue for viral arthritis

Multiple joint pain in patient working in day care center

28

cause of viral arthritis

parvovirus B19

29

localisation of pain in hand(3)

like RA
PIP
MCP

30

how long pain last in viral arthritis

2 months

31

patient at risk of vertebral osteomyelitis(3)

IV drugs user
sickle cell diseas
immunodepression

32

Paraclinique of vertebral osteomyelitis

MRI

33

bugs causing vertebral osteomyelitis

staph aureus

34

clue in physical exam in vertebral osteomyelitis

tenderness to gentle percussion of spinous process

35

young patient with low back pain

ankylosing spondylitis

36

Most common extra articular manif of ankylosing spondylitis

Ant uveitis

37

clue for Ankylosing spondylitis(3)

Morning stiffness
improve with exercice
link HLA-B27

38

bone involved in in Ankylosing spondylitis(2)

sacroillitis
then the spine

39

clue for lumbar stenosis(2)

elder patient
sitting relieves pain

40

why pain is relieved in lumbar stenosis while sitting

spine flexion open intervertebral space

41

quid of neural claudication

joint disease

42

what could be a complication of RA(2)

cervical subluxation spine
cervical spinal cord compression

43

clue for RA and pain

morning stiffness improving with activity

44

Marker of RA

anti-CCP

45

which immunoglobulin in RA

IGM

46

first drug used to treat RA

methotrexate

47

second line regimen if failure if no improvement after 6 months of treatment of RA

TNF inhibitor

48

what other drug can be used in adjunction to metotrexate(2)

hydroxychloroquine
or
sulfasalasine

49

quid of non biologic agent in RA(DMARD)(4)

methotrexate
hydroxychloroquine
sulfasalazine
azathioprine

50

quid of biologic effect(3)

ethanercept
infliximab
rituximab

51

mechanism of action of biologic agent in RA

TNF inhibitor

52

before beginning DMARD what to check first(2)

Hep B et C
TB

53

diasease causing erythema nodosum(7)

sarcoidosis
behcet
cocciodomycosis
TB
histoplasmosis
IBD
strep infection

54

what to do in presence of erythema nodosum(2)

chest x ray
search hilar adenopathy

55

erythema nodosum plus hilar adenopathy

sarcoidosis

56

oligoarthritis plus uretritis plus conjunctivitis

reactive arthritis

57

clue for reactive arthritis(3)

oligoarthritis
uretritis
conjunctivitis

58

oligo arthritis plus uretritis plus mouth ulcers

reactive arthritis

59

first line rx of reactive arthritis

NSAIDS

60

quid of enthesitis

Pain in tendon

61

tendon most frequently involved in enthesitis

achilles

62

most commonly involved joint in reactive arthritis(2)

Knee
sacroilliac

63

fluid synovial examination in gonococcal arthritis

negative or sterile

64

side effects of methotrexate(6)

oral ulcers
increase transaminase
pulmonary toxicity
BM suppression
alopecia
anemia

65

what the mechanism responsible of side effect in methotrexate

antimetabolite agent

66

patient taking prednisone develops hip pain Dx

avascular necrosis of femoral head

67

the best test to Dx avascular necrosi of femoral head

MRI
or
scintigraphy

68

shoulder pain in tennis player

subacromial bursitis

69

Physical exam finding of subacromial bursitis

pain during rotation and flexion of the shoulder

70

Neer impingement sign? meaning(2)

pain during rotation and flexion of the shoulder
subacromial bursitis

71

quid of sausage digit or dactylitis

diffusely swollen digit

72

disease causing dactilytis or sausage digit

psoriatic arthritis

73

rx of psoriatic arthritis(3)

NSAIDS
methotrexate

anti TNF agents

74

arthrocentesis finding in pseudogout

rhomboid shaped
positively birefringent crystals

75

Quid of CPPD

calcium pyrophosphate dihydrate

76

disease with CPPD

chondrocalcinosis in Pseudogout

77

clue for rotator cuff tear

pain not relieved by lidocaine shooting

78

clue for rotator cuff tendinitis

pain relieved by lidocaine shooting

79

best test to DX rotator cuff tear

MRI of shoulder

80

causes of rotator cuff tear(2)

rotator cuff tendinitis
trauma

81

physical exam clue of rotator cuff tear(2)

lifting the arm above the head causes pain
no possibility of abduction and external rotation

82

site of lesion in Myasthenia gravis

post synaptic acetylcholine receptor

83

site of lesion in lambert eaton syndrome

presynaptic voltage gated calcium channel

84

site of lesion in dermato myositis or polymyositis

MX fibers

85

clue for dermatomyositis(2)

gottron papules
heliotrop rash

86

quid of gottron papules

violaceus papules involving dorsum of fingers

87

In Lambert eaton how are reflexes

absent

88

patient of unilateral leg edema and fever(3)

DVT
cellulitis
lymphadenitis

89

clue for cellulitis in unilateral edema(2)

fissured web toe
macerated

90

clue of anserine bursitis(2)

pain in medial side of the tibia
just below the knee

91

meaning of valgus test

medial collateral ligament is touched

92

rx of anserine bursitis(2)

ice
rest

93

cause of anserine bursitis(3)

trauma
overuse
abnormal gait

94

clue of the arthritis in SLE

non deforming arthritis

95

quid of HLA-B27 arthropathy(4)

IBD
Ankylosing spondylitis
Reactive arthritis
psoriatic arthritis

96

point common of any disease with HLA b27

enthesitis

97

most common lieu for enthesitis

heel

98

finding of ankylosing spondylitis

spine limited mobility

99

other sites of enthesitis(2)

illiac crest
tibial tuberosities

100

clue for fibromyalgia

female with diffuse Mx pain

101

first rx for fibromyalgia

amitryptiline

102

alternative rx for fibromyalgia(3)

duloxetin
pregabalin
milnacipran

103

quid of negative birefringent needle(2)

yellow needle like crystal
when parallel to polarizing axis
blue needle like crystals when perpendicular to polarizing axis

104

crystals causing negative birefringent needle

monosodium urate crustal deposition

105

wbc in osteo arthritis

200-2000

106

arthrocenthesis result in inflammatory arthritis wbc

2000-100000

107

arthrocenthesis result in septic arthritis wbc

> 50000

108

how to differentiate septic arthritis from inflammatory arthritis(2)

PMN>50% inflammatory arthritis
PMN> 80% septic arthritis

109

risk factor for gout(3)

high meat consumption
excessive alcohol intake
drugs (diuretic)

110

drug causing gout

diuretic thiazide

111

short term rx of gout(3)

NSAIDS
colchicine
corticosteroids

112

long term rx of gout

allopurinol

113

clue for polymyositis et dermatomyositis(3)

elevated CPK
ESR high
proximal mx weakness

114

cause of proximal weakness(4)

drug induced myositis
hypothyroid myopathy
Mx dystrophy
Myathenia gravis

115

Confirmatory dx of polymyositis

Mx Biopsy

116

Drugs causing Myopathy(3)

statin
alcohol
antipsychotics

117

first line of polymyositis

corticosteroids

118

first line rx of fibromyalgia(2)

aerobic exercice
good sleep hygiene

119

second step of fibromyalgia

amitryptiline

120

lumbar pain during lifting heavy object

lumbar strain

121

what should be done to prevent further back pain

keep the back straight when lifting object

122

patient with back pain worse at night

metastasis cancer

123

first tumor to metastase in bone(5)

lung
breast
prostate
thyroid
kidney

124

rx for symptomatic sarcoidosis

glucocorticoid

125

workup for sarcoidosis and meaning (3)

chest xray
biopsy
ACE increases

126

chest xray for sarcoidosis

hilar adenopathy

127

biopsy finding for sarcoidosis

non caseiting granuloma

128

xray finding in paget

mosaic pattern of lameller bone

129

physiopatho of paget

bone remodelling

130

why can you have hearing loss in paget

cranial nerve entrapment

131

main cause of paget

osteoclast dysfunction

132

bone reached in paget

femoral bowing

133

clue for inflammatory arthritis(2)

pain worst with rest
improves with movement

134

first bone touched in ankylosing spondylitis

apophyse joint of axial skeleton

135

triad of gonococcemia(3)

thenosinovitis
polyarthritis
painless vesiculo pustular lesions

136

quid of thenosinovitis

pain along the tendon sheath

137

quid CREST(5)

calcinosis
raynaud phenomenon
esophageal dysmotility
sclerodactily
teleangiactasia

138

what's the most important guide in the treatment SLE

the grade of lupus nephtitis

139

in front of lupus dx what's the first step

kidney biopsy

140

clue for compression fractures

pain in back without trauma

141

patient with risk for Compression fractures

osteroporosis

142

quid of babinski sign

upper motor neuron problem

143

absent ankle reflex in elderly meaning?

It's normal

144

finding xray in ankylosing spondylitis(2)

fusion of sacroiliac joint
bamboo spine

145

gender in Ankylosing spondylitis

Male>female

146

why respiratory problem in Ankylosing spondylitis(2)

chest wall motion restriction
restrictive disease

147

why chest wall motion restriction in ankylosing spondylitis

fusion of costovertebral joints

148

clue of secondary amyloidosis

nephrotic syndrome in the setting of chronic and reccurrent infection

149

cause of secondary amyloidosis

any chronic inflammation

150

other name of secondary amyloidosis

AA

151

causes of secondary amyloidosis(5)

infection chronique
inflammatory arthritis
IBD
malignancy(lymphoma)
vasculitis

152

dx of AA and finding(2)

fad pad aspiration biopsy
Amyloid A

153

rx and prevention of AA

colchicine

154

target organs for amyloidosis(4)

rein
foie
coeur
system nerveux autonome

155

two presentation of gonococcal arthritis(2)

polyarthritis with skin rash and thenosinovitis
monoarthritis

156

cause of CPPD(3)

hyperparathyroidism
hemochromatosis
hypomagnesemia

157

high calcemia plus arthritis

CPPD

158

complication of Paget(2)

osteosarcoma
pathologic fractures

159

work up for paget(4)

high ALP
High urine hydroxyproline
Normal calcium and
phosphate

160

urinary marker of bone resorption(4)

N telopeptide
C telopeptide
hydroxyproline
deoxypiridinoline

161

Long ter complication of AS

decrease bone density

162

consequence of reduced bone density

fracture for minimal trauma

163

IBD et P anca positif plus arthritis

UC

164

P anca positif plus arthritis

UC

165

extracolonic manif of UC(5)

cholangitis
episcleritis
erythema nodosum
pyoderma gangrenosum
arthritis

166

disease with P-ANCA positive without vasculitis(2)

UC
AS

167

why sjogren causes difficulty swallowing

throat dryness because of lack of saliva

168

consequence of lack of saliva in sjogren(3)

high incidence of caries
submandibular swelling
dysphagia

169

cause of lack of saliva in sjogren

lymphocytic infiltration of salivary glands

170

quid of keratoconjonctivitis sicca in sjogren

dry eyes

171

glands problem in sjogren(2)

infiltration of salivary glands
and lacrymal glands

172

autoantibodies in sjogren

antiRO/SSA
anti LA/SSB

173

dermatomyositis antibody

anti mi 2

174

what is often associated with Dermatomyositis

malignancy

175

Most common malignancy associated with dermatomyositis(3)

ovarian # 1
breast lung
female urogenital

176

when you dx dermatomyositis what to do?

screen for Cancer

177

the most important surveillance approach in patient taking hydroxychloroquine

eye examination

178

risk with hydroxychloroquine

retinopathy

179

quid of phallen sign

flexion of wrist worsens paresthesia in carpal tunnel syndrome

180

cause of carpal tunnel syndrome

hypothyroidism

181

physiopatho of carpal tunnel syndrome in hypothyroidism

accumulation of matrix substances in the endneurium and perineurium of median nerve

182

quid of matrix substances

it's mucopolysaccharides

183

indication of cyclophosphamide in SLE(2)

severe renal impairement
CNS impairement

184

side effects of cyclophosphamide(4)

bladder carcinoma
hemorragic cystitis
sterility
myelosuppression

185

cause of bladder carcinoma and hemorragic cystitis in cyclophosphamide

bladder toxicity causes by accumulation of acrolein

186

quid of acrolein

metabolite of cyclophosphamide

187

how to avoid bladder toxicity in cyclophosphamide(2)

lot of fluids
Mesna

188

patient with history of gout seen with knee swollen ,what test should be done first?(2)

synovial fluid analysis

189

cause of neuropathic joints(6)

diabetes
B12
tabes dorsalis
syringomyelie
peripheral nerve damage
spinal cord injury

190

consequence of neuropathic joints in diabetes

charcot joint

191

quid of charcot joints

deformed foot

192

cause of baker cyst

inflamed synovium

193

cause of baker cyst(3)

rhumatoid arthritis
osteoarthritis
cartilage tears

194

the most readily modifiable risk factor for OA

obesity

195

study of choice for spiunal stenosis

MRI

196

pain variation in spinal stenosis

worst in standing
relieved by seating

197

neuropathic claudication /vascular claudication

pain persisting during rest

198

most common extra articular manif of AS

anterior uveitis

199

whtas the most common cause of back pain

lumbar strain

200

straight leg raise test in lumbar strain

Normal

201

neurologic exam in lumbar strain

normal

202

rx of lumbar strain(2)

NSaid
and
early mobilisation

203

mechanism of corticoid related osteonecrosis

disruption of bone vasculature

204

arthritis with no pain after 2 months

viral arthritis

205

cause of positive Rheumatoid factor(4)

viral arthritis
bact arthritis
malignancy
rheumatoid arthritis

206

ANA positive cause(4)

SLE
HIV
Hepatitis
rheumatoid arthritis

207

does a normal individual can have ANA positive

yes

208

other name of rotator cuff impingement

same rotator cuff tendinitis

209

mechanism of kidney damage in SLE(2)

immune complex mediated
complex antigen antibody activates complement

210

why C3 is decreased in immune complex mediated reaction

activation of complement system

211

cause of low C3

any disease caused by immune complex reaction

212

disease causing low C3(2)

lupus
GNA

213

articulation touche dans SLE(3)

MCP
PIP
it's like Rheumatoid arthritis

214

blood problem in SLE(3)

anemia
low platelet
low wbc

215

first initial treatment in OA

acetaminophen

216

what the two more common site of atherobolism event secondary to cardiac catheterisation(2)

pedal arteries
renal arteries

217

consequence of renal arterythrombo embolism post cardiac catheterisation

high creatinine

218

consequence of pedal artery thrombo embolism post cardiac catheterisation

blue toe syndrome

219

what's the cause of thromboembolism in post cardiac catheterisation

cholesterol embolism

220

why chemo causes gout

massive release of acid uric from DNA of destroyed cells

221

quid of acid uric

by product of DNA

222

back pain in OA cause(2)

osteophytes
hypertrophy of ligamentum flavum

223

dx of degenerative central canal stenosis

MRI

224

cause of Dequervain

inflammation of two muscles

225

Mx inflammed in Dequervain(3)

abductor pollicis longus
extensor pollicis brevis
when passing through fibrous sheath at the radial styloid process

226

quid of finkelstein sign

flexion of thumb into the palm elicit pain

227

Meaning of finkelstein sign

Dequervain

228

person at risk of Dequervain

mother who holds the baby with their thumb outstretched
abducted et extended

229

rx of polymyalgia rhumatica(PMR)

low dose of prednisone

230

dx criteria for PMR

age >50
Mx ache
ESR> 40

231

localisation of Mx ache in PMR(3)

pelvic girdle
shoulder
neck

232

association of PMR

giant cell arteritis

233

clue for OA

difficulty moving after a period of rest

234

predisposing factor for OA(2)

obesity
age

235

the most common cause of joint disease

OA

236

greatest risk for patient with rhumatoid arthritis

osteoporosis

237

how does last the morning stiffness in RA

> 1 hour

238

prevention of osteoporosis in rheumatoid arthritis(4)

calcium
vit D
biphosphonate
low glucorticoid use

239

spinal problem in degenerative joint disease

cervical spondylysis

240

clue for cervical spondylisis(2)

neck pain
sensory problem in forearm

241

xray in cervical spondylisis

bone spur over cervical vertebrae

242

the most common finding in cervical spondylisis

bone spur

243

quid of tennis elbow

lateral epicondylitis

244

cause of tennis elbow

degeneration of extensor carpi radialis brevis tendon

245

Localisation of pain in lumbar strain

perispinal

246

Localisation of pain in compression fracture

directly on vertebrae

247

quid of pain during direct palpation of vertebrae(3)

infection
compression fracture
lytic bone lesion

248

quid of straight leg raise test

herniated disc

249

3 cancer metastasis in the spine

lung
breast
prostate

250

spine involvement in rhumatoid arthritis

cervical spine

251

monoarticular arthritis in elderly with normal lab

OA

252

monoarticular arthritis in elderly with high acid uric and high ESR

gout

253

physical findings in OA

bony crepitus

254

criteria to dx OA(5)
at least 3 to DX OA

bony crepitus
bone enlargement
bone tenderness
lack of warmth
lack of morning stiffness
ahe >50

255

why myeloproliferative disorder can cause gout(3)

high turnover
high catabolism of purine
so over production of acid uric

256

example of myeloproliferative disorder causing gout

polycythemia vera

257

why Polycythemia vera produces gout(2)

because of high number of circulating basophiles
histamine release

258

scleroderma antibody

topoisomerase -I

259

Monoarthritis pain(3)

crystal induced arthritis
septic arthritis
OA

260

predisposing factor for septic arthritis

cartilage destruction(rhumatoid arthritis)

261

Rx of septic arthritis(2)

drainage
IV antibio

262

patient with AS ,back pain after minimal trauma

rule out vertebal fracture

263

risk of patient with AS

vertebal fracture with minimal trauma

264

red flag for back pain(7)

age > 50
pain during night or sleep
neurologic symptom
pain > 1 month
history of previous ca
weight loss
no response to previous rx

265

rx of temporal arteritis

high dose of prednisone

266

new headache in patient female > 50 ans

temporal arteritis

267

vessels involved in giant cell arteritis

aorta and its cranial branches

268

know to differentiate gonococcemia from toxic shock syndrome

pustules on extensor surfaces even in woman using tampon=gonococcemia

269

anterior knee pain in young patient(3)

patello femoral syndrome
patellar tendonitis
osgood schlatter

270

who's at risk for patellar femoral syndrome

female

271

who's at risk for patellar tendonitis

athletes

272

who's at risk for osgood schlatter

adolescent

273

clue for patello femoral syndrome

pain during climbing stairs

274

physical exam in patello femoral syndrome(2)

extend the knee while compressing the patella
patello femoral compressing test

275

rx of patellofemoral syndrome

exercice to stretch and strenghten the mx

276

pain location in patellar tendonitis

inferior patella

277

pain location in osgood schlatter

tibial tubercle

278

cause of lumbar spinal stenosis

spinal canal narrowing

279

cause of neurogenic claudication

spinal canal narrowing

280

mx pain with normal ESR

fibromyalgia

281

mx pain with high ESR

PMR

282

most common complication of giant cell arteritis

aortic aneurism

283

after dx giant cells arteritis next step

serial chest xray

284

specificity of neurogenic claudication

pain when standing

285

difference between anserine bursitis and patellar tendonitis

X?

286

quid of tophi

urate deposition in soft tissue forming tumor

287

HCTZ and gout(2)

hyperuricemia
can worsen gout

288

biopsy in whipple(2)

PAS positive macrophages in lamina propia
nonacd fast gram positive bacilli

289

action allopurinol

decrease acid uric production

290

Parvovirus in children

slapped cheek fever

291

risk factor for vertebral osteomyelitis

distant infection

292

Median for AS

20's-30's

293

palinfilm in AS

bilateral sacroilitis

294

quid of trigger finger

thenosinovitis of the palms

295

disease with trigger finger

RA

296

quid of rhumatoid nodules

nontender nodulesnear the elbows over the back the forearm

297

spinal complication of RA(2)

cervical spine subluxation---->
spinal cord compression

298

limitation of glucocorticoid in rx of RA

doesn't prevent cartilage destruction

299

when can you use glucocorticoid in RA

to provide short term in awaiting response of DMARD

300

quid erythema nodosum

painful reddish multiple on ant surface of legs

301

most common casue of recent infection

recent strep infection

302

patient on rx for RA develops cytopenia and high transminases,what drug he is on

leflunomide

303

quid of leflunomine

pyrimidine synthesis inhibitor

304

action of hydroxychloroquine and sulfasalasine

TNF
IL-1 suppresor

305

patient on rx for RA develops hemolytic anemia and high transminases and stomatitis,what drug he is on

sulfasalazin

306

TNF inhibitor(6)

adalimumab
certolizumab
ethanercept
infliximab
golumumab

307

DMARDS

adalimumab
certolizumab
ethanercept
infliximab
golumumab
methotrexate
leflunomide
hydroxychloroquine
sulfasalazine

308

how to reduce toxicity of metotrexate

folic acid

309

cause of avascular necrosis(3)

corticosteroids
alcoholism
hemoglobinopathies

310

articulation involved in psoriasis

DIP

311

when can occur pseudogout

after recent surgery
medical illness

312

what about deformity in SLE

deformity is uncommon

313

young patient with articular pain

AS

314

quid of PAget disease

osteoclast hyperfunction

315

hearing loss in paget why

entrapment of 8

316

syndrome nephrotic in a context of hepatomegaly,palpable kidneys,fourth heart sound

amyloidosis

317

quid of 4 heart sound

ventricular hypertrophy

318

tender articulation and fever in young adult sexually active

Neisseria gonorrhea

319

constipation plus hypercalcemia with arthritis

pseudo gout

320

what disease to rule out after dx pseudogout

hyperparathyroidism

321

CPPD

calcium pyrophosphate dihydrate

322

most commonly affected bone in paget

skull

323

cause of charcot joint(2)

complication of neuropathy
repeated joint trauma in diabetic

324

when baker cyst can be confused with DVT

when rupture

325

profession with risk of lateral epicondylitis

tennis player
screwdriver

326

initial work up in back pain

xray plain film

327

patient with RA develops swollen knee chills and fever

septic arthritis

328

cause of charcot joint

nerve damage

329

greatest risk of complication in RA

osteoporosis

330

pain during squatting in woman

patellofemoral syndrome

331

quid of Anti CCP

anti cyclic citrulinated peptide