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American Board of Internal Medicine > Rheumatology > Flashcards

Flashcards in Rheumatology Deck (85):
1

Side effects with Hydroxychloroquine (1)?

Irreversible retinopathy

2

Side effects with Thalidomide (2)?

Teratogenicity and peripheral neuropathy

3

What is ds-DNA antibody associated with?

Lupus nephritis

4

Describe these types of systemic sclerosis:
1. Limited cutaneous
2. Diffuse cutaneous
3. Sine scleroderma

1. Limited cutaneous (distal to elbows/knees)
Calcinosis
Raynaud
Esophageal Dysmotility
Sclerodactyly
Telangiectasias

2. Diffuse cutaneous (proximal elbows/knees)

3. Sine scleroderma: Visceral involvement without skin fibrosis

5

What is anti-Scl-70 associated with (2)?

1. Diffuse cutaneous systemic sclerosis
2. Interstitial lung disease

6

What is treatment for ILD associated with scleroderma?

Cyclophosphamide

7

Considering SLE, what is treatment for:
1. Joint pain alone
2. Mild rash or arthralgias (2)
3. Moderate disease (2)
4. Lupus nephritis (2)
5. What has not been shown effective?

1. NSAIDs
2. Hydroxychloroquine and steroids
3. Azathioprine, Methotrexate, etc...
4. Cyclophosphamide, Mycophenolate
5. NOT Rituximab

8

Common Side effect with Colchicine (2)?

1. Diarrhea
2. Bone marrow suppression

9

Critical Side effect with Allopurinol (1)?

Rash, must stop medication because of risk for Stephens-Johnson syndrome

10

Name four drugs that INCREASE excretion of uric acid

PHIL

1. Probenecid
2. High-dose Aspirin
3. Interleukin-6
4. Losartan

11

Name four drugs that DECREASE excretion of uric acid

1. Calcinurin Inhibitors (Cyclosporine or Tacrolimus)
2. Organic Acids
3. Thiazides
4. Furosemide

12

Diagnostic elements to CPPD (3)?

Calcium Pyrophosphage Deposition Disease
1. WEAKLY birefringent crystals in synovium
2. Xray CHONDROCALCINOSIS
3. Cystic erosions without marked joint space narrowing

13

Etiologies for Septic Arthritis (6) and susceptible populations:
1.
2.
3. a, b, c
4.
5.
6.

1. Staphylococcus Aureus, (esp RA or HD)
2. Streptococci (esp DM)
3. Gram Negative
Salmonella (esp SLE, AIDS, sickle cell)
Pseduomonas (esp IVDU)
Pasteurella (esp cat/dog bites)
4. Disseminated Gonococcal
5. Mycobacterium Marinum (esp swimming and fish tanks)
6. Mycobacterium Tuberculosis (esp sinus tracts)

14

How do you diagnose Parvovirus B19?

Antiparvovirus IgM

15

Which lab is falsely positive with Parvovirus B19?

Anti-RF

16

Name the three types of idiopathic inflammatory myopathies. Which one is clinically distinct?

1. Polymyositis
2. Dermatomyositis
3. Inclusion Body Myositis - distal muscles, asymmetric and male predominant

17

Which malignancy risk is increased with inflammatory myopathies (men =3, women = 4)?

Men: Lung, Colon, Pancreas
Woman: Breast, OVARY, Colon, Pancreas

18

Define mild disease in Rheumatoid Arthritis (5)

1. 5-10 inflamed joints
2. Mild function limitation
3. Minimally elevated ESR/CRP
4. No erosions
5. No anemia

19

1. List treatment for MILD Rheumatoid Arthritis (3)

2. Which can be used safely in pregnancy?

1. Methotrexate with folic acid (first line)
2. Sulfasalazine
3. Hydroxychloroquine****

****Can be used in pregnancy

20

List treatment for SEVERE Rheumatoid Arthritis (2)

DMARD plus:
1. Leflunomide
2. TNF-alpha antagonists

21

When should you supsect steroid induced myopathy in PM-DM?

When weakness worsens while CPK improves

22

What diseases are associated with anterior uveitis (3)?

1. Sarcoidosis
2. Ankylosing Spondylitis
3. Reactive Arthritis

23

What is the triad of anterior uveitis?

1. Eye pain
2. Photophobia
3. Blurred vision

24

What are the three ant-TNF-alpha meds?

1. Adalimumab
2. Etanercept
3. Infliximab

Mnemonic = AEI

25

What medication usually precedes a Sclerodermal Renal Crisis?

Steroids six months prior

26

What is Löfgren syndrome and what are three clinical features associated with it?

Variant of sarcoidosis with:
1. Acute inflammatory arthritis, typically ankles
2. Erythema nodosum
3. Hilar lymphadenopathy

27

What is the difference between IgG and IgM?

IgM - Acute exposure
IgG - Long-term immunity

Mnemonic "M" = MORNING

28

Name two LARGE vessel vasculitic diseases

1. Giant Cell Arteritis (ESR>40)
2. Takayasu's Arteritis

29

Name two MEDIUM vessel vasculitic diseases (one is clinically distinct)

1. Polyarteritis Nodosa (NO glomerulonephritis)
2. Kawasaki Disease

30

Name 6 SMALL vessel vasculitic diseases.

Which are three major forms and how are they related (2)?

1. Wegener's Granulomatosis***
2. Churg-Strauss Syndrome***
3. Microscopic Polyangiitis***

4. Henoch-Schonlein Purpura
5. Essential Cryoglobulinemic Vasculitis
6. Cutaneous Leukocytoclastic Vasculitis

***Focal segmental necrotising glomerulonephritis without immune complexes (pauci-immune) AND +ANCA

31

What are two medications to start for treatment of Giant Cell Arteritis?

1. Prednisone 40-60 mg daily
2. Aspirin 81 mg daily

32

What condition is associated with GCA?

Polymyalgia Rheumatica
- 50% of GCA have PMR
- 10% of PMR have GCA (no bx required)

33

Takayasu's Arteritis:
1. Which specific vessels are affected?
2. What are symptoms (3-4)?
3. How is it diagnosed?
4. Who does it affect?

1. Aorta and its branches
2. Fever, weight loss, sweats, arthralgias, LIMB claudication, TIA, syncope
3. Aortography
4. Young women

34

What c-ANCA and p-ANCA? Which diseases are mostly associated with them (1, 2)?

1. c-ANCA = Cytoplasmic staining for protease-3
*Wegener's

2. p-ANCA = Perinuclear staining for MPO
*Microscopic Polyangiitis
*Churg-Strauss
*Crescentic Glomerulonephritis

35

1. What is another name for Wegener's Granulomatosis?
2. What is it histologically?

1. Granulomatosis with Polyangiitis
2. Necrotizing vasculitis with parenchymal granulomas of small- and medium-vessels but NO IMMUNE COMPLEXES on histology

36

How does Wegener's manifest clinically (3)?

1. Glomerulonephritis (rapid progressive)
2. Pulmonary nodules ("coin lesions"), infiltrates and/or cavities with hemoptysis
3. Destructive rhinitis or sinusitis

37

How is Wegener's treated (active vs. remission)?

1. Cyclophosphamide + Pred
2. a. MTX + Pred
b. Azathioprine + Pred

38

What is the dignostic criteria for Adult Onset Still Disease (major 4, minor 5)?

Two of five features:

Major
1. Fevers (daily) >39C for >1 week
2. Polarthritis
3. Leukocytosis >80% granulocytes
4. Macular rash during fevers

Minor
1. Lymphadenopathy
2. Splenomegaly
3. Abnormal LFT
4. Sore throat
5. Negative ANA and RF

39

What is a symptom of Adult Onset Still Disease (with two etiologies for this one symptom)?

Pleuritic Chest Pain
1. Pleural Serositis
2. Pericarditis

40

What are some CBC and rheumatologic lab valuves for Adult Onset Still Disease (4)?

1. Normocytic anemia
2. Elevated ESR/CRP
3. Elevated (markedly) ferritin > 2500
4. Absence of ANA or RF

41

What is a non-systemic treatment for acute gout attack?

Methylprednisolone injection

42

What gastric pathology can occur in patient's with systemic sclerosis?

GAVE (gastric antral vascular ectasia) which can lead to GIB with microcytic anemia

43

What are three clinical manifestations related to a Sclerodermal Renal Crisis?

1. HTN
2. AKI
3. MAHA

44

What is treatment for a Sclerodermal Renal Crisis? What is CONTRAINDICATED?

Treatment: ACEI like captopril

Contraindicated: Cyclosporine can worsen renal disease by renal vasoconstriction

45

Name 4 side effects of Cyclophosphamide

1. Bone marrow suppression
2. Bladder Cancer (transitional)
3. Infertility (ovarian failure)
4. Myeloproliferative disease

46

What is Microscopic Polyangiitis (histologically)?

Necrotizing vasculitis with few or no immune complexes (pauci-immune) and NO GRANULOMAS (unlike Wegener's)

47

What are clinical features of Microscopic Polyangitis (4)?

1. Glomerulonephritis
2. Pulmonary hemorrhage
3. Mononeuritis multiplex
4. Cutaneous small-vessel vasculitis with palpable purpura

48

What are the clinical features of Henoch-Schonlein Purpura (4)?

1. Glomerulonephritis
2. Palpable purpura
3. Arthritis
4. Gastrointestinal complaints (intussception) think IgA

49

What is Henoch-Schonlein Purpura (histologically)?

SKIN biopsy with Leukocytoclastic Vasculitis with predominant IgA deposition on vessel walls

50

What is the pathophysiology of Cryoglobulinemic Vasculitis?

Cold-precipitable monoclonal or polyclonal immunoglobulins

51

What diseases are associated with Cryoglobulinemic Vasculitis (4)?

1. HCV
2. B cell dyscrasias
3. Chronic Infections
4. Inflammatory Disease

52

1. Who is affected by Behcet's Disease?
2. What are the clinical manifestations?-
a.
b.
-
-
-
-

1. Asians and Eastern Mediterraneans

2. Manifestations:
a. Recurrent aphthous oral ulcers
b. Two of the following:
- Cutaneous lesions
- Recurrent genital ulcers
- Uveitis with HYPOPYON
- Positive pathergy (skin prick test)

53

What are three features of Sjogren's syndome?

Autoimmune disorder characterized by:
1. Keratoconjunctivitis sicca
2. Xerostomia
3. Presence of antibodies (SSA, SSB)

54

What malignancy is associated with Sjogren's syndrome?

B-cell Lymphoma

55

List causes of salivary gland enlargement (8)

1. Bulimia
2. Excess EtOH
3. Sarcoidosis
4. Amyloidosis
5. Infection: GC, RPR, mono, HIV, TB, fungal
6. Neoplasm: adenoma, adeno
7. Toxicity: lead, iodide, copper
8. Sjogren's

Mnemonic = BE SAINTS

56

Which rheumatology patient should receive Isoniazid prophylaxis?

1. PPD > 5mm AND
2. Taking > Prednisone 15 mg or other rx

57

Which rheumatology patient should receive osteoporosis prophylaxis?

Patients taking >5mg Prednisone for more than three months

58

What joints are affected with arthritis associated with Hemochromatosis?

2nd MCP and PIP

59

What is the diagnostic test for osteonecrosis? What ISN'T the diagnostic test?

MRI and not X-ray

60

What are two indications for an ankle x-ray?

1. Patient cannot bear weight
2. Lateral malleolus pain

61

What is a serologic test for CREST syndrome?

Anti-CENTROMERE ANA

62

What is a serologic test for Autoimmune Hepatitis (2)?

1. Anti-smooth muscle antibody
2. Anti-LKM

63

What is a serologic test for Mixed Connective Tissue Disease?

Anti-RNP antibody

64

1. What is a serologic test for Churg Strauss?
2. What are three other features?

1. p-ANCA with Antimyeloperoxidase-ab
2. Asthma
Vasculitis
Eosinophilia

**Mnemonic PAVE

65

What is a serologic test for Microscopic Polyangiitis?

p-ANCA

66

In which population is RF positivity not a sensitive marker for Rheumatoid Arthritis?

HCV

67

What are 3 exam findings of Takayasu Arteritis?

1. HTN (from bilateral renal artery stenosis)
2. Bruits
3. Diminished or asymmetric pulses

**Think diffuse vascular insufficiency

68

What is a radiographic feature of Polyarteritis Nodosa?

Aneurysmal beading on angiography

69

Which infections are associated with Polyarteritis Nodosa?

HBV and (less) HCV

70

Which rheumatologic drug should be discontinued after a diagnosis of cancer and why?

TNF-alpha inhibitors because TNF-alpha is active against certain forms of cancer

71

What is anti-Jo related to (2)?

PM/DM and Interstitial Lung Disease

72

1. What is the symptom and exam finding for a Morton's Neuroma?
2. What is treatment?

1. Pain between 3rd-4th MTP when weight bearing in shoes with Mulder's sign (click with transverse loading)
2. Metatarsal pad and wider shoes

73

What is the general upper limit of normal in ESR for men and women?

Men = Age / 2
Women = (Age + 10) / 2

74

What is a rheumatologic lab pattern for Sjogrens (4)?

+ANA
+SSA
+SSB
+RF

75

What is a serologic test for Primary Biliary Cirrhosis?

Anti-MITOCHONDRIAL

76

What is a serologic test for Hashimoto's thyroiditis (2)?

1. Anti-thyroglobulin
2. Anti-microsomal

77

What is the histological feature of Polyarteritis Nodosa?

PANmural necrotizing inflammation by PMNs

Mnemonic = PAN

78

What is treatment for Reactive Arthritis?

Sulfasalazine

79

List four rheumatologic labs findings of Drug-Induced Lupus.

1. ANA
2. Anti-HISTONE***
3. Anti–dsDNA
4. Anti-Smith

80

What nonbiologic DMARD is use in the treatment of IBD arthritis?

Sulfasalazine

81

What is Morphea?

Scleroderma limited to the skin only

82

What is treatment for Psoriatic Arthritis?

Methotrexate

83

What is the difference between Type I and Type II cryoglobulinemia?

Type I: IN-active HCV disease
Type II: active HCV disease

84

1. What is treatment for acutely painful ischemic fingers withy Raynaud's?
2. How does it work?

Epoprostenol - prostacyclin analogue that decreases sympathetic vasoconstriction

85

When you start ___ for Gout prophylaxis in an asymptomatic person, you should also start __.

1. Allopurinol
2. Colchicine