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MCCQE1 > Rheumatology > Flashcards

Rheumatology Flashcards

(54 cards)

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1
Q

Red, hot, swollen joint. Next step?

A

arthrocentesis

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2
Q 
Arthrocentesis
Appearance: Serous
WBC: < 200
Polys: < 25%
Gram/Cx: (-)
Crystals: (-)
A

Normal. Consider Osteoarthrosis

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3
Q 
Arthrocentesis
Appearance: Cloudy
WBC: 200-50,000
Polys: > 50%
Gram/Cx: (-)
Crystals: +/-
A

Inflammatory

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4
Q 
Arthrocentesis
Appearance: Pus, opaque, white
WBC: > 50,000
Polys: > 75%
Gram/Cx: (+)
Crystals: (-)
A

Septic arthitis

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5
Q

ANA. Interpretation?

A

Sensitive lupus

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6
Q

Rheumatoid factor. Interpretation?

A

Rheumatoid arthritis

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7
Q

Anti-CCP. Interpretation?

A

Rheumatoid arthritis

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8
Q

ds-RNA. Interpretation?

A

Lupus + renal involvement

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9
Q

Histone. Interpretation?

A

Drug-induced lupus

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10
Q

Centromere antibodies. Interpretation?

A

Scleroderma (CREST)

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11
Q

Topoisomerase. interpretation?

A

Systemic scleroderma

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12
Q

Smooth muscle antibody. Interpretation?

A

Autoimmune hepatitis

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13
Q

Ro+LA. Interpretation?

A

Sjogren’s

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14
Q

Jo. Interpretation?

A

Polymyositis, dermatomyositis

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15
Q

Anti-Mitochondrial antibodies. Interpretation?

A

Primary biliary cirrhosis

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16
Q

Black woman with malar rash, pleuritic chest pain, oral ulcers, pain in hips, elbows, knees, shoulders, and photosensitivity.

Test show anemia, leukopenia and thrombocytopenia.

Dx, next steps and tx?

A

Lupus

Next steps:

  • 1st ANA: Sensitive test, gate test. If negative, it’s likely that it is not an autoimmune disease
  • sd-DNA (nephritis)
  • Anti-smith
  • Urinalysis, proteinuria, renal function
  • ESR, CRP
  • Low C3 and C4

Treatment:

  • Everyone: Hydroxychloroquine
  • 2nd line: methotrexate
  • Symptomatic: NSAIDs
  • Azathioprine: adjunctive
  • Flare: steroids
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17
Q

Patient taking hydralazine with malar rash, pleuritic chest pain, pain in hips, elbows, knees, shoulders, and photosensitivity.

Dx, next steps and tx?

A

Drug-induced lupus

Next step: Anti-histone antibody

Tx: Remove medication

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18
Q

Patient with Dx of lupus who has HTN and proteinuria.. Dx, next steps and tx?

A

Lupus nephritis

Next steps:
ds-DNA antibodies
Biopsy

Dx: IV cyclophosphamide mofetil then transition to oral mycophenolate

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19
Q

Fever, altered mental status, pleuritic chest pain. C3, C4 low. Dx?

A

Lupus flare.

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20
Q

45 y-o woman, morning stiffness of more than 60 mins, joint pain in > 3 small joints (hands, feet) symmetric and spares the distal interphalangeal (DIP).
Anti-CCP positive
Rx-Ray: erosion and periarticular osteopenia

Dx and Tx?

A

Rheumatoid arthritis

Tx:
Ibuprofen/meloxicam + Methotrexate

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21
Q

Anti-CCP vs Rheumatoid factor in rheumatoid arthritis

A

Anti-CCP: more specific–> if positive, it’s RA

Rheumatoid factor: more sensitive–> if negative, it’s NOT RA

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22
Q

Patient with rheumatoid arthritis in treatment with Methotrexate. Patient with positive pregnancy test. Next step?

Study These Flashcards
A

Change Methotrexate for Hydroxychloroquine

23
Q

Examples of disease-modifying antirheumatic drugs (DMARDs) for RA

Study These Flashcards
A
  • Methotrexate: 1st line
  • Leflunomide: 2nd line
  • Hydroxychloroquine: 3rd line or in pregnant patient
  • Sulfasalazine: 4th line
24
Q

Patient with Dx of Rheumatoid arthritis. In treatment with meloxicam, Methotrexate, Hydroxychloroquine, and Sulfasalazine. Patient still symptomatic despite tx.
Dx, next step, tx?

Study These Flashcards
A

Severe rheumatoid arthritis

Next step:
Vaccinate, screen for TB, screen for fungus

Tx:
Start a biologic (TNF-alfa inhibitor) such as infliximab, rituximab, or etanercept.

25
Patient with RA who visitis the ER with fever and exacerbated joint pain. Dx and tx?
Flare of rheumatoid arthritis Tx: Short regimen of prednisone (3-5 days)
26
Patient with Rheumatoid arthritis who will go in surgery. | What should be done befeore the surgery?
Get an x-ray of the cervical spine. RA can affect cervical spine
27
Felty’s syndrome triad?
* Rheumatoid arthritis * Neutropenia * splenomegaly
28
Patient with HTN, Reynold’s, severe GERD, no wrinkles, Telangiectasias, GI bleeds, and iron def anemia. Dx, next step and tx?
Limited cutaneous systemic sclerosis (CREST) Next step: Anti-centromere Tx: Penicillamine (for scleroderma), PPI and CCB
29
Patient with HTN, Reynold’s, severe GERD, no wrinkles, Telangiectasias, and Diffuse Pulmonary Lung Disease/constrictive pericarditis/acute kidney injury. Dx, next step and tx?
Diffuse cutaneous systemic sclerosis Next step: Anti-Scl70 (aka topoisomerase) Tx: Penicillamine (for scleroderma), PPI, CCB, ACEI (DON’T give steroids, they might precipitate renal crisis!!!)
30
Patient with history of CKD who develops Sclerodactyly, and loss of wrinkles after receiving gadolinium on a MRI. Dx?
Nephrogenic systemic sclerosis
31
Patient with Dry eyes, Dry mouth and Parotid swelling. Dx, next step and tx?
Sjogren’s Next steps: - Screening: (+) ANA and RF - Confirmatory: Anti Ro and Anti La - Schirmer test - Screen for lupus and RA Tx: Artificial tears, artificial saliva
32
Patient with painless subacute difficulty raising from a chair or getting things from overhead or going up and downstairs. On physical exam, purple discoloration around eyes with periorbital edema, scaly lesions that are symmetrical and occur on large joints and photosensitive rash in exposed areas. Dx, next step and tx?
Idiopathic inflammatory myopathy Next steps: - 1st: ↑CK - EMG - Biopsy of muscle - Anti-Mi, anti-Mo Tx: - Steroids - F/U: Cancer screening
33
Patient, man, low back pain that gets better with use, morning stiffness in low back. Lateral lumbar x-ray: Bamboo sign Dx, tx?
Ankylosing Spondylitis Tx: - NSAIDs - Local steroids - Physical therapy - TNF-alfa-inhibitors (Etanercept) if severe disease
34
Patient with ankylosis spondylitis who goes to the ER with back pain. Next step?
Do a CT to rule out fracture
35
Patient man, Psoriasis, Arthitis and Nail pitting on physical exam. Dx, next step and tx?
Psoriatic Arthritis Next step: Nothing else needed, dx is clinical Tx: - NSAIDs - Local steroids - DMARDs (hydroxychloroquine, methotrexate) - TNF-alfa-inhibitors (Etanercept) if severe disease
36
Patient, Man, Urethritis, arthritis. Dx, next step and tx?
Reactive Arthritis Next step: - Arthrosentesis: inflammatory joint, no evidence of microorganism - Swap of mouth, anus, uretra Tx: - Doxycycline, or azithromycin + ceftriaxone - NSAIDs - Time
37
Microorganism that generally produces Reactive Arthritis?
Chlamydia
38
Patient, Man, Urethritis, arthritis, conjunctivitis. Dx?
Reiter’s syndrome
39
Patient with history of IBD who now has arthritis. Dx, tx?
IBD-related/ Enteropathic Arthritis Tx: Treating the IBD will improve arthritis
40
Patient at the ER with Red, hot, swollen, tender, loss of function of one joint. Arthrocentesis shows: - Appearance: cloudy - WBC < 50.000 - Polys > 50% - Gram (-) - Crystals: Positively birefringent, rhomboid-shaped crystals Dx and tx?
Flare of Pseudogout ``` Tx of flare • NSAIDs • Colchicine (dose-limit by diarrhea) • Steroids ***Tx underlying methobolic condition ```
41
Patient with CKD/EtOH/HCTZ at the ER with Red, hot, swollen, tender, loss of function of one joint. Arthrocentesis shows: - Appearance: cloudy - WBC < 50.000 - Polys > 50% - Gram (-) - Crystals: Negatively birefringent, needle-shaped crystals Dx and tx?
Flare of Gout Tx: • Flare: NSAIDs, colchicine (dose-limit by diarrhea), steroids • Prevent future flares with lifestyle modifications (↓EtOH, meat, complex carbs), stop change BP meds
42
Patient more that 2 podragra episodes during the past year. Dx, next step and tx?
Gout Next step: Get uric acid (should be > 6 for dx) Tx: • Lifestyle modifications: ↓EtOH, meat, complex carbs • Allopurinol • Flare prophylaxis with colchicine, NSAIDs, steroids in lower doses
43
Patient with leukemia/lymphoma on Chemotherapy with renal failure. Dx, next step?
Tumor lysis syndrome Prophylaxis of gout with IVF and allopurinol If prophylaxis fails: Rasburicase
44
Gout produced by reduced elimination of uric acid. Tx?
Probenecid
45
Patient who had a penetrative trauma in a joint which is now red, hot, swollen, and tender. Arthrocentesis: - Appearance: Plus, opaque, white - WBC > 50.000 - Polys > 75% - Gram (+) for gram positive cocci in clusters - Crystals: (-) Dx and tx?
Septic joint Tx: • Nafcillin for methicillin-susceptible Staphylococcus aureus (MSSA) • Vancomycin or linezolid for methicillin-resistant Staphylococcus aureus (MRSA)
46
Patient PWID/hemodyalisis/ endocardiatis who has a red, hot, swollen, and tender joint. Arthrocentesis: - Appearance: Plus, opaque, white - WBC > 50.000 - Polys > 75% - Gram (+) for gram positive cocci in clusters - Crystals: (-) Dx and tx?
Non-gonococcal (staph) septic joint Tx: • Nafcillin for methicillin-susceptible Staphylococcus aureus (MSSA) • Vancomycin or linezolid for methicillin-resistant Staphylococcus aureus (MRSA)
47
Patient STD, HIV, syphilis, cervicitis, urethritis, sex worker who has a red, hot, swollen, and tender joint. - Appearance: Plus, opaque, white - WBC > 50.000 - Polys > 75% - Gram (-) - Crystals: (-) Dx, next step and tx?
Gonococcal septic joint Next step: Nucleic acid amplification test Tx: Ceftriaxone 7-14 days IV + doxycycline/azithromycin
48
Patient > 50, Jaw claudication, Amaurosis fugax, temporal headache, Temporal tenderness oh physical exam. Dx, next step and tx?
Giant cell arteritis (Large vessels like External carotid, ophthalmologic, temporal) Next step: Star steroids, don't wait for Bx to show granulomas.
49
Patient < 40, Pulselessness on femoral and brachial arteries. Dx, next step and tx?
Takayasu (large vessels) Next step: Angiogram Tx: Steroids
50
Asian child, who presents to the ER with chest pain, strawberry -like tongue and rash with desquamation in palms and soles. Dx and tx?
Kawasaki (medium vessels) Tx: IV Ig + ASA
51
Patient with history of Hepatitis B with mesenteric ischemia/renal failure, purpura, subcutaneous painful nodules, motor and sensory deficit in a peripheral nerve that comes and goes (mononeuritus multiplex). Dx, next step, tx?
Polyarteritis nodosa (medium vessels) Next step: Angiogram --> aneurisms of medium vessels Tx: Steroids + cyclophosphamide
52
Patient with hemoptysis, hematuria, and nasal involvement. Dx, next step, tx?
Wegener’s–granulomatosis with polyangiitis (small vessel) Next step: C-ANCA, Bx of pulmonary tissue Tx: steroids + cyclophosphamide
53
Patient with history of Hepatitis C who has palpable purpura. Dx, next step, tx?
Cryoglobulinemia (small vessel) Next step: • ↓complement • Cryoglobulins Tx: 1. Treat Hep C 2. Steroids 3. Cyclophosphamide 4. Severe: plasmapheresis
54
Patient with GI bleed, abdominal pain, and palpable purpura. Dx, next step, tx?
Henoch-Schönlein purpura (small vessel) Next step: Bx of purpura--> Leukocytoclastic vasculitis Tx: Steroids

MCCQE1 (19 decks)

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