Rheumatology Flashcards Preview

USMLE Step 3 MTB > Rheumatology > Flashcards

Flashcards in Rheumatology Deck (187)
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1

- women greater than 50 yoa
- joint pain
- MORNING stiffness; SYMMETRICAL, multiple joints of hands, LASTS MORE THAN 1 HOUR
- symptomatic episodes last for at least 6 weeks

rheumatoid arthritis

2

how is rheumatoid arthritis (RA) defined?

4 or more of the following:

1. morning stiffness more than 1 hour
2. wrist and finger involvement
3. swelling of at least 3 joints
4. SYMMETRIC involvement
5. rheumatoid nodules
6. XR showing erosions
7. POSITIVE RF, or anti-CCP Ab
8. elevated CRP, or ESR
9. synovitis

3

cardiac findings in RA

- pericarditis
- valvular disease

4

pulmonary findings in RA

- pleural effusion with VERY LOW glucose level
- lung nodules

5

hematological findings in RA

anemia with NORMAL MCV

6

neurological findings in RA

mononeuritis multiplex

7

dermatological findings in RA

nodules

8

Felty's syndrome

1. RA
2. splenomegaly
3. neutropenia

9

joint findings in RA

- MCP (metacarpophalangeal) swelling and pain
- Boutonniere deformity
- swan neck deformity
- Baker's cyst
- C1/C2 cervical spine subluxation

10

Boutonniere deformity

PIP flexion with DIP hyperextension

11

swan neck deformity

PIP extension with DIP flexion

12

Baker's cyst

outpocketing of synovium at back of knee

13

treatment for RA

NSAIDs with DMARD

(disease-modifying antirheumatic drug)

14

which joint is SPARED in RA?

sacroiliac joint

15

what should be started to eliminate XR abnormalities in RA?

DMARDs

16

BEST INITIAL DMARD to start in RA

methotrexate

17

adverse effects of methotrexate

- bone marrow suppression
- pneumonitis
- liver disease

18

name the DMARDs

- methotrexate
- biological agents (infliximab, adalimumab, etanercept)
- hydroxychloroquine
- sulfasalazine

19

name the alternate DMARDs

- rituximab
- anakinra
- tocilizumab
- leflunomide
- abatacept
- gold salts

20

MOA of rituximab

anti-CD20 Ab

21

MOA of anakinra

IL-1 receptor antagonist

22

MOA of tocilizumab

IL-6 receptor antagonist

23

MOA of leflunomide

pyrimidine antagonist (similar to methotrexate)

24

MOA of abatacept

inhibits T-cell activation

25

MOA of biological agents (infliximab, adalimumab, etanercept)

block TNF-a

26

what could be added if methotrexate alone fails?

biological agents (infliximab, adalimumab, etanercept)

27

patient being treated with hydroxychloroquine, should get?

regular eye exams

28

adverse effect of sulfasalazine

bone marrow suppression

29

adverse effect of gold salts

nephrotic syndrome

30

what is the role of steroids in RA?

- BRIDGE to DMARD therapy
- to treat acutely ill pt with severe inflammation