Internal Medicine
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| What are three causes of migratory arthropathy? | 1. rheumatic fever
2. disseminated gonococcal infection
3. lyme disease
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| What are the 4 questions in evaluating a patient with joint swelling? | 1. Distribution
2. Acute or chronic
3. Systemic symptoms
4. Inflammation (morning stiffness, ↑ ESR)
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| Which disease is inflammatory in nature: rheumatoid arthritis or osteoarthritis? | rheumatoid
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| What are the 3 basic tests in rheumatologic diseases? | 3C's to run on synovial fluid aspirate
1. WBC cell count
2. crystals
3. cultures
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| 1. negative birefringent crystals 2. positive birefringent crystals | 1. gout
2. pseudogout
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| 1. antihistone antibodies 2. anti ds-DNA 3. anti-centromere 4. anti-RO 5. c-ANCA 6. p-ANCA | 1. drug-induced lupus
2. SLE
3. CREST
4. Sjogren syndrome
5. Wegener's
6. polyarteritis nodosa, Churg-Strauss
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| What is rheumatoid factor? | an autoantibody against the FC portion of IgG
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| What joints of the hand are involved in rheumatoid arthritis? | 1. MCPs
2. PIPs
never DIP
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| 1. RA + splenomagaly 2. RA + pneumoconiosis | 1. Felty syndrome
2. Caplan syndrome
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| 1. boutonniere deformity 2. swan-neck deformity | 1. PIP flexed, DIP extended
2. PIP extended, DIP flexed
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| What causes 1. boutonniere deformity 2. rheumatoid nodules | 1. damage to ligaments and tendons
2. focal vasculitis
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| What routine screening test are necessary for rheumatoid arthritis patients on the following drugs: 1. hydroxychloroquine 2. methotrexate | 1. regular eye exams
2. CBC and liver enzymes
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| What are the 3 TNF-α inhibitors? | 1. infliximab
2. abdilimumab
3. etanercept
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| 1. Antibodies may form against which biological agent used to Rx rheumatic diseases. 2. What is known to reduce this complication? | 1. infliximab is not an entirely human antibody and therefor anti-infliximab antibodies may form
2. co-treatment with methotrexate
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| Patient with RA complaining of occipital headaches and upper extremity tingling/numbness. | atlantoaxial subluxation
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| Patient with RA presenting with swollen painful calf. | ruptured Baker cyst
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| What meds are used to treat severe complications of SLE? | azathioprine, cyclophosphamide
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| Treatment for anti-phospholipid antibodies in pregnancy? | LMWH
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| Which drugs cause drug-induced lupus? | See first aid for step 1
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| What causes Raynauds phenomenon is patients with scleroderma? | vascular dmage from accumulation of connective tissue diminishes blood flow to the extremities
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| Medication that prevents scleroderma renal crisis induced by malignant hypertension. | ACE inhbitors
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| Acronym of CREST syndrome | 1. Calcinosis
2. Raynaud
3. Esophageal dysfunction
4. Sclerodactyly
5. Telangiectasias
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| Medications used in scleroderma for: 1. skin manifestations 2. severe Raynaud phenomenon 3. hypertension | 1. D-penicillamine
2. calcium-channel blockers
3. ACE inhibitors
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| What 2 infectious disease cause symmetrical polyarthropathy? | 1. parvovirus B19
2. hepatitis B
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| Young male with lower back stiffness that is worse in the morning and improves with exercise. 1. diagnosis 2. treatment | 1. clinical and x-ray findings
2. TNF blockers
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| What are the 3 extraarticular manifestations of ankylosing spondylitis? | 1. anterior uveitis
2. aortic insufficiency
3. third-degree heart block
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| What is the infectious cause: 1. Reiter syndrome 2. Septic arthritis 3. What is the difference in presentation of these two diseases? | 1. chlamydia (back stiffness, urethritis)
2. gonorrhea, S. aureus (fever, erythemia)
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| Enteropathic arthropathy occurs in which diseases? | 1. ulcerative colitis
2. Crohn disease
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| 1. Most common joint affected by osteoarthritis 2. Second most common | 1. knee
2. base of thumb
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| First drug used for pain in osteoarthritis | acetaminophen
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| Treatment of: 1. acute gout 2. chronic gout | 1. indomethacin, prednisone, colchicine
2. probenecid, allopurinol, or febuxostat
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| What are the four H's to investigate in individuals with pseudogout? | 1. hyperparathyroidism
2. hemochromatosis
3. hypophosphatemia
4. hypomagnesemia
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| Rx for septic arthritis | Depends on likely etiology
1. ceftriaxone if suspect gonorrhea
2. nafcillin or vancomycin if suspect S. aureus (elderly)
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| 1. What organs are commonly involved in Wegener's granulomatosis? 2. How do you confirm diagnosis? 3. Treatment | 1. lungs, kidney's,joints
2. biopsy of involved organ
3. prednisone + cyclophosphamide
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| 1. First test done in suspected temporal arteritis 2. If this test is positive, what is the management? | 1. ESR
2. start corticosteroids immediately and then perform temporal artery biopsy
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| 40 year old individual with proximal muscle weakness and rash. What are the first labs to order? | 1. creatine kinase
2. aldolase
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| Polyarticular symmetric arthritis (3) | 1. rheumatoid arthritis
2. SLE
3. viruses (hepatitis B, parvovirus B19)
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| Mainstay of treatment in rheumatoid arthritis. | methotrexate
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| Predominant infiltrating cell in rheumatoid arthritis. | T lymphocyte
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| Patient with long-term rheumatoid arthritis has anemia. What are your two differentials and workup? | 1. anemia of chronic disease or PUD from glucocorticoid use leading to bleeding
2. check iron and ferritin levels
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| Screening tests for patients taking methotrexate | CBC and liver enzymes (side effects of hepatitis/hepatic fibrosis)
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| If a lupus patient becomes pregnant, what is the proper screening test to protect the fetus? | screen for anti-Ro (SSA) and anti-La (SSB) antibodies because these cross the placenta and can cause neonatal lupus
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| Symptoms of drug induced lupus | 1. fever, fatigue and arthritis
2. No systemic manifestations
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| 1. Arthritis following diarrhea 2. Arthritis following urethritis | 1. reactive arthritis from Campylobacter, Shigella or Salmonella
2. reactive arthritis from Chlamydia
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| 1. First line drug in acute gouty arthritis of an otherwise healthy adult. 2. Drug used in acute gouty arthritis if patient has renal failure 3. 2nd line for acute gout | 1. indomethacin
2. steroids
3. colchicine
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| After confirming that a patient has pseudogout, what is the next step? | 1. determine if systemic symptoms are present
2. four H's: hyperparathyroidism, hemochromatosis, hypophosphatemia, hypomagnesemia
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| What is chondrocalcinosis? | deposits in joint menisci or articular cartilage seen with pseudogout
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| What vasculitis syndrome is associated with hepatitis B? | polyarteritis nodosa
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| First step in possible temporal arteritis? | erythrocyte sedimentation rate
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| Proximal muscle weakness and ocular symptoms? | myasthenia gravis or Eaton-Lambert
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| 1. What is the most common rash on the face? 2. How do you distinguish the butterfly rash of SLE? | 1. seborrheic dermatitis
2. the SLE rash does not involve the nasolabial folds
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| Which lab is elevated in antiphospholipid antibody syndrome? | 1. PTT is falsely elevated
2. false positive RPR and VDRL
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amichael@siumed.edu
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