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Rheumatology
Internal Medicine
| Question | Answer |
|---|---|
| What are three causes of migratory arthropathy? | 1. rheumatic fever 2. disseminated gonococcal infection 3. lyme disease |
| 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) |
| Which disease is inflammatory in nature: rheumatoid arthritis or osteoarthritis? | rheumatoid |
| 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 |
| 1. negative birefringent crystals 2. positive birefringent crystals | 1. gout 2. pseudogout |
| 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 |
| What is rheumatoid factor? | an autoantibody against the FC portion of IgG |
| What joints of the hand are involved in rheumatoid arthritis? | 1. MCPs 2. PIPs never DIP |
| 1. RA + splenomagaly 2. RA + pneumoconiosis | 1. Felty syndrome 2. Caplan syndrome |
| 1. boutonniere deformity 2. swan-neck deformity | 1. PIP flexed, DIP extended 2. PIP extended, DIP flexed |
| What causes 1. boutonniere deformity 2. rheumatoid nodules | 1. damage to ligaments and tendons 2. focal vasculitis |
| 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 |
| What are the 3 TNF-α inhibitors? | 1. infliximab 2. abdilimumab 3. etanercept |
| 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 |
| Patient with RA complaining of occipital headaches and upper extremity tingling/numbness. | atlantoaxial subluxation |
| Patient with RA presenting with swollen painful calf. | ruptured Baker cyst |
| What meds are used to treat severe complications of SLE? | azathioprine, cyclophosphamide |
| Treatment for anti-phospholipid antibodies in pregnancy? | LMWH |
| Which drugs cause drug-induced lupus? | See first aid for step 1 |
| What causes Raynauds phenomenon is patients with scleroderma? | vascular dmage from accumulation of connective tissue diminishes blood flow to the extremities |
| Medication that prevents scleroderma renal crisis induced by malignant hypertension. | ACE inhbitors |
| Acronym of CREST syndrome | 1. Calcinosis 2. Raynaud 3. Esophageal dysfunction 4. Sclerodactyly 5. Telangiectasias |
| Medications used in scleroderma for: 1. skin manifestations 2. severe Raynaud phenomenon 3. hypertension | 1. D-penicillamine 2. calcium-channel blockers 3. ACE inhibitors |
| What 2 infectious disease cause symmetrical polyarthropathy? | 1. parvovirus B19 2. hepatitis B |
| 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 |
| What are the 3 extraarticular manifestations of ankylosing spondylitis? | 1. anterior uveitis 2. aortic insufficiency 3. third-degree heart block |
| 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) |
| Enteropathic arthropathy occurs in which diseases? | 1. ulcerative colitis 2. Crohn disease |
| 1. Most common joint affected by osteoarthritis 2. Second most common | 1. knee 2. base of thumb |
| First drug used for pain in osteoarthritis | acetaminophen |
| Treatment of: 1. acute gout 2. chronic gout | 1. indomethacin, prednisone, colchicine 2. probenecid, allopurinol, or febuxostat |
| What are the four H's to investigate in individuals with pseudogout? | 1. hyperparathyroidism 2. hemochromatosis 3. hypophosphatemia 4. hypomagnesemia |
| Rx for septic arthritis | Depends on likely etiology 1. ceftriaxone if suspect gonorrhea 2. nafcillin or vancomycin if suspect S. aureus (elderly) |
| 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 |
| 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 |
| 40 year old individual with proximal muscle weakness and rash. What are the first labs to order? | 1. creatine kinase 2. aldolase |
| Polyarticular symmetric arthritis (3) | 1. rheumatoid arthritis 2. SLE 3. viruses (hepatitis B, parvovirus B19) |
| Mainstay of treatment in rheumatoid arthritis. | methotrexate |
| Predominant infiltrating cell in rheumatoid arthritis. | T lymphocyte |
| 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 |
| Screening tests for patients taking methotrexate | CBC and liver enzymes (side effects of hepatitis/hepatic fibrosis) |
| 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 |
| Symptoms of drug induced lupus | 1. fever, fatigue and arthritis 2. No systemic manifestations |
| 1. Arthritis following diarrhea 2. Arthritis following urethritis | 1. reactive arthritis from Campylobacter, Shigella or Salmonella 2. reactive arthritis from Chlamydia |
| 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 |
| 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 |
| What is chondrocalcinosis? | deposits in joint menisci or articular cartilage seen with pseudogout |
| What vasculitis syndrome is associated with hepatitis B? | polyarteritis nodosa |
| First step in possible temporal arteritis? | erythrocyte sedimentation rate |
| Proximal muscle weakness and ocular symptoms? | myasthenia gravis or Eaton-Lambert |
| 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 |
| Which lab is elevated in antiphospholipid antibody syndrome? | 1. PTT is falsely elevated 2. false positive RPR and VDRL |
Created by:
amichael@siumed.edu
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