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Rheumatology

Internal Medicine

QuestionAnswer
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