1.8 Rheumatology

Question 1

heberden and bouchard nodes

Answer 1

englargement of the interphalangeal joints that appear on osteoarthritis

heberden: distal
bouchard: proximal

Question 2

side effects of colchicine

Answer 2

diarrhea

bone marrow suppression (neutropenia)

Question 3

what drugs should I remove from a patient’s prescription to manage chronic gout?

Answer 3

thiazides

aspirin

niacin

*give losartan for hypertension

Question 4

what to substitute allopurinol with if it is contraindicated?

Answer 4

febuxostat

xanthine oxidase inhibidor

Question 5

pegloticase

Answer 5

dissolves uric acid

Question 6

probenecid and sulfinpyrazone

Answer 6

increase the excretion of uric acid in the kidney

treat gout (rarely used)

Question 7

antigout drugs that should not be started during acute attacks of gout

Answer 7

urisouric (probenecid, sulfinpyrazone)

allopurinol

Question 8

what are the most common risk factors for pseudogout?

Answer 8

hemochromatosis

hyperparathyroidism

Question 9

Milnacipran

Answer 9

Inhibitor od the Reuptake of Serotonin & Norepinephrin

approves specifically for the management of fibromyalgia

Question 10

what joint is always spared in rheumatoid arthritis?

Answer 10

DIP

distal interpahalangeal joint

Question 11

sicca syndrome

Answer 11

dry eyes, mouth and mucous membranes

Question 12

RA + splenomegally and neutropenia

Answer 12

Felty Syndrome

Question 13

RA + pneumoconiosis and lung nodules

Answer 13

Caplan Syndrome

Question 14

What does a patient with RA + erosive disease or X-ray abnormalities need? Why?

Answer 14

Methotrexate!!!

to stop the progression of the disease

Question 15

erosive RA

Answer 15

• joint space narrowing
• physical deformity
• x-ray abnormalities

Question 16

adverse effects of methotrexate

Answer 16

• liver toxicity
• lung toxicity
• bone marrow suppression

Question 17

which DMARDs are safe in pregnancy?

Answer 17

TNF inhibitors

(infliximab, adalimumab, etanercepts, golimumab, certolizumab)

Hydroychloroquine

Sulfasalazine

Question 18

what precautions do I need to take before giving a patient a TNF inhibitors?

Answer 18

screen for TB with PPD

Question 19

adverse effects of TNF inhibitors

Answer 19

reactivation of TB

infections

Question 20

adverse effect of hydroxychloroquine

Answer 20

toxicity to the retina

do a dilated eye exam

Question 21

sulfazalazine adverse effects

Answer 21

bone marrow toxicity

hemolysis with G6PD deficiency

rash

Question 22

adverse effect of rituximab

Answer 22

infection

Question 23

adverse effect of gold salts

Answer 23

nepthrotic syndrom

Question 24

🚩 rash, high spiking fever of unidentified etiology in a young person

Answer 24

JRA (juvenile rheumatoid arthritis)

Question 25

STILLS

Answer 25

* Salmon colored rash * Temperatur elevation * Ill appearing patient * Lymphadenopathy * Leukocytosis * Splenomegaly

Question 26

what are the 11 diagnostic critera for SLE?

Answer 26

1. macular Rash 2. discoid Rash 3. photosentivity 4. oral ulcers 5. arthritis (normal x-ray) 6. chest pain (with preicardia/pleural effusion) 7. renal involvement (mc: membranous glom.) 8. neurologic symptoms (psychosis, seizures, stroke) 9. hemolytic anemia (mc: anemia of chronic disease) 10. positive ANA 11. postive: * Anti-double stranded DNA * Anti-Sm * False + for Syphilis * + LE cell preparation

Question 27

🚩 thrombosis + recurrent spontaneous abortions

Answer 27

APL syndrome

Question 28

🚩 clotting + elevaded aPTT + normal PT

Answer 28

APL syndrome

Question 29

what is the treatment to preven spontaneous abortion recurrence?

Answer 29

heparin and aspirin

Question 30

CREST syndrome

Answer 30

(limited scleroderma) Calcinosis Raynaud Esophageal dysmotility Sclerodactyly Telangiectasia

Question 31

💡 proximal weakness + dysphagia

Answer 31

inflammatory miositis

Question 32

💡 unresolving pneumonia not better with antibiotics

Answer 32

Wegner Granulomatosis

Question 33

🚩 leukocytoclastic vasculitis on biopsy

Answer 33

Henoch Scholein Purpura

Question 34

sterile skin postules from minor trauma

Answer 34

pathergy

Question 35

what is treatment for anti-TNF resistant psoriatic arthritis?

Answer 35

secu-kinu-mab ixe-kizu-mab antil IL17 medications

Question 36

apremilast

Answer 36

**oral phosphodiesterase inhibitor** psoriasis and psoriatic arthritis

Question 37

when does densitometry screening start?

Answer 37

all women above the age of 65

Question 38

denosumab

Answer 38

**RANKL inhibitor** firt line with biphosphonates to treat osteoporosis

Question 39

🚩 bowel or bladder incontinence, erectile dysfunction with saddle area anesthesia

Answer 39

cauda equina syndrome

Question 40

3 main types of antiphospholipid syndrome

Answer 40

lupus anticoagulant anticardiolipin antibodies beta 2 glycoprotein