Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Rheumatology > 351 Rheumatoid Arthritis > Flashcards

351 Rheumatoid Arthritis Flashcards

1
Q

Based on the American College of Rheumatism (ACR) and European League Against Rheumatism (EULAR) criteria, what is the score to the fulfills requirement for definite Rheumatoid Arthritis?

A

7

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Earliest joints involved in rheumatoid arthritis

A

Small joints of hands and feet

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Most frequently involved joints

A

MCP, PIP and wrist

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

True or false: DIP frequently involved in RA

A

False but a when present means coexistent osteoarthritis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Frequent hallmark of rheumatoid arthritis

A

Flexor tendon tenosynovitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Hypertension of PIP and flexion of DIP

A

Swan neck deformity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Subluxation of the MCP joint with subluxation or partial dislocation of the proximal phalanx to volar side of the hand

A

Ulnar deviation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Flexion of the PIP with hyper extension of the DIP

A

Boutonniere deformity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Subluxation of the first MCP joint with hyper extension of the first interpahalangeal joint

A

Z line deformity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Inflammation about ulnar styloid and tenosynovitis of the extensor carpi ulnaris may cause subluxation of the distal iulnar

A

Piano key movement of ulnar styloid

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What differentiates RA from spondyloarthritides

A

RA rarely affects thoracic and lumbar spine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Initial radiographic finding in RA

A

Periarticular osteopenia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

DMARDS of first choice for the treatment of early RA

A

Methotrexate

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Ranks as an important long term complication of chronic prednisone use

A

Osteoporosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

DMARDS which causes irreversible retinal damage

A

Hydorxychloroquinee

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Examples of conventional DMARDs

A

Hydroxychloroquine
Sulfasalazine
Methotrexate
Leflunamide

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

most common form of chronic inflammatory arthritis

A

rheumatoid arthritis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

rheumatoid arthritis

A

small joints of the hands and feet

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

typical complaints of patients with RA

A

early morning stiffness lasting more than 1 h that eases with physical activity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

joints that standout as the most frequently invovled

A

MCP, PIP, wrist

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

True or false. Involvement of the DIP is usually a manifestation of coexistent OA

A

True.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

frequent hallmark of RA and leads to decreased range of motion, reduced grip strength and trigger fingers

A

flexor tendon tenosynovitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

results from subluxation of the MCP jionts with sublaxation or partial dislocation, of the proximal phalanx to the volar side of the hand

A

ulnar deviation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

subluxation of the first interphalangeal joint

A

z line deformity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

hypertension of the PIP with flexion of the DIP

A

swan neck deformity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

flexion of the PIP with hyperextension of the DIP

A

boutonniere deformity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

inflammation of the ulnar styloid and tenosynovitis of the extensor carpi radialis may subluxation of the distal ulna

A

piano key movement

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

cause of pes planovalgus in RA

A

chronic inflammation of the ankle and midtarsal region

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

True or false. Atlantoaxial subluxation in RA occurs in less than 10% of patient

A

True.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

True or false. Unlike spondyloarthritidies, RA rarely affects the thoracic and lumbar spine

A

True.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

True or false. Approx 10% of patients with RA have secondary Sjogrens syndrome

A

True.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

most common pulmonary manifestation of RA

A

pleuritis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

most frequent site of cardiac involvement in RA

A

pericardium

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

True or false. Subcutaneous nodules have been reported in 30-40% of patients and more commonly in those with highest levels of disease activity

A

True.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

rare subset of pulmonary nodulosis characterized by the development of nodules and pneumoconiosis following silica exposure

A

Caplan syndrome

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

most common hematologic abnormality of RA

A

normochronic normocytic anemia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

True or false. The degree of anemia correlate with the levels of CRP and ESR

A

True.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

clinical triad of neutropenia, splenomegaly and nodular RA

A

Felty’s syndrome

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

characterized by chronic indolent clonal growth of Large granular lymphocyte leading to neutropenia and splenomegaly

A

T cell large granula lymphocyte leukemia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

T LGL vs Feltys

A

T LGL occurs in the early course of RA

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

True or false. RA patients have 2x-4x increased risk of lymphoma compared to the general population

A

True.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

most common cause of death in RA

A

??

43
Q

true or false. CHF is more common in RA than in the general population

A

True.

44
Q

True or false. Osteoporosis is more common in patients with RA than in age sex matched population

A

True.

45
Q

HLA that bestow highest risk of disease

A

HLA DRB1*0401

46
Q

oral microbiome said to trigger development of RA

A

Porphyromonas gingivalis

47
Q

enzyme found on oral microiome that induce anti CCP anitbodies

A

peptidyl arginine deiminase (PAD)

48
Q

two cell types of the synovial membrane

A

Type A synoviocytes (macrophage derived) and Type B synoviocytes (fibroblasts derived)

49
Q

most abundant type and produce the structural components of joints

A

Synovial fibroblasts

50
Q

main constituents of the synovial fluid

A

Hyaluronan and lubricin

51
Q

glycosaminoglycan that contributes to vicious nature of synovial fluid

A

hyaluronan

52
Q

lubricates the surface of the articular cartilage

A

lubricates the surface of the articular cartilage

53
Q

pathologic hallmarks of RA

A

synovial inflammation and proliferation, focal bone erosions, thining of articular cartilage

54
Q

thickened cellular membrane containing fibroblast like synoviocytes and granulation reactive fibrovascular tissue

A

pannus

55
Q

mediates the structural damage to the mineralized cartilage and subchrondral bone in RA

A

osteoclast

56
Q

characterize the pre clinical stage of RA

A

breakdown of self tolerance

57
Q

score in the ACR classification for definite RA

A

score more than or equal to 6

58
Q

components of the ACR classification criteria for RA

A

joint involved, serology, acute phase reactatns, duration of symptoms

59
Q

Classification criteria of RA. Serology score of 2? 3?

A

0 if RF and anti CCP both negative. 2 if RF and anti CCP elevated but less than 3x ULN. 3 if RF and anti CCP 3x more than ULN

60
Q

Classification criteria of RA. Joint involvement.

A

0 if 1 large joint 1 if 10 large joint. 2 if 1-3 small joint, 3 if 4-10 small joints 5 if more than 10 joints at least 1 is small 0-1-2-3-5

61
Q

Classification criteria of RA. Acute phase reactants.

A

0 if CRP and ESR normal. 1 if CRP or ESR abnormal

62
Q

Classification criteria of RA. Duration of symptoms.

A

0 if less than 6 months. 1 if more than 6 months

63
Q

most frequently measure isotype if RF in commercial laboratories

A

IgM RF

64
Q

Percent IgM RF is positive in RA patient

A

75-80%

65
Q

True or false. A negative RF does not exclude the presence of the disease

A

True.

66
Q

useful for distinguishing RA from other forms of arthritis

A

anti CCP

67
Q

showing the most value for predicting worse outcomes

A

anti CCP

68
Q

initial radiographic finding in classical RA

A

periarticular osteopenia

69
Q

offers the greatest sensitivity for detecting synovitis and joint effusions as well as early bone and bone marrow changes

A

MRI

70
Q

Predictors of extra articular disease manifestation of RA

A

history of smoking, early onset of significant physical disability

71
Q

how many percent of RA patient go into remission

A

10% go into remission in 6 months esp seronegative patients

72
Q

Predictors of poor outcome in RA

A

extra articular involvement, RF positivity, Persistent synovitis, persistently high ESR and CRP

73
Q

early sign of RA on MRI

A

bone marrow edema

74
Q

conventional DMARDs

A

hydroxychloroquine, sulfasalazine, methotrexate, leflunomide

75
Q

what is the onset of action of DMARDs

A

delayed of 6-12 weeks

76
Q

DMARD of choice for treatment of RA

A

methotrexate

77
Q

inhibitor of pyrimidine synthesis similar to that of methotrexate

A

leflunomide

78
Q

True or false. Hydroxychloroquine is not considered a true DMARD as it does not show delay progression of the disease

A

True.

79
Q

first biologicals approved for the treatment of RA

A

TNF inhibitors

80
Q

Pharmacologic management of RA

A

NSAIDS, corticosteroids, DMARDS, biological DMARDS, Small molecule inhibitors ( Jak1, Jak3 inhibitors)

81
Q

critical upstream mediator of joint inflammation

A

TNF

82
Q

Chimeric part human part mouse monoclonal antibody

A

infliximab

83
Q

humanized monoclonal antibodies

A

adalimumab, golimumab

84
Q

pegylated Fc free fragment of a humanized monoclonal antibody with binding specificity for TNFa

A

certolizumab

85
Q

soluble fusionprotein comprising the TNF receptor 2 in a covalent linkage with the Fc portion of the IgG1

A

soluble fusionprotein comprising the TNF receptor 2 in a covalent linkage with the Fc portion of the IgG1

86
Q

contraindications for anti TNF agents

A

??

87
Q

anti TNF approved for monottherapy

A

Etanercept, adalimumab, certolizumab pegol and golimumab

88
Q

True or false. Anti TNF are typically used in combination with background methotrexate therapy

A

True

89
Q

True or false. There is concern for increased risk of reactivation of latent TB

A

True.

90
Q

recombinant form of natrually occuring IL-1 receptor antagonist

A

Anakinra

91
Q

soluble fusion protein consisting of the extracellular domain of human CTLA-4 linked to modified portion of human IgG

A

abatacept

92
Q

It inhibits co stimulation of T cells by blocking CD28-CD80/86 interaction

A

abatacept

93
Q

chimeric monoclonal antibody directed against CD20

A

rituximab

94
Q

cell surface molecule expressed by most mature B lymphocytes

A

CD20

95
Q

humanized monoclonal antibody directed against the membrane and soluble forms of the IL-6 receptor

A

tocilizumab

96
Q

small molecule inhibitor that primarily inhibits Jak1 and Jak2

A

tofacitinib

97
Q

DMARDS associated with pulmonary toxicity

A

methotrexate and leflunamide

98
Q

effective combinations in RA

A

triple therapy: methotrexate, sulfasalazine, hydroxychloroquine; methotrexate plus biological, methotrexate plus leflunamide

99
Q

True or false. Combination of methotrexate and an anti TNF has been shown to be superior to methotrexate alone

A

True.

100
Q

ACR/EULAR provisional definition of remission in RA

A

at any time, the patient must satisfy the follow A. tender joint less than 1, swollen joint less than 1, CRP less than 1 mg/dl patient goal assessment less than 1 OR B. any time point, patient has a simplified disease activity of less than 3.3

101
Q

True or false. Up to 75% of female with RA will note overall improvement in symptoms during pregnancy but will often flare after delivery

A

True.

102
Q

safest DMARDS to use during pregnancy

A

hydroxychloroquine, sulfasalazine

103
Q

Creatinine threshold for methotrexate

A

cannot be given for methotrexate more than 2 mg/dl

Rheumatology (15 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions