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OPT 537 > Exam 1 -- Randomized List of All Exam 1 Flashcards -- part 1 > Flashcards

Exam 1 -- Randomized List of All Exam 1 Flashcards -- part 1

1
Q

What are some of the side effects of methotrexate use?

A

Nausea, liver damage, pulmonary toxicity, mouth ulcers, alopecia, infections

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2
Q

What is a common drug used to decrease MMP activity?

A

Doxycycline

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3
Q

What are common symptoms of enteropathic arthritis?

A

Spondylitis, sacroilitis, stomach pain

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4
Q

What percentage of patients with giant cell arteritis experience severe HA?

A

70-90%

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5
Q

The COX-2 pathway is active in the kidneys. What is its result in the kidney?

A

Regulation of BP

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6
Q

What is the full name of lupus?

A

Systemic Lupus Erythematosus (SLE)

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7
Q

What cell types are associated with acute inflammation?

A

Neutrophils

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8
Q

Prevalence of giant cell arteritis is higher in patients with what other conditions?

A

RA, lupus, other vasculitis conditions

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9
Q

What systemic effects may be present in the lungs of a patient with RA?

A

Difficulty breathing, fibrosis, cough, nodules

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10
Q

Raynaud’s phenomenon can occur in response to what factors?

A

Stress, cold temperature, smoking

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11
Q

Why must care be taken after the immediate anaphylactic crisis is resolved?

A

Arachidonic acid metabolites are being created and will cause further problems 2-10 hours later

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12
Q

What is a normal ESR result for a male?

A

Half of the age in years (in mm/hr)

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13
Q

Which gender has a higher prevalence of osteoarthritis?

A

Female

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14
Q

What sort of testing can you do for Takayasu arteritis?

A

Bruit, angiography, imaging

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15
Q

A DEXA scan is one way to measure bone density. A score of how many standard deviations below the norm indicates osteoporosis?

A

2.5

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16
Q

What testing can be done to test for pseudogout?

A

X-ray (to see calcium deposits), synovial fluid analysis (looking for calcium pyrophosphate)

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17
Q

All of the spondyloarthropathy conditions are RF ___________ (negative/positive).

A

Negative

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18
Q

Which gender has a higher prevalence for Raynaud’s phenomenon?

A

Female (4:1)

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19
Q

A patient has already been diagnosed with polymyalgia rheumatica and you are suspicious for giant cell arteritis. What percentage of patients like this have a temporal artery biopsy that shows giant cells?

A

40-50%

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20
Q

True or false: RA is genetically associated with HLA-B27

A

False; HLA-B27 is associated with the spondyloathrothopy conditions, not RA.

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21
Q

What is a normal value for Serum Amyloid A test?

A

0

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22
Q

Which DMARD might be used if previous DMARDs haven’t been working?

A

Cyclophosphamide

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23
Q

What are the most common symptoms of giant cell arteritis?

A

Severe HA, scalp tenderness, jaw claudication, tenderness/swelling of temporal artery, sudden, transient painless vision loss in one eye*

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24
Q

Erythrocyte sedimentation rate is used to measure levels of what protein?

A

Fibrinogen

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25
Q

True or false: hip replacement surgery is an option for patients with AS

A

True.

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26
Q

What part of the skeleton is most affected in ankylosing spondylitis?

A

Spine, especially lower back

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27
Q

What neurologic effects may be present in a patient with RA?

A

Peripheral neuropathy

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28
Q

The end products of the COX pathway depends on the enzymes present in a particular type of cell. What cell type results in thromboxane A2 (TXA2)?

A

Platelets

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29
Q

How many joints are involved in Type 1 enteropathic arthritis?

A

6 or less

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30
Q

Although histamine is predominantly found in mast cells, where else might it be found?

A

Basophils and platelets

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31
Q

What are some medical treatment options for osteoarthritis?

A

Acetominophen (drug of choice), low-dose NSAIDs, topical capsaicin (for pain relief), corticosteroid injections, surgery

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32
Q

What is another term for rheumatology?

A

Collagen vascular diseases

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33
Q

What can cause bursitis?

A

Repetitive motion, pressure, RA, gout, trauma

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34
Q

What testing can be done for eosinophilic granulomatosis with polyangitis?

A

Eosinophilia*, ANCA, lung or skin biopsy with granulomas

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35
Q

What are some risk factors for osteoporosis?

A

Low estrogen, female, light weight, smoking, age (over 80 years)

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36
Q

What classes of drugs can cause dry mouth or dry eye?

A

Antihistamines, antipsychotics, anticonvulsants

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37
Q

Ankylosing spondylitis can have some manifestations outside of the axial skeleton. What is one such manifestation that occurs in the foot?

A

Achilles tendonitis; also, skin lesions (red papules on soles)

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38
Q

True or false: ankylosing spondylitis is more common among Caucasians

A

True.

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39
Q

Which DMARDs act as folic acid inhibitors?

A

Methotrexate and sulfasalazine

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40
Q

What is a good way to treat buritis?

A

PRICE (Protect, Rest with a little activity, Ice, Compress, Elevate); NSAIDs (higher doses); massage; corticosteroid (only if not bacterial in nature); possibly antibiotics; surgery in extreme cases

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41
Q

Podagra affects what percentage of gout patients?

A

90%

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42
Q

True or false: relapsing polychondritis can feature non-erosive joint pain

A

True.

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43
Q

What is the main difference between polymyositis and dermatomyositis?

A

Dermatomyositis involves the skin as well

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44
Q

What symptoms may be indicative of RA?

A

Pain, stiffness, swelling, and limited movement of small joints. Less common: weight loss, fever, fatigue, malaise

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45
Q

True or false: tenosynovitis is more common in diabetics

A

True.

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46
Q

What tests can be done for Kawasaki disease?

A

None, apart from an echocardiogram

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47
Q

Articular cartilage is a specific type of what cartilage?

A

Hyaline

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48
Q

What supplements can be taken to help with osteoporosis?

A

Calcium (1,000-1,200 extra mg per day) and Vitamin D (800 IU per day)

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49
Q

True or false: reactive arthritis is usually accompanied by acute, asymmetric lower limb arthritis

A

True.

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50
Q

What is a typical age of onset for lupus?

A

20-40 years

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51
Q

Which gender has a higher prevalence for Sjogren’s?

A

Female (12:1)

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52
Q

80% of lyme disease patients get what sort of sign?

A

Bull’s eye rash at site of tick bite

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53
Q

Briefly describe the wall touch test for ankylosing spondylitis

A

Have patient stand with their back up against the wall and try to move their head back to touch the wall too

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54
Q

What effects can relapsing polychondritis have in the nose?

A

Saddle-nose

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55
Q

Systemic effects are present in what percentage of RA patients?

A

40%

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56
Q

True or false: polymyalgia rheumatica is common under age 50

A

Flase; it is rare under age 50*

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57
Q

Describe migratory arthritis

A

Affects several joints in quick succession for 1-3 days each

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58
Q

What is/are the actions of NO?

A

Vasodilation (most potent vasodilator), microbiocide, antagonizes platelet activation, decreases leukocyte adhesion

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59
Q

What are the medical treatment options available for relapsing polychondritis?

A

NSAIDs, oral steroids, DMARDs, TNF inhibitors (cyclophosphamide reserved for severe cases)

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60
Q

What is the 10-year survival rate for systemic sclerosis?

A

60-80%

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61
Q

What are two examples of Type II reactions involving Ab-mediated cellular dysfunction?

A

MG and Grave’s disease

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62
Q

The cyclooxygenase pathway results in the production of what products?

A

Prostaglandins, prostacyclins, and thromboxanes

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63
Q

True or false: carpal tunnel syndrome is the most common entrapment neuopathy

A

True.

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64
Q

Which DMARDs are tetracyclines?

A

Minocycline and doxycycline

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65
Q

HLA B27 is “poor at fighting” what diseases?

A

Chlamydia, gonorrhea, salmonella

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66
Q

Kidney involvement with lupus is sometimes called what?

A

Lupus nephritis

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67
Q

Which Ab is involved in Type I reaction?

A

IgE

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68
Q

Behcet’s disease can cause oral and genital ulcers like what spondyloarthropathy?

A

Reactive arthritis

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69
Q

What parts of the body experience pain in ankylosing spondylitis?

A

Buttocks, hips

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70
Q

Does psoriatic arthritis feature more or less joint pain than RA?

A

Less

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71
Q

What percentage of lupus patients experience arthralgia?

A

More than 90%

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72
Q

What percentage of systemic sclerosis patients are ANA (+)?

A

95%

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73
Q

True or false: RA is the #1 cause of secondary amyloidosis

A

True.

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74
Q

True or false: patients with lupus have an increased risk of developing lymphoma

A

True.

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75
Q

What testing can be performed to try and differentiate lupus?

A

CBC, ESR, CRP, urea/creatinine (from urinalysis, if renal involvement), ANA, anti-dsDNA Ig, anti-SM Ig

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76
Q

What is the 10-year survival rate for lupus?

A

80-90%

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77
Q

What is another name for pseudogout?

A

Calcium pyrophosphate deposition (CPPD)

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78
Q

Febuxostat plays the same type of role as allopurinol in treating gout. When would it be preferred to allopurinol?

A

If patient has kidney failure, since it is less toxic to the kidney

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79
Q

Which joint(s) of the fingers are affected by RA?

A

MCP and PIP, not DIP (the proximal two joints, but not the distal joint)

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80
Q

What percentage of Sjogren’s patients are RF (+)?

A

Up to 90%

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81
Q

Which Ig is the most common?

A

IgG (75% of all Ig)

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82
Q

What is the name for the mass of modified macrophages that accumulates during granulomatous inflammation?

A

Giant cell (made from epitheloid cells, which are modified macrophages)

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83
Q

What is the main difference between gout and pseudogout?

A

Gout has sodium urate crystals, pseudogout has calcium crystals

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84
Q

What is the age and gender of a typical patient with fibromyalgia?

A

Middle-aged woman

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85
Q

Part of testing for RA can involve testing for Anti-Citrullinated Protein Antibodies (ACPAs). What percentage of RA patients have ACPAs?

A

50-70%

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86
Q

Most of the systemic organs are involved in polyarteritis nodosa. Which major organ is not invovled?

A

Lungs

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87
Q

What percentage of IBD patients have Type 1 enteropathic arthritis?

A

5%

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88
Q

Tumor necrosis factor (TNF) is produced by what type of cell?

A

Activated macrophages

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89
Q

What is the term for the crackling of joints that can sometimes be heard in a patient with osteoarthritis?

A

Crepitus

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90
Q

Which gender has a higher prevalence for granulomatosis with polyangitis?

A

Neither; prevalence is equal between the genders

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91
Q

What percentage of patients with psoriatic arthritis also get uveitis?

A

7%

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92
Q

What is a normal ESR result for a female?

A

Half of (the age in years plus 10) (in mm/hr)

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93
Q

Methotrexate causes a decrease in what cellular substance?

A

Folic acid, decreasing the ability of the cell to contribute to the inflammatory response. This leads to apoptosis.

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94
Q

How would you treat a patient with lupus?

A

NSAIDs, topical and/or oral corticosteroids, hydroxychloroquine*, cyclophosphamide/cyclosporine in severe cases

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95
Q

What is a potential environmental risk factor for systemic sclerosis?

A

Silica dust

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96
Q

What causes carpal tunnel syndrome?

A

Prolonged pressure and/or use, arthritis, pregnancy

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97
Q

Patients with Juvenile Idiopathic Arthritis are at risk for what ocular conditions?

A

Chronic uveitis and band keratopathy

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98
Q

Which areas of the body are common sites of Type III reactions?

A

Blood vessels, kidneys, and joints

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99
Q

What types of granulomas are there?

A

Foreign body and immune

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100
Q

How would you treat carpal tunnel syndrome?

A

Splint at night, corticosteroid injection, surgery

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101
Q

Relapsing polychondritis is associated with what conditions?

A

Vasculitis and arthritis

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102
Q

What is the age of onset for Raynaud’s phenomenon?

A

15-25 years

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103
Q

What might a brain MRI show in a patient with lupus, if they have nervous system involvement?

A

Increased white matter

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104
Q

If you are suspicious of giant cell arteritis in a patient who has recently experienced monocular transient vision loss, would you consider it an emergency?

A

Yes; there is risk of an aortic aneurysm, as well as vision loss in the other eye within a few hours or days

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105
Q

True or false: there is a cure for systemic sclerosis

A

False; there is no cure. All you can do is treat the lung and heart issues and use creams for the skin

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106
Q

Which joints are affected in pseudogout

A

Knee*, elbow, ankle

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107
Q

How many joints are involved in Type 2 enteropathic arthritis?

A

More than 6

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108
Q

What sort of testing can be performed for granulomatosis with polyangitis?

A

ANCA*, chest x-ray and/or CT-scan (pulmonary nodules, infiltrates, nodules), renal biopsy, urinalysis (increased protein, abnormal creatinine)

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109
Q

An x-ray of the spine of a patient with ankylosing spondylitis may show what?

A

Fused vertebrae (bamboo spine)

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110
Q

True or false: RA leads to destruction of bone, cartilage, and tendons, but not of ligaments.

A

False; it leads to destruction of all of these.

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111
Q

What sort of dietary restriction can help with gout?

A

Reduce alcohol, reduce calories and cholesterol, reduce soft drinks, reduce offal/organ meats, increase water intake

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112
Q

Which Ig is the largest?

A

IgM

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113
Q

Corticosteroid use is contraindicated in what common condition?

A

Pregnancy

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114
Q

What percentage of patients with polymyositis or dermatomyositis are ANA (+)?

A

80%

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115
Q

Psoriatic arthritis is characterized by what type of lesion?

A

White, scaley skin rashes

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116
Q

True or false: the pain of podagra usually begins at night

A

True.

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117
Q

Is the pain from polymyalgia rheumatica worse in the morning or later in the day?

A

Morning

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118
Q

True or false: the arthralgia experienced in lupus is unilateral and deforming

A

False; it is bilateral and non-deforming

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119
Q

What is the 5-year survival rate for treated patients with polyarteritis nodosa?

A

80%

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120
Q

How would you treat the underlying infection in reactive arthritis?

A

Oral antibiotic (azithromycin or doxycycline)

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121
Q

True or false: the pain from RA is worse in the morning and gets better with activity.

A

True.

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122
Q

True or false: lyme arthritis typically presents bilaterally

A

False; it typically presents unilaterally

123
Q

Which gender has a higher prevalence of ankylosing spondylitis?

A

Males (3:1)

124
Q

How old must a patient be in order for their condition to be considered Juvenile Idiopathic Arthritis, assuming all other symptoms match?

A

Under age 16 years

125
Q

True or false: about half of patients with recurrent uveitis have some spondyloarthropathy condition

A

True.

126
Q

Which gender has a higher prevalence for eosinophilic granulomatosis with polyangitis?

A

Male

127
Q

Rheumatoid factor is found in what percentage of healthy patients over the age of 70?

A

25%

128
Q

What percentage of the US population is affected with rheumatoid arthritis (RA)?

A

1%

129
Q

What are the main non-ocular symptoms that can occur in Takayasu arteritis?

A

Absent peripheral pulse (unilateral; could lead to gangrene or ulcerations), asymmetric BP, peripheral claudication*, chest pain, renal dysfunction, arthralgia, myalgia, syncope, dementia

130
Q

What percentage of RA patients have rheumatoid factor?

A

70%

131
Q

True or false: reactive arthritis is most common over age 50

A

False; it is more common in younger patients

132
Q

What are some risk factors for osteoarthritis?

A

Obesity, trauma, estrogen, smoking

133
Q

What treatment strategies can be employed for not only bursitis, carpal tunnel syndrome, and tenosynovitis, but also for RA?

A

Rest and light exercise, physical therapy, smoking cessation, alcohol reduction, weight loss, Omega-3, fish oil supplements, medications

134
Q

True or false: cyclosporine is safe to take during pregnancy

A

False.

135
Q

True or false: osteoarthritis is the second most common cause of diability

A

False; it is the most common cause of diability

136
Q

What are some of the side effects of doxycycline use?

A

Skin rash, GI upset, sensitivity to sun, dizziness, decreases effectiveness of birth control, increases potency of blood thinners, causes teeth and bone deformity in children (CI pregnancy and breast feeding)

137
Q

Fact: Osteoarthritis is related to aging.

A

Free card!

138
Q

What class of medication is effective in treating most patients with AS? Which drug in this class is usually used? What other class of drug could be used?

A

NSAIDs (effective in 70%); indomethacin; TNF-alpha blockers

139
Q

Treatment of conditions involving the joints can consist of different classes of drugs. Which classes are meant to relieve the pain?

A

NSAIDs, corticosteroids, analgesics

140
Q

True or false: polyarteritis nodosa affects middle-aged men most commonly

A

True.

141
Q

What is another name for granulomatosis with polyangitis?

A

Wegener’s granulomatosis

142
Q

True or false: patients with enthesis-related Juvnile Idiopathic Arthritis can be HLA B27 (+)

A

True.

143
Q

Uric acid stones cause what percentage of kidney stones?

A

5-10%

144
Q

What is most commonly the first sign of osteoporosis?

A

Fragility fracture (usually in the spine)

145
Q

Which complement molecules increase vascular permeability by mast cell degranulation?

A

C3a, C5a

146
Q

Briefly outline Ab-mediated cellular dysfunction during a Type II reaction.

A

Ab binds to or blocks a receptor, thus interfering with normal tissue function

147
Q

What sort of heart issues can a person with lupus experience?

A

Heart attack, stroke, vasculitis, anemia

148
Q

What is another name for Kawasaki disease?

A

Mucocutaneous lymph node syndrome

149
Q

True or false: patients with oligoarticular Juvenile Idiopathic Arthritis are RF (-)

A

True.

150
Q

How would you treat polymyalgia rheumatica?

A

10-15mg prednisone in the morning

151
Q

What is the age of onset for Sjogren’s?

A

About 40 years

152
Q

What sort of testing can be done for systemic sclerosis?

A

CBC, urea and creatinine (urinalysis), ANA, RF

153
Q

What type of infection can be reactivated with DMARD use?

A

Usually TB

154
Q

What are common features of the acute phase reaction (APR)?

A

Fever, fatigue, malaise, elevated WBC, elevated HR and BP, anorexia

155
Q

True or false: kyphosis can lead to heart and lung problems

A

True; kyphosis is a bending of the spine due to ankylosing spondylitis, which compresses the heart and lungs

156
Q

Takayasu arteritis is also known as?

A

Pulseless disease, or aortic arch syndrome

157
Q

HLA B27 is “best at fighting” what diseases?

A

HIV, hepatitis C, influenza

158
Q

Polymyositis and dermatomyositis are more common in what ethnicity?

A

African American

159
Q

Which ethnicity has a higher prevalence of relapsing polychondritis?

A

Caucasian

160
Q

True or false: rheumatoid nodules are tender to the touch

A

False; they are non-tender

161
Q

What is another name for Type III hypersensitivity?

A

Immune complex mediated

162
Q

The pain from polymyalgia rheumatica is generally ____________ (bilateral/unilateral).

A

Bilateral

163
Q

What is the name for the bony spurs that can occur in the PIP joint?

A

Bouchard’s nodes

164
Q

Pseudogout crystals have what shape?

A

Triangular or rhomboid

165
Q

How long after infection can symptoms of reactive arthritis occur?

A

1-4 weeks

166
Q

What is the age of onset for systemic sclerosis?

A

30-50 years

167
Q

True or false: almost all patients with giant cell arteritis have complete vision recovery eventually

A

False; many have permanent partial or complete vision loss

168
Q

HLA B27 is most common in what demographic?

A

Northern/Western European

169
Q

What is another name for eosinophilic granulomatosis with polyangitis?

A

Churg-Strauss syndrome

170
Q

What medications can cause an attack of gout?

A

Cyclosporine, aspirin, diuretics

171
Q

Cytokines are produced mostly by what types of cells?

A

Lymphocytes and macrophages

172
Q

Focal erosion of cartilage occurs in osteoarthritis, leading to bone rubbing on bone. What is the name for the bone overgrowth that occurs as the bone attempts to repair itself?

A

Osteophyte

173
Q

Patients with giant cell arteritis have a higher risk of what conditions?

A

Stroke and coronary artery disease

174
Q

True or false: although polyarteritis nodosa mainly affects arteries, it can affect veins too

A

False; it only affects arteries. If veins are involved, the condition is not PAN

175
Q

Which leukotriene(s) is/are responsible for neutrophil chemotaxis?

A

LTB4

176
Q

What are some of the side effects of cyclosporine use?

A

HTN, kidney problems (in 50%), infection

177
Q

What tests can be performed for giant cell arteritis?

A

ESR (>50mm/hr) and CRP, temporal artery biopsy (gold standard), pulse

178
Q

True or false: virtually all of patients with systemic sclerosis experience Raynaud’s phenomenon

A

True.

179
Q

The first signs of ankylosing spondylitis (as seen in an x-ray) are seen in the _______ joint of 95% of AS patients.

A

Iliosacral

180
Q

Collagens make up how much of the synovial fluid?

A

90%

181
Q

Type 1 and Type 2 enteropathic arthritis can be distinguished based on which came first, the arthritis symptoms or the IBD symptoms. List the order for each type.

A

Type 1: arthritis then IBD; Type 2: IBD then arthritis

182
Q

How would you treat polymyositis or dermatomyositis?

A

Physical therapy, corticosteroids, DMARDs, biologics, methotrexate

183
Q

Which Ig is involved in allergic responses?

A

IgE

184
Q

True or false: all biologic drugs for RA are injections

A

True.

185
Q

What is another name for Type I hypersensitivity?

A

Anaphylactic (also, atopic)

186
Q

How many patients without spondyloarthropathy conditions test HLA B27 (+)?

A

5-10%

187
Q

What is a normal dose of hydroxychloroquine for RA?

A

200-400mg (usually 200mg) bid

188
Q

Does a tendon connect bone to bone or muscle to bone?

A

TMB (Tendon connects muscle to bone)

189
Q

Briefly outline inflammation during a Type II reaction.

A

Ab binds to cellular or tissue “Ag;” complement is activated and neutrophils and monocytes are recruited; these release inflammatory mediators which cause tissue damage due to frutrated phagocytosis

190
Q

What sort of CNS symptoms could a patient with lupus experience?

A

Migraines, epilepsy, cerebellar ataxia, cognitive and mood disorders, memory loss

191
Q

What type of adhesion molecule causes the WBC to stop along the vessel wall?

A

Integrin

192
Q

If a biologic drug is used to treat RA, it is usually given with what other DMARD?

A

Methotrexate

193
Q

What are some of the side effects of cyclophosphamide use?

A

Herpes zoster, alopecia, nausea/vomiting, infertility in males and females

194
Q

Lyme arthritis is accompanied by what symptoms?

A

Joint swelling, bursitis, tendonitis, fatigue, fever, HA, weight loss

195
Q

How would you treat pseudogout?

A

Steroid injections, NSAIDs, colchicine, methotrexate, hydroxychloroquine

196
Q

What are some symptoms caused by expression of IL-1?

A

Fever, lethargy, and decreased appetite

197
Q

Polymyositis and dermatomyositis affect which gender more?

A

Female (2:1)

198
Q

What are some symptoms caused by expression of TNF?

A

Fever, lethargy, and decreased appetite

199
Q

What are complications that can arise from Kawasaki disease?

A

Cardiac aneurysms, heart failure

200
Q

What are two examples of Type II reactions involving inflammation?

A

Acute rheumatic fever, Mooren ulcer

201
Q

How would you treat the non-infection-related symptoms of reactive arthritis?

A

Start with NSAIDs, move on to corticosteroids, then to sulfasalazine and methotrexate, then finish with the TNF inhibitors

202
Q

What is another term for Type II hypersensitivities?

A

Antibody-mediated

203
Q

What are some symptoms of unique to dermatomyositis?

A

Gottron’s papules (raised skin lesions); heliotrope rash (looks like purple eye makeup); facial erythema; shawl sign, V sign, Hoster sign (look like sunburn); nail changes, scalp changes, calcinosis cutis

204
Q

The symptoms of enthesis-related Juvnile Idiopathic Arthritis are usually seen in which portion of the skeleton?

A

Axial

205
Q

Besides chlamydia, what other types of infections are common in patients who then develop reactive arthritis?

A

Salmonella, Yersinia, Shigella, campylobacter, E. coli

206
Q

What is the action of thromboxane?

A

Vasoconstriction and platelet aggregation

207
Q

How much of the primary care workload is rheumatology?

A

20-30%

208
Q

What are some examples of Type IV T-cell mediated cytotoxicity reactions?

A

T1DM, MS, Hashimoto thyroiditis

209
Q

Which medications can be used for maintenance of granulomatosis with polyangitis?

A

Methotrexate or azathioprine

210
Q

What effects can relapsing polychondritis have in the lungs?

A

COPD, apnea

211
Q

How many joints are affected in oligoarticular Juvenile Idiopathic Arthritis?

A

Four or fewer

212
Q

True or false: NSAIDs can damage the liver

A

True.

213
Q

What is the role of CRP?

A

Binds to cell wall of bacteria and fungi as opsonin and activates complement

214
Q

What medications can be used to treat psoriatic arthritis?

A

Topical corticosteroids or tacrolimus (for skin lesions), NSAIDs, DMARDs (except methotrexate, hydroxychloroquine, and sulfasalazine), anti TNF agents, and biologics

215
Q

The COX-1 pathway leads to what kind of prostaglandins?

A

Cytoprotective–protection of gastric mucosa; also aid in platelet aggregation

216
Q

Briefly outline opsonization and phagocytosis during a Type II reaction.

A

Drug on cell surface makes cell look foreign; Ab (IgG or IgM) attaches to cell and activates complement; cell is either destroyed by MAC, or C3a attracts neutrophils and macrophages while C3b serves as opsonin.

217
Q

What substances act as opsonins during an inflammatory response?

A

IgG and C3b (among others)

218
Q

How many patients with reactive arthritis are HLA B 27 (+)? What other tests can be done to test for reactive arthritis?

A

40-75%; stool sample and testing for chlamydia

219
Q

Describe transudate in terms of protein and cellular content.

A

Low protein content and few cells

220
Q

How would you treat a patient with lyme arthritis?

A

Oral doxycycline or amoxicillin for a month, followed by another month if needed. If those fail, treat with IV ceftriaxone

221
Q

What is/are the actions of IL-8?

A

Chemo-attractant; activates PMNs (polymorphonuclear leukocytes), setting the stage for phagocytosis

222
Q

What are the side effects of biologic drugs?

A

Infection risk, TB activation, increased risk of malignancy, demyelination

223
Q

Does the arthritic portion of psoriatic arthritis present unilaterally or bilaterally?

A

Unilaterally

224
Q

What is another name for giant cell arteritis?

A

Temporal arteritis; also anterior arteritic ischemic optic neuropathy (AAION )

225
Q

Enthesis-related Juvnile Idiopathic Arthritis is sometimes referred to by what other name?

A

Pediatric spondyloarthropathy

226
Q

True or false: diabetes and renal failure can induce attacks of gout

A

True.

227
Q

What is the name for nutrient rich fluid that is secreted by cells in the ECM?

A

Hyaluronan

228
Q

Which leukotriene(s) is/are responsible for vasoconstriction?

A

LTC4, D4, and E4

229
Q

Use of biologic drugs for a patient with RA is contraindicated if the patient has what other condition?

A

MS

230
Q

Which complement molecules are important in opsonization?

A

C3b

231
Q

What is citrullination? What effect does it have in terms of inflammation?

A

The conversion of an arginine to a citrulline. In the synovial fluid, the citrullinated site fits into the antigen binding site of HLA. This starts an inflammatory response.

232
Q

Describe exudate in terms of protein and cellular content.

A

High protein content and some WBC and RBC

233
Q

For how long must a patient have symptoms in order to be diagnosed with Juvenile Idiopathic Arthritis?

A

More than 3-6 weeks

234
Q

What two symptoms are the most prevalent in psoriatic arthritis? What percentage of patients with PA experience these symptoms?

A

Nail dystrophy (pitting, separation of nail from bed; 80-90%); dactylitis (50-60%)

235
Q

Does a ligament connect bone to bone or muscle to bone?

A

LBB (Ligament connects bone to bone)

236
Q

True or false: about 25% of patients in the advanced stages of RA have rheumatoid nodules.

A

True.

237
Q

How would you treat a moderate to severe case of microscopic polyangitis?

A

Prednisone with cyclophosphamide and rituximab

238
Q

Which leukotriene(s) is/are responsible for bronchospasm?

A

LTC4, D4, and E4

239
Q

What are some of the common skin-related symptoms of lupus (apart from the malar rash)?

A

Lesions on nails, urticaria (hives) and purpura, livedo reticularis (net-like appearance of BVs), palmar and plantar erythema, mouth ulcers, Raynaud’s phenomenon

240
Q

Which gender has a higher prevalence for Kawasaki disease?

A

Male

241
Q

What is the peak onset age for oligoarticular Juvenile Idiopathic Arthritis?

A

3 years

242
Q

What is the most common ocular effect of RA?

A

Dry eye (occurs in 15-25% of RA pts)

243
Q

What is the 5-year survival rate for patients with Takayasu arteritis?

A

80-90%

244
Q

How many patients with spondyloarthropathy conditions other than ankylosing spondylitis test HLA B27 (+)?

A

70%

245
Q

True or false: granulomatosis with polyangitis generally occurs in younger patients

A

False; it generally occurs in older patients

246
Q

Systemic sclerosis is characterized by ____________.

A

Thickened, hardened skin

247
Q

What is the name for the pockets of synovial fluid that can occur in the back of the knee in osteoarthritis?

A

Baker’s cysts

248
Q

What are some of the common symptoms of Sjogren’s?

A

Dry mouth, dry eyes, dry skin and/or vaginal dryness*, dyspnea, COPD, pulmonary fibrosis, Raynaud’s phenomenon, liver and kidney damage, hearing loss, dental cavities

249
Q

Fill in the blank: patients with systemic Juvenile Idiopathic Arthritis usually have ______ (high/low) CRP, _____ (high/low) ESR, and are RF ______ (positive/negative)

A

High, high, negative

250
Q

True or false: the spondyloarthropathy condtions involve inflammation of the synovial fluid

A

False; they involve inflammation of tendons and/or ligaments

251
Q

The COX-2 pathway results in prostacyclins. What is the role of prostacyclins?

A

They cause vasodilation and keep thromboxanes in check. Hence, inhibition of COX-2 results in vasoconstriction (an increase in BP) and an increase in clot formation due to the thromboxanes.

252
Q

True or false: sulfasalazine is safe to take during pregnancy

A

True.

253
Q

What are some treatment options for Sjogren’s?

A

Artificial tears, Restasis, punctal plugs, ointment, saliva replacement, pilocarpine (NSAIDs, DMARDs, corticosteroids for arthralgia)

254
Q

What is a normal value for a CRP?

A

Less than 1.0 mg/dL (less than 10 mg/L)

255
Q

Osteoarthritis normally affects which joints?

A

Knees, hips, fingers, spine

256
Q

What is a mnemonic for the symptoms of systemic sclerosis?

A

CREST: Calcinosis, Raynaud’s*, Esophageal dysfunction, Sclerodactyly, Telangiectasia

257
Q

How would you treat a moderate to severe case of granulomatosis with polyangitis?

A

Prednisone with cyclophosphamide and rituximab

258
Q

What are the 4 benefits of NSAIDs?

A

Anti-pyresis (fever-reducing); anti-platelet (clot reduction); analgesic (pain-reducing); anti-inflammatory (in higher doses)

259
Q

What class of medication should a patient with psoriatic arthritis NOT be prescribed?

A

Oral steroids (they decrease the response of the skin in healing itself; lesions last longer)

260
Q

Which gender has a higher prevalence of relapsing polychondritis?

A

Neither; prevalence is equal between the genders

261
Q

Prostaglandins and leukotrienes are metabolites of what molecule?

A

Arachidonic acid

262
Q

True or false: Type 2 enteropathic arthritis is chronic.

A

True.

263
Q

Briefly describe the Schober test for ankylosing spondylitis

A

Draw a line 10 cm above the iliac crest and one 5 cm below; have patient bend over, and distance between these two lines should be greater than 21 cm in a normal person

264
Q

How would you treat eosinophilic granulomatosis with polyangitis?

A

Prednisone, can add cyclophosphamide; methotrexate or azathioprine for maintenance

265
Q

What percentage of lupus patients are ANA (+)?

A

95%

266
Q

Fibrosis of which internal organs is most worrisome in a patient with systemic sclerosis?

A

Lungs, heart, GI tract

267
Q

How are lupus patients with kidney involvement monitored?

A

Urinalysis

268
Q

What sort of lung involvement can a person with lupus experience?

A

Pleural effusion, chest pain, dyspnea

269
Q

What is a key difference between hyperplasia and neoplasia?

A

Hyperplasms continues to respond to regulatory systems; neoplasms do not.

270
Q

What are some of the side effects of hydroxychloroquine use?

A

Irreversible retinopathy (bull’s eye retinopathy) 1 in 2000; GI upset, nightmares, psychosis

271
Q

Which gender has a higher prevalence for polymyalgia rheumatica?

A

Female (2:1)

272
Q

What role do glycoproteins have in joints?

A

Tissue remodeling (they are also known as fibronectin)

273
Q

What is the main characteristic of fibromyalgia?

A

Diffuse musculoskeletal pain

274
Q

What percentage of patients with giant cell arteritis experience blurred vision (20/200 or worse)?

A

30%

275
Q

What is the most common age of onset for RA?

A

45-75 years

276
Q

What is lyme arthritis?

A

Arthralgia (joint pain) secondary to late stage lyme disease

277
Q

What four classes of drugs are important for ODs in terms of inflammation?

A

Antihistamines, mast cell stabilizers, NSAIDs, corticosteroids

278
Q

Which gender has the highest prevalence for systemic sclerosis?

A

Female (3-:1)

279
Q

What is the 5-year survival rate for untreated patients with polyarteritis nodosa?

A

13%

280
Q

What is the typical age of onset for polymyositis and dermatomyositis?

A

40-50 years

281
Q

True or false: MMPs are upregulated during inflamation

A

True.

282
Q

Systemic sclerosis is also known as?

A

Scleroderma

283
Q

What sort of ocular issues can a person with lupus experience?

A

Dry eye, optic neuritis, cranial neuropathies, episcleritis, scleritis, conjunctivitis, retinopathy

284
Q

Use of doxycycline is contraindicated in what populations?

A

Pregnant, breast-feeding, or kids (causes bone and teeth deformity)

285
Q

True or false: NSAIDs do not typically work for fibromyalgia

A

True.

286
Q

What is a normal value for CRP?

A

0-0.5 mg/dL

287
Q

True or false: spinal stenosis (narrowing of spinal column) can occur in osteoarthritis

A

True.

288
Q

True or false: some DMARDs can cause lupus

A

True.

289
Q

What is/are the actions of TNF?

A

Causes aggregation and activation of neutrophils, activates vessel endothelium to increase WBC adhesion (activates selectins and integrins), increases thrombogenicity of endothelium (activates fibroblasts and increases collagen synthesis)

290
Q

How would you treat fibromyalgia?

A

Anti-depressants, anti-anxiety meds, anticonvulsants

291
Q

True or false: systemic Juvenile Idiopathic Arthritis affects girls and boys equally

A

True, up to age 5, then girls are more affected than boys

292
Q

What ocular symptoms can occur in Takayasu arteritis?

A

VF loss, HA, retinal hemorrhages, decreased vision

293
Q

What are symptoms of psoriatic Juvenile Idiopathic Arthritis?

A

Multiple rashes, sausage digits, nail pitting

294
Q

Which vasculitis conditions are considered to be small vessel conditions?

A

Granulomatosis with polyangitis, microscopic polyangitis, eosinophilic granulomatosis with polyangitis

295
Q

What ophthalmic solution contains cyclosporine?

A

Restasis (for dry eye)

296
Q

What causes acute rhematic fever?

A

Streptococcal pharyngitis infection followed 2-4 weeks later by migratory arthritis

297
Q

What are the symptoms of fibromyalgia?

A

Fatigue, morning stiffness, aching, disturbed sleep, anxiety, depression, cognitive dysfunction (slow responses, difficulty concentrating, memory loss)

298
Q

Where can type 2 collagen be found?

A

Articular cartilage and the vitreous humor of the eye

299
Q

Which leukocytes are involved in Type I reactions?

A

Mast cells and basophils

300
Q

The end products of the COX pathway depends on the enzymes present in a particular type of cell. What cell type results in prostacyclin (PGI2)?

A

Endothelial cells

301
Q

What type of inflammation is associated with new vessel growth and fibrosis?

A

Chronic

302
Q

If acute rheumatic fever is left untreated, it can lead to rheumatic heart disease. How much time can pass before the onset of the rheumatic heart disease?

A

10-20 years

303
Q

What are some non-medical treatment options for osteoarthritis?

A

Weight loss, light exercise, alternating heat and ice packs, massages

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