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Exams endo / Rheuma Flashcards

1
Q

Which symptom is most typical in patients with Sjögren syndrome?

A

Dryness of mouth and eyes

Other symptoms can include enlarged major salivary glands.

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2
Q

Enthesitis is a common feature of which conditions?

A
  • Rheumatoid arthritis
  • Reactive arthritis
  • Psoriatic arthritis
  • Gout

Enthesitis refers to inflammation where tendons or ligaments attach to bone.

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3
Q

Which vasculitides belong to the ANCA associated vasculitis group?

A
  • Microscopic polyangiitis
  • Granulomatosis with polyangiitis
  • Eosinophilic granulomatosis with polyangiitis

Giant cell arteritis is not part of this group.

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4
Q

Medications used for treatment of systemic vasculitis include:

A
  • Azathioprine
  • Glucocorticosteroids
  • Cyclophosphamide
  • Hydroxychloroquine

Other options like sulfasalazine and allopurinol are not typically used for systemic vasculitis.

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5
Q

Symptoms of polymyalgia rheumatica include:

A
  • Pain of the neck, shoulders, and pelvic muscles for more than a month
  • Elevated ESR (more than 50 mm/h)
  • Age of the patients is 60 or more

Polyarthritis and Gottron’s papules are not typical for polymyalgia rheumatica.

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6
Q

Which rheumatic disease can be radiologically diagnosed by a ‘bamboo spine’?

A

Ankylosing spondylitis

This is a characteristic radiographic finding in ankylosing spondylitis.

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7
Q

Typical clinical signs of polymyositis include:

A

Weakness of proximal muscles

Induration and hypertonus of shoulder and pelvic girdle muscles are also signs.

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8
Q

Pyrophosphate arthropathy is diagnosed by:

A
  • Measuring pyrophosphates in the blood
  • Testing synovial fluid
  • Radiological investigation

This condition is also known as CPPD deposition disease.

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9
Q

Lung damage is not characteristic of which condition?

A

Polyarteritis nodosa

Eosinophilic granulomatosis with polyangiitis and microscopic polyangiitis can affect the lungs.

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10
Q

How is pyrophosphate arthropathy treated?

A

NSAIDs

Other treatments may include corticosteroids or joint injections.

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11
Q

Extra-articular symptoms characteristic for reactive arthritis include:

A
  • Uveitis
  • Urethritis
  • Conjunctivitis
  • Arthritis

Xerostomia is not typically associated with reactive arthritis.

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12
Q

Features of polymyalgia rheumatica include:

A
  • Markedly elevated inflammatory markers (CRP and ESR)
  • Good response to corticosteroids
  • Older age of the patient

Necrosis of muscle fibers is not a feature of this condition.

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13
Q

What can provoke an attack of gout?

A
  • Kidney function insufficiency
  • Starving diet
  • Diet rich in purines
  • Use of diuretics

These factors increase uric acid levels and precipitate gout attacks.

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14
Q

What eye problems are most common in ankylosing spondylitis?

A

Acute anterior uveitis

This condition can lead to inflammation and pain in the eye.

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15
Q

Laboratory findings related to polymyalgia rheumatica include:

A
  • Elevated CRP and ESR
  • Normal concentrations of muscle enzymes

Anti-cyclic citrullinated peptide (anti-CCP) is not typically elevated in this condition.

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16
Q

Infections that can cause reactive arthritis include:

A
  • Ureaplasma urealyticum
  • Shigella flexneri
  • Chlamydia pneumoniae
  • Yersinia enterocolitica

These infections often lead to post-infectious arthritis.

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17
Q

What is the first step in diagnosing a patient with sudden knee pain and swelling?

A

Perform joint aspiration

This helps to determine if there is fluid accumulation due to conditions like gout or infection.

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18
Q

Which laboratory tests are appropriate for diagnosing dermatomyositis?

A
  • Myolysis markers like ALT, AST, CK, aldolase

Anti-double stranded DNA is more indicative of systemic lupus erythematosus.

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19
Q

Factors that can reduce fall risk include:

A
  • Appropriate chosen walking stick or frame
  • Appropriate nutrition
  • Appropriate chosen footwear
  • Adjusted home environment

All these factors contribute to a safer living environment for the elderly.

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20
Q

Peculiarities of diseases in the elderly include:

A
  • Multimorbidity
  • Chronic course of diseases
  • Frequent complications related to disease or treatment

Older patients often have multiple chronic conditions that complicate treatment.

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21
Q

Scleroderma renal crisis may present with:

A
  • Abrupt onset of hypertension
  • Rapidly progressive kidney failure

Inflammation of kidney tissue and collection of stones are less characteristic.

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22
Q

Which symptom is not characteristic of fibromyalgia?

A

Arthritis

Fibromyalgia typically presents with widespread pain, fatigue, and mood disturbances.

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23
Q

What do you expect when prescribing corticosteroids for polymyalgia rheumatica?

A

The patient dramatically improves

Corticosteroids are highly effective for this condition.

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24
Q

Which medications are TF blockers?

A
  • Rituximab
  • Etanercept
  • Infliximab

These medications target tumor necrosis factor (TNF) in autoimmune diseases.

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25
Involutional changes in hearing include:
* Difficulty distinguishing words in a noisy environment * Hearing declines ## Footnote Sensitivity to high-pitched sounds decreases with age.
26
Stochastic theories of biological aging state that:
Changes of aging occur randomly and accumulate with age ## Footnote This theory contrasts with programmed aging theories.
27
Secondary biological aging is determined by:
* Diseases * Medications * Hereditary factors * External factors ## Footnote All these factors contribute to how aging manifests in individuals.
28
Changes expected in the spine of a patient with rheumatoid arthritis include:
* Sacroiliitis * Atlanto-axial subluxation or instability ## Footnote Osteochondrosis and spondylosis can also occur.
29
Osteoarthritis is characterized as:
A degenerative joint disease with typical x-ray signs of sclerosis of subchondral bone and formation of new bone spurs (osteophyte) ## Footnote This condition contrasts with inflammatory joint diseases.
30
Factors that provoke Raynaud's syndrome include:
* Emotional stress * Cold ## Footnote Exposure to sun and calcium channel blockers are not typical triggers.
31
WHO (1994) criterion of osteoporosis based on bone mineral density is:
T-score is -2.5 or lower ## Footnote This indicates a significant increase in fracture risk.
32
Medications that can increase fall risk include:
* Antihypertensive drugs * Tricyclic antidepressants ## Footnote These medications can cause dizziness or sedation.
33
Diseases associated with enteropathic arthritis include:
* Crohn's disease * Ulcerative colitis ## Footnote These inflammatory bowel diseases often have associated joint symptoms.
34
Features of antiphospholipid syndrome include:
* Episcleritis * Pregnancy loss * Arterial and venous thromboses ## Footnote Elevation of inflammation markers and Raynaud's phenomenon can also be seen.
35
Laboratory tests to differentiate psoriatic arthritis include:
No specific test ## Footnote Clinical diagnosis is often based on the presence of skin lesions and joint symptoms.
36
Dactylitis is defined as:
One or more fingers swelling, which extends beyond the joint ## Footnote This is a classic feature of psoriatic arthritis.
37
Medications prescribed for treatment of ankylosing spondylitis include:
* NSAIDs * TNF-alpha blockers * Sulfasalazine ## Footnote Allopurinol and antibiotics are not typically used.
38
Biological aging is influenced by:
* Diseases * Lifestyle * Social environment * Hereditary factors ## Footnote All these factors play a role in the aging process.
39
Features of Felty syndrome include:
* Granulocytopenia * Hepatomegaly * Splenomegaly ## Footnote Positive anti-DNA is not a typical finding in Felty syndrome.
40
Pathogenetic therapy drugs not suitable for patients with systemic lupus include:
* Infliximab * Sulfasalazine ## Footnote Mycophenolate mofetil and Azathioprine are often used.
41
Clinical situations suitable for a patient with systemic sclerosis presenting with hypertension and lung fibrosis include:
Scleroderma kidney (hypertensive crisis due to kidney pathology of systemic sclerosis) ## Footnote Other options may not directly relate to the symptoms presented.
42
What is the blood pressure recorded in the case?
220/125 mmHg
43
What is the pulse rate in the case?
120 times per minute
44
What does tachypnea indicate in a clinical context?
Increased respiratory rate
45
What did the chest X-ray reveal?
Lung fibrosis
46
What is 'scleroderma kidney' associated with?
Hypertensive crisis due to kidney pathology of systemic sclerosis
47
What condition can be associated with polymyalgia rheumatica?
Giant cells or temporal arteriitis
48
What is the first step to take for a patient with choking and visible neck fullness?
Perform thoracic, abdominal and pelvic CT scan, looking for malignancies
49
What symptoms are associated with the 46-year-old woman suffering from systemic sclerosis?
Acrocyanosis, sclerodactylia, dyspnea, small crackles in the lungs
50
What is the most likely condition for the woman with systemic sclerosis who exhibits dyspnea?
Pulmonary hypertension
51
What treatment should be prescribed for a patient with ankylosing spondyloarthritis experiencing increased liver enzymes?
TNF alpha blocker
52
What is the most likely diagnosis for a 62-year-old woman with rheumatoid arthritis and severe headaches?
Atlantoaxial joint instability
53
What is the likely diagnosis for a 32-year-old woman with a sun-sensitive rash and muscle pain?
Drug-induced systemic lupus erythematosus
54
What is the most appropriate reason for a 77-year-old woman who experiences falls after standing up?
Orthostatic hypotension
55
What further investigation should be planned for the 86-year-old woman with right hip pain?
Right hip X-ray, traumatologist consultation
56
Which test is the least useful for diagnosing episodic lower extremity joint pain?
X-ray of MTP joints
57
What non-medical treatment measures would you recommend for a 75-year-old obese woman with hip pain?
Regular exercise, lose weight
58
What is the first step for a patient with dermatomyositis experiencing choking and muscle weakness?
Perform thoracic, abdominal and pelvic CT scan, looking for malignancies
59
What is the recommended treatment for a patient diagnosed with Henoch Schönlein purpura?
Low dose of aspirin, bed rest
60
What rheumatic disease should be suspected in a patient with acute, extremely painful arthritis after renal colic?
Gout
61
What should be done for a patient suspected of having polymyalgia rheumatica who experiences sudden headache and vision loss?
Bring the patient to emergency department for ophthalmologist and therapeutist consultations
62
What is the most likely diagnosis for a patient with severe shoulder pain and elevated inflammatory markers?
Septic arthritis
63
What should be the further diagnostic and treatment tactics for a patient with systemic lupus erythematosus and proteinuria?
Assess the amount of protein in 24-hour urine and refer to nephrologist for kidney biopsy
64
What additional test would be recommended for a patient with a distal radius fracture?
Bone mineral density measurement
65
What is the most probable diagnosis for a patient with itching eyes, lack of tears, and joint pain?
Sjogren's disease
66
What diagnosis should be considered for a patient with rheumatoid arthritis whose condition worsened despite treatment?
Drug-induced systemic lupus erythematosus
67
What does a morning stiffness lasting about 3 hours indicate in a patient with rheumatoid arthritis?
Active disease
68
What is a common symptom found in patients with dermatomyositis?
Neckline shaped rash
69
What is one of the major laboratory findings in a patient with dermatomyositis?
Elevated creatinkinase
70
What is an important clinical feature to observe in patients with rheumatoid arthritis?
Subcutaneous nodules
71
What are the symptoms of rheumatoid arthritis in the presented case?
Feet joints and morning stiffness lasting about 3 hours, subcutaneous nodules, swollen right elbow with functional contracture, painful and swollen wrists and metacarpophalangeal joints bilaterally, slightly swollen left knee, painful metatarsophalangeal joints bilaterally. ## Footnote Objective findings indicate systemic involvement, common in rheumatoid arthritis.
72
What laboratory tests were performed, and what were the results?
HB 122g/I; platelets 460x10^9/L; ENG 45mm/hr; periarticular osteopenia of hand joints visible in X-rays. ## Footnote These results indicate inflammation and possible joint damage.
73
What treatment options are suggested for the patient with rheumatoid arthritis?
Prescribe an additional biological disease modifying anti-rheumatic drug, add cyclophosphamide tablets, discontinue methotrexate and prescribe sulfasalazine, add hydrochloroquine. ## Footnote Treatment options depend on the severity and response to current therapy.
74
What pathology should be suspected in the 35-year-old woman with psoriatic arthritis who developed cough, night sweats, and fever?
Tuberculosis due to treatment of biological drugs. ## Footnote Biological drugs can increase the risk of infections such as tuberculosis.
75
What recommendations are made for the 76-year-old woman with primary arterial hypertension and a hip fracture?
Assess bone mineral density, perform routine laboratory tests assessment, perform comprehensive geriatric assessment. ## Footnote These recommendations address both hypertension management and fall risk.
76
What two diseases should be suspected in the 48-year-old woman with new symptoms after gardening?
Deep vein thrombophlebitis, rupture of Baker's cyst. ## Footnote Symptoms like swelling and pain in the calf can indicate these conditions.
77
What treatment is inappropriate for the 82-year-old woman with vertebral compression fractures?
Bed mode. ## Footnote Bed rest is not recommended as it can lead to further complications.
78
What rheumatic disease is suspected in the 41-year-old female with poorly controlled asthma and glove-like numbness?
Eosinophilic granulomatosis with polyangiitis. ## Footnote Eosinophilia and neurological symptoms suggest this condition.
79
What is the recommended treatment for the 67-year-old man with knee pain and no morning stiffness?
Exercise, rehabilitation procedures, paracetamol, ointments with non-steroidal anti-inflammatory drugs. ## Footnote These treatments are aimed at managing osteoarthritis symptoms.
80
What rheumatological disease should be suspected in the 71-year-old woman with temporal pain and vision loss?
Polymyalgia rheumatica with temporal arteritis. ## Footnote Symptoms like jaw pain and visual changes are classic for this condition.
81
What pathology is suspected in the 22-year-old patient with swollen joints and rash?
Systemic lupus erythematosus. ## Footnote The combination of joint swelling, rash, and laboratory findings supports this diagnosis.
82
What condition is suspected in the 62-year-old male with acute renal colic followed by arthritis?
Gout. ## Footnote The acute onset of arthritis after renal colic is suggestive of gout.
83
What initial tests are not appropriate for the 32-year-old man with acute joint pain and recent travel history?
Antinuclear antibodies. ## Footnote This test is not relevant to the acute presentation and recent travel.
84
What tests or procedures should be performed for the 79-year-old woman with ineffective treatment for chronic bronchitis?
Functional independence measurement, Mini-Mental State examination, Barthel index, Timed Up and Go test. ## Footnote These assessments help evaluate the patient's overall health and independence.
85
What conclusion should be drawn from the comprehensive geriatric assessment of the 80-year-old woman?
Adapt the home environment. ## Footnote Modifying the home can prevent falls and improve safety.

Exams Q1 (3 decks)

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