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ITE Rheumatology Flashcards

1
Q

Disease with upper and lower respiratory symptoms, eyes, skin, kidneys, sinuses; skin rash, glomerulonephritis and nodular lung disease in a 67 year old

A

Granulomatosis with polyangiitis

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2
Q

How to diagnose granulomatosis with polyangiitis

A

Kidney biopsy

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3
Q

What does a kidney biopsy show with granulomatosis with polyangiitis

A

Pauci-immune crescentic necrotizing glomerulonephritis

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4
Q

Treatment for severe suspected granulomatosis with polyangiitis?

A

High dose glucocorticoids (IV pulse steroids or high dose oral) with rituximab (or with cyclophosphamide)

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5
Q

A noninflammatory condition that causes calcification and ossification of spinal ligaments and entheses; causes pain, stiffness and reduced range of motion for patient

A

DISH (diffuse idiopathic skeletal hyperostosis)

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6
Q

Plain film finding of: flowing linear calcification and ossification along the anterolateral aspects of vertebral bodies

A

DISH

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7
Q

> 45 year old male with back pain and stiffness without sacroiliac pain

A

DISH

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8
Q

Next line of therapy for Ankylosing spondylitis with someone who has failed/not tolerated NSAIDs?

A

TNF-inhibitor (etanercept)

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9
Q

How do you treat scleroderma renal crisis?

A

IV ACE-i (Captopril)

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10
Q

Patients with scleroderma who present with anemia, thrombocytopenia, proteinuria, and schistosytes on peripheral smear

A

Scleroderma renal crisis

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11
Q

Pathophysiology of scleroderma renal crisis

A
  1. Endothelial damage: vascular constriction, intimal thickening and fibrin deposition
  2. activation of RAAS

Presentation: hypertensive emergency

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12
Q

Common comorbidities associated with Lupus (SLE)?

A

Cardiovascular problems (ie. MI, CVA)

Patients also have risk factors for malignancy (NHL, gynecological cancers)

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13
Q

How to treat tophaceous gout in a patient with contraindications to allopurinol?

A

Febuxostat

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14
Q

How to treat tophaceous (uncontrolled) gout with allopurinol or febuxostat if those medications were contraindicated/failed?

A

Pegloticase

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15
Q

Young woman (30s) with limb ischemia and associated diminished (or absent) pulses, mesenteric ischemia (post prandial abdominal pain), and hypertension

A

Takayasu arteritis

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16
Q

Renal artery stenosis in young woman would prompt what vasculitis?

A

Takayasu arteritis

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17
Q

How to diagnose and treat Takayasu arteritis?

A

Imaging of the aorta and its branches (MRA); probably steroids and immunosuppression

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18
Q

For severe ACUTE gout flares in patients who do not respond/contraindicated to typical medications (Colchicine, NSAIDs, steroids), what is the medication of choice?

A

Anakinra

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19
Q

When to use Cevemeline?

A

Sjogren syndrome for excessive dry mouth

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20
Q

First line treatment for Sjogren syndrome-related oral dryness?

A

local moistening with water, sugar-free/acidic candies, lozenges, and/or mechanical stimulants (sugar free gum)

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21
Q

What medication is used in Sjogren syndrome for oral dryness?

A

Anti-cholinergic (Cevimeline)

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22
Q

RA patient with neutropenia and splenomegaly

A

Felty syndrome

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23
Q

Patients with Felty syndrome are at risk for what?

A

Serious bacterial infections, LE ulceration, lymphoma and vasculitis

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24
Q

Difference between Acute Cutaneous Lupus erythematosus (ACLE) and Subacute … ?

A

Acute = malar butterfly rash with patchy erythematous, and edematous rashes on back and other sun-exposed skin

Subacute = Annular/polycyclic photosensitive plaques on the back, chest, and extremities OR psoriasis appearance of rashes

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25
How to treat Familial Mediterranean Syndrome
Colchicine
26
What can patients take in setting of acute giant cell arteritis when they cannot take Steroids (Prednisone)?
Tocilizumab
27
Management of dermatomyositis?
Prednisone for first outbreak then... Glucose sparing agent: Methotrexate or Azathioprine PT
28
How to treat new-onset granulomatosis with polyangiitis? Induction and maintenance?
High dose glucocorticoids and Rituximab
29
Patients with RA who do not respond to initial therapy of Methotrexate with/without biologic could be placed on what two different treatment regimens?
1. Triple therapy: methotrexate, sulfasalazine, and hydroxychloroquine 2. Biologic: Humira (adalimumab)
30
Which vaccinations are contraindicated in patients with RA on heavy immunosuppressants?
Live attenuated vaccines: influenza and herpes zoster Live vaccines: MMR
31
What medications can mimic symptoms of Sjogren's syndrome?
Anti-depressants Anti-histmaine agents
32
Abrupt, acute symmetric and polyarticular joint pain particularly affecting proximal small joints of hands after patient has been exposed to viral illness? Facial rash can occur as well
Parvovirus B19 arthropathy; treat with NSAID like diclofenac
33
Cryoglobulinemia (severe) is treated with what?
High dose glucocorticoids and rituximab
34
What lab results point to a diagnosis of cryoglobulinemia?
severely decreased C4, elevated rheumatoid factor, and low CH50
35
When disease is associated with cryoglobulinemia?
HCV (look for elevated transaminases)
36
Refractory tophaceous gout that has not responded to allopurinol then febuxostat is treated with what?
pegloticase
37
What GI condition typically affects individuals with systemic sclerosis?
SIBO; tx: monthly antibiotics in rotating fashion to decrease bacterial load in small intesting
38
Dx for patient with swelling and redness of helices of ear, diminished hearing bilaterally, bilateral conjunctivitis, flattening or any weird deformity of the nasal bridge
relapsing polychondritis
39
What is a relatively common manifestation of SLE in regards to cardiac health?
MI (1) and pericarditis (2)
40
Pregnancy and SLE: What drugs are okay? Which drugs are not?
Okay: Hydroxychloroquine and (only if necessary) Azathioprine
41
The abrupt onset of monoarticular inflammatory arthritis in ANY patient should prompt what on differential?
Joint infection (esp a knee); diagnosis should be confirmed with synovial fluid analysis
42
Dx: Photosensitive rash that occurs especially on the arms, neck, and upper trunk, usually sparing the central face and consisting of erythematous annular/polycyclic or patchy papulosquamous lesions
Subacute Cutaneous Lupus Erythematosus
43
The Malar butterfly rash would constitute what diagnosis?
Acute Cutaneous Lupus Erythematosus
44
What is a typical drug that can cause drug-induced Lupus Erythematosus?
Minocylcine (doesn't have to have positive antihistone ab's HIP: hydralazine, isoniazid, procainamide
45
What disease do you expect in someone with Sjrogen's syndrome who has experienced unintentional weight loss, fever, and drenching night sweats?
Lymphoma Risk Factors: parotid gland enlargement, depressed C4, elevated RF, antiRo, antiLa, monoclonal gammopathy
46
What test is indicated in a patient with SLE and rapidly declining renal function (proteinuria, protein-cr ratio greater than 500, and unexplained decrease in eGFR)?
Kidney Biopsy
47
Early onset (<3 months) and Late onset (>12 months) prosthetic joint infections are usually caused by what organism?
Staph aureus
48
Delayed onset (3-12 months) prosthetic joint infections are caused by what organism?
Coag-negative Staph (Staph epidermidis)
49
Patients with long-standing, poorly controlled Ankylosing Spondylitis (AS) can develop what renal complication?
Renal (AA) Amyloidosis: proteinuria and renal insufficiency
50
Dx: combination of infiltrative and destructive bone lesions, skin lesions, parotid and lacrimal enlargement, hilar lymphadenopathy, and hepatic nodules strongly suggest what disease?
Sarcoidosis
51
Sarcoidosis can be confirmed with what diagnostic modality? What is the preferred area?
Biopsy (skin if involved); can also use bone biopsy and hilar lymph node biopsy (more invasive)
52
Patients with Systemic Sclerosis are at risk for what vascular abonormality? What would be the initial diagnostic test of choice and definitive diagnostic modality?
Echo first and then Right heart cath (don't do this first since it's invasive)
53
Infiltratrive involvement located in parotid and lacrimal glands. Can also see retroperitoneal fibrosis and periaortitis is most consistent with what disease?
IgG-4 disease
54
Treatment for IgG-4 disease
High dose glucocorticoids and Rituximab RItuximab mono-therapy also appropriate
55
Reactive arthritis is typically treated with what?
NSAIDs at anti-inflammatory doses for at least 2 weeks
56
Really SICK with high fevers and incapacitating polyarticular joint pain, conjunctivitis and rash. Question stem will likely provide some sort of location
Chikungunya virus
57
MCTD (Mixed connective tissue disease) is characterized by what antibodies?
Anti-U1-ribonucleoprotein antibodies
58
What gene do you have to screen for in high risk individuals before starting allopurinol?
HLA-B*58:01 allele
59
Kidney disease with nodular skin lesions and abdominal pain after eating and neuropathy
think polyarteritis nodosa
60
How to treat parvovirus B19?
NSAIDs
61
Palpable purpura, digital ischemia, ulcers, necrosis, and livedo reticularis
cryo-vasculitis
62
How to differentiate Limited versus Diffuse Cutaneous Systemic Sclerosis
Limited = anti-centromere Diffuse = Scl-70
63
How to treat ILD in patient's with systemic sclerosis?
Mycophenolate mofetil
64
How to treat reactive arthritis
NSAID (anti-inflammatory dose) for 2-3 weeks
65
Recurrent oral ulcers in Bechet
A - word

Medicine (7 decks)

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