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Medicine > ITE Rheumatology > Flashcards

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
Q

How to treat Familial Mediterranean Syndrome

A

Colchicine

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26
Q

What can patients take in setting of acute giant cell arteritis when they cannot take Steroids (Prednisone)?

A

Tocilizumab

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27
Q

Management of dermatomyositis?

A

Prednisone for first outbreak then…

Glucose sparing agent: Methotrexate or Azathioprine

PT

28
Q

How to treat new-onset granulomatosis with polyangiitis? Induction and maintenance?

A

High dose glucocorticoids and Rituximab

29
Q

Patients with RA who do not respond to initial therapy of Methotrexate with/without biologic could be placed on what two different treatment regimens?

A
  1. Triple therapy: methotrexate, sulfasalazine, and hydroxychloroquine
  2. Biologic: Humira (adalimumab)
30
Q

Which vaccinations are contraindicated in patients with RA on heavy immunosuppressants?

A

Live attenuated vaccines: influenza and herpes zoster

Live vaccines: MMR

31
Q

What medications can mimic symptoms of Sjogren’s syndrome?

A

Anti-depressants

Anti-histmaine agents

32
Q

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

A

Parvovirus B19 arthropathy; treat with NSAID like diclofenac

33
Q

Cryoglobulinemia (severe) is treated with what?

A

High dose glucocorticoids and rituximab

34
Q

What lab results point to a diagnosis of cryoglobulinemia?

A

severely decreased C4, elevated rheumatoid factor, and low CH50

35
Q

When disease is associated with cryoglobulinemia?

A

HCV (look for elevated transaminases)

36
Q

Refractory tophaceous gout that has not responded to allopurinol then febuxostat is treated with what?

A

pegloticase

37
Q

What GI condition typically affects individuals with systemic sclerosis?

A

SIBO; tx: monthly antibiotics in rotating fashion to decrease bacterial load in small intesting

38
Q

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

A

relapsing polychondritis

39
Q

What is a relatively common manifestation of SLE in regards to cardiac health?

A

MI (1) and pericarditis (2)

40
Q

Pregnancy and SLE: What drugs are okay? Which drugs are not?

A

Okay: Hydroxychloroquine and (only if necessary) Azathioprine

41
Q

The abrupt onset of monoarticular inflammatory arthritis in ANY patient should prompt what on differential?

A

Joint infection (esp a knee); diagnosis should be confirmed with synovial fluid analysis

42
Q

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

A

Subacute Cutaneous Lupus Erythematosus

43
Q

The Malar butterfly rash would constitute what diagnosis?

A

Acute Cutaneous Lupus Erythematosus

44
Q

What is a typical drug that can cause drug-induced Lupus Erythematosus?

A

Minocylcine (doesn’t have to have positive antihistone ab’s

HIP: hydralazine, isoniazid, procainamide

45
Q

What disease do you expect in someone with Sjrogen’s syndrome who has experienced unintentional weight loss, fever, and drenching night sweats?

A

Lymphoma

Risk Factors: parotid gland enlargement, depressed C4, elevated RF, antiRo, antiLa, monoclonal gammopathy

46
Q

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)?

A

Kidney Biopsy

47
Q

Early onset (<3 months) and Late onset (>12 months) prosthetic joint infections are usually caused by what organism?

A

Staph aureus

48
Q

Delayed onset (3-12 months) prosthetic joint infections are caused by what organism?

A

Coag-negative Staph (Staph epidermidis)

49
Q

Patients with long-standing, poorly controlled Ankylosing Spondylitis (AS) can develop what renal complication?

A

Renal (AA) Amyloidosis: proteinuria and renal insufficiency

50
Q

Dx: combination of infiltrative and destructive bone lesions, skin lesions, parotid and lacrimal enlargement, hilar lymphadenopathy, and hepatic nodules strongly suggest what disease?

A

Sarcoidosis

51
Q

Sarcoidosis can be confirmed with what diagnostic modality? What is the preferred area?

A

Biopsy (skin if involved); can also use bone biopsy and hilar lymph node biopsy (more invasive)

52
Q

Patients with Systemic Sclerosis are at risk for what vascular abonormality? What would be the initial diagnostic test of choice and definitive diagnostic modality?

A

Echo first and then Right heart cath (don’t do this first since it’s invasive)

53
Q

Infiltratrive involvement located in parotid and lacrimal glands. Can also see retroperitoneal fibrosis and periaortitis is most consistent with what disease?

A

IgG-4 disease

54
Q

Treatment for IgG-4 disease

A

High dose glucocorticoids and Rituximab

RItuximab mono-therapy also appropriate

55
Q

Reactive arthritis is typically treated with what?

A

NSAIDs at anti-inflammatory doses for at least 2 weeks

56
Q

Really SICK with high fevers and incapacitating polyarticular joint pain, conjunctivitis and rash. Question stem will likely provide some sort of location

A

Chikungunya virus

57
Q

MCTD (Mixed connective tissue disease) is characterized by what antibodies?

A

Anti-U1-ribonucleoprotein antibodies

58
Q

What gene do you have to screen for in high risk individuals before starting allopurinol?

A

HLA-B*58:01 allele

59
Q

Kidney disease with nodular skin lesions and abdominal pain after eating and neuropathy

A

think polyarteritis nodosa

60
Q

How to treat parvovirus B19?

A

NSAIDs

61
Q

Palpable purpura, digital ischemia, ulcers, necrosis, and livedo reticularis

A

cryo-vasculitis

62
Q

How to differentiate Limited versus Diffuse Cutaneous Systemic Sclerosis

A

Limited = anti-centromere

Diffuse = Scl-70

63
Q

How to treat ILD in patient’s with systemic sclerosis?

A

Mycophenolate mofetil

64
Q

How to treat reactive arthritis

A

NSAID (anti-inflammatory dose) for 2-3 weeks

65
Q

Recurrent oral ulcers in Bechet

A

A - word

Medicine (7 decks)

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