Master the Boards: Rheumatology 1

Question 1

RA DX needs 4 of the following

Answer 1

• Morning Stiffness lasting >1hr
• Positive ACCP or RF
• Elevated CRP or ESR
• Inflamatory arthritis in 3 or more joints(MCP and PIP common)
• Duration of Sx greater than 6 weeks

Question 2

Why do RA patients need X-ray or CT prior to intubation

Answer 2

C1-C2 subluxation

Question 3

MCV in RA anemia

Answer 3

normal

Question 4

Felty syndrome

Answer 4

RA
Splenomegaly
Neutropenia

Question 5

Do NSAIDs delay progression of RA

Answer 5

no just help w pain

Question 6

When to start DMARD and NSAIDs for RA

Answer 6

as soon as Dx is made

Question 7

SE of Methotrexate

Answer 7

• bone marrow suppression
• pneumonitis
• liver dz

Question 8

anakinra class

Answer 8

IL-1 receptor antagonist

Question 9

tocilizumab/sarilumab class

Answer 9

IL-6 receptor antagonist

Question 10

Rituximab class

Answer 10

CD-20 antibody

Question 11

Leflunomide class

Answer 11

pyrimidine antagonist similar to methotrexate

Question 12

Abatacept class

Answer 12

inhibits T cell activation

Question 13

Infliximab, adalimunab, etanerercept, certolizumab, golimumab class

Answer 13

TNF-a inhibitors

Question 14

Tests before adding TNF-a onto methotrexate

Answer 14

Hep B and TB

Question 15

Are TNF-a inhibitors safe in pregnancy

Answer 15

yes

Question 16

When to use Janus Kinase inhibitors (Tofacitinib)

Answer 16

severe RA not responsive to Methotrexate

Question 17

Hydroxychloroquine tests

Answer 17

eye exam to check for retinopathy

Question 18

RA patient acutely ill w severe inflammation tx (bridge)

Answer 18

add on steroids try not to do long term

Question 19

Best test RA

Answer 19

ACCP, 95% specific

Question 20

RA pleural effusion glucose level

Answer 20

lowest of all causes of pleural effusions

Question 21

Most common joint abnormality

Answer 21

OA

Question 22

length of morning stiffness in OA

Answer 22

less than 30 min

Question 23

synovial leukocyte count OA

Answer 23

<2000

Question 24

OA w inadequate pain control with acetaminophen next step

Answer 24

NSAIDS unless contrindicated

Question 25

OA w inadequate pain control with Acetaminophen and NSAIDS

Answer 25

• Duloxetine
• Topical diclofenac- okay renla insufficiency
• Capsaicn -topical works for neuropathic pain also
• Steroid or hyaluronic acid injections

Question 26

Seronegative Spondyloarthropathies

Answer 26

Psoriatic
Ankylosing Spondylitis
Idiopathic (JIA/Stills)
Reactive

Question 27

Seronegative Spondyloarthropathies common features

Answer 27

negative RF
spine
SI involvment
HLA-B27

Question 28

Where to X-ray Ankylosing Spondylitis

Answer 28

SI joint and spine

Question 29

Do you give methotrexate for Ankylosing Spondylitis

Answer 29

no it does not work well for spine of SI joint

Question 30

Do you give steroids for Ankylosing Spondylitis

Answer 30

no they don’t work

Question 31

Ankylosing Spondylitis tx

Answer 31

NSAIDS first
add on TNF-a inhibitors
then add IL-17i like secukinumab