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Rheumatology > MKSAP > Flashcards

MKSAP Flashcards

1
Q

Typical clinical presentation of Behcet syndrome

A

Young Male from the Mediterranean region with recurrent painful oral and scrotal/vulvar ulcers and eye inflammation (panuveitis, retinal vasculitis, optic neuritis). They can also have neurological symptoms, GI symptoms, and arthralgia.

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2
Q

How do you establish the diagnosis of Behchets

A

International scorch guidelines:
1. Recurrent oral, genital or ocular inflammation
2. Pathergy

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3
Q

Pharmacological management of Behchets

A
  1. Colchicine (first line for muco-cutaneous manifestations)
  2. Apremilast (PDE-4 inhibitor) for recurrent oral lesions
  3. Glucocorticoids
  4. Azathioprine and thalidomide
  5. TNF-alpha agents
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4
Q

Inflammatory arthritis with DIP involvement

A

PsA

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5
Q

Steroids in PsA can ppt ____ psoriasis

A

Erythrodermic

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6
Q

2 drugs associated with ANCA vasculitis

A

PTU and levamisole

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7
Q

Monoclonal antibody FDA approved for EGPA

A

Mepolizumabable Mugratory Eosinophilic Granulomatosis with Polyangitis —> treated with IL-5 inhibition

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8
Q

The test I need before doing anything else for inflammatory back pain is __

A

HLA-B27

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9
Q

What does seronegativity imply?

A

RF, ANA, and CCP are negative

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10
Q

Initiating pregablin for fibromyalgia

A

Start at low doses at night and titrate to max of 225 mg daily

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11
Q

2 SNRIs approved by FDA for fibromyalgia

A

Milnacipran

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12
Q

Characteristic finding of CPPD synovial fluid analysis

A

Positively birefringent rhomboid shaped crystals

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13
Q

Timeline for temporal artery biopsy in GCA

A

2 weeks within intubation of steroids

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14
Q

Preferred first like therapy for GCA

A

High dose prednisone + tocilizumab

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15
Q

Imaging modality for Gout if arthrocentesis cannot be performed?

A

Dual energy CT and double contour sign in US

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16
Q

IL-1BC

A

Anakinra and Canakinumab

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17
Q

Allele associated with hypersensitivity to allopurinol

A

HLA-B*58:01

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18
Q

Cholenergic agonists used for treatment of sicca symptoms when behavioral management fails

A

Cevemiline and pilocarpine

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19
Q

Patients with sjogrens and lupus are at increased risk of this malignancy

A

NHL

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20
Q

Characteristic radio graphic feature of CCPD in MCP joints

A

Hooked osteophytes

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21
Q

4 conditions associated with CCPP

A

Hyper PTH
Hemochromatosis
Hypo PO4
Hypo Mg

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22
Q

DDx of sjogrens

A

Sarcoidosis
IgG4 related diseases
GPA
HIV
Hep C
Lymphoma

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23
Q

What is the timeline for development of Reactive arthritis

A

2-3 weeks

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24
Q

Cutaneous manifestations of reactive arthritis

A

Keratoderma blenorrhagicum and circinate Balanitis

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25
Q

Least common SpA

A

Reactive arthritis

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26
Q

Joint distribution for reactive arthritis

A

Asymmetric pauci arthritis involving the lower extremities

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27
Q

Treatment of reactive arthritis

A

NSAID x 2 weeks —> persistent —> steroids —> persistent for 3-6 months —> DMARDs for RA —> continued therapy for 3-6 months post disease resolution

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28
Q

Rx of IgG4 related disease

A

Long taper of steroids —> can add rituximab since disease recurs with discontinuation/taper of steroids

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29
Q

Rx of idiopathic RP fibrosis

A

MTX

30
Q

Organisms implicated in post prosthetic join replacement infection:
1. Early <3 months
2. Late > 12 months
3. Intermediate (3-12 months)

A
  1. Early and late - S. Aureus
  2. Intermediate - CONS
31
Q

What is FABER test

A

Flexion
Abduction
External rotation

32
Q

Which joints are involved in AS

A

SI and synovial facet joints of the vertebrae

33
Q

What is the 40% rule in AS

A

Patients are most comfortable when then are in 40% flexi on of the spine. Even AG night they use 3-4 pillows to prop to that position. Finally fibrosis and ossification ensue leading to kyphosis

34
Q

What are the three stages of AS

A

Inflammation —> fibrosis —> ossification

35
Q

Patient with AS has chest pain at night and at rest that improved with activity

A

Enthesitis of the Costco vertebral joints

36
Q

Which peripheral joints are most commonly involved in AS

A

Hip and knee

37
Q

2 DDx for renal disease in AS

A
  1. Amyloidosis - more common
  2. IgA nephropathy
38
Q

Cause equina in AS. Culprit?

A

Arachnoid diverticula

39
Q

HRCT finding in AS

A

Upper lobe fibrosis

40
Q

What are the three patterns of joint involvement in IBD associated SpA and which ones correlate with IBD activity

A
  1. Isolated SI or with AS
  2. Type I peripheral: asymmetric oligo articular in BL LE —> correlate with add activity
  3. Type 2 peripheral: symmetric poly arthritis in UE with wide range join involvement —> independent of IBD activity
41
Q

Which ass of biologics cause IBD flare

A

IL-17

42
Q

Meds for lupus in pregnant

A

Azathioprine and HCQS

43
Q

Most dramatic presentation of relapsing oolychomdritis requiring extensive workup and urgent attention

A

Tracheobronchial involvement

44
Q

Relapsing polychondritis presentation

A

Ear, middle ear (hearing loss), eye, modals bridge, trachea and bronchi, articular cartilages (inflammatory arthritis), heart valves, and the dons

45
Q

Condition associated with relapsing polychondritis in 30% patients

A

ANCA vasculitis

46
Q

What is MAGIC syndrome?

A

Mouth and Genital ulcers with Inflamed Cartilage (MAGIC) - Behchets + relapsing PC

47
Q

Rx of RPC - mild and severe disease

A

Mild : NSAID + dapsone
Severe: steroids, MTX, TNF agents, and tocilizumab

48
Q

Classic manifestation of SIBO

A

Explosive diarrhea following a meal.

49
Q

Rx of SIBO antibiotics

A

Ciprofloxacin, doxycycline, amoxi/clav, and rifaximin

50
Q

Labs that can help differentiate lupus flare from pre-eclampsia

A

Complements, ds-DNA, and irate levels (elevated in pre eclampsia)

51
Q

Life threatening Pulmonary manifestations of SLE

A
  1. Acute lupus pneumonitis —> difficult to differentiate from infection —> Rx with Ab and steroids
  2. DAH —> urgent bronch
52
Q

CV manifestations of lupus (valve)

A

Aortic and mitral thickening, regurgitation, and LSE

53
Q

GI manifestations of lupus

A
  1. Abdominal pain that correlates with disease activity and resolves with improvement
  2. Mesenteric vasculitis
  3. Non infectious hepatitis with anti ribosomal P antibody
54
Q

Alopecia is in lupus

A

Non-scarring

55
Q

How is DILE different from normal SLE

A

Less organ involvement and more constitutional with skin, joint, and fatigue

56
Q

Protein dysfunction in SpA

A

Fibrillar 1–> destruction of articular cartilages —> acetabular destruction

57
Q

MOA of mepolizumab

A

IL-5 inhibitor

58
Q

Rx of IGG4 related Ds

A
  1. High dose steroids x 4 weeks —> slow taper over 1 years.
  2. Steroids sparing agents: Azathioprine and Rituximab
59
Q

Two rheum medications that can cause serum sickness like reaction

A

Infliximab and rituximab

60
Q

Typical location of rheumatoid modules in the lung

A

Sub plural and around the interlobar septum

61
Q

Characteristic finding of DISH in C, L, And T spine

A

Cervical: downward pointing spurs
Thoracic: ligamental calcification
Lumbar: upward pointing spurs

62
Q

OA at MCP

A

Hemochromatosis

63
Q

RA pattern but not RA

A

Chronic CPPD

64
Q

4 DDx of dactylitis (S3T)

A

SpA
Sarcoidosis
Sickle cell
TB

65
Q

Medical condition mimicking scleroderma in hands

A

Diabetic stuff hands

66
Q

Dorsal pitiing edema if hands

A

RS3PE

67
Q

OA joints in feet

A

Mid foot and 1st MTP

68
Q

How many toes should you normally see when looking for behind

A

1-1.5

69
Q

Toe splaying is a finding in

A

RA

70
Q

What is haglund deformity

A

Bony hypertrophy at the back of the heel die to chronic pressure from tight shoes

71
Q

Coxalgic gait

A

Leaning over arthritic hip when that hip bears weight, pelvis remains level

72
Q

Normal elbow valgus make and female

A

Make 5
Female 10-15

Rheumatology (2 decks)

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