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Rheumatology > MKSAP Rheum > Flashcards

MKSAP Rheum Flashcards

1
Q

In what condition is erythema marginatum found? Keratoderma blenorrhagicum? Lupus pernio? Circinate balanitis?

A
  1. Rheumatic fever 2. Reactive arthritis 3. Sarcoidosis 4. Reactive arthritis
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2
Q

What disease is antiribosomal P associated with? Anticentromere? c-ANCA? p-ANCA?

A
  1. Lupus cerebritis and lupus hepatitis
  2. Limited sclerosis, more likely to develop PAH
  3. GPA
  4. MPA, EGPA
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3
Q

What are the side effects of Leflunomide, which is used in RA? Name 3. How is it washed out if the drug needs to be eliminated quickly, for example in women wishing to become pregnant?

A
  1. Hepatotoxicity, myelosuppression, nausea, peripheral neuropathy
  2. Cholestyramine
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4
Q

What is Tofacitinib (Xeljanz) and what is it used for? What are some side effects? Name 5.

A

JAK signaling inhibitor used in RA and ulcerative colitis

Hyperlipidemia, hepatotoxicity, leukopenia, diarrhea, headache, infections, malignancy, HTN

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5
Q

What is Apremilast (Otezla) and what is it used for? What are the side effects?

A

PDE-4 inhibitor used in psoriasis

Nausea, diarrhea, weight loss; caution in patients w/ hx of depression

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6
Q

What are the side effects of Febuxostat?

A

Transaminitis, cardiovascular related death (black box warning)
CAN use in patients w/ CKD that cannot tolerate allopurinol

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7
Q

What is Pegloticase?

A

Uricase that lowers serum urate in severe gout
Administered IV every 2 weeks
If pre-infusion uric acid >6, discontinue since patient may have developed antibodies

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8
Q

What presents in an RA patient w/ hoarseness, sore throat, dysphagia, and stridor and may pose problems for endotracheal intubation?

A

Cricoarytenoid arthritis

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9
Q

What are 3 examples of TNF-alpha inhibitors?

A

Etanercept, Infliximab, Adalimumab

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10
Q

Hemochromatosis is associated with OA of what joints?

A

Second/third MCP joints

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11
Q

What is DISH? What part of the spine does it typically affect? How does it present on X-ray?

A
  1. Diffuse Idiopathic Skeletal Hyperostosis - calcification and ossification of spinal ligaments
  2. Right side of thoracic spine
  3. Confluent ossification of at least 4 contiguous vertebral levels
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12
Q

What condition is associated w/ pain at proximal medial aspect of the tibia? What is associated w/ pain at the lateral aspect of the knee, and what exacerbates this?

A
  1. Pes anserine bursa

2. Iliotibial band syndrome; exacerbated by physical activity such as walking up/down the stairs, running, or cycling

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13
Q

What are the most common locations of enthesitis for ankylosing spondylitis? For psoriatic arthritis?

A
  1. Achilles tendon

2. Achilles tendon, calcaneal insertion of plantar fascia, ligamentous insertions into pelvic bones

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14
Q

What are the 7 clinical domains for the 2019 EULAR/ACR lupus criteria? 3 immunological domains?

A
  1. Constitutional, Heme, Mucocutaneous, Serosal, Renal, MSK, Neuropsych
  2. Low C3 and/or C4; anti-dsDNA or anti-smith; anti-phospholipid antibodies
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15
Q

What is the condition in which lupus patients present w/ pleuritic chest pain, dyspnea, and progressive decrease in lung volumes?

A

Shrinking lung syndrome

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16
Q

What are some cardiovascular drugs that can cause drug-induced lupus? Name 4.

A

Statins, ACEis, calcium channel blockers, thiazides, hydralazine

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17
Q

What drugs used for lupus are safe during pregnancy?

A

Hydroxychloroquine, steroids, azathioprine

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18
Q

What antibodies are seen in immune-mediated necrotizing myopathy? In inclusion body myositis?

A
  1. Anti signal recognition particles (SRPs), anti-HMG-CoA reductase
  2. Anti-cytoplasmic 5’-nucleotidase 1A
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19
Q

What type of myositis presents as slow onset of weakness in proximal AND distal muscles? What 3 muscle groups are typically involved? Is CK usually higher or lower than that seen in poly/dermatomyositis? 50% of patients can have dysphagia and aspiration risk due to which muscle involvement?

A
  1. Inclusion body myositis
  2. Quadriceps, wrist, and finger flexor muscles
  3. Lower
  4. Cricopharyngeal
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20
Q

What disease is anti-RNA polymerase III associated with? Anti-U3-RNP?

A
  1. Diffuse scleroderma, scleroderma renal crisis, gastric antral vascular ectasia (GAVE)
  2. Diffuse scleroderma, PAH, myositis
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21
Q

What is the preferred drug for SSc-associated ILD?

A

Mycophenolate

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22
Q

What is Caplan syndrome?

A

Pneumoconiosis related to occupational dust, seen in RA. Presents w/ multiple basilar lung nodules and mild airflow obstruction

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23
Q

What is hypertrophic osteoarthropathy? What conditions is it associated with?

A
  1. Proliferation of skin and osseous tissue at distal hands and feet. Clubbing, painful periostosis of long bones, synovial effusions, and new periosteal bone formation
  2. COPD, chronic pulmonary infections, lung cancer, right to left shunts
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24
Q

What are 3 cardiovascular manifestations of ankylosing spondylitis? Name 1 pulmonary manifestation?

A
  1. Aortic valve regurgitation, aortic aneurysm/aortitis, conduction defects
  2. Restrictive lung disease
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25
Q

What is the treatment for ankylosing spondylitis?

A

NSAIDs, TNF inhibitors

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26
Q

What presents as indurated plaques/patches on the back, shoulder, girdle, and neck? Who is this seen in?

A
  1. Scleredema

2. Long-standing diabetes; can also be a complication of monoclonal gammopathy

27
Q

What presents as waxy, yellow-red papules over thickened skin of face, upper trunk, neck, and arms? What diseases is it associated with?

A
  1. Scleromyxedema

2. AL amyloidosis or multiple myeloma

28
Q

What medication can precipitate a scleroderma renal crisis and should be avoided overall in scleroderma?

A

Steroids

29
Q

Per 2012 ACR and 2016 EULAR guidelines what are the criteria for urate-lowering therapy for patients with gout?

A

Stage 2 CKD or greater, 2 or more acute attacks per year, One or more tophi, and/or Uric acid nephrolithiasis

30
Q

How long should prophylaxis for gout be continued?

A

For patients without tophi, for at least 3 months after achieving target serum urate level (<6 in those w/o tophi, <5 with tophi).
For those with tophi continue for at least 6 months after achievement of target serum urate level and resolution of tophi

31
Q

What joints does chronic calcium pyrophosphate deposition (CPP) typically affect?

A

Wrist and MCP

32
Q

What type of crystals deposit periarticularly and can cause inflammatory arthritis and periarthritis, typically in elderly women? If in the shoulder what is the name of this condition?

A
  1. Basic calcium phosphate 2. Milwaukee shoulder
33
Q

What anti-hypertensive has a uricosuric effect and is effective in patients with gout? Which anti-hypertensives increase the risk of gout?

A
  1. Losartan

2. Diuretics, beta blockers, ACEi, and most ARBs

34
Q

What conditions should you screen for in patients with CPPD and under 50 years of age? Name 4.

A

Hemochromatosis, hyperparathyroidism, hypomagnesemia, hypophosphatemia, hypothyroidism

35
Q

How does diffuse infiltrative lymphocytosis syndrome present? What disease is it associated with?

A

Salivary gland enlargement, sicca, and peripheral CD8+ lymphocytosis
Seen in HIV patients

36
Q

What presents as focal segmental panmural necrotizing inflammation of a medium-sized vessel on biopsy? How does this present on angiogram of renal vessels?

A
  1. Polyarteritis nodosa

2. Aneurysms and stenosis

37
Q

What are the 3 histologic presentations of primary angiitis of the CNS? What is found in the CSF? How does it present on brain MRI? How does it present on cerebral angiogram? What is the treatment?

A
  1. Granulomatous, lymphocytic, necrotizing
  2. High protein, high lymphocytes, occasional oligoclonal bands
  3. Non-specific white and gray matter changes & infarcts
  4. Alternating dilations and stenoses
  5. Steroids and cyclophosphamide
38
Q

Name 2 clinical features of polyarteritis nodosa for each of the following organ systems: constitutional, MSK, skin, neurological, kidney, and GI

A
  1. Fever, weight loss, malaise
  2. Arthralgia, myalgia
  3. Purpura, nodules
  4. Mononeuritis multiplex, peripheral neuropathy
  5. HTN, proteinuria/hematuria
  6. Mesenteric ischemia, appendicitis, pancreatitis, cholecystitis, GI bleeding
39
Q

What are the treatment options in Behcet for ulcers? Prevention of ulcers and acute arthritis? Tx of recurrent/chronic arthritis? Tx of acute exacerbations of abdominal pain? Tx of CNS attacks?

A
  1. Topical steroids
  2. Colchicine
  3. Azathioprine, interferon alpha, TNF-alpha inhibitors
  4. Steroids + 5-ASA or azathioprine
  5. Steroids + azathioprine
40
Q

What presents w/ leukocytosis, fevers, arthralgia, salmon colored maculopapular rash, sore throat, LAD, elevated LCTs or LDH? What is the first line treatment?

A
  1. Adult onset Still’s disease

2. NSAIDS

41
Q

What is the syndrome with fever, uveitis, and parotitis w/ or w/o cranial nerve VII palsy? Which disease is it seen in? What autoimmune disease can it mimic?

A
  1. Heerfordt syndrome 2. Sarcoidosis 3. Sjogren syndrome
42
Q

Name the large vessel (2), medium vessel (2), and small vessel (7) vasculitides

A

Large: Giant cell, Takayasu
Medium: Polyarteritis nodosa, primary angiitis of the CNS
Small: GPA, MPA, EGPA, hypersensitivity, cryoglobulinemic, Behcet, IgA

43
Q

Which vasculitis may not be associated with glomerular kidney disease, so may not have urine RBCs, casts, or proteinuria?

A

Polyarteritis nodosa

44
Q

What syndrome presents w/ neuropathic pain, autonomic dysfunction (edema, color changes, sweating), swelling, dystrophy (hair loss, skin thinning, ulcers), movement disorder (difficulty initiating movement, dystonia, tremor, weakness) and patchy bone demineralization of the extremities? What are treatment options?

A
  1. Complex regional pain syndrome

2. PT, steroids, gabapentin, TCAs, bisphosphonates (even in absence of osteoporosis)

45
Q

Exposure to beryllium (found in workers in light bulb or semiconductor factories) can mimic what autoimmune disease?

A

Sarcoidosis

46
Q

What is the management for methotrexate-induced stomatitis?

A

Folic acid supplementation

47
Q

What are some side effects of colchicine? Name 3. What are some side effects of gabapentinoids? Name 4.

A
  1. Diarrhea, myelosuppression, neuromuscular toxicity (myalgia, proximal muscle weakness, neuropathy; cystoplasmic vacuolization on muscle biopsy)
  2. Dizziness, somnolence, weight gain, peripheral edema, cognitive difficulties, disequilibrium
48
Q

Rheumatoid arthritis is associated with which type of leukemia?

A

Large granular lymphocyte leukemia

49
Q

Abatacept, Rituximab, and Tocilizumab are some biologic DMARDs. Which can cause hypogammaglobulinemia? Which is relatively contraindicated in COPD? Which should be avoided in diverticulitis due to risk of bowel perforation?

A
  1. Rituximab
  2. Abatacept
  3. Tocilizumab
50
Q

What disease is Anti-neuronal antibody associated with? Anti-U1-RNP? Anti-Ro/SSA?

A
  1. Neuropsych lupus
  2. Raynaud, esophageal dysmotility, MCTD
  3. Sjogrens, photosensitive rashes, discoid lupus, neonatal lupus
51
Q

What is Belimumab used for?

A

Patients w/ moderate-severe lupus with skin/joint involvement who haven’t responded to other treatments

52
Q

What presents w/ mononuclear cell infiltrates w/ unique “rimmed” vacuoles w/o muscle cell necrosis on muscle biopsy?

A

Inclusion body myositis

53
Q

What cardiovascular and pulmonary screening should patients with systemic sclerosis undergo and how often?

A

High resolution CT at time of diagnosis
PFTs w/ DLCO every 6-12 months for 5 years
TTE annually

54
Q

What are some drugs that can cause myopathy? Name 5.

A

Alcohol, anti malarials, cocaine, colchicine, steroids, statins, zidovudine

55
Q

In what patients should probenecid be avoided?

A

CKD (GFR <60) and nephrolithiasis

56
Q

What are some treatment options for mild relapsing polychondritis? Name 3. What can be used for more severe disease? Name 4.

A
  1. NSAIDs, colchicine, dapsone

2. Steroids, cyclosporine, azathioprine, methotrexate

57
Q

How does bony involvement of sarcoidosis present on X-ray?

A

Cystic or sclerotic lesions, and a lacy pattern of multiple lesions

58
Q

What are some cardiovascular manifestations of relapsing polychondritis?

A

Aortic and mitral valve insufficiency

59
Q

What medication(s) can be used for prevention of coronary events in Kawasaki disease?

A

ASA for coronary artery abnormalities
Clopidogrel + ASA for multiple aneurysms
Warfarin for giant aneurysms

60
Q

What is the treatment for gouty cellulitis?

A

Prednisone 40 mg x 5 days

61
Q

What conditions are associated with pseudogout? Name 4.

A

Hypothyroidism, hemochromatosis, renal osteodystrophy, hyperparathyroidism

62
Q

What can be given to patients with Raynauds that are at risk for digit ulceration?

A

ASA

63
Q

What kind of phototherapy is used in the initial treatment of psoriasis?

A

Narrowband ultraviolet B therapy

64
Q

What are 2 medications that can be used for xerostomia?

A

Pilocarpine, Cevimeline

Rheumatology (1 decks)

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