MKSAP STOCK5 Flashcards
What are the two most common peripheral nerve manifestations of polyarteritis nodosa?
Mononeuropathy, Mononeuritis multiplex
What is the expected physiologic changes in plasma osmolality and serum sodium during pregnancy?
Decrease in BOTH osmolality and sodium with normalization after delivery
What is the most common mechanism of cardiac involvement in patients with systemic sclerosis and cardiomyopathy?
Microvascular disease (leads to patchy myocardial fibrosis)
What kidney disease is associated with mesalamine therapy?
Interstitial nephritis
What are four indications to start urate-lowering therapy for gout?
Two or more attacks within 1 year period; one attack in the setting of CKD (at least stage II), one attack and the presence of tophi, one attack and a Hx of nephrolithiasis
What is the definitive diagnostic intervention for primary angiitis of the central nervous system?
Intracerebral angiography with brain biopsy
What is a long term complication of meniscectomy?
Early onset knee OA
What is the diagnostic imaging test for knee osteoarthritis?
STANDING plain radiograph of the knee
What is the treatment of rheumatoid arthritis that is inadequately controlled with methotrexate?
Addition of tumor necrosis factor alpha inhibitior (adalimumab, golimumab, certolizumab, infliximab, or etanercept)
Cause of persistent urogenital infection associated with reactive arthritis
Chlamydia trachomatis
What is the management of methotrexate therapy before conception?
Must be discontinued
What nonpharmacologic therapy is indicated for all patients with fibromyalgia?
Regular aerobic exercise
What are two common causes of hypersensitivity vasculitis
Drugs and Infection
What is the most likely cause of progressive weight loss, abdominal cramping, and loose stools in a patient with diffuse cutaneous systemic sclerosis?
Bacterial Overgrowth Syndrome
What is the treatment of polymyalgia rheumatica?
Low-Dose Prednisone i.e. 10-20 mg –expect rapid improvement
What is the recommended pharmacologic therapy for knee osteoarthritis in patients with inadequate response to acetaminophen
NSAIDs systemic or topical
What is the diagnosis for insidiously progressive shoulder pain, stiffness, and swelling following either trauma or overuse in older women?
Basic Calcium Phosphate Deposition (Milwaukee Shoulder Syndrome)
What are two antihypertensive medications that lower the risk of an acute flare in patients with gout?
Losartan (but NOT other ARBs) and CCBs
What is the urine study useful for determining the cause of a metabolic alkalosis?
Urine chloride levels
What is the confirmation for a diagnosis of drug-induced lupus?
Aside from the anti-histone Ab, cessation of sx when drug is stopped
What agents are recommended by JNC 8 for initial tx of stage I HTN in blacks?
Thiazide or CCB
What imaging is required for patients with clinically diagnosed hand osteoarthritis?
NONE- woooh tricked ya!
What is the recommended initial pharmacologic therapy for knee osteoarthritis
Acetaminophen
What is the initial treatment of new-onset, rapidly progressive, or erosive rheumatoid arthritis?
Methotrexate (some form of DMARD)
What are the complement levels in cyroglobulinemic vasculitis?
Low C4, normal C3
What are three findings predictive of diffuse alveolar hemorrhage in a patient with systemic lupus erythematosis?
Hypoxemia, New pulmonary infiltrates on chest radiograph, decreasing hematocrit
Cultures of these two body fluids should be obtained before initiating empiric antibiotics for suspected prosthetic joint infection
Blood and synovial fluid
What is the formula for estimating the maximal expected ESR based on age?
(Age in years + 10) /2
What are four clinical findings highly suggestive of cryoglobulinemic vasculitis?
Multisystem vasculitis, Low C4, normal C3, and a positive rheumatoid factor
What is the preferred type of vascular access in patients with ESRD requiring HD
AV fistula
What endocrine disorder is associated with acquired hypokalemic periodic paralysis?
Thyrotoxicosis
What is the diagnosis for erosive arthritis involving the distal interphalangeal and carpometacarpal joints NOT associated with elevation of inflammatory markers?
Erosive Osteoarthritis
This is a disease characterized by eosinophilia, migratory pulmonary infiltrates, purpuric skin rash, and mononeuritis multiplex
Eosinophilic Granulomatosis with polyangiitis
What is the indicated therapy for the treatment of a scleroderma renal crisis?
Captopril
What ist he recommended manipulation of NSAID therapy in older patients to decrease the risk of gastrointestinal toxicity?
Switch from oral to topical
What serum antibody levels correlate with disease activity in SLE (esp. kidney involvement)
Anti-Double Stranded DNA ab
What is the initial treatment of polymyositis or dermatomyositis with muscle involvement?
Glucocorticoids (high dose)
What routine lab monitoring is required q8-12 weeks in patients treated with leflunomide?
Liver enzymes
Reactive arthritis and psoriatic arthritis are more common and more severe in patients with this systemic infection
HIV infection
What antibody is often associated with mixted connective tissue disease?
Anti-U1 ribonucleoprotein
What is the initial treatment of mild systemic lupus erythematosis
Hydroxychloroquine
What is the most overrepresented cancer in women with dermatomyositis compared with women without it
Ovarian CA
What is the recommended mgmt of secondary hyperparathyroidism in patients with CKD?
Normalization of calcium, phosphorus, and vitamin D levels with active vitamin D (i.e. Calcitriol)
What is the diagnosis associated with distal skin thickening and features of CREST syndrome?
Limited Cutaneous Systemic Sclerosis
What is pegloticase?
Infusional uric acid specific drug used for gout refractory to xanthine oxidase inhibitors
What is the name of the neuropathy characterized by abnormal findings in the territory of two or more nerves in separate parts of the body?
Mononeuritis multiplex
Testing for this infection is indicated before initiating treatment with a biologic agent
Mycobacterium tuberculosis
What is the form of osteoarthritis affecting non weight bearing joints such as the shoulders or wrists?
Osteoarthritis with calcium pyrophosphate deposition
What is the primary therapy for parvovirus B19 associated arthritis?
NSAIDs
What are the four clinical findings of which TWO are required to make a diagnosis of Behcet syndrome in addtion to recurrent painful oral ulcers?
Recurrent painful genital ulcers, eye involvment, skin involvement, and pathergy
What is the recommended initial therapy for minimal change disease in adults?
High dose steroids
What rheumatologic disorder is characterized by high spiking fevers, arthritis, rash, high neutrophil counts, and markedly elevated serum ferritin?
Adult Onset Still Disease
What are two clinical criteria to diagnose preeclampsia in a patient without proteinuria?
New onset HTN after 20 weeks of pregnancy or evidence of end-organ damage i.e. thrombocytopenia, kidney dysfxn, liver dysfxn, pulm edema etc)
What are three indications for kidney biopsy in patients with suspected lupus nephritis?
Increasing serum creatinine without explanation, proteinuria >1 g / 24h; and proteinuria with cellular casts or hematuria
What are four synovial fluid studies indicated when evaluating probable crystal related arthritis?
Leukocyte count, crystal analysis, gram stain, and culture
What are the three cardinal findings of Lofgren syndrome?
Acute arthritis, Bilateral Hilar lymphadenopathy, and erythema nodosum
What is the clinical diagnosis in a patient with findings consistent with rheumatoid arthritis but negative rheumatoid factor of anti-cyclic citrullinated peptides?
Seronegative Rheumatoid Arthritis
What is the diagnosis of a lymphoplasmacytic infiltration and enlargement of pancreas, lymph nodes, salivary glands, kidneys, or skin?
IgG4-Related Disease
Name four autoimmune diseases associated with scleritis?
Rheumatoid Arthritis, Relapsing Polychondritis, Inflammatory Bowel Disease, and Vasculitis
What is the most common inherited kidney disorder?
Autosomal Dominant Polycystic Kidney Disorder
What is the kidney disease causing marked proteinuria without apparent systemic disease that may occur in extremely obese patients?
Secondary focal segmental glomerulosclerosis (FSGS)
What is the serum bicarbonate level for which oral alkali therapy is indicated in patients with CKD?
If it is <23
What are two coexisting conditions that may present as acute monoarthritis?
Gout and Septic Arthritis
What is an indication for gouty flare prophylaxis when treating tophaceous gout?
Any sign of active disease including flares of acute gout or tophi
What is the diagnostic criteria for preeclampsia
New onset hypertension after 20 weeks of pregnancy with proteinuria (>300 mg or urine prot/cr ratio >300)
What is the recommended method to monitor ankylosing spondylitis disease activity in patients responding to Tx?
A good physical exam
What are four factors associated with a worse clinical outcome in patients with IgA nephropathy?
HTN, Kidney dysfunction, Persistent proteinuria >1g, and tubulointerstitial damage seen on kidney bx
What are the two most common causes of pseudohyponatremia?
Hyperglycemia, significantly elevated serum lipid levels, and abnormal serum paraproteins
What is a cause of acute kidney injury associated with peripheral eosinophilia, hypocomplementemia, and eosinophiluria?
Cholesterol embolization
What is the likely diagnosis in a patient younger than 40 with signs and symptoms of large vessel stenosis and evidence of systemic inflammation?
Takayasu arteritis
What is the imaging study indicated for all patients with Marfan syndrome?
Transthoracic Echocardiography
Patients who are treated with cyclophosphamide are at increased risk for developing what malignancy?
Bladder CA
What are three culture sites for suspected disseminated gonococcal infection?
Blood, GU tract, or pharynx
What is the potential rheumatologic prodrome of acute hepatitis B infection?
Rapid Onset Symmetric Polyarthritis
What is the diagnosis for the syndrome that includes features of systemic lupus erythematosis, systemic sclerosis, and/or polymyositis and positive anti-U1 Ribonucleoprotein antibodies?
Mixed Connective Tissue Disease
What is the immunosuppressant treatment for dry eyes associated with Sjogren syndrome?
Topical Cyclosporine
What is the imaging study for suspected osteonecrosis if plain radiographs are normal?
MRI
What are four clinical features characteristic of reactive arthritis?
Asymmetric monoarthritis or oligoarthritis of the lower extremities, enthesopathy, dactylitis, and sacroiliitis
What condition is defined by flowing osteophytes involving contiguous vertebrae in the thoracic spine with preservation of disk space in the absence of inflammatory change?
Diffuse Idiopathic Skeletal Hyperostosis (DISH)
What are the two most common causes of death in patients with ESRD?
Cardiovascular disease and infection
What is an inflammatory myopathy characterized by insidious onset, slow progression, and weakness of both distal and proximal muscles?
Inclusion Body Myositis
What are four clinical features in patients with Raynaud phenomenon indicating and increased risk for developing an associated connective tissue disease?
Severe and prolonged episodes of vasospasm, asymmetric involvement of digits, abnormal nailfold capillary exam, and digital pitting
What is the recommended tx for patients with CKD and hyperphosphatemia after following low phosphate (renal) diet?
Oral Phosphate Binders
What acid-base disorder is associated with anxiety disorder and panic episodes
Respiratory alkalosis
What is the recommended treatment of acute ethylene glycol poisoning?
IV hydration, fomepizole (competes for EtOH dehydrogenase) and HD
What is the initial diagnostic study for evaluating possible diabetes insipidus?
Water Restriction test
What are three drugs that may be safely continued during pregnancy in women with SLE requiring immunosuppression?
Azathioprine, hydroxychloroquine, and prednisone
What is the most common cause of hyporesponsiveness to EPO in patients with CKD related anemia?
Iron deficiency
What is the recommended BP goal by JNC8 for pt aged 60 and over
Less than 150/90
What is the sequence of the two serologic tests for a diagnosis of Lyme arthritis?
ELISA followed by B. borgdurferii Western Blot
Increasing the dietary intake of this type of food may help decrease risk of gout flares?
Low-Fat dairy products
What is the diagnostic laboratory study for suspected granulomatosis with polyangiitis?
Antiproteinase 3 antibodies (C-ANCA)
What is the first line treatment of ankylosing spondylitis when NSAIDs are inadequate?
tumor necrosis factor alpha inhibitor therapy
What medication is indicated to lower serum urate levels in pt with gout who do not respond to xanthine oxidase inhibitors?
Pegloticase (this is infusional therapy)
What is the most common cardiac manifestation of rheumatoid arthritis?
Pericarditis
What are four potential causes of secondary membranous glomerulopathy?
Malginancies (solid organ), Autoimmune diseases (lupus or MCTD), HBV/HCV, and medications like Gold, NSAIDs and penicillamine
What urate-lowering agent is contraindicated in patients being treated with azathioprine?
Febuxostat (allpurinol requires dose reduction)
What is the agent used in tumor lysis syndrome to rapidly decrease serum urate levels?
Rasburicase (urate oxidase)
What is the initial therapy to rapidly lower serum potassium levels in severe hyperkalemia?
IV insulin and glucose
Three classes of antihypertensive medication that is ABSOLUTELY contraindicated in pregnancy
ACE, ARBs, and direct renin inhibitors (aliskerin)
