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ABIM > MKSAP15 > Flashcards

MKSAP15 Flashcards

1
Q

What can you say about white blood cell counts in septic arthritis of prosthetic joints?

A

Often times it is much lower than native joint and some say the cutoff leukocyte count should be as low as 1100 to call it septic arthritis

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2
Q

What is the most appropriate tx for pt with arthritis, conjunctivitis, urethritis and PCR + for C. trachomatis?

A

Azithromycin + NSAID (i.e. indomethacin); pustular skin lesions, if present = Keratoderma blenorrhagicum

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3
Q

Most appropriate test for a pt with a non-diminishing varicocele L sided

A

CT abdomen

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4
Q

What should be started while culture findings are pending in patients with suspected septic arthritis?

A

Empiric Vancomycin and CTX

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5
Q

What are Lofgren’s syndrome and Heerfordt’s syndrome?

A

Both are acute forms of sarcoidosis; Lofgren = ankle arthritis, erythema nodosum, and hilar LAD; Heerfordt’s = uveoparotid fever and CN VII palsy

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6
Q

What are some common manifestations of dermatomyositis aside from rash and muscle weakness? When do these tend to be present?

A

Arthritis and ILD (usually NSIP) and these are usually when there is an anti-synthetase syndrome (Ab against aminoacyl t-RNAs, Anti-Jo-1)

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7
Q

What is the first line tx for Raynaud phenomenon in pt with limited cutaneous systemic sclerosis

A

Amlodipine or nifedipine

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8
Q

This finding on a BAL specimen would clinch a diagnosis of Coccidiodes

A

Spherule

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9
Q

What is the most appropriate tx for idiopathic cutaneous small vessel vasculitis?

A

Prednisone

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10
Q

The cancer with which acanthosis nigricans is most associated is ______

A

Gastric CA

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11
Q

What are the crystals in Milwaukee Shoulder Syndrome made of?

A

Calcium Hydroxyapatite

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12
Q

Most likely diagnosis in a young smoker with occlusive arterial dz with limb loss

A

Thromboangiitis obliterans; Buergers disease

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13
Q

Preferred mgmt of pseudogout involving a single joint

A

Intraarticular glucocorticoid injection

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14
Q

What is the cause of meralgia parasthetica?

A

Entrapment of the lateral femoral cutaneous nerve at the inguinal ligament

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15
Q

Where is a Codman Triangle seen?

A

This is the periosteal reaction, “sunburst” pattern of osteosarcoma

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16
Q

SCC found in a cervical LN is __________ until proven otherwise; next steps?

A

Head and Neck CA; CT and “Triple Endoscopy” with laryngoscopy, endoscopy, and bronchoscopy

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17
Q

In a patient on steroids, when should you consider PCP ppx?

A

If on 20 mg or more of prednisone for more than 3 weeks; Tx is with one SS pill daily or a DS pill 3x weekly; same for AIDS

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18
Q

How can you use complement levels to help differentiate cryoglobulinemia from HSP?

A

Complement levels are often normal in HSP because IgA does not fix complement; cryoglobulinemia often has low complement levels and can be associated with HCV; also less likely to have abdominal pain seen in HSP bc cryo does not affect abdomen as much

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19
Q

A patient with a hx of oligoarticular juvenile idiopathic arthritis should be screened for what joint condition as an adult

A

TMJ arthritis

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20
Q

What is the most sensitive test for inflammatory sacroiliitis in a patient with Crohn dz

A

MRI of the sacroiliac joints

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21
Q

What tumor and tumor marker is associated with cryptorchidism?

A

Seminoma; B-HCG

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22
Q

What workup should be done for a pregnant patient with SLE with Anti-Ro antibodies?

A

Fetal cardiac US bc baby can have congenital heart block

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23
Q

What is the most appropriate test for a woman with an inflammed breast that has not responded to PO abx?

A

Biopsy as it is likely inflammatory breast CA

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24
Q

Explain the relationship between cyclosporine and gout

A

Cyclosporine commonly causes hyperuricemia and it also inhibits hepatic metabolism of colchicine

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25
Q

Cryoglobulins are immunoglobulins that precipitate out of serum at temps < ______. The infection MC assoc with Type II “Mixed” cryoglobulinemia is ______

A

37 C; HCV

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26
Q

The development of acute sarcoidosis with uveoparotid fever and CN VII palsy is ______

A

Heerfordts syndrome

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27
Q

What has fixed splitting of S2, a mitral regurgitation murmur and L axis deviation

A

Ostium primum ASD (MR due to mitral valve cleft)

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28
Q

A cutaneous nodule with a bruise-like appearance in a patient with previous hx of radiation to the area is suspicious for _________

A

Radiation-Associated Angiosarcoma

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29
Q

What disorder of the shoulder is associated with a large shoulder effusion, destructive arthritis, and calcium hydroxyapatite crystals?

A

Milwaukee Shoulder syndrome

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30
Q

What is also usually given to women who have brest conserving therapy for breast CA?

A

Adjuvant RT; if ER/PR positive then also add hormone therapy x10 years (tamoxifen if premenopasual, AI if not)

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31
Q

80% of patients with PSC also have this disease

A

Ulcerative Colitis so if PSC is dx’d they need to be screened for UC but the opposite is not true

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32
Q

Patients with HHV-8 seropositivity undergoing a solid organ transplantation have a high risk of ______

A

Kaposi Sarcoma (due to immunosuppression)

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33
Q

The presence of earlobe infarctions in a cocaine user should prompt you to think of ________

A

Cocaine-induced vasculitis due to levamisole (a veterinary antihelminthic agent); often strongly ANCA positive with BOTH anti-PR3 and anti-MPO

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34
Q

What is the best step in mgmt of a young woman with acute monoarticular arthritis that appears septic but whose gram stain is negative and there are no crystals?

A

Aside from empiric abx would check Nucleic Acid Amplification test for Gonorrhea (cervical or throat); can also test for Chlamydia to differentiate from reactive arthritis

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35
Q

The 3 markers of APS are ____________. What is an ulcerating skin rash seen in APS?

A

Anti-cardiolipin, Anti-Beta-2-glycoprotein, and Lupus anticoagulant (check 2x, 12 w apart); Occlusive vasculopathy (would not expect nodules as seen in PAN)

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36
Q

The triad of erythema nodosum, arthritis (often ankles), and hilar adenopathy is _________

A

Lofgren’s syndrome a form of acute sarcoid (don?t forget that acute sarcoid can have a fever)

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37
Q

In a pt with GCA the symptom most likely to portend blindness is ________

A

Amaurosis fugax

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38
Q

What can you say about vasoreactivity testing in patients with WHO 1 pulmonary HTN associated with a CTD (eg. SS w/ anti-centromere)?

A

While it is a WHO 1 group so you should do a vasoreactivity test to look for drop in MPAP or in pulmonary vascular resistance, there is a low likelihood of having a positive test in CTD related

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39
Q

Most appropriate test for a post-menopausal woman treated with tamoxifen who has irregular vaginal bleeding

A

Endometrial biopsy; in general post-meno women with irregular bleeding shoud get bx

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40
Q

Pain related to spondylolysis is worse in what position? What structure is affected?

A

Extension; pars interarticularis

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41
Q

Most important component of mgmt of hypercalcemia of malignancy

A

Aggressive IV hydration followed by an IV bisphosphonate

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42
Q

Granulomas in the skin and lungs without another explanation suggests this dx __________

A

Sarcoidosis

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43
Q

What often precedes the vasculitic phase of EGPA by several months to years? Greatest mortality in EGPA supposedly from ______

A

Asthma, allergic rhinitis and atopic symptoms almost always precede the vasculitic phase; cardiac involvment

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44
Q

Most likely dx in a pt with persistent fevers, organomegaly, arthritis, elevated transaminases, and a highly elevated ferritin level

A

Adult Onset Still Disease (Yamaguchi criteria); often with evanescent salmon colored rash

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45
Q

What are the ceruloplasmin levels and urinary copper levels in Wilson Dz?

A

Low ceruloplasmin and high urinary copper

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46
Q

Dyspnea and decreased exercise tolerance in systemic sclerosis is likely due to one of 2 things how would you differentiate? Abs assoc?

A

Pulmonary HTN (WHO 1, get vasoreactivity test) and this is more common with Anti-Centromere; or ILD usually NSIP pattern more with Anti-Scl70/Topoisomerase 1

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47
Q

Most likely cause of cutaneous vasculitis in pt who uses cocaine

A

Levamisole (a veterinary antihelminthic agent) often positive for BOTH anti-MPO and anti-PR3 and commonly causes earlobe infarctions

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48
Q

The general leukocyte cutoff at which a joint is considered likely to be septic is ________; notable exception?

A

Around 50,000; however, if it is a prosthetic joint the cutoff can be lower

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49
Q

How is EGPA different from a Hypereosinophilic Syndrome?

A

HES often has cardiac involvement, eosinophilic PNA (>25% eos on BAL, photographic neg of CHF) but EGPA often has hx of pre-existing asthma and atopy and can have neuropathy and often + ANCA (anti-MPO/ p-ANCA)

50
Q

This is the most likely dx in a young adult with a destructive bony lesion of the knee with a sunburst pattern on XR

A

Osteosarcoma; CT chest next to look for ; the periosteal reaction is called the “Codman Triangle”

51
Q

This is the tumor marker for yolk sac tumors

A

Alpha-fetoprotein (AFP)

52
Q

Which part of the cerebral circulation is the most commonly affected by Giant Cell Arteritis?

A

Vertebrobasilar circulation (but also get involvement of ophthalmic artery which is an anterior circulation artery)

53
Q

How is the sinus sx different in GPA vs. EGPA

A

GPA (anti-PR3/ C-ANCA) often has vasculitic destruction and bleeding whereas the sinus involvment in EGPA is more atopic so things like nasal polyps and allergic rhinitis

54
Q

What is the most likely Dx in an afebrile pt who presents with erythema and tenderness of the breast one month into the course of adjuvant RT for breast CA

A

Radiation-Induced Dermatitis

55
Q

What labs should be checked in a man with predominant osteoblastic mets and adenocarcinoma of unknown primary

A

PSA as it is likely prostate CA

56
Q

Violaceous lesions on the the face are _________ and pathognomonic for _________

A

Lupus pernia; sarcoidosis

57
Q

What type of glomerulonephritis is commonly associated with cryoglobulinemic vasculitis?

A

Membranoproliferative GN (recall: this is mixed cryo, type 2. polyclonal and monoclonal)

58
Q

Best mgmt of recurrent ganglion cyst on dorsal aspect of wrist with pain

A

Surgical Excision

59
Q

Chronic blood loss in scleroderma may be due to ________

A

GAVE as it is actually a manifestation of the vascular pathology (i.e. Telangiectasias)

60
Q

How can oral ulcerations and GI sx in a pt on MTX for DMARD tx for RA be managed?

A

First line would be folate supplementation but if truly cannot tolerate then may need to switch drugs

61
Q

Membranoproliferative Glomerulonephritis is commonly associated with this vasculitis

A

Cryoglobulinemic (Type 2 Mixed Cryoglobulinemia) often RF positive, assoc with HCV

62
Q

What is the best mgmt in suspected “preradiographic” axial spondyloarthritis

A

Would want to start NSAIDs and PT and continue to monitor for radiographic changes

63
Q

What would be the best test to order for a patient with systemic sclerosis, anti-Scl70 who has shortness of breath?

A

HRCT as they probably have ILD (often NSIP pattern); if anti-centromere more likely pulmonary HTN

64
Q

What is the most common pattern of ILD for ILD associated with a connective tissue disease? Exception?

A

Most CTDs have an NSIP pattern though they can have any that is the most common; RA on the other hand commonly causes a UIP pattern

65
Q

This is a common knee syndrome in athletes who complain of lateral knee pain that radiates to the thigh

A

Iliotibial band syndrome; often in runners on uneven terrain; + Noble test pain when extending knee from 90->30 degrees with pressure on lateral condyle

66
Q

A patient with RA being treated with infliximab who develops malar rash, serositis, and oral ulcers should raise suspicion for ___________

A

Drug induced lupus; check Anti-Histone (positive in >90% of cases)

67
Q

A person with APS who develops multiple thrombotic events in multiple organs despite AC likely has what?

A

Catastrophic APS- when person develops a TMA with APS; tx is AC and steroids along with either PLEX or IVIG

68
Q

What rheumatologic condition can Anti-TNF-A inhibitors potentially CAUSE

A

Drug-Induced Lupus (Anti-Histone); whereas DI-SLE usuallly does NOT cause nephritis, the SLE induced by TNFs can

69
Q

What needs to be checked for pt with gout of Thai or Han descent prior to starting allopurinol and why

A

HLA-B5801 allele as there is an increased risk for severe allergic rxn in these pts

70
Q

What is the most appropriate tx for a single brain met in NSCLC?

A

Stereotactic radiosurgery > resection; WBRT if multiple; IT chemo more for lymphomatous meningitis and leptomeningeal carcinomatosis

71
Q

Combination of malar rash, serositis, and arthralgia in a patient who just started taking chlorpromazine; tx?

A

Drug-induced Lupus (Anti-Histone); withdrawal of drug and if severe then steroid; also assoc: procainamide, hydralazine, minocycline, and TNF-A, as well as methyldopa

72
Q

How are the pulmonary-renal syndromes of SLE and anti-GBM different from ANCA vasculitis

A

SLE and anti-GBM would not affect upper airways and sinsuses; also ANCA vasculitis causes a pauci-immune GN whereas SLE would cause immune deposits (Type III hypersens) and GBM only affects lungs and kidneys and causes linear staining)

73
Q

What is Caplan Syndrome?

A

RA and coal workers pneumoconiosis

74
Q

What is Felty Syndrome? What hematologic malignancy is on the same spectrum?

A

RA, neutropenia, and splenomegaly; assoc with T cell LGL (but not NK cell LGL)

75
Q

What type of bladder CA is associated with exposure to aromatic amine dyes (B-napthylene)

A

Transitional Cell CA

76
Q

What is the most appropriate test to confirm a dx of HCC (i.e. seen on screening US)

A

Dyanamic Contrast-Enhanced MRI (or CT- 4 phase detector CT); often there is intense arterial enhancement with delayed washout in the venous phase; specific imaging findings can obviate need for Bx

77
Q

Which type of cryoglobulins are “mixed” and are monoclonal and polyclonal and associated with HCV?

A

Type II “mixed” cryoglobulinemia

78
Q

ANCA (p-ANCA/anti-MPO) tends to be positive in ______% of EGPA patients

A

Only 30-40% so need to go on clinical suspicion etc as well

79
Q

The combination of uveitis and a junctional rhythm should make one consider ______; tx?

A

Cardiac sarcodosis; steroids are the mainstay

80
Q

What diuretics can increase serum uric acid levels? Which can decrease?

A

Thiazides and Loops can increase; losartan can have uricosuric effects but unclear if it actually reduces gout flares

81
Q

This cytokine tends to be elevated in Castleman’s Disease

A

IL-6

82
Q

A patient with new onset RA is likely to have arthritis at which joints? Which joint can help differentiate RA from other diagnoses such as OA and psoriatic arthritis?

A

Mainly PIP, MCP and flexor tendons; the DIP is more commonly affected by OA, gout, and psoriatic arthritis

83
Q

What cause of septic arthritis will classically have a negative gram stain?

A

N. gonorrhea (gonococcal arthritis in disemminated gonoccocemia); why the dx requires clinical suspicion and the WBC count

84
Q

What severe pulmonary disorder can occur with EGFR inhibitors such as afatinib and gefitinib

A

Interstitial Lung Dz

85
Q

Recurrent episodes of inflammation involving ears, nose, respiratory tract and polyarthritis is characteristic of ___________

A

Relapsing polychondritis

86
Q

How would the presentation of IgG4 related cholangitis differ from PSC?

A

PSC would mostly just affect the liver whereas IgG4 disease would likely also affect the pancreas and possibly cause retroperitoneal fibrosis as well

87
Q

What is the appropriate mgmt of surgically excised LCIS

A

Should continue with annual diagnostic mammography as well as chemoprevention with tamoxifen (almost always ER+); tends to recur in ipsilateral or contralateral breast

88
Q

What are the 3 types of cryoglobulinemia?

A

Type I = MONOCLONAL immunoglobulins often d/t malignancy such as Waldenstroms and cause hyperviscosity syndrome; Type II = Mixed bc both polyclonal and monoclonal and most likely to cause vasculitis, HCV assoc; Type III is polyclonal and MC in CTDs and chronic infxn such as chronic osteo

89
Q

What is the most likely organism to cause acute olecranon bursitis?

A

MSSA

90
Q

Which type of cryoglobulins are monoclonal and most often seen in Waldenstroms where they can cause hyperviscosity and vasculitis?

A

Type I = monoclonal i.e. see ear infarctions etc in WM

91
Q

Absent or diminished pulses in a young woman with arm pain and elevated inflammatory markers

A

Takayasu arteritis

92
Q

What is the most appropriate agent to prevent recurrence of mild to moderate mucocutaneous Behcet dz

A

Colchicine

93
Q

Why is it important to start IV abx right away if you suspect septic arthritis?

A

Because it can be rapidly destructive to the joing and bc the person could develop sepsis etc.

94
Q

In patients with SLE the most common cause of symptomatic cardiac disease is _________

A

Pericardial effusions or pericarditis; however, they also have increased risk of accelerated coronary dz

95
Q

A unilateral, warm, swollen, and erythematous foot in a DM pt who is afebrile with a normal ESR is likely _________

A

Diabetic Neuropathic Arthropathy (often with pes planus) aka Charcot Foot

96
Q

Testing for what infection is important in Type II cryoglobulinemia?

A

HCV; Type II = mixed so see both polyclonal and monoclonal and often RF positivity; important to find the HCV bc tx of HCV helps tx the dz

97
Q

Explain how the renal involvment of PAN would be different from HSP

A

Both are vasculitides that can cause abdominal pain; HSP is IgA nephropathy and has normal compliment levels; PAN does not cause glomerulonephritis bc it is a medium vessel vasculitis but can cause renal artery aneursyms and renal dysfxn

98
Q

Best mgmt of enlarged lymph nodes in pt with Sjogren?

A

Excisonal bx as there is increased risk of DLBCL and marginal zone lymphoma

99
Q

Which types of cryoglobulins are polyclonal and often associated with CTDs and chronic infections?

A

Type III cryoglobulins

100
Q

This is the name of the criteria used to dx Adult Onset Still disease

A

Yamaguchi criteria

101
Q

Homonymous hemianopsia indicates a lesion __________ whereas bitemporal hemianopsia indicates one _________

A

Homonymous hemianopsia or quadrantanopsia is due to occipital lobe infarction whereas bitemporal hemianopsia is due to optic chiasm lesion

102
Q

This vasculitis is often ANCA positive and positive for BOTH anti-PR3 and anti-MPO

A

Cocaine-induced vasculitis due to levamisole (a veterinary antihelminthic agent); often causes earlobe infarctions (cryoglobulinemia does this too)

103
Q

How are initial attacs vs. recurrent attacks of gout different?

A

Tend to be monoarticular at first but later on can become polyarticular and involve the upper extremities

104
Q

Best additional workup of pt with sx of Raynaud phenomenon but no other signs or symptoms of systemic dz?

A

No additional workup; could tx with CCBs if ya want (if concern for other sx could do Anti-Scl70/topoisomerase 1 for Systemic Sclerosis; Anti-Centromere for LcSC)

105
Q

How does Wilson disease tend to present in young patients? Old patients?

A

Young people can have acute liver failure and it can induce a hemolytic anemia; older patients tend to have more chronic liver dz and parkinsonian sx

106
Q

This is the most appropriate tx to relieve sx of diarrhea and flushing associated with carcinoid syndrome while also controlling tumor growth

A

Octreotide

107
Q

What is Catastrophic Antiphospholipid Syndrome? What is the mainstay of tx?

A

When a pt with APS develops a thrombotic microangiopathy; Tx is with anticoagulation AND glucocorticoids and EITHER PLEX or IVIG; the presentation is often multiple thrombotic events in multiple organs despite AC

108
Q

Tx of choice for advanced or inoperable GIST

A

Imatinib (C-Kit is the activating mutation here)

109
Q

What antibodies are associated with paraneoplastic sensory neuropathy and encephalomyelitis

A

Anti-Hu (often SCLC)

110
Q

What are some cancers that people with Von-Hippel Lindau are at risk for?

A

RCC (clear cell), pheochromocytoma, and CNS hemangioblastoma

111
Q

What is the common histopathologic pattern of ILD associated with Sjogren syndrome?

A

While most CTDs cause NSIP; Sjogren tends to cause LIP

112
Q

MC AE of bevacizumab

A

Hemorrhage (i.e. pulmonary hemorrhage) but also nephrotic syndrome and elevated BP, poor wound healing

113
Q

This zoonotic disease can cause bloody “lakes” in the liver known as hepatis peliosis

A

Bartonella henselae

114
Q

Differentiate the arthritis of RA vs. SLE

A

RA is erosive and commonly affects MCPs, PIPs; SLE causes Jaccoud arthropathy which is nonerosive and causes reversible deformities

115
Q

Patients receiving ADT for prostate CA should be monitored for this endocrine side effect?

A

Osteopenia; get DEXA at Dx

116
Q

What is the difference between Lofgren’s syndrome and Loffler’s syndrome? Loeffler endocarditis?

A

Lofgren’s is a form of acute sarcoidosis with erythema nodosum, hilar LAD, and arthritis; Loffler syndrome is a pulmonary infiltration of eosinophils in response to a parasite; Loeffler endocarditis is a restrictive CMO with infiltration of eosinophils (aka eosinophilic myocarditis)

117
Q

How should lupus nephritis be treated?

A

With steroids and one of the 2 first line immunosuppresants = either MMF or Cyclophosphamide

118
Q

What kind of gout is precipitated by lead toxicity?

A

Saturnine gout

119
Q

What is the maximum dose of MTX for RA? What do you do if pt is still symptomatic on this dose?

A

25 mg qWeekly (often with folate supplement); ADD a TNF-alpha inhibitor (watch for drug induced lupus)

120
Q

How is the presentation of HSP different from PAN?

A

Both are small vessel vasculitides; HSP often follows a URI whereas PAN often has association with HBV; both can affect the abdomen though PAN prob has lots of aneurysms; additionally the skin lesions in PAN are often livedo reticularis or racemosa and there are DEEP CUTANEOUS ULCERS OR NODULES that are not seen in HSP

ABIM (18 decks)

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