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MTB STEP 3 (R) > MTB 2 CK - Rheumatology > Flashcards

MTB 2 CK - Rheumatology Flashcards

1
Q

Composition of Tophi

A

Deposits of urate crystals with foreign body reaction. From longstanding gout

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2
Q

Most accurate diagnostic test for gout

A

Arthrocentesis (esp. to rule out infectious pathology)

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3
Q

Best initial treatment for Osteoarthritis

A

Acetaminophen (if not controlled, use NSAIDs like aspirin)

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4
Q

Corticosteroid role in management of gout

A

Used in Acute attack in pts. resistant to NSAIDs or those with c/i to NSAIDs (renal insufficiency)

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5
Q

Colchicine role in management of Gout

A

Used in patients with c/i to both NSAIDs and Steroids in acute attack; Chronic management to prevent second attack

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6
Q

Allopurinol role in management of gout

A

Used for chronic management (Febuxostat also acts via xanthine oxidase inhibition)

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7
Q

Probenecid role in management of gout

A

Rarely used in chronic management (inc. secretion in kidneys)

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8
Q

Rx for Hypertension in gout patient

A

Losartan (ARB) -also lowers uric acid; STOP thiazides

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9
Q

Colchicine toxicity

A

Diarrhea, Neutropenia

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10
Q

Allopurinol major toxicity

A

Stevens-Johnson rash&raquo_space; Toxic epidermal necrolysis

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11
Q

Risk factors for Pseudogout

A

Hemochromatosis and HyperPTHism; minor: DM, Hypothyroidism, Wilson’s (calcium salts deposition in articular cartilage)

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12
Q

Athrocentesis revealing positively birefringent crystals in ________________ disease

A

CPPD disease (rhomboid shaped crystals)

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13
Q

Athrocentesis revealing negatively birifringent crystals in _______________ disease

A

Gout (needle shaped crystals)

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14
Q

Best initial drug for CPPD disease

A

Aspirin (NOT Acetaminophen -its inflammatory disease)

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15
Q

Pegloticase mechanism of action

A

Dissolves uric acid (useful in gout)

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16
Q

Signs of Cord compression with high fever and elevated ESR in _____________ pathology

A

S aurues epidural abscess

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17
Q

Management of Pt. with a hx of cancer presenting with sudden onset neurologic deficit (sensory level)

A

Suspect cord compression (neurologic emergency)

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18
Q

Sensitive Clinical sign of Cord compression

A

Point tenderness over vertebra

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19
Q

Pain upon Straight leg raise clinical significance

A

disk herniation -50% chance only (can be present for other reasons too)

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20
Q

No pain upon straight leg raise clinical significance

A

Disk herniation excluded -high sensitivity (negative PPV)

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21
Q

Dorsiflexion of toe affected in ___________ nerve root compression

A

L5

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22
Q

Dorsiflexion of foot affected in ____________ nerve root compression

A

L4

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23
Q

Eversion of foot affected in ______________ nerve root compression

A

S1

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24
Q

Best initial test for uncomplicated back pain

A

Do not image (unless serious pathology suspected)

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25
Q

Best initial test for back pain with compression or infection suspected

A

CXR

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26
Q

Most accurate test for back pain with compression or infection suspected

A

MRI (do CT myelogram if MRI is contraindicated -pacemaker)

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27
Q

MRI indications in case of pain upon straight leg raise

A

Do MRI if accompanied by neuro deficits (isolated SLT pain is 50% of times not herniation)

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28
Q

Rx for Cord compression

A

Steroids for decompression; chemo/radiation for tumor -surgical decompression if fails

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29
Q

Initial treatment for Epidural abscess

A

Steroids to control acute neurologic deficits, Vancomycin/Linezolid until sensitivity is found; then switch to oxacillin/nafcillin + Gentamicin&raquo_space; surgical drainage if resistant

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30
Q

Treatment for Disk herniation

A

NSAIDs with ordinary mobility&raquo_space; Steroid injection (resistant)&raquo_space; Surgery (rarely needed)

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31
Q

Important diseases to rule out in suspected spinal stenosis

A

PAD (vascular studies and physical findings are normal)

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32
Q

Spinal Stenosis clinical picture

A

Person > 60yrs, pain while walking radiating to buttocks and thighs b/l, worse on extending back/walking downhill, relieve in cycling/bending

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33
Q

Most accurate test to diagnose Spinal Stenosis

A

MRI

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34
Q

Spinal Stenosis Management

A

Weight loss, pain meds, Steroid injections, PT/exercise&raquo_space; Surgical dilation of spinal canal in 75%

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35
Q

Fibromyalgia clinical picture

A

Young woman, chronic generalized MS pain and tenderness with trigger points

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36
Q

Best initial treatment for Fibromyalgia

A

amitriptyline and Milnacipran (SNRI specifically for Fibromyalgia)

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37
Q

Systemic disease that can cause Carpal Tunnel Syndrome

A

Pregnancy, Diabetes, RA, Acromegaly, Amyloidosis, Hypothyroidism

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38
Q

Most accurate diagnostic test for Carpal Tunnel Syndrome

A

Electomyography, Nerve Conduction Testing

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39
Q

Best initial therapy for Carpal Tunnel Syndrome

A

Wrist splints, avoidance&raquo_space; Steroid injections and surgically cutting the flexor retinaculum in resistant cases

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40
Q

Best initial therapy for Rotator Cuff tear

A

NSAIDs, rest and physical therapy

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41
Q

Surgery indications for rotator cuff tears

A

Complete tear, failure to respond to NSAIDs, steroids and physical therapy

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42
Q

Patellofemoral Syndrome clinical picture

A

Anterior knee pain at patella that is worse just after starting to walk after prolonged sitting

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43
Q

Causes of Patellofemoral Syndrome

A

Trauma, imbalance of quadriceps strength, meniscal tear

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44
Q

Surgical indications of Patellofemoral syndrome

A

NO indication (nothing to fix)

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45
Q

Pain of _________________ (Tarsal tunnel syndrome/Plantar Fasciitis) improves with use

A

Plantar fasciitis (tarsal tunnel pain worsens)

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46
Q

Plantar fasciitis clinical picture

A

Very severe pain at the calcaneus with point tenderness

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47
Q

Rx for Dupuytren Contracture

A

Collagenase injection, Triamcinolone

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48
Q

Episcleritis is a feature of _____________ chronic inflammatory disease

A

RA

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49
Q

Vertebral joint commonly affected in RA

A

C1 and C2 (leading to subluxation)

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50
Q

Factors for point-based diagnoses of RA

A

Joint involvement (up to 5), ESR/CRP (1), >6 wks (1), RF/CCP (1) (6 points = RA)

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51
Q

Most common cause of death due to RA

A

Coronary artery disease (due to vasculitis)

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52
Q

RA with splenomegaly and neutropenia in _____________ syndrome

A

Felty Syndrome

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53
Q

RA with pneumoconiosis and lung nodules in _______________ syndrome

A

Caplan Syndrome

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54
Q

Methotrexate indications in RA

A

Erosive disease (joint space narrowing, physical deformities, X ray abnormalities)

55
Q

TNF-inhibitors indications in RA

A

As a combination with MTX as initial DMARDS, Disease unresponsive to MTX

56
Q

Labs to accompany TNF-inhibitor therapy

A

PPD skin test

57
Q

Steroids indications in RA

A

When NSAIDs do not control symptoms; while DMARDs take effect (Steroids do not halt progression)

58
Q

MTX major toxicity

A

Lung, LIver and marrow toxicity

59
Q

Hydroxychloroquine major toxicity

A

Retinal damage (do dilated eye exam)

60
Q

Rituximab major toxicity

A

Infection (anti-CD20 antibody -useful in Hodgkins and in RA)

61
Q

High fever of unknown origin in a young person accompanied with salmon colored truncal rash. Likely diagnoses is ______________

A

JRA (joint symptoms are relatively mild)

62
Q

Immunologic labs that form SLE diagnostic criteria

A

Positive ANA, or any of: Anti-dsDNA, Anti-Sm, VDRL, Positive LE cell prep)

63
Q

Xray findings in SLE arthritis

A

None (no deformation -just pain brings pt. to physician)

64
Q

Diagnostic test for SLE with high NPV

A

ANA (sensitive -negatives are not false )

65
Q

Diagnostic test for SLE with high PPV

A

Anti-dsDNA, Anti-Sm (specific -positives are not false)

66
Q

Complement levels in SLE

A

Correlate with disease activity (drop with exacerbations); Dec. C3

67
Q

Acute SLE flareup diagnostic labs

A

Dec. complement, rise in Anti -dsDNA

68
Q

Hydroxychloroquine indications for SLE

A

mildly chronic disease limited to skin and joint

69
Q

Steroids indication in SLE

A

Bolus prep used in acute flare ups, Nephrotic disease

70
Q

SLE drug that controls progression

A

Belimumab

71
Q

Rx for Lupus nephritis

A

Steroids, alone or in combination with Cyclophosphamide and Mycophenolate

72
Q

2 main types of anti-phospholipid antibodies

A

Lupus anticoagulant and Anticardiolipin antibodies

73
Q

Clotting profile in Antiphospholipid syndrome

A

high APTT, normal PT, normal INR

74
Q

_________________ antibodies are associated with spontaneous abortion in Antiphospholipid sydnrome

A

Anti-cardiolipin

75
Q

_________________ antibodies are associated with arterial/venous thromboses in Antiphospholipid sydnrome

A

Lupus anticoagulant

76
Q

Best initial test for Antiphospholipid syndrome with clotting abnormality

A

Mixing studies

77
Q

Most specific test for lupus anticoagulant

A

Russel viper venom test (RVVT) prolonged

78
Q

Rx for abortion due to Antiphospholipid syndrome

A

Cannot stop an imminent abortion; heparin and aspirin for recurrence

79
Q

Intestinal manifestations of Systemic sclerosis

A

Large-mouthed diverticuli

80
Q

Renal manifestations of systemic sclerosis

A

Sudden hypertensive crisis

81
Q

Role of anti-Scl70 positivity in systemic sclerosis diagnostics

A

high PPV (specific but not sensitive -present only in 30%)

82
Q

Most sensitive test for Systemic sclerosis

A

ANA (high NPV but non specific)

83
Q

_______________ (Dermatomyositis/polymyositis) is associated with cancer

A

Dermatomyositis (of ovary, lung, GI and Lymphoma)

84
Q

Best initial test for Dermatomyositis/polymyositis

A

CPK and aldolase

85
Q

Anti-Jo antibody positivity clinical significance

A

Often associated with lung fibrosis

86
Q

Hepatobilliary condition associated with Sjogren’s

A

Primary biliary cirrhosis

87
Q

Most dangerous complication of Sjogren’s

A

Lymphoma (up to 10%)

88
Q

Best initial test for Sjogren’s

A

Schirmer test (filter paper against the eye)

89
Q

Most accurate test for Sjogren’s

A

Lip or parotid gland biopsy showing lymphoid infiltration

90
Q

Best initial blood test for Sjogren’s

A

SS-A and SS-B (also present in SLE -sensitivity also only 65%)

91
Q

PFT findings in PAN

A

NO findings (always spares the lungs)

92
Q

Most common neurologic abnormality in PAN

A

Foot drop (also stroke in a young person)

93
Q

Most accurate test for PAN

A

Biopsy of symptomatic site

94
Q

Angiography findings in PAN

A

Beading/abnormal dilation of renal, mesenteric or hepatic artery

95
Q

Test to differentiate polymyositis/dermatomyositis from Polymyalgia rheumatica

A

Normal CPK and aldolase in PMR

96
Q

Wegener’s is associated with positive _________________ (Anti-proteinase-3 Ab/Anti-myeloperoxidase Ab)

A

Anti-proteinase-3 (c-ANCA; Anti-myeloperoxidase associated with Churg Strauss)

97
Q

Clinical picture of Wegener’s lung involvement

A

Unresolving pneumonia not better with Antibiotics

98
Q

Eosinophillia is most strongly associated with _______________ vasculitis

A

Churg Struass Syndrome (also has asthma)

99
Q

Biopsy findings in HSP

A

Leukocytoclastic vasculitis

100
Q

Lab findings to diagnose HSP

A

None (IgA levels not reliable) -clinical diagnoses + biopsy

101
Q

chronic HCV infection is associated with increased _________ Ig levels

A

Cryoglobulins (Cryoglobunemia)

102
Q

Cryoglobulinemia clinical findings

A

Joint pain, Glomerulonephritis, Purpuric lesions, neuropathy

103
Q

Rx for Cryoglobulinemia

A

Treat underlying HCV with interferon/Ribavirin (steroids NOT effective)

104
Q

IgM associated with EBV infection

A

Cold Agglutinins (cause hemolytic anemia in EBV, mycoplasma, lymphoma)

105
Q

Characterstic Behcet Syndrome skin lesions

A

Pathergy -Sterile skin pustules from minor trauma (needlestick)

106
Q

Oral and Genital ulcers; Erythema nodosum like lesions on the skin. Likely diagnoses

A

Behcet Syndrome (also can have ocular, joint and CNS lesions)

107
Q

Characteristic clinical picture of seronegative spondyloarthropathy

A

Men

108
Q

Backache and stiffness in young man that improves with activity and worsens with rest. Likely diagnoses

A

Early Ankylosing Spondylitis

109
Q

Best initial test for Ankylosing spondylitis

A

Xray of Sacroiliac joint showing space narrowing

110
Q

Most accurate test for ankylosing spondilitis

A

MRI

111
Q

Bridging syndesmophytes over vertebral bodies seen in ________________ disease

A

Ankylosing spondylitis (causing bamboo spine)

112
Q

Findings in psoriatic arthritis

A

Sausage digits (from enthesopathy), Nail pitting, Xray showing pencil-in-a-cup deformity of DIP

113
Q

Best initial test for psoriatic arthritis

A

Xray of DIP

114
Q

Rx Treatment order for Psoriatic arthritis

A

NSAIDs&raquo_space; MTX&raquo_space; Anti-TNF

115
Q

Best initial test for Reactive arthritis

A

No specific test. Rule out Reactive arthritis and look for underlying cause (IBS, Chlamydia infection, GI infection)

116
Q

Most Accurate test for Osteoporosis

A

Bone Densitometry (DEXA)

117
Q

Osteopenia diagnostic criteria

A

T-score between 1 to 2.5 SD lower than normal

118
Q

Osteoporosis diagnostic criteria

A

T-score below 2.5 SD lower than normal

119
Q

Risk factors for Septic arthritis

A

Prosthetic joint > RA > OA

120
Q

Best Initial therapy for Septic arthritis

A

Ceftriaxone and Vancomycin

121
Q

Therapy for Septic arthritis with culture showing S aureus

A

Oxacillin, Nafcillin (beta-lactam sensitive), Linezolid, Daptomycin (resistant)

122
Q

Management of Infected prosthetic joints

A

Removal first, Antibiotic for 6-8 wks, replacement

123
Q

Distinct presentation of arthritis caused by Gonorrhea

A

Accompanied by rash and tenosynovitis, and with polyarticular involvement

124
Q

Gonococcal arthritis diagnostics

A

Culture multiple sites -pharynx, rectum, urethra, cervix as well as joint and blood

125
Q

Rx for Gonococcal arthritis

A

Third gen cephalosporin (ceftriaxone, cefotaxime, ceftizoxime); Fluroquinolones if determined sensitive

126
Q

Lab diagnostics for recurrent gonorrhea

A

Complement levels for MAC

127
Q

Risk factors for Osteomyelitis

A

Vascular insufficiency, DM, SCD (Salmonella)

128
Q

Route of infection to bone is most commonly __________________ in adults

A

Contiguous (from nearby foot ucler in DM, for eg)

129
Q

Route of infection is most commonly _______________ in adults

A

Hematogenous

130
Q

Clinical picture of Osteomyelitis

A

Warmth, redness and swelling in the area that takes weeks to develop, with/without draining ulcer

131
Q

Best initial test for Osteomyelitis

A

X ray; if normal, MRI

132
Q

Most accurate test for osteomyelitis

A

Biopsy (also imp. to know sensitivity)

133
Q

Emperic therapy for osteomyelitis

A

None (obtain culture on biopsy first and treat acc. to sensitivity -takes wks. to develop)

MTB STEP 3 (R) (9 decks)

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