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

MTB 2 CK - Rheumatology Flashcards

1
Q

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

A

Composition of Tophi

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2
Q

Arthrocentesis (esp. to rule out infectious pathology)

A

Most accurate diagnostic test for gout

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3
Q

Acetaminophen (if not controlled, use NSAIDs like aspirin)

A

Best initial treatment for Osteoarthritis

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4
Q

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

A

Corticosteroid role in management of gout

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5
Q

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

A

Colchicine role in management of Gout

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6
Q

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

A

Allopurinol role in management of gout

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7
Q

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

A

Probenecid role in management of gout

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8
Q

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

A

Rx for Hypertension in gout patient

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9
Q

Diarrhea, Neutropenia

A

Colchicine toxicity

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10
Q

Stevens-Johnson rash&raquo_space; Toxic epidermal necrolysis

A

Allopurinol major toxicity

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11
Q

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

A

Risk factors for Pseudogout

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12
Q

CPPD disease (rhomboid shaped crystals)

A

Athrocentesis revealing positively birefringent crystals in ________________ disease

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13
Q

Gout (needle shaped crystals)

A

Athrocentesis revealing negatively birifringent crystals in _______________ disease

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14
Q

Aspirin (NOT Acetaminophen -its inflammatory disease)

A

Best initial drug for CPPD disease

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15
Q

Dissolves uric acid (useful in gout)

A

Pegloticase mechanism of action

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16
Q

S aurues epidural abscess

A

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

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17
Q

Suspect cord compression (neurologic emergency)

A

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

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18
Q

Point tenderness over vertebra

A

Sensitive Clinical sign of Cord compression

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19
Q

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

A

Pain upon Straight leg raise clinical significance

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20
Q

Disk herniation excluded -high sensitivity (negative PPV)

A

No pain upon straight leg raise clinical significance

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21
Q

L5

A

Dorsiflexion of toe affected in ___________ nerve root compression

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22
Q

L4

A

Dorsiflexion of foot affected in ____________ nerve root compression

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23
Q

S1

A

Eversion of foot affected in ______________ nerve root compression

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24
Q

Do not image (unless serious pathology suspected)

A

Best initial test for uncomplicated back pain

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25
Q

CXR

A

Best initial test for back pain with compression or infection suspected

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26
Q

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

A

Most accurate test for back pain with compression or infection suspected

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27
Q

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

A

MRI indications in case of pain upon straight leg raise

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28
Q

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

A

Rx for Cord compression

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29
Q

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

A

Initial treatment for Epidural abscess

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30
Q

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

A

Treatment for Disk herniation

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31
Q

PAD (vascular studies and physical findings are normal)

A

Important diseases to rule out in suspected spinal stenosis

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32
Q

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

A

Spinal Stenosis clinical picture

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33
Q

MRI

A

Most accurate test to diagnose Spinal Stenosis

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34
Q

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

A

Spinal Stenosis Management

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35
Q

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

A

Fibromyalgia clinical picture

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36
Q

amitriptyline and Milnacipran (SNRI specifically for Fibromyalgia)

A

Best initial treatment for Fibromyalgia

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37
Q

Pregnancy, Diabetes, RA, Acromegaly, Amyloidosis, Hypothyroidism

A

Systemic disease that can cause Carpal Tunnel Syndrome

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38
Q

Electomyography, Nerve Conduction Testing

A

Most accurate diagnostic test for Carpal Tunnel Syndrome

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39
Q

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

A

Best initial therapy for Carpal Tunnel Syndrome

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40
Q

NSAIDs, rest and physical therapy

A

Best initial therapy for Rotator Cuff tear

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41
Q

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

A

Surgery indications for rotator cuff tears

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42
Q

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

A

Patellofemoral Syndrome clinical picture

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43
Q

Trauma, imbalance of quadriceps strength, meniscal tear

A

Causes of Patellofemoral Syndrome

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44
Q

NO indication (nothing to fix)

A

Surgical indications of Patellofemoral syndrome

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45
Q

Plantar fasciitis (tarsal tunnel pain worsens)

A

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

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46
Q

Very severe pain at the calcaneus with point tenderness

A

Plantar fasciitis clinical picture

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47
Q

Collagenase injection, Triamcinolone

A

Rx for Dupuytren Contracture

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48
Q

RA

A

Episcleritis is a feature of _____________ chronic inflammatory disease

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49
Q

C1 and C2 (leading to subluxation)

A

Vertebral joint commonly affected in RA

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50
Q

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

A

Factors for point-based diagnoses of RA

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51
Q

Coronary artery disease (due to vasculitis)

A

Most common cause of death due to RA

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52
Q

Felty Syndrome

A

RA with splenomegaly and neutropenia in _____________ syndrome

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53
Q

Caplan Syndrome

A

RA with pneumoconiosis and lung nodules in _______________ syndrome

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54
Q

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

A

Methotrexate indications in RA

55
Q

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

A

TNF-inhibitors indications in RA

56
Q

PPD skin test

A

Labs to accompany TNF-inhibitor therapy

57
Q

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

A

Steroids indications in RA

58
Q

Lung, LIver and marrow toxicity

A

MTX major toxicity

59
Q

Retinal damage (do dilated eye exam)

A

Hydroxychloroquine major toxicity

60
Q

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

A

Rituximab major toxicity

61
Q

JRA (joint symptoms are relatively mild)

A

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

62
Q

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

A

Immunologic labs that form SLE diagnostic criteria

63
Q

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

A

Xray findings in SLE arthritis

64
Q

ANA (sensitive -negatives are not false )

A

Diagnostic test for SLE with high NPV

65
Q

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

A

Diagnostic test for SLE with high PPV

66
Q

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

A

Complement levels in SLE

67
Q

Dec. complement, rise in Anti -dsDNA

A

Acute SLE flareup diagnostic labs

68
Q

mildly chronic disease limited to skin and joint

A

Hydroxychloroquine indications for SLE

69
Q

Bolus prep used in acute flare ups, Nephrotic disease

A

Steroids indication in SLE

70
Q

Belimumab

A

SLE drug that controls progression

71
Q

Steroids, alone or in combination with Cyclophosphamide and Mycophenolate

A

Rx for Lupus nephritis

72
Q

Lupus anticoagulant and Anticardiolipin antibodies

A

2 main types of anti-phospholipid antibodies

73
Q

high APTT, normal PT, normal INR

A

Clotting profile in Antiphospholipid syndrome

74
Q

Anti-cardiolipin

A

_________________ antibodies are associated with spontaneous abortion in Antiphospholipid sydnrome

75
Q

Lupus anticoagulant

A

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

76
Q

Mixing studies

A

Best initial test for Antiphospholipid syndrome with clotting abnormality

77
Q

Russel viper venom test (RVVT) prolonged

A

Most specific test for lupus anticoagulant

78
Q

Cannot stop an imminent abortion; heparin and aspirin for recurrence

A

Rx for abortion due to Antiphospholipid syndrome

79
Q

Large-mouthed diverticuli

A

Intestinal manifestations of Systemic sclerosis

80
Q

Sudden hypertensive crisis

A

Renal manifestations of systemic sclerosis

81
Q

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

A

Role of anti-Scl70 positivity in systemic sclerosis diagnostics

82
Q

ANA (high NPV but non specific)

A

Most sensitive test for Systemic sclerosis

83
Q

Dermatomyositis (of ovary, lung, GI and Lymphoma)

A

_______________ (Dermatomyositis/polymyositis) is associated with cancer

84
Q

CPK and aldolase

A

Best initial test for Dermatomyositis/polymyositis

85
Q

Often associated with lung fibrosis

A

Anti-Jo antibody positivity clinical significance

86
Q

Primary biliary cirrhosis

A

Hepatobilliary condition associated with Sjogren’s

87
Q

Lymphoma (up to 10%)

A

Most dangerous complication of Sjogren’s

88
Q

Schirmer test (filter paper against the eye)

A

Best initial test for Sjogren’s

89
Q

Lip or parotid gland biopsy showing lymphoid infiltration

A

Most accurate test for Sjogren’s

90
Q

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

A

Best initial blood test for Sjogren’s

91
Q

NO findings (always spares the lungs)

A

PFT findings in PAN

92
Q

Foot drop (also stroke in a young person)

A

Most common neurologic abnormality in PAN

93
Q

Biopsy of symptomatic site

A

Most accurate test for PAN

94
Q

Beading/abnormal dilation of renal, mesenteric or hepatic artery

A

Angiography findings in PAN

95
Q

Normal CPK and aldolase in PMR

A

Test to differentiate polymyositis/dermatomyositis from Polymyalgia rheumatica

96
Q

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

A

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

97
Q

Unresolving pneumonia not better with Antibiotics

A

Clinical picture of Wegener’s lung involvement

98
Q

Churg Struass Syndrome (also has asthma)

A

Eosinophillia is most strongly associated with _______________ vasculitis

99
Q

Leukocytoclastic vasculitis

A

Biopsy findings in HSP

100
Q

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

A

Lab findings to diagnose HSP

101
Q

Cryoglobulins (Cryoglobunemia)

A

chronic HCV infection is associated with increased _________ Ig levels

102
Q

Joint pain, Glomerulonephritis, Purpuric lesions, neuropathy

A

Cryoglobulinemia clinical findings

103
Q

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

A

Rx for Cryoglobulinemia

104
Q

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

A

IgM associated with EBV infection

105
Q

Pathergy -Sterile skin pustules from minor trauma (needlestick)

A

Characterstic Behcet Syndrome skin lesions

106
Q

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

A

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

107
Q

Men

A

Characteristic clinical picture of seronegative spondyloarthropathy

108
Q

Early Ankylosing Spondylitis

A

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

109
Q

Xray of Sacroiliac joint showing space narrowing

A

Best initial test for Ankylosing spondylitis

110
Q

MRI

A

Most accurate test for ankylosing spondilitis

111
Q

Ankylosing spondylitis (causing bamboo spine)

A

Bridging syndesmophytes over vertebral bodies seen in ________________ disease

112
Q

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

A

Findings in psoriatic arthritis

113
Q

Xray of DIP

A

Best initial test for psoriatic arthritis

114
Q

NSAIDs&raquo_space; MTX&raquo_space; Anti-TNF

A

Rx Treatment order for Psoriatic arthritis

115
Q

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

A

Best initial test for Reactive arthritis

116
Q

Bone Densitometry (DEXA)

A

Most Accurate test for Osteoporosis

117
Q

T-score between 1 to 2.5 SD lower than normal

A

Osteopenia diagnostic criteria

118
Q

T-score below 2.5 SD lower than normal

A

Osteoporosis diagnostic criteria

119
Q

Prosthetic joint > RA > OA

A

Risk factors for Septic arthritis

120
Q

Ceftriaxone and Vancomycin

A

Best Initial therapy for Septic arthritis

121
Q

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

A

Therapy for Septic arthritis with culture showing S aureus

122
Q

Removal first, Antibiotic for 6-8 wks, replacement

A

Management of Infected prosthetic joints

123
Q

Accompanied by rash and tenosynovitis, and with polyarticular involvement

A

Distinct presentation of arthritis caused by Gonorrhea

124
Q

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

A

Gonococcal arthritis diagnostics

125
Q

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

A

Rx for Gonococcal arthritis

126
Q

Complement levels for MAC

A

Lab diagnostics for recurrent gonorrhea

127
Q

Vascular insufficiency, DM, SCD (Salmonella)

A

Risk factors for Osteomyelitis

128
Q

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

A

Route of infection to bone is most commonly __________________ in adults

129
Q

Hematogenous

A

Route of infection is most commonly _______________ in adults

130
Q

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

A

Clinical picture of Osteomyelitis

131
Q

X ray; if normal, MRI

A

Best initial test for Osteomyelitis

132
Q

Biopsy (also imp. to know sensitivity)

A

Most accurate test for osteomyelitis

133
Q

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

A

Emperic therapy for osteomyelitis

MTB STEP 2 (R) (12 decks)

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