MTB

Question 1

Rheumatoid Arthritis Marker that has high specificity and good for early diagnosis

Answer 1

Anti-CCP

Anticitrulline-containing protein IgM Abs

Question 2

MTX

Answer 2

First line DMARD RA Tx; slows dz progression

Question 3

Infliximab

Answer 3

RA tx: First line DMARD NOT responding to MTX

Question 4

Rituximab

Answer 4

Resistant cases of RA

Question 5

RA pt with occipital HAs and UE tingling and numbness

Answer 5

Atlantoaxial subluxation - excessive movement at jnc of C1 (atlas) and C2 (axis) and pannus formation at synovial joints

Question 6

RA with swollen painful calf

Answer 6

Baker cyst rupture, mimicking DVT

Question 7

Hydroxychloroquine

Answer 7

DMARD for Mild Dz monotherapy

Question 8

RA Presentation

Answer 8

BL, symmetric joints involved - PIP and MCP (no DIP) - hands, wrists, knees, ankles

Question 9

Felty sydrome

Answer 9

RA + splenomegaly + neutropenia

Question 10

Caplan syndrome

Answer 10

RA and Pneumoconiosis, lung nodules

Question 11

MCC death in RA

Answer 11

Coronary Artery Dz

Question 12

Sulfasalazine

Answer 12

DMARD added to MTX if anti-TNF agents ineffective

Question 13

Symptom control for pain in RA

Answer 13

NSAIDS: best initial therapy for pain control

Question 14

Gold Salts

Answer 14

RA tx

Question 15

Renal Dz in SLE

Answer 15

MC Glomerulonephritis - Membranous seen in severe dz

Question 16

SLE Ocular findings

Answer 16

Photophobia, photosensitivity, blindness, retinal lesions -cotton wool spots = fluffy white patches ass’d w/ischemia causing nerve fiber damage.

Question 17

Cotton Wool spots

Answer 17

fluffy white patches ass’d w/ischemia causing nerve fiber damage.

Question 18

Complement levels affected in SLE

Answer 18

C3 and C4 Decreased = correlate with dz activity

Question 19

SLE Pregnancy Screen

Answer 19

Screen all for SSA/anti-Ro abs - cross placenta, passively transferred to fetus - cause neonatal lupus and heart block

Question 20

Markers in SLE flare up

Answer 20

Low complement levels

Question 21

SLE flare up tx

Answer 21

Steroids

Question 22

Death in SLE in young patients

Answer 22

Young pts: Infxn

Question 23

SLE Tx

Answer 23

Sx control
Avoid sunlight
NSAIDs
Hydroxychloroquine
Corticosteroids
Anticoagulate PRN

Question 24

Causes of Drug induced Lupus

Answer 24

Hydralazine, INH, Phenytoin, Procainamide, Quinidine

Question 25

Antiphospholipid syndrome

Answer 25

Majority NOT ass'd with SLE

Question 26

Abs to Scl-70 are what?

Answer 26

Anti-DNA topoisomerase 1 abs

Question 27

Best initial test for Antiphospholipid syndrome

Answer 27

Mixing study: mix patient's plasma w/ equal amt normal plasma.

Question 28

Most specific test for Lupus anticoagulant

Answer 28

Russel viper venom test (RVVT) - prolonged w/ APL abs

Question 29

When do we Investigate for anticardiolipin ab for abortion and TX

Answer 29

Two or more FIRST trimester events

Question 30

Symmetric and Polyarticular Arthritis

Answer 30

RA

Question 31

Dz's ass'd with Primary biliary cirrhosis

Answer 31

Sjogrens

Question 32

Most dangerous complication of Sjogrens

Answer 32

Lymphoma (since lymphocytic dz)

Question 33

Testing for Sjogrens

Answer 33

Best initial: Schirmer's test = decreased tear production

Question 34

Tx for Sjogrens

Answer 34

Best initial: water mouth, also flouride, artificial tears

Question 35

Test for Ankylosing spondylitis

Answer 35

Best initial: xray SI joint

Question 36

Treatment Ankylosing spondylitis

Answer 36

Exercise program and NSAIDS

Question 37

Osteoarthritis (DJD) affects what?

Answer 37

Articular cartilage - destruction and secondary remodeling and bone hypertrophy

Question 38

OA Risk factors

Answer 38

age, female, genetic, trauma, repetitive use, obesity

Question 39

OA affects what joints?

Answer 39

Weight bearing joints: Knee - MC joint involved; Base of thumb - 2nd MC; DIP and PIP involved

Question 40

OA Tx

Answer 40

1. PT and weight loss 2. NSAIDs 3. Scheduled Acetaminophen

Question 41

OA Diagnosis

Answer 41

Most accurate: radiography: X-ray shows joint space narrowing, ostephytes, dense subchondral bone, bone cysts

Question 42

Acute Gout Tx

Answer 42

1. NSAIDs

Question 43

Chronic Gout non medical TX

Answer 43

1. Wt loss, low purine diet, limit alcohol

Question 44

Allopurinol during an acute attack

Answer 44

Do NOT start

Question 45

Pseudogout causes

Answer 45

``` 4 H's: Hyperparathyroidism Hemochromatosis Hypophosphatemia Hypomagnesemia ```

Question 46

Wegeners Best initial test

Answer 46

C-ANCA = anti-proteinase-3 abs

Question 47

Polyarteritis Nodosa organs involved

Answer 47

NO lung involvement; Skin, Kidneys, nerves, GI

Question 48

Churg-Strauss Systems involved Abs involved?

Answer 48

Pulmonary and renal involvement, P-ANCA

Question 49

Cryoglobinemia

Answer 49

HCV - Chronic

Question 50

Polymyalgia Rheumatica

Answer 50

Pain and stiffness in shoulder and pelvic girdle muscles

Question 51

Glomerular dz ass'd with cryoglobinemia

Answer 51

Membrano proliferative

Question 52

Cold Agglutinin Ass'd with?

Answer 52

EBV, Mycoplasma, lymphoma

Question 53

Septic Arthritis Treatment

Answer 53

Ceftriaxone and Vancomycin

Question 54

Polymyositis and dermatomyositis

Answer 54

Proximal muscle weakness - difficulty getting up from seated position or walking up stairs

Question 55

Dermatomyositis

Answer 55

Malar involvement, shawl sign, heliotrope rash (eyelids), Gottron papules (PIP and MCP - scaly patches)

Question 56

Henoch Schonlein Purpura Renal involvement

Answer 56

IgA mediated - deposition in mesangium

Question 57

Behcet Syndrome Population? Presentation? TX?

Answer 57

``` Asian/ME Recurrent painful oral and genital ulcers Arthritis Conjunctivitis, uveitis Tx: Supportive, steroids during flares ```

Question 58

Fibromyalgia

Answer 58

Trigger points: Trapezius, medial fat pads - knees, lateral epi elbow, medial epi knee

Question 59

Spinal cord compression causes

Answer 59

Malignancy/Infxn

Question 60

Disc Herniation aka?

Answer 60

Sciatica

Question 61

Lumbar Spinal Stenosis

Answer 61

Pain worse with Extension - leaning back - worse when walking downhill, better with Flexion - when sitting, leaning foward

Question 62

Dupuytren Contracture

Answer 62

Hyperplasia =palmar fascia -> nodule formation, contracture of 4th and 5th fingers