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MTB3 Flashcards

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USMLE® Step 1 flashcards
1
Q

Joint findings in RA?

A
  • c1-c2 sublaxation
  • Swan neck deformity - knee invovement
  • Botunier deformity
  • Becker cyst
  • MCP and PIP swelling and pain
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2
Q

Alternates for DMARDS:

A
  • Rituximab
  • Anakinra: IL 1 receptor antagonist
  • Abatacept: Inhibits Tcell activation
  • Leflunamide: Primidine Antagonist
  • Tocilizumab: IL6 receptor Antagonist
  • Gold salt
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3
Q
  • an important charactristic of whipple disease other than GI symptoms?
A

Joint pain

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4
Q

Joints involved in OA?

A
  • PIP=> Buchard’s nodes

- DIP=> Heberden nodes

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5
Q

Tx for whipple disease?

A

TMX-SMX

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6
Q

TX for OA?

A

Acetaminophen

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7
Q

WBCs in RA and in OA?

A

In OA

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8
Q

Best initial test for OA?

A

Xray

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9
Q

Tests need to be ordered in OA?

A
  • ESR
  • ANA
  • RF
  • Anti-CCP
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10
Q

Presence of Anti Ro or Anti SSA antibody in SLE is the indication of:

A

Heart block

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11
Q

Which tests are diagnostic for Lupus flates?

A
  • Anti DS DNA

- low complement

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12
Q
  • best initial test to diagnose Reumatoid Arthritis?
  • most accurate and specific test to diagnose RA?
  • best initial test to diagnose Ankylosing Sponylitis?
  • best initial test to diagnose Reactive Arthritis?
  • best initial test to diagnose SLE?
  • best initial test to diagnose psoriatic arthritis?
  • best initial test to diagnose OA?
  • best specific test to diagnose SLE?
A
  • ESR, CRP, RF
  • Anti CCP
  • MRI
  • no diagnostic test for reactive arthritis
  • ANA
  • no test to diagnose psoriatic arthritis
  • xray
  • Anti smith Ab
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13
Q
  • Drugs cause SLE?

- charactristics of drug induced SLE?

A
  • Procain amid, Hydralazine, Isoniazide
    positive anti histon antibody
    No renal or neurological symptoms
    Complement levels and anti Ds- DNA are normal
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14
Q

Most accurate test for sjogren syn?

A

Lip biopsy

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15
Q

What is shirmer test?

A

A test to dx sojgren .. Decreased wetting of the papr held to the eye shows decreased lacrimation

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16
Q 
Tx for renal involvement in sclerodermia?
Tx for raynauds in sclerodermia?
Tx for GERD in sclerodermia?
Tx for lung fibrosis in sclerodermia?
Tx for pulmonary HTN in sclerodermia?
A
  • ACE inh.
  • Ca- channel blocker
  • PPI
  • Cyclophosphamide
  • Bosentan( anti- endothelium )/ Prostaglandines analogues( Epoprostenol, Treprostinil, iloprost) / Sildenafil
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17
Q

What disease we see giant capillaries in the nail folds?

A

Scleroderma

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18
Q

Tx of Anaphylaxis?

A

1- Epinephrine 1/1000
2- corticosteroids
3- Antihistamines ( Hydroxyzine and Diphenhydramine)

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19
Q

Difference between Joint fluid leukocyte count in OA and RA?

A

In OA

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20
Q

Tx for Sjogren disease?

A
  • keep the eyes and mouth moist

- Pilocarpin & Cevimeline => theyveill increase Acetylcholin

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21
Q

What is Eosinophilic Fascitis?

A

Thickening of the skin/ DDX with Scleroderma/ no systemic involvement/ no raynaud or hand involvement/ skin looks like podo orange/

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22
Q

Diagnostic tests for Polymyositis and Dermatomyositis?

A

EMG/ increased Aldolase and CPK/ for ccs order ANA and liver function tests.

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23
Q

Tx for eosinophilic fasciitis?

A

Corticosteroids

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24
Q

Polymyositis / Dermatomyositis with high anti JO?
Seriuse complication of Polymyositis Dermatomyositis?
Tx for PM / DM?

A

Interstitial nephritis
Malignancy
Corticosteroids

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25
Q

How to diiferentiate between chronic fTigue syndrome, fibromyalgia and Polymyalgia Rheumatica?

A

In chronic fatigue syn. The patient has fatigue for more than 6 months.
In Fibromyalgia there are trigger points, in polymyalgia Rheumatica there is high ESR.
No TX for chronic fatigue syndrome, Fibrolmyalgia TX is pain relief, Polymyalgia Rheumatica TX is Corticosteroids.

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26
Q
  • the most accurate test for vasculitis?
  • vasculitis TX?
  • what if steroids are not effective?
A
  • Biopsy
  • Steroids
  • Methtroxate/ Azatiprine - 6 Mercaptopurine/ Cyclophosphamide
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27
Q

PAN charactristics?

A
  • Abdominal pain
  • Renal involvement
  • Testicular involvement
  • HTN
  • Pericarditis
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28
Q

Which Ag is positive in PAN?

A

Hepatitis B surface Ag

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29
Q

How to differenciate PAN, Wegner, Churchstrauss?

A

There is abdominal involvement in PAN, in Wegner there is upper or lower respiratory involvement and c- ANCA is positive/ in Churg strauss the patient has asthma and eosiniphilia and positi

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30
Q

Lab tests in Vasculitis?

A

Normochrom normocytic anemia
Thrombocytosis
Elevated ESR

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31
Q

Charactristics of Takayaso Arthritis in Lab?

A
  • Anemia / elevated ESR
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32
Q

Complications of Takayasu Arthritis?

A

TIA/Stroke

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33
Q

Behcet charactristics:

A
  • oral and genital ulcers
  • ocular involvement
  • Pathergy
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34
Q

Clinical manifestations of all vasculitis diseases?

A
  • Malaise - weight loss
  • Fatigue - Neuropathy
  • Arthralgia
  • skin rash
  • Fever
35
Q

Joint cells in Septic Arthritis, Inflammatory ( gout/ pseudo gout) and infections ?

A

NL 50.000

36
Q

What are Rasburicase and Pegloticase?

A

They break uric acid to Allantoin. We use it when Allopurinol and Febuxostat are not useful.

37
Q

Triggers for gouty attacks?

A

1- Alcohol
2- thiazide diuretics
3- Nicotinic Acid

38
Q

What’s the first step after suspeciouse of gout and before starting the TX?

A
  • you should tap the joint
39
Q

Management of acute attacks in pseudogout?

A

NSAIDS and Steroids

40
Q

Prenentive meds for Gout?

A
  • Allopurinol if no response=> Febuxostat
41
Q

Empiric therapy for septic Arthritis?

A
  • Ceftriaxone and Vancomycine
42
Q

Charactristics of Morton Neuroma?

A

Painful burning sensation in the interdigital web space 3rd and 4th
Tenderness on the head of 3 and 4
Sharp intermittent pain radiating into toes and feel better when shoes are taken off

43
Q

Best initial test and most accurate test in Pagets disease?

A

Best initial test: AlkP

Best accurate test: xray

44
Q

Charactristics of plantar fasciitis and tarsal tunnel syn?

A

Plantar fasciitis is ginna be better with walking but tarsal tunnel syn. Getting worse with walking.

45
Q

Best initial diagnostic test to Dx iron defficiency, Anemia of chronic diseases, Thalassemia, Sideroblastic Anemia:

A
  • Iron defficiency anemia: low ferritin/ high TIBC/ low Fe/ low Fe sat/ high RDW
  • thalassemia: NL
  • Sideroblastic Anemia: high Fe
  • Anemia of chronic diseases: high ferritin, low TIBC, Low Fe and NL to low Fe sat
46
Q

What is the main cause of signs and symptoms in Sideroblastic Anemia?

A

Iron build up in mitochondria

47
Q

What is HbH?

A

3 gene deletion in alpha thalassemia and Beta-4 tetrads.

48
Q

What are the other charactristics beside megaloblastic anemia in patients with B12 defficiency?

A

Glossitis/ Diarrhea/ Neurologic signs and symptoms.

49
Q

What is the medication that blocks B12 absorbtion and will cause macrocytic anemia?

A

Metformin

50
Q

After B12 therapy which signs and syptoms will retun first and last?

A

First=> Retic count

Last=> Neurologic

51
Q

In B12 defficiency anemia B12 is really low?

What is the best test to DX B12 defficieny macrocytic anemia?

A

No bcz B12 is a phase reactant and any form of stress will increase it.
Methyl malonic test

52
Q

What are the two tests after Measuring B12 level and Methylmalonic acid level to confirm the Dx of B12 defficiency macrocytic anemia?

A

Anti- Intrinsic factor Ab / Anti Parietal cell Ab

53
Q

Which electrolyte abnormality should we aware of with B12 therapy?

A

Ilow Ptassium

54
Q

What kind of disease other than hereditary spherocytosis give us the spherocytes?

A

Autoimmune hemolysis

55
Q

How is the clinical definition of the SCD case ?

A

Pain in the chest, back, tighs that is very severe.

56
Q

How is the approach to SCD patients?

A

First hydration, Analgesics, Oxygen to reduce fever. If fever exist then antibiotics: Ceftriaxone, Levofloxacin, Moxifloxacin

57
Q

What is the sudden derops in the hematocrit indication of?

A

UpParovirus B19 infection or folate defficiency.

58
Q

What kind of supplement should be hiven to the patients with SCD?

A

Folic acid

59
Q

Which drugs will cause hemolythic Anemia?

A
  • Penicillin -Dapson
  • Alpha methyl dopa
  • Quinidin
  • Sulfa drugs
  • Primaquine
60
Q

What are TX options for Hemolytic Anemia?

A

1- steroids
2- IVIG if there is no response to Prednisone
3- Splenectomy for recurrent episodes

61
Q

Why is Rituximab effective against RA and cold and warm hemolythic anemia?

A

Because Rituximab is anti CD20 which affect on the CD20 lymphocytes that make IgG and IgM.

62
Q

What kind of test should be done before prescribing Dapson?

A

G6PD

63
Q

What is Heinz body?

A

Percipitated oxidased HB in RBC membrane.

64
Q

1- what is the best test to Dx G6PD?

2- TX of G6PD?

A

1- G6PD level after 6 months

2- no Tx

65
Q
  • what is the TX for TTP- HUS?

- why is it helpful?

A
  • plasmaphresis

- because it will replace the ADAM13 which will break down the VWF . No platelet infuion is indicated.

66
Q

Charactristics of TTP and HUS?

A

-ART( Autoimmune Hemolysis)/ ( Renal insufficiency)/ ( Thrombocytopenia)

67
Q

-Etiologies of TTP and HUS?

A 
TTP= decrease level of Adam 13/ like Ticlopidine
HUS= E.colin0157H7
68
Q

PNH can transforms into two things.. What are those?

A
  • Aplastic Anemia

- AML

69
Q

What is the charactristic of myoglobine in urine?

Tx of Methemoglobinemia?

A

Brown blood

Methylene blue

70
Q

What kind of medications are associated with Methemoglobinemia?

A
  • Nitroglycerine
  • Amylnitrite
  • dapson
  • Nitroprusside
  • caine - drugs
71
Q

Leukemia Tx?

A
  • Idarubicin
  • Daunorubicin
  • Cytosin Arabinoside
  • also ATRA for AML M3
  • also Mthotroxate for ALL
72
Q

Charectristic of Myelodysplastic synd.?

A

Pelger Huet cells ( Neutrophils wit 2 lobes)

73
Q

Clinical manifestation of Myelodysplastic Syn.?

A
  • Pancytopenia
  • elevated MCV
  • low Retic
  • Macroovalocyte
74
Q

Tx of Myelodysplasia?

A
  • transfusion as needed
  • azacitadine
  • Decitabine
  • Lenalidomide
75
Q
  • Bone Osteolytic leision in:

- Bone osteoblastic leision in:

A
  • Bone Osteolytic leision in MM

- Bome Osteoblastic leisions in Prostate cancer metastasis

76
Q

What are the CML medications beside Imatinib?

A

Nilotinib/ Dasatinib

77
Q

Difference between dysphagia & Odynophagia?

Causes of Odynophagia?

A
  • Dysphagia= difficulty swallowing
  • Odynophagia= painfull swallowing
  • infections: CMV, HSV, Candida, HIV
78
Q

Diagnostic methods for esophageal pathologies and stomach pathologies?

A

Esophageal pathologies= Barium study
Stomach pathologies= Endoscopy
Exceptions: cancer & Pre cancerouse leisions in Esophagus=> endoscopy n biopsy

79
Q

Difference between TIA and stroke?

A

TIA is less than 24 hours . It affects the face and causes aphasia. Stroke is more permenant. More than 24 hours and have seriouse consequences.

80
Q

When do we use Brain CT with conrast?

A

When there is infection or cancer

81
Q

First step when you suspeciouse of TIA?

A

Non-conrast CT to R/O hemorrhagic stroke.

82
Q

Approach to TIA?

A

First step is non contrast head CT . If it’s not hemorrhagic and it’s within 3 hours start throbmolytic, if it’s more than 3 hours and it’s not hemorrhagic start ASA. If the patient is already on ASA then switch to clopidogrel or add Dypiridamole. Start Statin for all non- hemorrhagic stroke patients.

83
Q

Contraindications of thrombolytic therapy?

A
  • HX of hemorrhagic stroke - trauma or injury within 6 months
  • intracranial mass - aortic dissection
  • active bleeding or surgery within 3 weeks - CPR within 3 weeks
  • bleeding disorder
  • stroke within 1 year

Usmle (8 decks)

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