RA and Gouty arthritis Flashcards
Biomarkers for RA diagnosis
Anti-CCPs and RF
Which of the ff is TRUE about RA?
A. Result from inflammation of the joints, tendons, and bursae.
B. Early morning joint stiffness lasting less than 1 hr
C. Earliest involved joints are small joints of hands and feet
D. Two of the options
E. All of the options
D. Two of the options
Early morning joint stiffness lasting MORE THAN 1HR
Frequent hallmark of RA
Flexor tendon tenosynovitis
Hyperextension of the PIP joint with flexion of the DIP joint
Swan-neck deformity
Flexion of the PIP joint with hyperextension of the DIP joint
Boutonniere deformity
Subluxation of MCP joint with hyperextension of the first IP
Z-line deformity
Subluxation of the distal ulna
Piano-key movement
The most frequent site of cardiac involvement in RA is the __________
A. Endocardium
B. Myocardium
C. Pericardium
D. Any of the options
C. Pericardium
Cardiomyopathy, a clinically important manifestation of RA can only be identified by which of the ff?
A. Echocardiography
B. CT scan
C. MRI
D. Any of the options
D. Any of the options
Echocardiography and MRI
The most common valvular abnormality in RA is ________
A. Aortic stenosis
B. Mitral regurgitation
C. Tricuspid regurgitation
D. Any of the options
B. Mitral regurgitation
The most common pulmonary manifestation of RA is ________
A. interstitial lung disease
B. pulmonary vasculitis
C. pleuritis
D. pleural effusion
C. Pleuritis
The most common hematologic abnormality in RA is _________
A. Anemia
B. Neutropenia
C. Leukemia
D. Lymphoma
A. Anemia
The most common cause of death in RA patients is ________
A. Pulmonary disease B. Hematologic disease C. Cardiovascular disease D. Two of the options E. All of the options
C. Cardiovascular disease
The gene to confer the greatest risk of RA is _________
HLA-DRB1 gene
The most reproducible environmental factor linked to RA is _________
Cigarette smoking
Citrullination involves the conversion of citrulline from what amino acid?
A. Arginine
B. Alanine
C. Tryptophan
D. Valine
A. Arginine
What are the pathologic hallmarks of RA?
Synovial inflammation and proliferation, focal bone erosions, and thinning of articular cartilage.
Chronic inflammation leads to ___________
A. Synovial lining hyperplasia B. Formation of pannus C. Nephritis D. Two of the options E. All of the options
D. Two of the options
Synovial lining hyperplasia
Formation of PANNUS - thickened cellular membrane containing fibroblast-like synoviocytes and granulation-reactive fibrovascular tissuie
The structural damage to the mineralized cartilage and subchondral bone is mediated by the _______
A. Osteoclast
B. Osteoblast
C. Osteocytes
D. Any of the options
A. Osteoclast
-multinucleated giant cells, identified by expression of CD68, and appear at the pannus-bone interface where they form resorption lacunae
Immunoglobulin which is most frequently measured by laboratories and found in 75-80% of the patients
IgM
Synovial fluid WBC count in RA
5000 - 50,000
2000 - noninflammatory (OA)
Most useful confirmatory lab test for inflammatory arthritis such as RA
Synovial fluid analysis
In plain radiography, the initial finding is ___________
A. Periarticular osteopenia
B. Soft tissue swelling
C. Symmetric joint space loss
D. Subchondral erosions
A. Periartricular osteopenia
What part of the feet is often targeted first in RA?
A. 1st MTP B. 2nd MTP C. 3rd MTP D. 4th MTP E. 5th MTP
A. 1st MTP
What imaging technique offers the greatest sensitivity for detecting synovitis and joint effusions, as well as early bone and bone marrow changes?
MRI
What is the most common cause of death in RA patients?
A. Infection B. MI C. Ischemic heart disease D. Pneumonia E. Any of the options
C. Ischemic heart disease
DMARD of first choice for the treatment of RA
Methotrexate
Osteoporosis ranks as an important long-term complication of chronic use of what drug?
Prednisone
Which of the following is/are used to reduce the signs and symptoms of RA, slow radiographic progression of joint damage, and improve physical function and quality of life?
A. Infliximab B. Adalimumab C. Etanercept D. Two of the options E. All of the above
E. All of the above
This drug is a chimeric monoclonal antibody directed against CD20, a molecule expressed by most mature B lymphocytes
Rituximab
What drugs are considered as oral triple therapy for RA?
A. Methotrexate + Leflunomide + Tofacitinib
B. Methotrexate + Sulfasalazine + Hydroxychloroquine
C. Methotrexate + Anankira + Infliximab
D. Methotrexate + Abatacept + Rituximab
B. Methotrexate, Sulfasalazine, and hydroxychloroquine (oral triple therapy)
Which of the following is TRUE about Gout?
A. Affects middle-aged man and postmenopausal women
B. Results from increased body pool of calcium pyrophosphate with hyperuricemia
C. Characterized by episodic acute or chronic arthritis
D. Two of the options
E. All of the options
D. Two of the options
Results from increase body pool of urate with hyperuricemia
Most common early clinical manifestation of gout.
Acute arthritis
Which of the following may precipitate acute gouty arthritis?
A. Dietary excess B. Surgery C. Excessive ethanol ingestion D. Two of the options E. All of the options
E. All of the options
Several events may precipitate acute gouty arthritis:
dietary excess, trauma, surgery, excessive ethanol ingestion, hypouricemic therapy, and serious medical illnesses such as myocardial infarction
and stroke.
Best drug to lower serum urate in overproducers, urate stone formers, and patients with renal disease.
Allopurinol
This drug reduces neutrophil mediated inflammatory
response by blocking the beta tubulin polymerization→ prevents the migration of neutrophils into the inflamed area
Colchicine
This drug is a urate oxidase enzyme, third-line and newest urate-lowering therapy to be approved for
the treatment of refractory chronic gout.
A. Febuxostat
B. Colchicine
C. Pegloticase
D. Any of the options
C. Pegloticase
This drug is a potent and selective inhibitor of xanthine oxidase, thereby reducing the formation of xanthine and uric acid without affecting other enzymes in the purine or pyrimidine metabolic pathway.
A. Allopurinol
B. Febuxostat
C. Probenecid
D. Any of the options
B. Febuxostat
This uricosuric drug/s are employed to
decrease the body pool of urate in patients with tophaceous gout or in those with increasingly frequent gouty attacks.
A. Probenecid B. Sulfinpyrazone C. Allopurinol D. Colchicine E. Any of the options
E. Any of the options
Probenecid and Sulfinpyrazone
This stage of gout presents an imaging which shows characteristic juxta articular bone and loss of
joint space
Chronic tophaceous gout
