reumato

Question 1

disease modifying antirheumatic drugs

Answer 1

methotrexate; folate antimetabolite, hepatotoxicity, stomatitis, cytopenias = folate supplements

leflunomide; pyridine synthesis inhibitor. hepatotoxicity cytopenia

hydroxychloroquine ; TNF and IL1 suppressor , retinopathy

sulfasalazine, TNF and IL1 suppressor, hepatotoxicity stomatitis, hemolytic anemia

TNF inhibitors ( adali, certo, etanercept, goli, infliximab); Infection, demyelination, CFF, malignancy interfron gamma release assay

Question 2

conditions associated with ankylosing spondylitis

Answer 2

one of them is restrictive lung disease due to limited costovertebral joint motion ,…acute anterior uveitis, aortic regurgitation, apical pulmonary fibrosis, IgA nephropathy

these patients normally have the same life expectancy linked normal population

Question 3

transplant and gout

Answer 3

transplant patients take cyclosporine which decreases uric acid excretion

Question 4

systemic sclerosis clinical manifestation autoantibodies and comlications

Answer 4

(skin , extremities: arthralgia and myalgia and contracture)gastrointestinal; esophageal dysmotility, dysphagia, acid reflux, lung; dyspnea, dry cough, vascular raynaud )

ANA, anti- topoisomerase type 1 (anti- scl70)
anticentromere( limited SSc)

lungs ( interstitial lung disease, pulmonary arterial HTN, kidneys: HTN( treatment : ace and nitroproside, scleroderma renal crisis, heart; myocardial fibrosis, pericarditis , pericardial effusion

Ace inhibitors are not in the treatment of AKI only one exception and that is it

Question 5

infection susceptibility of hemochromatosis

Answer 5

vibrio vulnificus and yersinia entrocolitica

Question 6

scaphoid fracture

Answer 6

if suspected even without pain : one week later another x ray or MRI or Radioscintigraphy

Question 7

autoantibodies for myositis

Answer 7

ana anti jo 1

Question 8

sjogren syndrome

Answer 8

anto ro LA (SS,A- AA,B)

Question 9

scleroderma renal crisi ( hypertention)

Question 10

clinical manifestations of hereditaty hemochromatosis

Answer 10

skin; hyperpgmintation
musculo: arthralgia (second and third metacarpophalangeal) and arthropathy, chondrocalcinosis joint asprations can identify calcium pyrophosphate dihydrate
gastro; elevated hepatic enzymes with hepatomegaly, cirrhosis, hepatocellular carcinoma,
endocrin; DM , secondary hypogonadism and hypothyroidism
cardiac; restrictive nad dilated
infections Listeria , vibriovulnificus, yersinia entrocloitica

Question 11

how can we see scaphoid fracture

Answer 11

MRI or repeat the XRAY in 1- 2 weeks or radioscintography bone scan in 3-5 days

Question 12

NSAIDS contra

Answer 12

peptic ulcer , acute or chronic kidney diseases, CHF, anticoagulation meds

Question 13

clinical manfistation od dermatomyositis

Answer 13

proximal symmetric, weakness in UE=LE, gottron sign papuls, heliotope rash,
INTERSTITIAL lung disease, dysphagia, myocarditis, anti jo anti Mi2,
high dose corton= glucocorticoids sparing agents,
screening for malignancy( adenocarcinomas, lung stomach bladder and cervix ovaries)

Question 14

lupus management

Answer 14

hydoxychloroquine , prevents further kidney and central nervous system damage, low dose cotton for short term to improve patients symptome until the hydroxy takes full effect,
combination of cotton and cyclophosphamide; reserved for the patients with more serious manifestations ( lupus nephritis and CNS involvement and vasculitis,

Question 15

femoral < tidal and fibular nerve sensory regions

Question 16

ace inhibitors and arbs on acid uric

Answer 16

decrease ( good in patients with gout for HTN)

Question 17

patella pain

Answer 17

patellofemoral sundrome ( younge female athlete SUBACUTE pain to chronic squatting, sitting and running with positive patellofemoral test ( extension with holding the atella)

patellar tendnitis primary athlete jimpers knoee < episodic pain and tenderness at INFERIOR atella

osgood schlatter preadolecents and adolescents athlete recent growth spur

bursitis acute housemaids knee localized and visible swelling anterior to patella secondary infection with aureus,

anserine bursitis medial to knee acute and episodic

Question 18

complex regional pain syndrome

Answer 18

pain swelling and skin changes vasomotor changes after recent injury

sympathetic nerve block

Question 19

reactive arthritis

Answer 19

GI , and genitourinary : chlamydia trachomatis
musculoskeletal ; asymmetric , peripheral oligoarthrtis , enthestis , dactylitis

uveitis and cnjuctivitis , uretgrutus cervicitis anf prostitis , dermal keratoderma blennorhagicum , and circinate balanitis, oral ulcers

AB (chlamydia) NSAID if fails cotton and …

Question 20

circinate balanitis

Answer 20

painless shallow ulcers of the glans of penis is an extraarticular manifestation of reactive arthritis
it may be for several month , without lymphadenopathy

by contrast : lymphogranuloma vereum LVG resolve within few days with lymphadenopathy

Question 21

cobb angle

Answer 21

under 10 normal
10 to 40 nonsurgical
40 and up surgical after puberty

Question 22

management of vertebral compression fracture

Answer 22

avoid muscle relaxant
resume normal activity
avoid excessive bed rest and order PT

vertebroplasty in selected patients ( refractory ppain)
fall prevention and osteoporosis

Question 23

acute back pain

Answer 23

normal activity and NSAID (not bed rest)

Question 24

myotonic dystrophy

Answer 24

AD, CT , myotinia and weakness
childhood; cognitive behavioral difficulties
infantile: hypotonia respiratory and V shaped lips,
arrhythmia and cardiomyopathy
dysphagia and constiapation , pharyngeal weakness and hypoventilation , INSULIN resistant< CATARACT, FRONTAL BALDING EXCESSIVE DAYTIME SLEEPINESS