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ABIM > Rheum 1 > Flashcards

Rheum 1 Flashcards

1
Q

Small joint polyarthritis, fever, rash, exposure to children. Dx? What test for active dz?

A

Parovirus B19. anti-parovirus IgM antibodies, igG (old previous infection)

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2
Q

Spiking fever, Salmon Colored Rash on trunk (pink maculopapular rash) and extremities, fever, Arthritis, lymphadenopathy, Elevated WBC, HIGH FERRITIN. Dx?

A

Adult-onset still disease

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3
Q

Athritis with radiographic evidence of Articular surface Erosions. Dx?

A

Erosive osteoarthritis

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4
Q

Hx of TB + Arthritis.

Test?

A

TB arthritis- Chronic inflammatory Monoathritis ( Can occur with latent TB).

Synovial biopsy

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5
Q

Blood test for Sjogren Syndrome?

Test for definitive diagnosis for Sjogren syndrome?

Rx?

A

Anti-Ro/SSA antibodies.

Lip Biopsy or minor Salivary gland Biopsy

Artificial Tears, Lubricants, Periodontal care every 6 months

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6
Q

Pt is Febrile, with R knee Swollen and Tender for 2 days duration. Next step?

What constitutes as inflammatory?
What constitutes as infectious?

A

Aspirate Knee (Arthrocentesis) 200-2000 WBCs noninflammatory.

WBC > 2000 Inflammatory

WBC > 50,000 Infectious

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7
Q

Hx of Limited Cutaneous Sclerosis presents with Dyspnea, normal CXR, but increase P2 with wide split s2.

Dx?

A

Pulmonary HTN

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8
Q

Hx of gout, presenting withLeg pain, Swelling and Redness
Non-Responsive to abx. Blood cultures negative. Dx?

A

Gouty Cellulitis

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9
Q

Raynaud phenomenon, inflammatory arthritis, positive ANA, negative anti-double stranded antibodies, anti-smith, Anti-CCP, Anti-U1-Ribonucleoprotein, Anti-Ro/SSA, Anti-la/SSB.
Dx? Rx?

A

Undifferentiated Connective Tissue Disease

Hydroxycholorquine

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10
Q

Pain and swelling of Wrist and Knees. Xray shows chondrocalcinosis.
Dx?

A

Calcium Pyrophosphate Crystal Arthritis (Psuedogout)

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11
Q
  1. Rx of RA for quick relief
  2. Rx for erosive disease?
  3. Hx of RA presenting with pleural effusions, lights criteria showing exudative effusion. Dx?
A
  1. NSAID
  2. Methrotrexate, start immediately in patients with Erosive disease
  3. Rheumatoid Pleuritis (rheumatoid lung)
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12
Q
  1. Skin thickening distal elbows and knees, Absent renal crisis, PH, CREST syndrome is Absent.
    Dx?
  2. Hx of Diffuse Cutaneous Systemic Sclerosis + AKI, Severe HTN, mild Proteinuria, Microangiopathic hemolytic anemia, Thrombocytopenia Dx? Rx?
A
  1. Limited Cutaneous Systemic Sclerosis
  2. Scleroderma Renal Crisis
    RX: Catopril (ACE inhibitor).
    • Diffuse Cutaneous Systemic Sclerosis has the Renal Crisis
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13
Q

Painful Oral and Genital mucosal ulcerations with inflammatory eye disease and pathergy (inflammatory response to skin prick with sterile needle.)
Dx?
Complication?

A

Bechet syndrome

Thrombosis

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14
Q

Chronic Granulomatous Vasculitis seen in Asian women. They present with Claudication in the extremities, Discrepancy in Blood Pressure btw arms and reduced pulses.
Dx?

A

Takayasu Arteritis

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15
Q

Acute arthritis, Bilateral hilar Adenopathy and Erythema Nodosum. Dx? Test?

A

Logren syndrome

When all 3 features are present. No further testing is warranted

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16
Q

Rx for Class V Lupus Nephritis?

Diagnostic test for lupus nephritis?

A

Mycophenolate Mofetil

Kidney Biopsy

17
Q

Bright erythematous Rash over both Cheeks and Nasal bridge sparing the Nasolabial folds. Dx?

A

Acute Cutaneous Lupus Erythematous which will develop into SLE.

18
Q

Pt presents with intermittent sensory loss of hands and occasional shock like sensation from neck down the back with neck flexion. Has 15 year hx of RA.

Test?

A

Xray of neck with flexion/extension of Cervical Spine. R/O C1-C2 subluxation

19
Q

Hx of SLE presenting with HA, Mild Cognitive Dysfunction and Mood disorder?

Complication?

A

Neuropsychiatric SLE

Pt can develop seizure and psychosis

20
Q
  1. Name the 4 Sponylarthritis:
  2. Pt presents with psoriasis, enthesitis, dactylitis, tenosynovitis and arthritis. (pencil in cup ) deformity on xray.
    Dx? Rx?
  3. RX for IBD Associated Arthritis?
  4. Rx for Ankylosing Spondylitis?
  5. Management of Reactive arthritis ?
A
  1. Psoriatic Arthritis
    Reactive Arthritis,
    Ankylosing Spondyltiis
    IBD-Associated Arthritis
  2. Psoriatic Arthritis. NSAID, Methotrexate and/or Anti-TNF (Can eventually discontinue methotrexate)
  3. Adalimumab and Infliximab
  4. NSAIDs, Steroid Injections, Anti-TNF
  5. Test for GU and GI infections, self limited.
21
Q

Side effect of Leflunomide?

A

Peripheral neuropathy

22
Q

Management of inadequately treated Tophaceous Gout?

A

Increase allopurinol in 100 mg increments. Total dose is 800mg.

23
Q

Rx for pt with SLE who still has moderate disease while on appropriate immunosuppressive agents?

24
Q

What abx should NOT be used with colchicine ?

A

Clarithromycin

No colcha with Claritha

25
Q

Digital Clubbing, Painful Periostosis of Long Bones, Synovial effusion and Periosteal bone formation.

Dx?

What is the next step in Management?

What is it commonly associated with?

A

Hypertrophic Osteoarthropathy

CXR or CT to r/o Malignancy
(Non-Small Cell Lung Cancer commonly associated)

26
Q

Raynaud Phenomenon, arthritis, puffy fibers, sclerodactly, serositis, esophageal dysmotility, myositis, ILD, PAH.
Dx?
Rx ?

A

Mixed Connective Tissue Disease.

Anti-U1RNP Antibodies.

Fulfills criteria for at least two of the following SSc, Polymyositis, SLE.

Rx is organ specific

DMARDs for arthritis, Vasodilators for PAH, PPI for esophageal issues

27
Q

Older adults with Aching and Morning stiffness in the proximal muscles of the Shoulder and Hip girdle.
ESR > 50

Dx?
Rx?

A

Polymyalgia Rheumatica

Low dose Prednisone

28
Q

HTN, Renal insuffiency, Arterial aneursym (Non glomerular kidney disease) , Mononeuritis Mutiliplex, Skin lesions (Ulcers, Purpura, Livedo Reticularis, Nodules), Mesenteric Ischemia (Post-prandial Abd pain), Orchitis.

Dx?

Test?

What Viral infection is commonly associated?

Rx?

A
  1. Polyarteritis Nodosa ( MultiSystem Necrotizing Vasculitis of Small-Medium Sized Vessels)
  2. Biopsy of Involved Tissue & Renal Angiography.
  3. Hep B or C

Prednisone and Cyclophosphamide or Rituximab

29
Q

Recurrent Middle Ear Infections, Destructive rhinitis, sinusitis, saddle-nose deformity, tracheal collapse, pulmonary infiltrates, cavities, hemoptysis and pauci-immune GN.

Dx?
Test?
Rx?

A

Granulomatosis with Polyangitis ( Wegners)

C- ANCA and Anti-RP3 antibody assay.

Prednisone and Cyclophosphamide or Rituximab

30
Q

Pulmonary infiltrates, Palpable Purpura, and Rapidly progressive Pauci-Immune GN.

Dx?
Test?
Rx?

A

Microscopic polyangiitis (Small-Medium Sized Vessels)

P-ANCA and Anti-MPO Antibody Assay

Prednisone and Cyclophosphamide or Rituximab

31
Q

Asthma, Eosinophilia, Elevated IgE and Pulmonary infiltrates/hemoptysis
Dx?
Test?
Rx?

A

Eosinophilic Granulomatosis with polyangiitis

P-ANCA and Anti-MPO antibody assay and biopsy.

Prednisone and Cyclophosphamide or Rituximab

32
Q

Palpable Purpura, Joint and Abdominal pain, Glomerulonephritis (RBCs in Urine) after URI.
Dx?
Test?
Rx?

A

IgA Vasculitis/Henoch-Schonlein purpura

Skin biopsy (IgA immune Complex Deposition)
Kidney biopsy showing IgA Nephropathy

Self Limited

33
Q

22 yo girl presents with Conjunctival injection and Swelling in her left knee for 3 days. She had diarrhea 1 month ago and tested positive for the past 3 days. Knee Aspiration has 4,000 WBC. Dx? Rx?

A

Reactive Arthritis

Clinical Diagnosis

Rx: NSAIDs, Self Limiting

34
Q

Management of Severe Osteoporosis:

Initial Management?

If there is < 5% BMD ?

If there is > 5% BMD?

A
  1. Oral Bisphosphenate & Repeat DXA
  2. BMD < % Continue with Bisphosphenate and Repeat DXA in 2 years
  3. BMD> 5% Switch to IV Bisphosphenate, Teriparatide or Denosumab
35
Q

Name the Condition:
1. DNA Histone Complex Antibody
2. Double-stranded DNA Antibody
3. RNA Polymerase I& III (scl 70)Antibody, Anti-topoisomerase
4. Ribonucleoprotein (RNP) Antibody
5. SS-A/Ro, SS-B/La Antibody
6. Centromere Antibody
7. Aminoacyl–Transfer RNA Synthetases (Jo-1) Antibody
8. Myeloperoxidase Antibody (MPO)
9. Proteinase 3 (RP3) Antibody

A
  1. Drug induced lupus
  2. SLE
  3. Systemic sclerosis
  4. Mixed connective tissue disease
  5. Sjorgen Syndrome
  6. Limited Scleroderma
  7. Polymyositis, Dermatomyositis
  8. Microscopic with polyangiitis
  9. Granulomatosis with polyangiitis (Wegners)

ABIM (45 decks)

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