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2020 ABIM studying > Rheum > Flashcards

Rheum Flashcards

1
Q

What’s the first choice medication for RA?

A

Mtx

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2
Q

What’s the mechanism of action for methotrexate? Supplement with what medication?

A

Dihydrofolate reductase inhibitor; folate

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3
Q

What organ toxicity (3) is there for methotrexate?

A

Marrow suppression, pneumonitis, and hepatotoxicity

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4
Q

Avoid rx methotrexate In conjunction with what medication?

A

Trimethoprim-sulfamethoxazole

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5
Q

Which 2 RA meds can be used in pregnancy?

A

Hydroxychloroquine and sulfasalazine

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6
Q

Sulfasalazine causes what side effect in men?

A

Decreased sperm count

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7
Q

Which gene test should be checked before administering azathioprine to prevent dangerous bone marrow suppression?

A

TPMT gene test (thiopurine S-methyltransferase)

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8
Q

With osteoarthritis, what would you expect the ESR and CRP levels to be?

A

Normal (versus elevated in rheumatoid arthritis)

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9
Q

Needle-shaped, (-) birefringent crystals Dx of?

A

Gout (monosodium urate crystals)

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10
Q

What’s the mechanism of action for methotrexate? Supplement with what medication?

A

Dihydrofolate reductase inhibitor; folate

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11
Q

What is the most sensitive method of diagnosing avascular necrosis?

A

MRI

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12
Q

With systemic lupus erythematosus exacerbation, what would you expect the complement (high/low), anti-dsDNA (pos/neg) and ESR (high/low) levels to be?

A

Low complement, pos anti-dsDNA, high ESR

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13
Q

Rapid fire assoc:Rhomboid crystals, (+) birefringent

A

Pseudogout (calcium pyrophosphate dihydrate crystals)

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14
Q

Which agent used in the treatment of rheumatoid arthritis requires frequent eye exams?

A

Hydroxychloroquine

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15
Q

Rapid fire assoc:Polished, “ivory-like” appearance of bone at cartilage erosion

A

Eburnation (osteoarthritis resulting in bony sclerosis)

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16
Q

What is the most specific test for diagnosing rheumatoid arthritis?

A

Anti-citrullinated protein(anti-CCP) antibody

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17
Q

What is the leading cause of death inpatients with systemic lupus erythematosus?

A

Cardiovascular disease

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18
Q

Painful fingers/toes changing color from blue to white to red with cold or stress

A

Raynaud phenomenon (vasospasm in extremities)

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19
Q

What would you expect pleural effusion glucose level to be in individuals with rheumatoid arthritis?

A

Less than 30 mg/dl

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20
Q

Dry eyes, dry mouth, arthritis Dx?

A

Sjogren syndrome (autoimmune destruction or exocrine glands)

21
Q

What rheumatological condition can often be associated with temporal arteritis?

A

Polymyalgia rheumatica(PMR)

22
Q

What is the most common extra-articular manifestation of rheumatoid arthritis?

A

Subcutaneous Rheumatoid nodules

23
Q

Rapid fire assoc: Anticentromere antibodies

A

Scleroderma (CREST)

24
Q

Rapid fire assoc: Anti-topoisomerase antibodies

A

Diffuse systemic scleroderma

25
Q

Urethritis, conjunctivitis, arthritis in a male

A

Reactive arthritis associated with HLA-B27

26
Q

Rapid fire assoc:”Bamboo spine” on x-ray

A

Ankylosing spondylitis (chronic inflammatory arthritis: HLA-B27)

27
Q

What is the initial diagnostic test to check in an individual you suspect to have temporal arteritis?

A

ESR

28
Q

What is the goal uric acid level to prevent further attacks in patients with gout? Goal w/tophi?

A

Less than 6mg/dl, less than 5

29
Q

Rapid fire assoc:Antineutrophil cytoplasmic antibodies (ANCAs)

A

Microscopic polyangiitis and eosinophilic granulomatosis with polyangiitis (Churg-Strauss syndrome) (MPO-ANCA/p-ANCA); granulomatosis with polyangiitis (Wegener; PR3-ANCA/c-ANCA)

30
Q

What is the initial diagnostic test to check of an individual you suspect of having polymyositis?

A

Creatine phosphokinase (CPK)or Creatinine kinase (CK)

31
Q

Rapid fire assoc:Antihistone antibodies

A

Drug-induced SLE (eg, hydralazine, isoniazid, phenytoin, procainamide)

32
Q

Rapid fire assoc:Anti-IgG antibodies

A

Rheumatoid arthritis (systemic inflammation, joint pannus, boutonniére deformity)

33
Q

Rapid fire txt: Kawasaki disease

A

IVIG, high-dose aspirin

34
Q

What class of medication is the first-line treatment of renal crisis in scleroderma?

A

ACE inhibitors

35
Q

What HLA marker can often be associated with ankylosing spondylitis?

A

HLA-B27

36
Q

Patient who uses cocaine and has a weak handshake. What is the likely diagnosis?

A

Inclusion body myositis

37
Q

Rapid fire txt: Chronic gout

A

Xanthine oxidase inhibitors (eg, allopurinol, febuxostat); pegloticase; probenecid

38
Q

Patient with rheumatoid arthritis on leflunomide decides she wants to get pregnant. What is the best next step in management?

A

Give cholestyramine for 9-11 d for leflunomide wash out

39
Q

Rapid fire txt: Acute gout attack

A

NSAIDs, colchicine, glucocorticoids

40
Q

Patient with polymyositis is on high dose steroids. CPK levels are improving but weakness worsening. What to do?

A

Taper down on the steroids

41
Q

If pts with osteoarthritis present with morning stiffness, what length of time should it not exceed?

A

30 minutes

42
Q

Of the MCP, PIP, and DIP joint, which of the following is least likely to be involved with rheumatoid arthritis?

A

DIP joint

43
Q

Greater than what value is the WBC count expected to be in cases of septic arthritis?

A

More than 50,000/uL

44
Q

what is the Initial step for a patient symptomatic for Atlanto-odontoid subluxation?

A

Cervical spine X Ray with flexion and extension views.

45
Q

Antibody in diffuse systemic sclerosis?

A

Anti SCL 70. AntiTopoisomerase.

46
Q

Cytoplasmic vacuolization in muscle is Seen with what dz that also has elevated CK?

A

Chronic accumulation of colchicine in ckd patients

47
Q

What are the components of felty syndrome?

A

Rheumatoid arthritis, neutropenia, splenomegaly

48
Q

What dz is suggested by aggressive destruction of the glenohumeral joint & rotator cuff and has a hemorrhagic effusion?

A

Basic calcium phosphate deposition dz, Milwaukee shoulder

2020 ABIM studying (12 decks)

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