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Fall Y3 > Rheum Exam 3 > Flashcards

Rheum Exam 3 Flashcards

1
Q

What is the effect of dopamine on the brain?
a. reward
b. encourages us to be social
c. happiness
d. a and b

A

a and b

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2
Q

What is the effect of serotonin on brain?
a. happiness
b. seek pleasure and avoid pain
c. encourages us to do things
d. a and c

A

a and c

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3
Q

What is the effect of opioids on the brain?
a. seek pleasure and avoid pain
b. happiness
c. encourage a feeling of well-being
d. a and c

A

a and c

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4
Q

What dose the endocannabinoid system cause?
a. relaxation and reduction in anxiety
b. increase appetie
c. seek pleasure and avoid pain
d. a and b

A

a and b

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5
Q

What is the structure of the endocannabinoids?
a. protien
b. steriod
c. lipid
d. carbohydrate

A

lipid

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6
Q

Can endocannabinoids accumulate in intreacellular storgae organelles?
Yes or No

A

Yes

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7
Q

Which of the following is true about 2-AG?
a. higher in the immune system
b. produced by immune cells
c. made by immune cells and neurons
d. not made by the immune system

A

higher in the immune system

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8
Q

Which of the following is true of AEA?
a. higher in the immune system
b. produced by immune cells
c. made by immune cells and neurons
d. not made by the immune system

A

produced by immune cells

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9
Q

Which of the following is true regarding PEA?
a. higher in the immune system
b. produced by immune cells
c. made by immune cells and neurons
d. not made by the immune system

A

made by immune cells and neurons

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10
Q

Which of the following is more selective for CB1R?
a. 2-AG
b. AEA
c. PEA

A

AEA

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11
Q

Which of the following dosen’t work through CB2R?
a. 2-AG
b. AEA
c. PEA

A

2-AG

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12
Q

Where do anandimide come from?
a. phospholipids dervied precursors
b. protiens
c. enzyme NAPE-PLD turning phospholipids dervied precursors into

A

enzyme NAPE-PLD turning phospholipids dervied precursors into

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13
Q

Where do 2-AG come from?
a. phospholipids dervied precursors
b. protiens
c. enzyme DAG lipase turning phospholipids dervied precursors

A

enzyme DAG lipase turning phospholipids dervied precursors

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14
Q

What enzymes breakdown AEA and 2-AG?
a. NAPE-PLD and FAAH
b. DAG lipase and MAGE-lipase
c. FAAH and MAGE-lipase
d. NAPE-PLD and DAG lipase

A

FAAH and MAGE-lipase

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15
Q

Which of the endocanabinoids can create eicosanoids?
a. 2-AG
b. AEA
c. PAE
d. NAE

A

2-AG

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16
Q

What dose 2-AG NOT control?
a. mood
b. nocicpetion
c. appetite
d. happiness

A

happiness

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17
Q

Where are CBR1 NOT located?
a. brain
b. heart
c. digestive system
d. muscles

A

muscles

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18
Q

Where are CBR2 located?
a. immune cells
b. brain
c. digestive system
d. two of the answers are correct
e. all of the above

A

two of the answers are correct

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19
Q

What is the activity of CBR1?
a. responsible for psychoactive effects
b. critical for immune efects systemic and brain

A

responsible for psychoactive effects

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20
Q

Which of the following is NOT an endocannabinoids receptor to illicit immune effects?
a. TRPV-1
b. PPAR a and y
c. GPR55
d. CBR2
e. CBR1

A

CBR1

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21
Q

What is the fucntion of TRPV-1?
a. recognize body temperature
b. provide sensation of pain
c. provide sensation of scalding heat
d.

A

all of the above

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22
Q

What is endocannabioids and exogenous CB effect on TRPV-1?
a. upregulate
b. downregulate
c. no effect

A

downregulate

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23
Q

What activates PPAR a and y?
a. arachadonic acid
b. prostglandins
c. leuotrienes
d. cytokines

A

arachadonic acid

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24
Q

What are endocannabinoids and THC effect when bound to PPARy?
a. inhibit growth of cancer cell lines
b.recognize body temperature
c. provide sensation of pain
d. provide sensation of scalding heat

A

inhibit growth of cancer cell lines

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25
Q

What is AEA effect on the innate immune system?
a. increases Treg by increasing macrophages that promote Treg promoting tolerance in the gut
b. blocks mast cell activation via CB1R
c. decrease IL-6, IL-1, TNFa, IL-12, IL-23, IL-4
d. all of the above

A

all of the above

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26
Q

What are the effects of 2-AG on the innate immune system?
a. reduces IL-6 and TNFa
b. increases IL-12 from dendritic cells promoting a Th1 response
c. activates eosinophils via CB2R increasing allergic inflammation
d. all of the above

A

all of the above

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27
Q

What is PEA on innate immune system?
a. inhibits macrophage inflammation in brain
b. stimulates clerance of pathogens
c. inhibits mast cell degranulation via CB1R in the brain
d. all of the above

A

all

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27
Q

What is PEA effect on innate immune system?
a. inhibits macrophage inflammation in brain
b. stimulates clerance of pathogens
c. inhibits mast cell degranulation via CB1R in the brain
d. all of the above

A

All of the above

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28
Q

What are the effects of AEA on specific immunity in vitro?
a. supresses T cell division and sytokine release through CB2R and PPARy
b. inhibits INFy and IL-17, increases Th2 and Treg
c. increase endocannabinoids production
d. all of the above

A

all

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29
Q

What are 2-AG effects on specific immunity?
a. supresses IL-2 decreasing T cell dividon through PPARy
b. inhibits INFy and IL-17, increases Th2 and Treg
c. increase endocannabinoids production
d. all of the above

A

supresses IL-2 decreasing T cell dividon through PPARy

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30
Q

Which of these is NOT a factor that impacts your response to cannabis?
a. ligand concentration
b. presence of other cannabinoids and endogenous cannabinoids
c. receptor density
d. quality of signling protiens
e. the strain of cannabis

A

the strain of cannabis

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31
Q

what are the possible responses to cannabis receptor activation?
a. partial agonism
b. inverse agonism
c. functional selectivity
d. different confromations
e. all of the above

A

all

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32
Q

Which statement best defines partial agonism?
a. activates with less efficacy
b. induces opposite effect
c. different ligands trigger different signal transuction pathways
d. same protein with slightly different physical forms

A

activates with less efficacy

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33
Q

Which statement best describes what different conformations means?
a. activates with less efficacy
b. induces opposite effect
c. different ligands trigger different signal transuction pathways
d. same protein with slightly different physical forms

A

same protein with slightly different physical forms

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34
Q

Which statement best describes what functional selectivity means?
a. activates with less efficacy
b. induces opposite effect
c. different ligands trigger different signal transuction pathways
d. same protein with slightly different physical forms

A

different ligands trigger different signal transuction pathways

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35
Q

What is the effect of Cannabis on innate immunity?
a. decrease IL-1, IL-6, TNFa, IL-12, IL-10
b. decreases phagocytosis, antigen presentation
c. reduces arachadonic acid metabolites
d. all of the above

A

all of the above

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36
Q

What is Cannabis effect on immunity?
a. causes B cell to make IgE antibodies
b. decrease Th1 and increases Th2
c. reduces INFgamma and IL-17 helping with autoimmune disease
d. all of the above

A

all of the above

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37
Q

What is Cannabis effect on Multiple Sclerosis?
a. high concentration it CB2R decreases activity of macrophages, microgila, and B and T cells, and reduces MBP specific T cells
b. in low concentration it slows axonal loss and potentiate endogenous cannabinoids activity
c. slowing down machrophage
d. all of the above

A

all

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38
Q

What endocannabinoid is missing in those with RA and OA?
a. PEA
b. 2-AG
c. AEA

A

PEA

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39
Q

What is Cannabis effect on atherosclerosis?
a. THC inhibits macrophage recruitment leading to decreased plaque formation
b. anandimide inhibits monocyte adhesion and inhibits inflammatory gene expression in endothelial cells
c. all of the above

A

all

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40
Q

What are cannabis effect on diabetes?
a. inhibits Th1
b. dec INFy, TNFa, and IL-12
c. inhibits neuropathic pain
d. all

A

all

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41
Q

What is Cannabis effect on asthma?
a. decreases inflammatory response accompaning the th2 response
b. decreases mucus production in the lungs
c. increases bronchodilation
d. all of the above

A

all

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42
Q

What is Cannabis effect in the gut?
a. suppression of pro-inflammatory cytokines
b. inhibiton of intestinal motility
c. attenuation of visceral sensitivity
d. all of the above

A

all

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43
Q

What is Cannabis effect on neruoinflammation?
a. anti-inflammatory
b. supress IL-1 and protect glial cells from apoptosis
c. microglia, astrocytes, macrophages, and neurons produce eCBS which attenuate neural damage
d.all of the above

A

all of the above

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44
Q

Endocannabinoids are lipid mediators. What does that mean?
a. They accumulate in intracellular storage organelles
b. They need fat-soluble vitamins to be absorbed
c. They cross the blood brain barrier
d. They can be stored in cholesterol

A

They accumulate in intracellular storage organelles

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45
Q

What are two outcomes of the endocannabinoid system being activated?
a. Increase hunger
b. Increase energy
c. Reduce pain
d. Relax/reduce anxiety

A

Increase hunger
Relax/reduce anxiety

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46
Q

These are the two most well studied endocannabinoids
a. O-arachidonoylethanlamine and 2-AG-ether
b. 2-arachidonoyglycerl and anandamide
c. 2-AG-ether and N-Palmitoylethanolamine
d. Anandamide and 2-N-acylethanolamines

A

2-arachidonoyglycerl and anandamide

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47
Q

Which two compounds are produced by immune cells
a. 2-AG and PEA
b. AEA and 2-AG
c. AEA and PEA

A

AEA and PEA

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48
Q

Which enzyme is involved in linking endocannabinoids to inflammation?
a. MAGE-lipase
b. FAAH
c. DAG lipase
d. NAPE-PLD

A

MAGE-lipase

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49
Q

Which cannabinoid receptor is found in the digestive system?
a. CBR2
b. CBR1

A

CBR1

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50
Q

Endocannabinoids and plant cannabinoids are _____ of the TRPV-1 receptor.
a. Agonists
b. Antagonists
c. Partial agonists

A

Agonists

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51
Q

What is the action of PPAR-gamma receptor?
a. Inhibits growth of cancer cell lines
b. Decrease blood pressure
c. Create a sensation of heat and burning
d. Inhibit anxiety and induce relaxation

A

Inhibits growth of cancer cell lines

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52
Q

Which of the following cells do NOT express cannabinoid receptors?
a. Macrophages
b. Mast cells
c. Neutrophils
d. Eosinophils

A

Eosinophils

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53
Q

These diagnoses are associated with endocannabinoid deficiencies (check all that apply):
a. Fibromyalgia
b. Chronic fatigue syndrome
c. Autism
d. Epilepsy
e. Arthritis
f. Irritable bowel syndrome

A

Fibromyalgia
Irritable bowel syndrome
Epilepsy

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54
Q

Cannabis decreases these cytokines leading to decreased pain, heat, and anxiety.
a. IL-4, IL-5, IL-13
b. IL12, IL-10
c. IL-1, IL-6, TNF alpha

A

IL-1, IL-6, TNF alpha

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55
Q

Cannabis causes class switching of IgM to:
a. IgA
b. IgG
c. IgD
d. IgE

A

IgE

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56
Q

In low concentrations, cannabis has this effect on individuals with MS
a. decreased activity of macrophages, microglia, B and T cells
b. Reduces Myelin Basic Protein specific T cells
c. Slows axonal loss

A

Slows axonal loss

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57
Q

Cannabis increases Th2, which theoretically would make allergic asthma worse. Why is it generally found to be beneficial for asthmatic patients?
a. It stimulates bronchodilation
b. It decreases the inflammatory response accompanying Th2 response
c. It decreases mucus production in the lungs
d. all of the above

A

all

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58
Q

Cannabis has been found to improve atherosclerosis by:
a. Lowering lipid levels
b. Disintegrating plaques
c. Lowering blood pressure
d. Decreasing plaque formation

A

Decreasing plaque formation

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59
Q

Studies have found that some neurological disorders arise from having a shortage in endocannabinoids.
Select one:
True
False

A

T

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60
Q

In theory, cannabis is therapeutic for autoimmune disease.
Select one:
True
False

A

T

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61
Q

When is endocannabinoids highest?
a. at night
b. in the morning
c. in the middle of the day
d. in the evening

A

at night

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62
Q

Which has increasing effect with increased dose?
a. isolate
b. broad spectrum

A

broad spectrum

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63
Q

What is the average dose fro CBD?
a. 20 mg
b. 100 mg
c. 1500 mg
d. 500 mg

A

100 mg

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64
Q

How much THC dose durban poison have in it?
a. 90%
b. 10%
c. 50%
d. 15%

A

90%

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65
Q

What increased absoprtion of cannabis?
a. grapefruit oil
b. capsaicin
c. milk thistle
d. a and b

A

a and b

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66
Q

What is the entourage effect?
a. compund from other plants that act synergistically with cannabis
b. cannabinoids and terpenes
c. found in pine, lavendar, black peper, hops, citrus
d. all of the above

A

all

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67
Q

What is the MOA of Corticosteroids?

A

inhibition of eicosanoids via phospholipase A2, suppresses endogenous glucocorticoids, gene expression primarily NF-kB

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68
Q

Which of the following is NOT an effects of endogenous glucocorticoids?
a. decreasse blood glucose
b. increase BP
c. immune supression
d. suppression of HPA axis

A

decreasse blood glucose

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69
Q

What is adverse effect of exogenous corticosterioids?
a. skin thinning
b. abdominal striae
c. muscle wasting
d. all of the above

A

all of the above

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70
Q

What is the reason for tapering glucocorticoids?
a. can impact HPA axis causing adrenal insuffiency
b. its better for the patient
c. it causes kidney faliure
d. it causes MI

A

can impact HPA axis causing adrenal insuffiency

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71
Q

What are the side effects of corticosteroids?

A

hyperglycemia, osteoprosis, muscle wasing, tissue atropy, skin thinning, abdominal striae, growth retardation in children, poor wound healing, susceptibility to infections, HTN, edema, hypernatermia, hypokalemia, acne, hirsutism, moon facies, central adiposity, buffalo hump, insomnia, anxiety, psychosis, cataracts, peptic ulcers

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72
Q

What is the dosing for corticosteroids?
a. low dose for short time
b. low dose for long time
c. high dose for long time
d. high dose for short time

A

low dose for short time

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73
Q

Methotrexate MOA

A

similar to folate and impacts rapidly dividing cell populations so that you can’t repair DNA, can’t divide,

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74
Q

Which of the following is an intraarticular glucocorticoids?
a. methylprednisolone
b. dexamethasone
c. triamcinolone
d. all of the above

A

all of the above

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75
Q

What are the adverse effects of intraarticular glucocorticoids?

A

risk of infection, tendon rupture, atrophy of skin and underlying fat, hypopigmentation, cartilage damage, osteonecrosis, hyperglycemia

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76
Q

What are the CI of intraarticular glucocorticoids?
a. infection of the area
b. joint instability or periarticular fracture
c. juxta-articular osteoporosis
d. all of the above

A

all of the above

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77
Q

What are the two COX-2 inhibitors?
a. celecoxib
b. ibuprofen
c. aspirin
d. a and c

A

a and c

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78
Q

What are the side effects of non-asprin NSAIDs?

A

risk of bleeding, gastritis, gastric ulcers, interisital nephritis, renal faliure, airway hyperreactivity, HTN, risk of MI and stroke,

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79
Q

Acetaminophen mechanism of action is largely through COX enzymes.
Choose One:
True
Flase

A

Flase

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80
Q

Which of these is Apirins side effect but not one that non-asprin NSAIDs have?
a. salicylate hypersensitvity and toxicity
b. risk of reye’s syndrome in children
c. risk of MI and stroke
d. a and b

A

a and b

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81
Q

What is the side effect of acetaminophen?
a. risk of bleeding
b. gastritis, gastric ulcers
c. kidney faliure
d. HTN

A

kidney faliure

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82
Q

What are the common effect of DMARDs?
a. bone marrow suppression
b. opportunistic infections
c. secondary cancer
d. all of the above

A

all of the above

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83
Q

Which are examples of small-molecule DMARDs?
a. methotrexate
b. sulfasalazine
c. hydroxychloroquine
d. all of the above

A

all of the above

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84
Q

Which of following substances is closley related to folate?
a. methotrexate
b. sulfasalazine
c. hydroxychloroquine
d. cyclosporine

A

methotrexate

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85
Q

Which of the following is NOT a methotrexate side effect?
a. bone marrow suppression
b. renal, hepatic, pulmonary, GI, derm toxicity
c. opportunistic infections
d. primary malignancy

A

primary malugnancy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
86
Q

What is the selfasalazine used to treat?
a. RA
b. UC
c. crohn’s
d. all of the above

A

all of the above

87
Q

what are the side effects of sulfasalazine?
a. GI upset
b. CNS symptoms
c. kidney stone
d. mild bone marrow suppression
e. all of the above

A

all of the above

88
Q

Who should not take sulfasalazine?

A

those with asprin and sulfa drug allergies

89
Q

What is sulfasalaine?

A

a prodrug that is metabolized by bateria in the large intestine to 5-ASA and sulfapyridine

90
Q

What kind of drug is hydroxychloroquine?
a. antimalarial
b. NSAID
c. corticosteroid
d. prodrug

A

antimalarial

91
Q

What condtions are used to treat hydroxychloroquine?
a. early, mild RA
b. SLE
c. OA
d. a and b

A

a and b

92
Q

What is hydroxychloroquine adverse effect?
a. retionpathy
b. GI upset
c. opportunistic infection
d. kidney stones

A

retionpathy

93
Q

What is the mechanism of action of cyclosporine and tacrolimus?
a. COX-inhbitor
b. inhibit porgtalgandin A2
c. prevent production of IL-2 and other interleukins
d. metabolized by bacteria in the large intestine to 5-ASA and sulfapyridinie

A

prevent production of IL-2 and other interleukins

94
Q

What is cyclosporine and tacrolimus used for?
a. organ transplantation
b. RA
c. severe psoriasis
d. all of the above

A

all of the above

95
Q

What is cyclosporine and tacrolimus SE?
a. retionpathy
b. GI upset
c. opportunistic infection
d. kidney toxicity

A

kidney toxicity

96
Q

What conditon is tacrolimus treats that cyclosporine dose not?
a. atopic dermatitis
b. SLE
c. Sevre psoriasis
d. RA

A

atopic dermatitis

97
Q

Is cyclophosphamide use often?
True
False

A

false

98
Q

What are the biologic DMARDs?
a. adalimumab
b. inflizimab
c. entanercept
d. all of the above

A

all of the above

99
Q

Are TNF-a inhibitors given orally?
a. Yes
b. no

A

no

100
Q

What is the AE for TNF-a inhibitors?
a. inc risk of infection
b. inc risk of lymphoma and other cancer
c. dec risk of heart faliure and liver disease
d. pancytopenia

A

dec risk of heart faliure and liver disease

101
Q

Which drugs are considered safe in pregnancy?
a. adalimumab
b. infliximab
c. etanercept
d. all of the above

A

all of the above

102
Q

What is the mechanism of action of colchicine?
a. COX-inhbitor
b. inhibit porgtalgandin A2
c. prevent production of IL-2 and other interleukins
d. inhibits tubulin

A

inhibits tubulin

103
Q

What are SE of colchicine?
a. N/V
b. abdominal pain
c. diarrhea
d. all of the above

A

all of the above

104
Q

What is the symptoms of colchicine toxicty?
a. seziures
b. arrhythmias
c. shock and organ faliure
d. all of the above

A

all

105
Q

what is allopurinol moa?
a. purine analog
b. inhibit porgtalgandin A2
c. prevent production of IL-2 and other interleukins
d. COX-inhbitor

A

purine analog

106
Q

What is the SE of allopurinol?
a. rash
b. N/V
c. abdominal pain
d. diarrhea

A

rash

107
Q

What is probenacid MOA?
a. purine analog
b. inhibit porgtalgandin A2
c. inhibits uric acid reabsorption in the kidney
d. COX-inhbitor

A

inhibits uric acid reabsorption in the kidney

108
Q

What are the SE of probenacid?
a. nausea
b. vomitting
c. rash
d. uric acid kidney stones
e. al of the above

A

all

109
Q

Which is contraindicated with a G-6-PD defiency?
a. sulfasalazine
b. probenacid
c. allopurinol
d. colchicine

A

probenacid

110
Q

What are the SE of chronic colchicine?
a. myopathy
b. peripheral neuropathy
c. aplastic anemia and neutropenia
d. alopecia
e. all of the above

A

all of the above

111
Q

Why can’t you drink when taking actetaminophen?
a. depletes glutothione
b. depletes dopamine
c. depletes the ability to make it water soluble
d. depletes methylation

A

depletes glutothione

112
Q

What causes Reye syndrome?
a. asprin
b. ibprofuen
c. actetaminophen
d. naproxen

A

asprin

113
Q

What acute phase reactant helps to keep the microbiome in check?
a. Kinins
b. Defensins
c. Inflammatory cytokines
d. Complement

A

Defensins

114
Q

What T cell response is active in response to Fungi?
a. Treg
b. Th2
c. Th1
d. Th17

A

Th17

115
Q

IL-1 is an inflammatory cytokine that affects the brain and presents only as depression.

Select one:
True
False

A

F

116
Q

Which cytokine(s) results in IgG production? (two)
a. IL-17
b. IL-13
c. TGF beta
d. IFN gamma

A

IFN gamma
IL-17

117
Q

Which cell(s) expresses receptors for 5HT?
a. CD4 T cells
b. Macrophages
c. B cells
d. CD8 T cells

A

CD4 T cells
CD8 T cells

118
Q

What does the Snaith Hamilton Pleasure Scale measure?
a. If they anticipate finding pleasure in something soon
b. What a person finds pleasure in
c. How many things a person finds pleasurable in their life
d. A temporary experience of pleasure
e. A person’s capacity to experience pleasure

A

A person’s capacity to experience pleasure

119
Q

What is the role of the 5HTTPR gene?
a. It regulates contractility of the colon
b. It regulates how much serotonin, dopamine and norepinephrine is broken down in the brain
c. It regulates how extraverted you are
d. It regulates serotonin distribution in the brain

A

It regulates serotonin distribution in the brain

120
Q

Which effect is not attributed to GABA?
a. Relaxation
b. Happiness
c. Focus
d. Sleep

A

Happiness

121
Q

How do endocannabinoids affect immunity?
a. There are receptors on immune cells that respond to pathogens which reduces endocannabinoid degrading enzymes thereby increasing endocannabinoids and increasing B cell migration and shifting cytokine profiles
b. There are receptors expressed in parts of the brain that control immune cells and when stimulated by a cannabinoid, they cause increased production of macrophages and natural killer cells.
c. There are receptors expressed in parts of the brain that control immune cells and when stimulated by a cannabinoid, they cause decreased production of macrophages and natural killer cells.
d. There are receptors on immune cells that respond to food which increases endocannabinoid degrading enzymes thereby decreasing endocannabinoids and increasing B cell migration and shift cytokine profiles.

A

There are receptors on immune cells that respond to pathogens which reduces endocannabinoid degrading enzymes thereby increasing endocannabinoids and increasing B cell migration and shifting cytokine profiles

122
Q

Which of the following is NOT a result of high cortisol or acute stress?
a. Decreased testosterone
b. Reduced cytokine secretion
c. Increased T cell proliferation
d. Increased blood glucose

A

Increased T cell proliferation

123
Q

High levels of cortisol over a long period of time will have what effect on the nervous system?
a. Decreased overall memory over time
b. Decreased short term-memory
c. Has no effect on memory
d. Increased overall memory over time

A

Decreased overall memory over time

124
Q

Which of the following is NOT a result of chronically high cortisol?
a. Accumulation of abdominal fat
b. PCOS
c. Decreased thyroid function
d. Prolonged healing time and inability to respond to infections

A

PCOS

125
Q

Glucocorticoids inhibit which of the following:
a. Protein metabolism with increased amino acids
b. Gluconeogenesis
c. NF-KB
d. Glycogen storage

A

NF-KB

126
Q

What is theorized as to why autoimmune disease be more common in females?
a. Higher levels of estrogen increase Th1 and Th17
b. Higher levels of estrogen decrease Th1 (and increases Th2)
c. Higher levels of estrogen increases antibody production

A

Higher levels of estrogen increase Th1 and Th17
Higher levels of estrogen increases antibody production

127
Q

Which of the following is NOT an effect of oxytocin on the immune system?
a. Increased antibodies
b. Antibiotic
c. Wound healing
d. Anti Inflammatory

A

Increased antibodies

128
Q

Which hormones make autoimmunity worse?
a. Estrogen
b. Prolactin
c. Testosterone
d. Progesterone
e. Oxytocin

A

Estrogen
Prolactin

129
Q

Which hormones are associated with lower levels of autoimmunity
a. Oxytocin
b. Testosterone
c. Prolactin
d. Progesterone
e. Estrogen

A

Progesterone
Oxytocin
Testosterone

130
Q

Cortisol levels are low in Lupus

Select one:
True
False

A

T

131
Q

Which of the following is NOT an effect of adrenalin (epinephrine)?
a. Decreased Th1
b. Decreased Th17
c. Decreased prolactin
d. Decreased Treg

A

Decreased Th1

132
Q

What are the effects on alpha binding on a macrophage during a low stress situation with low amounts of epinephrine around?
a. Increased phagocytosis
b. Increased Il-6
c. Increased TNFa

A

a. Increased phagocytosis
b. Increased Il-6
c. Increased TNFa

133
Q

By what age is the microbiome development complete?
a. 2 years
b. 7 months
c. 2 months
d. 4 years

A

2 years

134
Q

Which microbial species are associated with GABA?
a. Lactobacillus and bifidobacterium
b. Escherichia and enterococcus
c. Bacillus
d. Candida and bacillus

A

Lactobacillus and bifidobacterium

135
Q

Which probiotic is now considered a psychobiotic?
a. Campylobacter
b. Lactobacillus
c. Bacteroides
d. Bifidobacterium infantis

A

Bifidobacterium infantis

136
Q

What neurotransmitter is most often deficient in Alzheimer’s disease?
a. GABA
b. Serotonin
c. Melatonin
d. Norepinephrine

A

GABA

137
Q

What gut dysbiosis pattern is observed in Parkinson’s disease?
a. Reduced prevotella and increased enterobacteriaceae
b. Increased lactobacillus and decreased bifidobacterium
c. Increased prevotella and decreased enterobacteriaceae
d. Reduced lactobacillus and increased bifidobacterium

A

Reduced prevotella and increased enterobacteriaceae

138
Q

Which microbial species are known to increase GABA?
a. Lactobacillus
b. Bifidobacterium
c. Prevotella
d. Bacteroides

A

Lactobacillus
Bifidobacterium

139
Q

Which of the following is the best way to increase IgA in the saliva?
a. Eat a perfect diet
b. Exercise until your legs fall off
c. Take 5 seconds to think about something that makes you happy
d. Take probiotics every day

A

Take 5 seconds to think about something that makes you happy

140
Q

The joint involvement seen in RA develops
a. Intermittently
b. RA may present as any of these patterns
c. Insidiously
d. Suddenly

A

RA may present as any of these patterns

141
Q

RA generally affects
a. The spine
b. peripheral joints
c. The shoulders
d. The knees

A

peripheral joints

142
Q

Which of the following describes the theory of the etiology and pathophysiology of RA
a. External trigger > synovial hypertrophy > susceptible individual > chronic joint inflammation
b. Synovial hypertrophy > external trigger > susceptible individual > chronic joint inflammation
c. Susceptible individual > external trigger > synovial hypertrophy > chronic joint inflammation
d. Chronic joint inflammation > susceptible individual > external trigger > synovial hypertrophy

A

Susceptible individual > external trigger > synovial hypertrophy > chronic joint inflammation

143
Q

RA is like hashimoto’s thyroiditis, It is an organ specific autoimmune disease, except that in RA, the joints are the organ that is affected.

Select one:
True
False

A

F

144
Q

Which of the following statements about RA is false?
a. The incidence of RA peaks from 55 to 85 years of age
b. Males with RA have been found to have lower testosterone levels
c. Males with RA are less likely to be RF positive
d. The disease is more prevalent in females than males

A

Males with RA are less likely to be RF positive

145
Q

Which statement concerning the HLA-DRB1 gene is false?
a. It’s the strongest known genetic risk factor for RA development
b. It has a variant that’s associated with a decreased risk of developing RA
c. It is the only gene found to increase the risk of RA development
d. It has been found to have an interaction with smoking

A

It is the only gene found to increase the risk of RA development

146
Q

Treating periodontal disease with antibiotics often worsens symptoms of RA.

Select one:
True
False

A

F

147
Q

Which of the following is not associated with an increased risk of RA?
a. Air pollution
b. Moderate alcohol intake
c. High red meat consumption
d. Obesity

A

Moderate alcohol intake

148
Q

Radiologic findings are helpful in diagnosing early RA

Select one:
True
False

A

F

149
Q

Which of the following is not a typical radiological finding of RA?
a. Ankylosis
b. Bare area erosions
c. Periarticular osteopenia
d. Radial deviation of the fingers

A

Radial deviation of the fingers

150
Q

Which of the following is the earliest radiological finding of RA?
a. Subluxations
b. Joint space narrowing
c. Bare area erosions
d. Periarticular osteopenia

A

Periarticular osteopenia

151
Q

Which of the following is true about periarticular osteopenia?
a. Both of these statements are true
b. It is a sign specific to RA, as most other arthropathies will present with bone mineralization
c. It occurs around inflamed joints because of the local release of inflammatory molecules
d. Neither of these statements are true

A

Both of these statements are true

152
Q

The joint narrowing in RA is
a. Eccentric
b. Concentric

A

Concentric

153
Q

Around ____________ of RA patients will develop bare erosions within the first year of their diagnosis.
a. 40%
b. 50%
c. 30%
d. 60%

A

40%

154
Q

Which of the following joins are generally not affected in RA?
a. DIPs
b. MTPs
c. MCPs
d. PIPs

A

DIPs

155
Q

In RA, morning stiffness generally lasts <1 hr in the morning.

Select one:
True
False

A

f

156
Q

Individuals presenting with a palindromic onset of RA
a. All of these are correct
b. None of these are correct
c. Will likely develop full blown RA with time
d. Can be symptom free for days to months
e. Have episodic attacks that resolve after they begin

A

All of these are correct

157
Q

Which of the following will you generally see during the PE of an RA patient?
a. Asymmetrical joint swelling
b. Increased skin creasing over joints
c. Thickening of tendons due to synovitis
d. Increased ROM due to ligament laxity

A

Thickening of tendons due to synovitis

158
Q

A common finding in individuals with RA is
a. Radial deviation
b. Ulnar deviation

A

Ulnar deviation

159
Q

Swan neck deformity describes _________ in flexion and _ in extension.
a. DIPs; MCPs
b. DIPs; PIPs
c. MCPs, DIPs
d. PIPs; DIPs

A

DIPs; PIPs

160
Q

Boutonniere deformity describes __________ in flexion and _______________ in extension.
a. PIPs; DIPs
b. MCPs; DIPs
c. DIPs, MCPs
d. DIPs; PIPs

A

PIPs; DIPs

161
Q

Rheumatoid nodules are
a. Uncommon but pathognomonic
b. Freely movable
c. Usually on flexor surfaces
d. Red and inflamed

A

Freely movable

162
Q

Rheumatic nodules are associated with
a. All of the above
b. More aggressive disease
c. Heart and lung pathology
d. Vasculitis
e. Higher titers of RF

A

All of the above

163
Q

Vasculitis in RA
a. Will only be seen as a skin manifestation
b. Can lead to pericarditis
c. Is fairly common
d. Affects large arteries

A

Can lead to pericarditis

164
Q

Select the answer that is NOT true concerning scleritis in RA.
a. It is painful
b. It is benign but bothersome
c. It is progressive and emergent
d. It can cause blindness

A

It is benign but bothersome

165
Q

Which of the following does NOT describe a risk factor in developing cardiac involvement for an RA patient?
a. Patients are at an increased risk for vasculitis, which can affect the heart
b. Medications used for RA have a protective effect on the heart due to the decrease in inflammation
c. Patients with RA have increased CRP, which is a risk factor for for CVD
d. The environmental risk factors associated with RA are also risk factors for CVD

A

Medications used for RA have a protective effect on the heart due to the decrease in inflammation

166
Q

Which of the following in NOT part of the Felty syndrome triad?
a. Hepatomegaly
b. Splenomegaly
c. RA
d. Leukocytopenia

A

Hepatomegaly

167
Q

The effects of Rheumatoid Arthritis tend to be isolated to the joints.

Select one:
True
False

A

F

168
Q

Which of the following extra-articular manifestations are commonly associated with Rheumatoid Arthritis?
a. Cardiovascular disease
b. Anemia
c. Fever
d. Dry mucous membranes
e. all of the above

A

all

169
Q

The morning pain and stiffness associated with ___ tends to be worse in the mornings, lasting greater than 30 minutes, while the pain and stiffness associated with____ tends to be worse with use, thus getting more severe throughout the day.

A

inflammatory; non-inflammatory

170
Q

The serologic tests ESR and CRP included in the diagnostic criteria for Rheumatoid Arthritis and both sensitive and specific.

Select one:
True
False

A

F

171
Q

Which of the following conditions should be considered in the differential for Rheumatoid Arthritis?
a. Myasthenia Gravis
b. Psoriatic Arthritis
c. Sjogren’s syndrome
d. Type II diabetes
e. Viral infections including hepatitis and parvo B19

A

Psoriatic Arthritis
Sjogren’s syndrome
Viral infections including hepatitis and parvo B19

172
Q

It is typically the PCP’s responsibility to order initial blood work for establishing a Rheumatoid Arthritis diagnosis. These tests include a RF, ACCP, CBC, ESR, CRP, and Hepatitis status.

Select one:
True
False

A

T

173
Q

The goal time for referral to rheumatology and initiation of pharmacology in Rheumatoid Arthritis is
a. One month
b. Three months
c. Within 24 hours
d. One week

A

One month

174
Q

To expedite access to rheumatology, telemedicine is a good option for the majority of individuals working toward a diagnosis of Rheumatoid Arthritis.

Select one:
True
False

A

T

175
Q

During initial wait time for individual’s rheumatology referral it is sometimes indicated for the PCP to to initiate
a. NSAIDS
b. Low dose corticosteroids
c. Referrals to OT and/or PT
d. Opiates

A

NSAIDS
Low dose corticosteroids
Referrals to OT and/or PT

176
Q

The PCP will continue working with an individual with Rheumatoid Arthritis with special care in monitoring for
a. Osteoporosis
b. Cardiovascular disease
c. all of the above

A

all

177
Q

Methotrexate use is contraindicated in pregnancy.

Select one:
True
False

A

T

178
Q

Which of the following drugs should be prescribed with caution to individuals with G6PD deficiency?
a. Leflunomide
b. TNF inhibitors
c. Methotrexate
d. Sulfasalazine

A

Sulfasalazine

179
Q

This DMARD is recommended to individuals with a milder Rheumatoid Arthritis presentation ow when they can not tolerate other DMARDS.
a. Sulfasalazine
b. Methotrexate
c. TNF inhibitors
d. Hydroxychloroquine

A

Hydroxychloroquine

180
Q

The main obstacle for utilizing biologics as first line therapy in individuals with Rheumatoid Arthritis is the cost of the drug.

Select one:
True
False

A

T

181
Q

Which of the following is the best form of exercise of RA patients?
a. There is not “best form of exercise”. Exercise recommendations should be tailored to the patient
b. Weight training, because it reverses cachexia of RA and increases joint stability
c. Stretching, because it is the least stressful to the joint and decreases flexion contractures
d. Aerobic exercise because it improves fatigue and is cardioprotective

A

There is not “best form of exercise”. Exercise recommendations should be tailored to the patient

182
Q

Which of the following is true about RA and food triggers?
a. The more severe the disease, the more likely dietary modifications will be therapeutic
b. There are been no associations between RA and food triggers
c. Younger females with RA have a more successful response to dietary modifications
d. Older patients seem to respond best to dietary modifications

A

Younger females with RA have a more successful response to dietary modifications

183
Q

Which diets have been studied with positive findings for rheumatoid arthritis?
a. Vegan diet
b. All of these have been studied for RA
c. Mediterranean diet
d. Vegetarian diet

A

All of these have been studied for RA

184
Q

Which form of omega-6 fatty acid has the best research for symptom reduction in RA?
a. Evening primrose oil
b. Black currant seed oil
c. Fish oil
d. Borage seed oil

A

Borage seed oil

185
Q

What can you tell your patient with RA when they ask if it’s okay to drink coffee?
a. Coffee is rich in polyphenols and has been found to scavenge free radicals
b. All of these are true
c. If you do choose to drink coffee it should be filtered and in moderation.
d. Coffee consumption may exacerbate osteoporosis that occurs commonly in RA

A

All of these are true

186
Q

Smoking is directly related to symptom severity in RA.

Select one:
True
False

A

T

187
Q

Anti-inflammatory foods and spices have good theoretical basis for use in RA patients but no research to support them thus far.

Select one:
True
False

A

F

188
Q

Which joint tissue is primarily involved in the pathophysiology of OA?
a. Ligamentous tissue
b. Synovial fluid
c. Bone marrow
d. Articular cartilage

A

Articular cartilage

189
Q

Which bony changes are typically observed in progressive OA?
a. Osteophytes
b. Bony changes are not typical in OA
c. Bone cysts
d. Fractures

A

Osteophytes
Bone cysts

190
Q

Synovial hypertrophy is a typical feature in OA.

Select one:
True
False

A

T

191
Q

Which of the following in NOT a risk factor for developing OA?
a. Age
b. Having an autoimmune disease
c. Genetics
d. Past joint trauma

A

Having an autoimmune disease

192
Q

At what age does the incidence of OA begin to increase?
a. >65
b. 40-45
c. 30-40
d. 20-25

A

40-45

193
Q

Which of the following are contributing factors for posttraumatic OA?
a. Immobility
b. Diet
c. Misaligned joint mechanics
d. Increased inflammatory markers in and around the joint

A

Misaligned joint mechanics
Increased inflammatory markers in and around the joint

194
Q

Obesity is a risk factor for the development of OA. What are the current theories regarding this connection?
a. Dietary influences
b. Lower levels of physical activity
c. Increased joint compression over time
d. Macrophages in adipose tissue secrete pro-inflammatory cytokines

A

c. Increased joint compression over time
d. Macrophages in adipose tissue secrete pro-inflammatory cytokines

195
Q

A genu varus presentation may increase the risk of
a. Lateral tibiofemoral
b. Both medial and lateral tibiofemoral OA
c. Medial tibiofemoral OA

A

Medial tibiofemoral OA

196
Q

Males are more likely to present with OA in which joints?
a. Knees
b. Spine
c. Hands
d. Hips

A

Spine
Hips

197
Q

Which pattern is consistent with an OA presentation?
a. Joint pain and stiffness better with use and worse with immobility
b. Joint pain and stiffness worse with use and better with rest
c. Joint pain and stiffness lasting more than 30 minutes in the morning
d. Joint pain and stiffness that doesn’t change in quality throughout the day

A

Joint pain and stiffness worse with use and better with rest

198
Q

OA typically presents symmetrically

Select one:
True
False

A

F

199
Q

Which of the following describes stage 1 OA?
a. Constant pain
b. Predictable, sharp pain
c. Dull, achy pain
d. Pain affects ADLs

A

Predictable, sharp pain

200
Q

Ligament and tendon laxity may develop in individuals with OA.

Select one:
True
False

A

T

201
Q

Heberden’s nodes occur at which joints?
a. PIPs
b. Wrists
c. DIPs
d. Elbows

A

DIPs

202
Q

Bouchard’s nodes occur at which joints?
a. PIPs
b. Elbows
c. DIPs
d. Wrists

A

PIPs

203
Q

When establishing a diagnosis of OA, lab studies are most beneficial for ruling out other conditions.
Select one:
True
False

A

T

204
Q

The diagnosis of OA can be made purely based on clinical signs and symptoms.

Select one:
True
False

A

T

205
Q

Which plain film findings are suggestive of OA?
a. Unilateral joint space narrowing
b. Osteophytes
c. Bilateral joint space narrowing
d. Increased joint space

A

a. Unilateral joint space narrowing
b. Osteophytes

206
Q

Erosive OA can present with exacerbations and remissions of symptoms.

Select one:
True
False

A

T

207
Q

Which joints must be effected to meet the diagnostic criteria for erosive OA?
a. Wrists
b. DIPs
c. Elbows
d. PIPs

A

DIPs

208
Q

Charcot’s joints may occur secondary to
a. Peripheral neuropathy
b. Chronic alcoholism
c. Type II diabetes
d. Overuse

A

a. Peripheral neuropathy
b. Chronic alcoholism
c. Type II diabetes

209
Q

Which type of exercise is most beneficial for patients with OA?
a. High impact training
b. Exercise is not recommended for OA
c. Targeted strength training
d. A combination of aerobic and strength training

A

A combination of aerobic and strength training

210
Q

Weight loss in obese patients with OA can result in up to a 50% reduction in joint pain.

Select one:
True
False

A

T

211
Q

According to several studies, adding hydrotherapy and/or balneotherapy to an OA treatment plan can reduce pain and increase joint function.

Select one:
True
False

A

T

212
Q

Which of the following botanicals/supplements may be useful in the treatment of OA?
a. Botanicals are not effective in the treatment of OA
b. Curcumin
c. Bromelain
d. Boswellia

A

b. Curcumin
c. Bromelain
d. Boswellia

213
Q

There is no evidence to support the use of MSM or chondroitin in the treatment of OA.

Select one:
True
False

A

F

214
Q

What are NOT PE findings in RA ?
a. palmar erythema and thickening of flexor tendons due to synovitis of the tendon sheath
b. increased grip strength
c. carpal tunnel syndrome
d. incomplete fist closure and hand extension

A

increased grip strength

215
Q

What are NOT PE findings in RA ?
a. palmar erythema and thickening of flexor tendons due to synovitis of the tendon sheath
b. increased grip strength
c. carpal tunnel syndrome
d. incomplete fist closure and hand extension

A

increased grip strength

Fall Y3 (10 decks)

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