Rheum Exam 4 Flashcards
What is the most common use of US guided arthrocentesis?
a. knee
b. elbow
c. MCP
d. a and c
a and c
Which of the following is NOT a reason to perform arthrocentesis?
a. aid in diagnosis
b. deliver therapy
c. with a clear mechanism of injury with some or no swelling, redness, and warmth
d. unexplained joint effusions
with a clear mechanism of injury with some or no swelling, redness, and warmth
What are you looking for when looking at the synovial fluid?
a. clarity
b. color
c. visosity
d. all of the above
all of the above
Which of the following dosen’t describe normal apperance of synovial fluid?
a. highly viscous
b. cloudy
c. clear
d. slightly yellow or white
cloudy
When doing a culture for synovial fluid analysis what organism are you looking for?
a. gram postive
b. spirochete
c. gram negative
d. virus
gram +
How high are WBC in noninflammatory?
a. <2000
b. >2000
c. <100
d. >100
<2000
How high are WBC in inflammatory conditons?
a. <2000
b. >2000
c. <100
d. >100
> 2000
Which of the following describes noninflammatory synovial fluid?
a. WBC 2000-20000, % neutrophils 50-75%, crysal may or may not, stain and culture -
b. WBC >20000, % neutrophils >75%, crytsal -, stain/culture -/+
c. WBC <2000, % neutrophils < 25%, crystal -, stain/culture -
d. WBC 1 for every 1000 RBC, <50%, bloody, stain/culture -
WBC <2000, % neutrophils < 25%, crystal -, stain/culture -
what factors do you have to take into account about RA and OA?
a. severity of disease
b.
c. the joint that you ar injecting
d. a and c
Which is NOT a risks of arthrocentesis?
a. infection
b. hemarthrosis
c. neurovascular damage
d. improves flares and pain immediately
improves flares and pain immediately
What should you NEVER do?
a. inject into tendon
b. inject into nerve
c. inject into bone
d. a and b
a and b
Do you aspirate the area before injecting the theraputic agent?
a. yes
b. no
yes
Which of the following is not a indication for corticosteroid?
a. tendonitis
b. frozen shoulder
c. arthritis
d. lyme arthritis
lyme
Which of the following is True of the problems with corticosteroids?
a. results last forever
b. possible toxicity
c.simulate healing
d. all of the above
possible toxicity
What is prolotherapy?
a. hyperosmolar dextrose solution
b. plasma protien
c. drug that inhibits phospolipase A2
d. all of the above
hyperosmolar dextrose solution
What are the indications of prolotherapy?
a. arthritis
b. tendinitis
c. ligamentous injury/laxity
d. all of the above
all of the above
Which of the following is NOT a common sign/symptom of gout?
a. These are all common findings associated with gout
b. Tender joint
c. Swollen joint
d. Red joint
e. Hot joint
These are all common findings associated with gout
What is the underlying etiology of gout?
a. Hypermagnesemia
b. Hypertonia
c. Hyperuricemia
d. Hyperreflexia
Hyperuricemia
What location other than joints is commonly affected by gouty crystals?
a. Bile duct
b. Brain
c. Coronary arteries
d. Kidney tubules
Kidney tubules
Which of the following is/are sources of purines?
a. Endogenous nucleic acid synthesis
b. Anchovies
c. Avocado
d. Shellfish
Endogenous nucleic acid synthesis
Anchovies
Shellfish
Which best describes podagra?
a. Foot pain
b. Gout in children
c. A gouty attack in the first metatarsal joint
d. None of these answers are correct
A gouty attack in the first metatarsal joint
Which are examples of drugs that decrease uric acid levels?
a. Xanthine oxidase inhibitors
b. NSAIDs
c. Uricosuric medications
d. Corticosteroids
Uricosuric medications
Xanthine oxidase inhibitors
Select the conditions that are associated with gout?
a. Acute coronary syndrome
b. Hepatitis
c. Urate nephropathy
d. Kidney stones
Urate nephropathy
Kidney stones
Which of the following is NOT associated with gout?
a. Bone and joint destruction
b. Recurrent attacks of acute inflammatory arthritis with calcium pyrophosphate crystals
c. All of the following are associated with gout
d. Elevated serum uric acid
Recurrent attacks of acute inflammatory arthritis with calcium pyrophosphate crystals
Which of the following is a risk factor for developing hyperuricemia?
a. Overproduction of uric acid
b. Underproduction of glutamine
c. None of these are risk factors
d. Overproduction of urine
Overproduction of uric acid
The vast majority of individuals with elevated uric acid never develop gout, tophi or kidney stones.
Select one:
True
False
T
Which of the following populations has a higher risk for developing gout?
a. Those who are fair and fertile
b. Females
c. Males
d. Individuals with a low BMI
males
The acute presentation of gout is most often
a. Severe pain, redness, warmth, swelling and disability
b. Extreme headaches and joint pain
c. Asymptomatic
d. During the night/early morning
Severe pain, redness, warmth, swelling and disability
During the night/early morning
Gout is a disease isolated to the first metatarsal phalangeal joint.
Select one:
True
False
f
Which best describes intercritical gout?
a. Gout that has been cured
b. Acute presentations in locations other than the first MTP
c. Pre-renal gout
d. The asymptomatic phase between acute presentations
The asymptomatic phase between acute presentations
Which best describes chronic tophaceous gout?
a. Bacterial gas production within muscle tissue.
b. Calcium deposits in soft tissue. Mostly benign.
c. Collections of solid urate, chronic inflammation and destructive changes
Collections of solid urate, chronic inflammation and destructive changes
Tophaceous deposits can occur during the intercritical period of gout.
Select one:
True
False
T
Which of the following locations in NOT a common place for tophi to occur?
a. Ears
b. Tendons
c. Articular structures
d. Chin
e. Bursa
chin
Which of the following is the gold standard for diagnosing gout?
a. positive x-ray
b. Positive arthrocentesis
c. History of painful MTP joint
d. physical exam with swollen joints
Positive arthrocentesis
Response to treatment is an accurate method for diagnosing gout.
Select one:
True
False
F
which of the following are common findings for gout on arthrocentesis?
a. Monocyte predominance
b. Monosodium urate crystals
c. 10,000-100,000 WBCs
d. Positive gram stain and culture
b. Monosodium urate crystals
c. 10,000-100,000 WBCs
Serum urate levels are typically high during acute gout flares.
Select one:
True
False
F
When is the best time to order serum urate levels to determine if someone with suspected gout has hyperuricemia?
a. During an acute attack
b. 2 weeks following an acute attack
c. 2 days after an acute attack
d. 2 weeks before an acute attack
2 weeks following an acute attack
When are ultrasounds useful in gout?
a. Early detection and/or monitoring of disease
b. Identification of subcortical bone cysts
c. To determine the size of tophi to then determine disease progression
d. Identification of urate deposits in acute attacks
Early detection and/or monitoring of disease
Which is NOT one of the classification criteria used to diagnose gout?
a. Previous patient reported attack
b. Male
c. Joint redness
d. High red meat diet
High red meat diet
How is gout diagnosed during the intercritical gout period?
a. Arthrocentesis demonstrating monosodium urate crystals
b. It is not possible to diagnose gout during the intercritical period
c. X-ray demonstrating osteoporosis
d. Clinical classification criteria
Arthrocentesis demonstrating monosodium urate crystals
Which of the following is NOT a differential diagnosis for an acute gouty flare?
a. Septic arthritis
b. RA
c. CPPD
d. Trauma
RA
Which of the following is a differential diagnosis for chronic gout?
a. RA
b. Reactive arthritis
c. Trauma
d. Dactylitis
Dactylitis
RA
Which are proposed mechanisms for healthy weight as a goal for management gout?
a. Adiposity is a contributor to hyperuricemia
b. It’s not specific. Losing weight is just good for everyone’s health
c. Decreased weight on joints
d. Insulin resistance is linked to hyperuricemia
Adiposity is a contributor to hyperuricemia
Insulin resistance is linked to hyperuricemia
Wine has a minimal to no effect on uric acid levels.
Select one:
True
False
T
Which of the following is NOT a dietary recommendation for individuals with gout?
a. Limit alcohol
b. Limit fresh vegetables
c. Limit meat
d. Limit high fructose corn syrup
Limit fresh vegetables
Which of the following is a food high in purines?
a. Cherries
b. Leafy greens
c. mushrooms
d. Eggs
mushrooms
What is the proposed mechanism of action for the benefits of cherries in the treatment for gout?
a. Cherry juice acts as a demulcent in joint spaces
b. Cherries are high in purines and should NOT be used in the treatment of gout
c. UNknown, but possibly related to lowering levels of plasma uric acid and antiinflammatory effects
d. D-mannose in cherries fights E. coli infections
UNknown, but possibly related to lowering levels of plasma uric acid and antiinflammatory effects
Which of the following is NOT a proposed mechanism of cinnamon’s effectiveness in gout treatment?
a. It inhibits xanthine oxidase
b. It has an effect on tophi deposition
c. It has an effect on serum and liver urate levels
It has an effect on tophi deposition
Which of the following is effective as an antipyretic and analgesic in rat models?
a. Organ meats
b. Cherry juice
c. Ginger
d. Ashwagandha
Ashwagandha
Which active compound in grape seeds lowers serum uric acid levels?
a. High vitamin and mineral content
b. Procyanidins
c. Tannins
d. Resveratrol
Procyanidins
Which combination was found to be a possible prevention tool in patients with hyperuricemia and gout?
a. Coffee and vitamin C
b. Resveratrol and ginger
c. Curcumin and coffee
Coffee and vitamin C
Curcumin is proven to work as a preventative for gout flares in human trials.
Select one:
True
False
F
What percentage of the adult population in the United States is affected by CPPD?
a. 10%
b. 1-3%
c. <1%
d. 4-7%
4-7%
Which age group has the highest incidence of CPPD?
a. >84 yo
b. 40-64 yo
c. <20 yo
d. 65-74 yo
> 84 yo
Which of the following conditions is associated with increased risk of developing CPPD?
a. Hypocalcemia
b. Gout
c. Hypermagnesemia
d. Hemochromatosis
Hemochromatosis
Which disease pathophysiologies are similar?
a. CPPD and acute gout
b. RA and acute gout
c. CPPD and costochondritis
d. CPPD and RA
CPPD and acute gout
Which metabolic disease has been shown to increase the risk of developing pseudogout?
a. Type II diabetes due to elevated blood glucose levels
b. Phenylketonuria due to high levels of phenylalanine in the blood
c. Hemochromatosis due to iron deposition into tissues
d. Type I diabetes due to poor pancreatic function
Hemochromatosis due to iron deposition into tissues
CPPD typically begins with a monoarticular presentation.
Select one:
True
False
T
Trauma can predisposed a joint to developing CPPD crystals.
Select one:
True
False
T
Which rheumatologic disorder is commonly found with CPPD?
a. Osteoarthritis
b. Psoriatic arthritis
c. Reactive arthritis
d. SLE
Osteoarthritis
CPPD has a highly distinctive clinical presentation with an easily identifiable symptom picture
Select one:
True
False
F
Which is the most common join affected (>50%) in pseudogout?
a. Knee
b. Great toe
c. Neck cervicals
d. Elbow
Knee
Which lab findings might be observed in a patient with pseudogout?
a. Leukocytosis with lymphocytosis
b. Neutrophilia
c. Elevated ESR/CRP
d. Leukocytosis with a left shift of differential
b. Neutrophilia
c. Elevated ESR/CRP
d. Leukocytosis with a left shift of differenti
Which radiologic findings are observed with CPPD?
a. Degenerative changes
b. No changes are observed on radiograph
c. Tophi similar to that seen in gout
d. Chondrocalcinosis (cartilage calcification)
Chondrocalcinosis (cartilage calcification)
Degenerative changes
What is the gold standard for diagnosing CPPD?
a. Plain film
b. MIR
c. CPPD is a clinical diagnosis of exclusion
d. Synovial fluid analysis
Synovial fluid analysis
What are some indications that suggest a diagnosis of CPPD rather than OA?
a. Radiographic appearance
b. Subchondral cyst formation
c. Tendon calcification
d. Uncommon site for primary OA
e. all of the above
all
Demonstration of CPP crystals obtained by biopsy, necroscopy or aspirate alone is enough to diagnose CPPD.
Select one:
True
False
T
Monoarticular glucocorticoid injection treatment should start to provide pain relief within
a. 1 month
b. 1 week
c. 8-24 hours
d. 3 days
8-24 hours
This treatment is recommended to patients with three or more joints affected by CPPD.
a. Aspirin
b. Injectable glucocorticoids
c. Colchicine
d. PRP
Colchicine
What is the primary mechanism of action of colchicine in the treatment of CPPD?
a. Blocks IL-1
b. COX inhibition
c. Increases T-regs
d. Proinflammatory
Blocks IL-1
What is the first line therapy for chronic CPP crystal inflammation?
a. Glucocorticoids
b. Biologics
c. NSAIDS
d. Methotrexate
NSAIDS
There is no current therapies available to specifically prevent CPP crystal deposition.
Select one:
True
False
T
Which of the following describes inflammatory synovial fluid?
a. WBC 2000-20000, % neutrophils 50-75%, crysal may or may not, stain and culture -
b. WBC >20000, % neutrophils >75%, crytsal -, stain/culture -/+
c. WBC <2000, % neutrophils < 25%, crystal -, stain/culture -
d. WBC 1 for every 1000 RBC, <50%, bloody, stain/culture -
WBC 2000-20000, % neutrophils 50-75%, crysal may or may not, stain and culture -
Which of the following describes septic synovial fluid?
a. WBC 2000-20000, % neutrophils 50-75%, crysal may or may not, stain and culture -
b. WBC >20000, % neutrophils >75%, crytsal -, stain/culture -/+
c. WBC <2000, % neutrophils < 25%, crystal -, stain/culture -
d. WBC 1 for every 1000 RBC, <50%, bloody, stain/culture -
WBC >20000, % neutrophils >75%, crytsal -, stain/culture -/+
Which of the following describes hemorrhagic synovial fluid?
a. WBC 2000-20000, % neutrophils 50-75%, crysal may or may not, stain and culture -
b. WBC >20000, % neutrophils >75%, crytsal -, stain/culture -/+
c. WBC <2000, % neutrophils < 25%, crystal -, stain/culture -
d. WBC 1 for every 1000 RBC, <50%, bloody, stain/culture -
WBC 1 for every 1000 RBC, <50%, bloody, stain/culture -
Which of teh following is NOT an indication for PRP?
a. tendinitis/osis and partial tear
b. ligamentous injury/laxity
c. arthritis
d. fracture
fracture
How dose PRP work?
a. local growth factor effects
b. immune/infalmmation modulation
c. indirect cellular effect
d. all of the above
all of the above
What is th mechanism of mesenchymal stem cells?
a. engraftment
b. immunomodulation
c. paracrin effects
d. all of the above
all of the above
Scleroderma is a disorder capable of affecting multiple organ systems
Select one:
True
False
T
Peak age of a scleroderma diagnosis is
a. >65
b. 35-65
c. Adolescence
d. 20-30
35-65
Which environmental factor has been lined to the development of Scleroderma?
a. Silica dust
b. Mold
c. Olive oil
d. No environmental factors have been linked to the development of scleroderma
Silica dust
Which of the following vasculopathies can occur in small arteries and capillaries as an associated outcome of scleroderma?
a. Adhesion and activation of platelets
b. Persistent vasodilation
c. Thinning of the vascular wall
d. Vasoconstriction and endothelial cell growth
Vasoconstriction and endothelial cell growth and Adhesion and activation of platelets
Which of the following cells are directly responsible for the fibrotic changes in scleroderma?
a. Chondrocytes
b. Fibroblasts
c. Macrophages
d. Thrombocytes
Fibroblasts
Linear scleroderma is a form of
a. Localized scleroderma
b. Systemic scleroderma
Localized scleroderma
Which are common findings associated with limited cutaneous systemic scleroderma?
a. Plaque-like rash
b. Raynaud’s phenomenon
c. Telangiectasias
d. Glaucoma
b. Raynaud’s phenomenon
c. Telangiectasias
Raynaud’s phenomenon, when associated with scleroderma can result in digital ischemic injury.
Select one:
True
False
T
Limited scleroderma generally does not affect the face.
Select one:
True
False
F
Which skin manifestation are associated with limited scleroderma?
a. Dystrophic nail beds
b. Ulcerations
c. Striae
d. Calcific deposits
Calcific deposits
Ulcerations
Acrolysis is
a. Calcific deposits
b. The resorption of the distal phalynx
c. Ulceration of the hands
d. Dermal fibrosis
bone resorption of the distal phalanges
The E in CREST stands for
a. Esophageal dysmotility
b. Eczema
c. Eosinophilia
d. Endocarditis
Esophageal dysmotility
Diffuse cutaneous systemic sclerosis has a poor prognosis, when compared to other variants.
Select one:
True
False
T
Which of the following GI symptoms/outcomes are associated with diffuse cutaneous systemic sclerosis?
a. Diarrhea
b. Rapid gastric emptying
c. Delayed gastric emptying
d. Malabsorption
Delayed gastric emptying
Malabsorption
Which of the following is a leading cause of morbidity and mortality is later stage systemic sclerosis?
a. Lung fibrosis
b. Endocrine gland dysfunction
c. Bowel obstruction
d. Skin changes
Lung fibrosis
Which factors predict risk for developing renal disease associated with scleroderma?
a. Ibuprofen use
b. Anti-RNA polymerase III antibodies
c. Diffuse disease in the first 5 years of diagnosis
d. Family history of renal disease
Anti-RNA polymerase III antibodies
Diffuse disease in the first 5 years of diagnosis
Individuals with scleroderma rarely have additional autoimmune rheumatic diseases.
Select one:
True
False
F
Which clinical findings raise suspicion for scleroderma ?
a. Raynaud’s phenomenon
b. GERD
c. Hand stiffness
d. Puffy/swollen fingers
e. all
all
ANA is positive in 95% of scleroderma cases.
Select one:
True
False
T
Which antibody is the specific for diffuse scleroderma?
a. Anticentromere
b. Antibody testing is not indicated
c. Anti-Scl-70
d. Anti-RNA-polymerase III
Anti-Scl-70
Which scoring system is primarily used to evaluate disease burden of scleroderma?
a. Systemic Sclerosis Severity Scale
b. Functional Assessment
c. SBIRT
d. Quality of Life Questionnaire
Systemic Sclerosis Severity Scale
The Rodnan score evaluates
a. Skin thickness
b. Amount of calcinosis present
c. Joint pain
d. Raynaud’s severity
Skin thickness
In patients with systemic scleroderma, the following conditions should be monitored for their development.
a. Pulmonary hypertension
b. Hyperthyroidism
c. Interstitial lung disease
d. Osteoarthritis
Pulmonary hypertension
Interstitial lung disease
What lifestyle modifications can be useful in the treatment of Raynaud’s phenomenon?
a. Smoking cessation
b. Avoiding exposure to cold
c. Layering warm clothes
d. Contrast hydrotherapy using very hot and ice water applications
Smoking cessation
Avoiding exposure to cold
Layering warm clothes
What therapy is often prescribed to treat interstitial fibrosis due to scleroderma?
a. Asthma inhalers
b. Lung transplantation
c. Long acting bronchodilators
d. Corticosteroids
Corticosteroids
Which dietary recommendations are utilized with individuals experiencing scleroderma symptoms?
a. Raw foods diet
b. DASH diet
c. Ketogenic diet
d. Any diet that is plentiful in anti-inflammatory nutrient rich and easily absorbed foods
Any diet that is plentiful in anti-inflammatory nutrient rich and easily absorbed foods
Selenium deficiency has been identified in many individuals with scleroderma. Which organ system is often affected by this deficiency in this patient population?
a. Neurological
b. Cardiac
c. Renal
d. Gastrointestinal
Cardiac
Which vitamin deficiency is commonly seen in individuals with scleroderma and should be regularly monitored?
a. Vitamin B6
b. Vitamin B12
c. Vitamin D
d. Vitamin C
Vitamin B12
Which supplement has been shown to improve symptoms of Raynaud’s and pulmonary fibrosis when administered as an IV infusion?
a. Vitamin B12
b. Magnesium
c. NAC
d. Curcumin
NAC
In regards to scleroderma, which herb has been studied and shown to improve skin and vascular health?
a. Centella
b. Taraxicum
c. Trifolium
d. Ginko
Centella
PABA has a fair amount of evidence for use in the treatment of scleroderma due to its antifibrotic action, however should be used with caution as large doses are associated with
a. Hepatotoxicity
b. Renal toxicity
c. Gastric ulcer
d. Hypoglycemia
Hypoglycemia
Hepatotoxicity
What are some ways to decrease pain and stiffness in patients with scleroderma before and during exercise?
a. Massage
b. Heat applications
c. Exercise is contraindicated in individuals with scleroderma
d. Warm water
Massage
Heat applications
Warm water
What are some techniques to improve pulmonary function in individuals with scleroderma?
a. Stretching
b. Restricted movement
c. Inspirometer breathing exercises
d. Aerobic exercise several times per week
Stretching
Inspirometer breathing exercises
Aerobic exercise several times per week
Which best describes the hygiene hypothesis?
a. A lack of exposure to pathogens necessary to build a functioning immune system
b. Western diet being the cause of increased morbidity and mortality
c. Excessive exposure to pathogens necessary to build a functioning immune system
d. Excessive hand washing leads to immune dysfunction
A lack of exposure to pathogens necessary to build a functioning immune system
Which of the following statements are true?
a. Research proving nutrition is directly linked to developing an autoimmune disease is lacking
b. No firm data supports are relationship between macronutrient intake and risk for autoimmune disease
c. People who are prone to autoimmunity have straightforward risk factors and are therefore easy to study
d. There is strong epidemiologic evidence that suggest diet change is necessary to prevent autoimmune disease
Research proving nutrition is directly linked to developing an autoimmune disease is lacking
No firm data supports are relationship between macronutrient intake and risk for autoimmune disease
There is a correlation between elevated BMI or obesity before adulthood and an elevated risk for the developing multiple sclerosis.
Select one:
True
False
t
Which of the following statements is false?
a. White adipose tissue is considered an endocrine organ
b. White adipose tissue has no impact on inflammation
c. Diet-induced obesity can promote TH-17
d. White adipose tissue has an impact on CD4 T cell populations
White adipose tissue has no impact on inflammation
In what way is GI health connected to autoimmunity
a. It has no role in autoimmunity
b. It affects the balance between tolerance and immunity
c. It has minimal potential in the treatment of autoimmune diseases
d. It controls zonulin release
It affects the balance between tolerance and immunity
Which diet affects the microbiome?
a. Western diet
b. All diets have the potential to affect the microbiome
c. Mediterranean diet
d. High fat diets
All diets have the potential to affect the microbiome
Which of the following is associated with intestinal permeability?
a. All of these are associated
b. Stress
c. Pesticide exposure
d. Food hypersensitivities
All of these are associated
Which of the following can trigger the release of proinflammatory cytokines?
a. Each of these can upregulate proinflammatory cytokine release
b. Obesity
c. Food hypersensitivities
d. Stress
Each of these can upregulate proinflammatory cytokine release
What are the 5 R’s in the “5-R protocol?”
a. Remove, replace, reinoculate, repair, rebalance
b. Relegate, reconstitute, repopulate, renovate, readjust
c. Relegate, repopulate, rest, raise, rebalance
d. Remove, reset, replace, repopulate, restore
Remove, replace, reinoculate, repair, rebalance
Which of the following could be used during the replacement phase of treating intestinal permeability?
a. Bitters
b. Vitamin A
c. Aloe
d. Gluten
bitter
What is the focus of the rebalancing phase?
a. Assisting in intestinal repair
b. Providing the nutrients for repair
c. Replacing the microbiome
d. Addressing lifestyle habits
Addressing lifestyle habits
How long should the maintenance phase of the autoimmune protocol last?
a. For the remainder of one’s life
b. 30 days to 3 months
c. 3 days
d. 15 to 30 days
30 days to 3 months
What is the focus of the autoimmune protocol?
a. Emphasis on proteins
b. Avoidance of foods, additives, and medications that trigger intestinal inflammation, dysbiosis, and symptomatic food intolerance
c. Elimination of foods that a person reacts to
d. Emphasis on fruits and vegetables
Avoidance of foods, additives, and medications that trigger intestinal inflammation, dysbiosis, and symptomatic food intolerance
Why are nightshades implicated in joint inflammation?
a. They are mildly poisonous and some people are highly sensitive to the toxin
b. They stimulate the release of zonulin
c. They have an anti-nutrient that wards off pathogens and insects
d. They have a high lectin content
They have an anti-nutrient that wards off pathogens and insects
They have a high lectin content
Which of the following is NOT a food requiring a trial removal during the elimination phase of the autoimmune protocol diet?
a. Coffee
b. Potatoes
c. Tomatoes
d. Arugula
Arugula
What is used as a sign it is time to start reintroducing foods during the autoimmune protocol?
a. Ability to run a mile
b. One month
c. Ability to eat ice cream
d. Improved signs, symptoms and/or labs
Improved signs, symptoms and/or labs
It can be useful to create communities of individuals who are on the autoimmune protocol so that they may support each other.
Select one:
True
False
T
The autoimmune protocol is easy to implement and maintain and should therefore be used with every patient presenting with an autoimmune disease.
Select one:
True
False
F
The autoimmune protocol can be used in which of the following conditions?
a. RA
b. It can be used for any autoimmune disease depending on the patient
c. MS
d. IBD
It can be used for any autoimmune disease depending on the patient
The antibodies in SLE are specific to
a. Cellular components, most frequently in the nucleus
b. Receptors in the kidneys
c. Langerhans cells in the skin
d. Kupffer cells in the liver
Cellular components, most frequently in the nucleus
Which of these symptom clusters best aligns with the clinical presentation of SLE?
a. Malar rash/discoid rash, photosensitivity, fatigue
b. Fatigue, raynaud’s phenomenon, chest pain
c. Photosensitivity, oral/nasal ulcers, GI pain
d. Neurological symptoms, joint pain/swelling, hair loss
Malar rash/discoid rash, photosensitivity, fatigue
Which two types of lupus are “curable”
a. Systemic Lupus Erythematosus
b. Cutaneous Lupus Erythematosus
c. Drug-induced Lupus Erythematosus
d. Neonatal Lupus
c. Drug-induced Lupus Erythematosus
d. Neonatal Lupus
Which of the following is the most common constitutional symptom in SLE patients?
a. Fatigue
b. Fever
c. Myalgia
d. Weight change
Fatigue
What distinguishes the arthritis/arthralgia of SLE from RA?
a. Morning stiffness in RA generally lasts >1hr, in SLE it lasts <1hr
b. The arthritis in RA is polyarticular whereas in SLE it is monoarticular
c. The arthritis in RA is asymmetrical, in SLE it’s symmetrical
d. The arthritis in SLE is generally associated with more stiffness and in RA it is generally associated with more pain.
Morning stiffness in RA generally lasts >1hr, in SLE is’t <1hr
Which of the following is true about the skin manifestations of lupus?
a. Photosensitivity occurs with UVA but not UVB
b. The rash appears immediately after sun exposure
c.The rash appears a few days after sun exposure and lasts for days to weeks
d. It is a rare but serious complication of lupus
The rash appears a few days after sun exposure and lasts for days to weeks
The lupus face rash “butterfly rash” appears where?
a. Symmetrically on both cheeks
b. Over the bridge of the nose
c. On the nasolabial folds
d. Directly under the lower lip
Symmetrically on both cheeks
Over the bridge of the nose
The oral ulcers in lupus are generally
a. Painless
b. Painful
Painless
GI manifestations in lupus are
a. A significant cause of morbidity and mortality
b. Localized to one region of the GI tract
c. Commonly secondary to adverse medication reactions
d. Pathognomonic for SLE
Commonly secondary to adverse medication reactions
Which type of anemia presents in SLE
a. Autoimmune hemolytic anemia
b. Anemia of chronic disease
c. Anemia of kidney failure
d. Each of these types of anemia are associated with SLE
Each of these types of anemia are associated with SLE
Which criteria is preferred by rheumatologists for making the diagnosis of lupus?
a. ACR
b. SLICC
c. EULAR
SLICC
What is the difference between the ACR and SLICC lupus diagnostic requirements?
a. SLICC required one laboratory test demonstrating antibodies for diagnosis
b. ACR requires more criteria be met for diagnosis
c. ACR includes a single biopsy demonstrating SLE associated nephritis as a sole requirement for diagnosis
d. A SLICC diagnosis can be made from clinical presentations alone
SLICC required one laboratory test demonstrating antibodies for diagnosis
Which of the following is NOT part of the ACR criteria for diagnosing lupus?
a. Biopsy of the kidneys
b. +ANA
c. Malar rash
d. Hemolytic anemia
Biopsy of the kidneys
The clinical presentation of SLE
a. Is chronic and progressive
b. Is acute
c. Encompasses periods of remission and relapse
d. Clinical course is variable, all of these can be true
Clinical course is variable, all of these can be true
Which of the following is true concerning SLE?
a. It is more common in males, but has more severe prognosis in females
b. It is more common in females but has more severe prognosis in males
c. Caucasians are two times as likely as African Americans to develop SLE
d. An older age at diagnosis is associated with a likelihood of a decreased life expectancy
It is more common in females but has more severe prognosis in males
Genetic factors linked to lupus are generally associated with
a. Modulating immune function
b. Antigen presentation
c. Immune complex processing
d. All of these are true
All of these are true
Which of the following is NOT a mechanism for estrogen association with SLE?
a. Estrogen increases Th1 and Th9
b. Estrogen upregulates Il-1 and Il-6 production
c. Estrogen decreases apoptosis of B cells specific to self antigen
d. Estrogen increases autoantibody production
Estrogen increases Th1 and Th9
Complement deficiencies are a ________________ SLE
a. risk factor for
b. cause of
c. Both of these are true
d. Neither of these are true
Both of these are true
Which of the following is NOT a virus that’s been strongly associated with the development of SLE?
a. EBV
b. Parvovirus
c. Cytomegalovirus
d. Coronavirus
Coronavirus
Patients with drug-induced SLE will experience what upon discontinuation of the implicated drug?
a. A rebound flare of symptoms
b. Complete resolution of symptoms
c. Nothing. Drug-induced SLE is persistent and stable with or without the medication.
Complete resolution of symptoms
Smoking is a _____________ factor; alcohol is a _____________ factor in those with SLE predisposition.
a. Protective; risk
b. Risk, protective
c. Risk; risk
d. Protective; protective
Risk, protective
Which is NOT indicated in treatment protocols for lupus?
a. Medications to treat the patient’s specific symptom and organ involvement
b. Medications to increase the patient’s photosensitivity
c. Wearing sunscreen and avoiding the midday sun
d. Discontinuing drugs that may be inducing lupus
Medications to increase the patient’s photosensitivity
There is a ________% 10 year survival associated with lupus
a. 25
b. 50
c. 65
d. 85
85
Which of the following is true concerning vitamin D and SLE?
a. Improvement plateaus after 40 ng/mL
b. Supplementation has been associated with improvement in symptoms
c. Patients are likely to be deficient due to avoidance of the sun
d. All of these are true
All of these are true
Treating pain in SLE/fibromyalgia patients with Tai Chi has the same benefits as treating with opioids.
a. True - Tai Chi has been shown to be just as effective as opioids for pain
b. False - Tai Chi is shown to be more effective that opioids in treating the patient’s perception of pain associated with SLE/fibromyalgia
False - Tai Chi is shown to be more effective that opioids in treating the patient’s perception of pain associated with SLE/fibromyalgia
Which of the following are dietary recommendations for SLE?
a. Removing gluten for all patients because there is an association between SLE and celiac disease
b. Avoiding pro-inflammatory and allergenic foods
c. Including polyunsaturated fats
d. Considering the inclusion of probiotics to modulate the activity of the microflora
e. Encouraging patients to eat whatever they want because comfort is key
Avoiding pro-inflammatory and allergenic foods
Considering the inclusion of probiotics to modulate the activity of the microflora
Which of the following therapies is most indicated for treating baseline chronic joint pain and other organ manifestations in SLE patients?
a. Injectable corticosteroids
b. NSAIDS and rest
c. Antimalarials like hydroxychloroquine
Antimalarials like hydroxychloroquine
For which lupus patient population does the use of hydroxychloroquine have the most supportive evidence?
a. Those with symptoms limited to dermatological manifestations
b. Patients with systemic involvement
c. Patients who present with joint pain as their only symptom
d. Patients with very mild symptoms
Patients with systemic involvement
In lupus, prednisone is indicated
a. As a first line therapeutic
b. only if patients have severe symptoms due to cost restraints
c. never
d. as a potent mediator of inflammation and is associated with many adverse effects
as a potent mediator of inflammation and is associated with many adverse effects
Which of the following does not accurately describe the role of the PCP in lupus care.
a. Be familiar with the signs and symptoms of lupus so the patient can receive an early diagnosis
b. Be familiar with lupus treatments so that you can treat patients who present with moderate to severe disease
c. Recognise when a referral to rheumatology is indicated
d. Monitor disease activity in those with mild to moderate disease
Be familiar with lupus treatments so that you can treat patients who present with moderate to severe disease
Lab test to monitor disease activity in patients with lupus should be performed every
a. 3-6 months
b. Year
c. 1-2 months
d. 3 years
3-6 months
The genetic association for SLE is generally stronger than in other autoimmune diseases.
Select one:
True
False
T
What are the risk factors associated with the development of hyperuriciemia?
a. absolute or relative impairment of renal acid excertion
b. overproduction of uric acid
c. overconsumption of purine-rich foods
d. all of the above
all of the above
What is the age of onset for gout?
a. 20-30
b. 40-60
c. 70-90
d. 23-45
40-60
What are some drugs that could lead to gout?
a. thiazide
b. loop
c. cyclosporine A
d. asprin
e. all of the above
all of the above
Which is NOT a common sites of acute flares of gout?
a. olecranon bursa and elbow
b. spine
c. wrist and fingers
d. MTP, midfoot, subtalar, ankle
spine
Which of the following is NOT a symptoms associated with untreated gout?
a. intercritical periods continue to decrease in length
b. fever
c. longer acute attacks
d. monoarticular
monoarticular
Can you see crystals and bony erosions during intercritical gout?
a. yes
b. no
yes
What is chronic tophaceous gout?
a. solid urate leading to chronic inflammation and destructive changes
b. complication of untreated acute gout
c. diffuse and symmetrical arthtiris
d. all of the above
all of the above
What is the gold standard for diganosing gout?
a. US
b. CT
c. arthrocentesis
d. CBC
arthrocentesis
What dose the arthrocentesis of gout look like?
a. WBC 10,000-100,000
b. neutophil predominance
c. cloudy white
d. all of the above
all of the above
What are the lab tests that indicate gout?
a. neutrophil leukocytosis on CBC
b. ESR/CRP elevation
c. urate level high, normal, or low
d. all of the above
all of the above
What are the x-ray imaging findings that indicate gout?
a. chondrocalcinosis
b. subcortical bone cyst and overhanging edges
c. terminal digit resorption
d. periarticular osteopenia
subcortical bone cyst and overhanging edges
What is used to detect early gout?
a. x-ray
b. US
c. duel-energy tomography
d. MRI
US
What is cinnamon MOA on gout?
a. inhibit of xanthine oxidase
b. dec WBC
c. anti-inflammatory activity
d. dec IL-1, swelling, and pain
inhibit of xanthine oxidase
What is ashwaganda MOA on gout?
a. inhibit of xanthine oxidase
b. dec WBC
c. anti-inflammatory activity
d. dec IL-1, swelling, and pain
dec WBC
What is MOA of grapeseed extract?
a. inhibit of xanthine oxidase
b. dec WBC
c. anti-inflammatory activity
d. dec IL-1, swelling, and pain
dec IL-1, swelling, and pain
What is the MOA of cucumin?
a. inhibit of xanthine oxidase
b. dec WBC
c. anti-inflammatory activity
d. dec IL-1, swelling, and pain
inhibit of xanthine oxidase
What is the MOA of cherry?
a. inhibit of xanthine oxidase
b. dec plasma urate and inflammation
c. anti-inflammatory activity
d. dec IL-1, swelling, and pain
dec plasma urate and inflammation
What is the MOA of Vit C?
a. inhibit of xanthine oxidase
b. dec plasma urate and inflammation
c. dec risk of gout
d. dec IL-1, swelling, and pain
dec risk of gout
What is the definiton of chondrocalcinosis?
a. refers to the radiographic calcification in hyaline and or fibrocartilage, cartilage caldifcation
b. joint disease or radiographic abnormalities accompanying crystal depostion
c. acute gout attach for calcium pyrophospate
d. all of the above
refers to the radiographic calcification in hyaline and or fibrocartilage, cartilage caldifcation
