Rheum Exam 5 Flashcards by Kristin Connolly

What dose the RAPID 3 score contain?
a. subjective sx
b. subjective sx and objective findings
c. objective findings
d. all of the above

subjective sx

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What is included in DAS 28?
a. subjective sx
b. objective sx
c. ESR +PGA and 28 joints assessed for swelling and tenderness
d. all of the above

all of the above

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What are used to asess disease progression?

Rapid 3
DAS 28
SDAI
CDAI

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What is the disease activity monitoring tool for ankylosing spondylitis?
a. rapid 3
b. DAS 28
c. BASDAI
d. SDAI

BASDAI

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What is the disease activity monitoring tool for SLE?
a. rapid 3
b. DAS 28
c. BASDAI
d. none of the above

none of the above

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Which of the following are true of psoriatic arthritis?
a. RF is always negative in individuals with PsA
b. Onset occurs simultaneously with psoriasis of the skin
c. The peak symptom onset is 30-55 years of age
d. Affects females and males equally

c. The peak symptom onset is 30-55 years of age
d. Affects females and males equally

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Which HLA is associated with psoriatic arthritis (though not as strongly as with other spondyloarthropathies)?
a. HLA-DR4
b. HLA-B27
c. HLA-DR2
d. HLA-DQ

HLA-B27

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Stress is considered a risk factor for developing psoriatic arthritis.

Select one:
True
False

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Peripheral joint involvement in PsA is more common in
a. Females
b. Males

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Axial involvement of PsA is more common in
a. Males
b. Females

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Which patterns are generally seen in PsA?
a. Morning stiffness lasting greater than 30 minutes
b. Joint pain worse with activity and better with immobility
c. Morning stiffness lasting less than 30 minutes
d. Joint pain worse with immobility and better with activity

Joint pain worse with immobility and better with activity
Morning stiffness lasting greater than 30 minutes

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Which is the most predominant subgroup of PsA?
a. Polyarthritis
b. Asymmetrical oligoarthritis
c. Distal interphalangeal joint disease
d. Arthritis mutilans
e. Spondylitis

Asymmetrical oligoarthritis

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“Sausage digit” occurs in about 50% of patients with psoriatic arthritis, What is the medical term for this symptom?
a. Dactylitis
b. Tenosynovitis
c. Kielbasa digit
d. Sclerodactyly

Dactylitis

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Approximately, which percentage of patients with PsA develop arthritis mutilans?
a. 25%
b. 1%
c. 5%
d. 15%

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Enthesitis is defined as inflammation at the site of the insertion of tendons, ligaments and synovium into bone. Which tendon is most commonly affected in PsA?
a. Biceps tendon
b. Achilles tendon
c. Patellar tendon
d. Extensor hallucis longus tendon

Achilles tendon

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Which should be included in the workup for psoriatic arthritis?
a. Deep tendon reflexes (DRTs)
b. Eye exam
c. Depression screening
d. Musculoskeletal exam
e. Skin and nail exam

b. Eye exam
c. Depression screening
d. Musculoskeletal exam
e. Skin and nail exam

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Which differential diagnoses should be considered in the workup for PsA?
a. Hemochromatosis
b. Osteoarthritis
c. Trauma
d. Ankylosing spondylitis
e. Rheumatoid arthritis

Hemochromatosis
Ankylosing spondylitis
Rheumatoid arthritis

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How is septic arthritis ruled out?
a. Physical exam
b. ESR/CRP
c. History alone
d. Joint aspiration and culture

Joint aspiration and culture

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Individuals with PsA are at higher risk for cardiovascular disease
Select one:
True
False

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Pencil-in-cup findings on imaging may be observed in which pathologies?
a. Osteoarthritis
b. Reactive Arthritis
c. Psoriatic arthritis
d. Rheumatoid arthritis

Psoriatic arthritis
Rheumatoid arthritis

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Which joints are most commonly affected by pencil-in-cup deformity?
a. DIPs
b. Hips
c. PIPs

DIPs

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Which osseous change observed on imaging is specific to PsA?
a. Cloudy opacity
b. Swan neck deformity
c. Subcortical cysts
d. Ivory phalynx

Ivory phalynx

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What is the first-line pharmaceutical therapy for mild peripheral PsA arthritis?
a. Biologic DMARDs (TNF inhibitors)
b. Synthetic DMARDs (Methotrexate)
c. NSAIDs
d. Vitamin D

NSAIDs

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What is the standard of care for severe psoriatic arthritis?
a. NSAIDs
b. Synthetic DMARDs (Methotrexate)
c. Biologic DMARDs (TNF inhibitors)
d. Vitamin D

Biologic DMARDs (TNF inhibitors)

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What is the primary initial pharmaceutical intervention for axial psoriatic arthritis? a. Biologic DMARDs (TNF inhibitors) b. Synthetic DMARDS (methotrexate) c. Intra Articular steroid injections d. NSAIDs

NSAIDs

What daily dose of curcumin has been shown to improve symptoms of RA (and potentially PsA? a. 1000mg b. 300mg c. 10g d. 100mg

1000mg

Celiac disease is more prevalent in individuals with PsA Select one: True False

Individuals with psoriasis and PsA should avoid even mild amounts of UV radiation and sun exposure Select one: True False

Which vitamin deficiency has been noted in psoriasis and PsA patients? a. Vitamin C b. Vitamin D c. B12 d. Vitamin E

Vitamin D

How often should a patient with active psoriatic arthritis or whos treatment is being adjusted be reassessed? a. Every 6 months b. Annually c. Every 3 months d. At least every month

Every 3 months

How often should a patient with stable psoriatic arthritis be reassessed? a. Every 6 months b. Every 3 months c. Annually d. At least once a month

Every 6 months

This remedy is indicated for sprains with boggy swelling. a. Carbo animalis b. Rhus tox c. Ledum d. Colchicum

ledum

80% of sarcoidosis cases present within this age range. a. 15-20 b. >50 c. 45-60 d. 20-50

20-50

About half the individuals in whom sarcoidosis is identified are asymptomatic. Select one: True False

In sarcoidosis, remission generally occurs a. In black individuals more often than in white individuals b. if there are no extra thoracic manifestations c. Within the first two years of diagnosis d. In individuals who are younger at diagnosis

Within the first two years of diagnosis

The most common systems involved in sarcoidosis include a. Heart and lungs b. Lymphatics and GI c. Lungs and lymphatics d. Lungs and GI

Lungs and lymphatics

Select the environmental exposures linked to increased risk of developing sarcoidosis. a. Zirconium b. Lithium c. Zinc d. Lead e. Beryllium f. Mercury g. Aluminum

Aluminum Beryllium Zirconium

Mycobacterium tuberculosis is histologically similar to sarcoidosis with the major difference being that the granuloma in tuberculosis is _ whereas in sarcoidosis it is _ a. Caseating; non-caseating b. Non-caseating; caseating

Caseating; non-caseating

The center of a sarcoid granuloma is filled with a. Dead epithelial cells b. bacteria c. specialized macrophages called epithelioid cells d. mast cells

specialized macrophages called epithelioid cells

Interstitial lung disease is defined as a. A disorder resulting in airflow obstruction and reduction b. As acute, inflammatory reaction in the lungs c. A disorder causing fibrosis or scarring of the lugs d. A disease only occurring in the interstitium of the lungs

A disorder causing fibrosis or scarring of the lungs

Which of the following is associated with chronic sarcoidosis and therefore likely to require systemic treatments? a. Lupus pernio b. Papular sarcoidosis c. Plaque-like lesions

Lupus pernio

It is imperative to recommend patients with sarcoidosis to follow up with an ophthalmologist annually because a. they are at increased risk of developing anterior uveitis leading to blindness b. development of keratoconjunctivitis sicca is associated with higher mortality c. They're more likely to develop Sjogren's syndrome, leading to dry eyes d. They may develop glaucoma leading to impaired vision

they are at increased risk of developing anterior uveitis leading to blindness

Cardiovascular manifestations of sarcoidosis are a. only addressed in someone with chest pain b. rare and easily treated c. Common in older individuals d. Uncommon and serious

Uncommon and serious

In individuals with sarcoidosis, hilar involvement with lymphadenopathy is seen in _________ % of cases. a. 90 b. 60 c. 30 d. 5

What helps differentiate the MSK symptoms of RA from sarcoidosis? a. The radial deviation of RA is correctable but with sarcoidosis it is not b. RA polyarthritis in symmetrical; sarcoidosis is asymmetrical c. The ulnar deviation in correctable by patients with sarcoidosis but not by those with RA d. RA will present with ulnar deviation; sarcoidosis presents with radial deviation

The ulnar deviation in correctable by patients with sarcoidosis but not by those with RA

Choose the symptom cluster described by Lofgren syndrome. a. Uveitis + papular sarcoidosis + fever + lymphadenopathy b. Erythema nodosum + polyarthritis + fatigue + glossitis c. Erythema nodosum + hilar adenopathy + migratory polyarthralgia + fever d. Hilar adenopathy + heart failure + erythema nodosum + glossitis

Erythema nodosum + hilar adenopathy + migratory polyarthralgia + fever

This is the most common presenting symptom in individuals with sarcoidosis. a. fatigue b. Polyarthralgia c. Hilar adenopathy d. fever

fatigue

Which bloodwork is likely to come back elevated in sarcoidosis patients. a. RBC count b. ESR and CRP c. Eosinophils d. Liver enzymes

ESR and CRP

A diagnosis of sarcoidosis requires this in the absence of lofgren syndrome a. Fatigue as a clinical symptom b. Migratory polyarthralgia c. An X-ray demonstrating hilar adenopathy d. A biopsy detecting noncaseating granulomas

A biopsy detecting noncaseating granulomas

For which stages of sarcoidosis is prednisone recommended? a. Stages 3 and 4 b. Stages 2 and 3 c. Stages 1 and 2 d. Stages 0 and 1

Stages 3 and 4

Which dose of melatonin has been shown to resolve dyspnea and skin lesions in sarcoidosis patients in whom glucocorticoids have failed? a. 10 mg/day b. 1 mg/day c. 5 mg/day d. 20 mg/day

20 mg/day

Infections leading to Reactive arthritis are typically a. Chronic b. Upper respiratory infections c. GI or GU infections d. Severe and debilitating e. Associated with septic arthritis

GI or GU infections

Around ___________% of individuals with Reactive arthritis are HLA B27 positive. a. 50 b. 25 c. 75 d. 10

Which of these Reactive arthritis differentials must be ruled out quickly with arthrocentesis? a. Rheumatoid arthritis b. Ankylosing spondylitis c. Septic Arthritis d. Psoriatic arthritis

Septic Arthritis

Which of the following is true concerning the classic triad of conjunctivitis, urethritis and arthritis for reactive arthritis? a. It is pathognomonic but extremely rare b. It is specific but not sensitive for reactive arthritis c. It is found in many inflammatory conditions d. It is sensitive but not specific for reactive arthritis

It is specific but not sensitive for reactive arthritis

This joints are most often affected by reactive arthritis. a. Knees and shoulders b. PIPs and DIPs c. Lower limb joints d. Neck and spine

Lower limb joints

Which of the following is NOT a typical digital finding associated with reactive arthritis? a. Subungual keratosis b. Clubbing c. Onycholysis d. Dactylitis

Clubbing

Which of the following is true about the mucous membrane ulcers of reactive arthritis? a. They are generally painless b. They are extremely painful

They are generally painless

What helps distinguish nail manifestations of reactive arthritis from those of psoriatic arthritis? a. Reactive arthritis typically only affects the toenails b. In reactive arthritis the skin peels around the nails (subungual keratosis), in psoriatic arthritis the skin around the nails is typically unaffected c. Psoriatic arthritis presents with pitting, reactive arthritis typically doesn't have pitting d. Reactive arthritis does not present with subungual keratosis

In reactive arthritis the skin peels around the nails (subungual keratosis), in psoriatic arthritis the skin around the nails is typically unaffected Psoriatic arthritis presents with pitting, reactive arthritis typically doesn't have pitting

Circinate balanitis is a. All of these are true b. Painless c. Highly suggestive for reactive arthritis when presenting with joint pain in a male d. Characterized by small, shallow ulcers

All of these are true

In reactive arthritis rheumatoid factor is a. Negative b. Positive as often as in the general population c. Positive

Positive as often as in the general population

The prognosis for reactive arthritis is a. The prognosis is highly variable and unpredictable. b. Poor. The disease progresses with treatment aimed at symptomatic relief c. Good. It resolves in 70-80% of cases

Good. It resolves in 70-80% of cases

Exercise is contraindicated in reactive arthritis. Select one: True False

Dietary recommendations for reactive arthritis a. Are specific for reactive arthritis b. Are well researched c. Can decrease overall inflammation d. Are not advised due to lack of research

Can decrease overall inflammation

Reactive arthritis is a clinical diagnosis. Select one: True False

Which of the following are key notes of ledum? a. Cold to the touch b. All of these are key notes of ledum c. Black eyes d. Better from cold applications

All of these are key notes of ledum

Which of the following remedies is/are indicated for podagra/gouty attacks a. Rhus tox b. Ledum c. Colchicum d. None of these remedies are indicated

Ledum Colchicum

Which remedy has aggravation from drinking coffee? a. Ledum b. Rhus tox c. Colchicum d. Coffea

Colchicum

What is rhus tox derived from? a. Poison oak b. Dog saliva c. Mercury d. Poison ivy

Poison ivy

Which of the following is an indication for rhus tox? a. Testicular pain b. Craving milk c. Arthritis d. Suicidality

Arthritis

Tuberculinum is considered a miasm by some individuals. Select one: True False

Tuberculinum is commonly used to treat a. Arthritis b. Flus c. Colds d. Each of these are possible indications for its use.

Each of these are possible indications for its use.

Which of the following best describes the emotional state associated with tuberculinum? a. Happy b. Discontent c. Content d. Lazy

Discontent

Individuals who may benefit from tuberculinum express an underlying weakness and will often overextend themselves triggering discharges and breakdowns. Select one: True False

Tuberculinum is indicated for individuals who stay in the same job and do not travel often. Select one: True False

Select the keynotes for tuberculinum. a. Content b. Wants to sleep all the time c. Desire for travel d. Allergy to milk e. Better in mountains

Desire for travel Allergy to milk Better in mountains

Tuberculinum is indicated in individuals prone to recurring colds. Select one: True False

Individuals willingness to travel is factored in their constitutional remedy, Select one: True False

Which remedy is associated with long, fine eyelashes? a. Ledum b. Rhus tox c. Colchicum d. Tuberculinum

Tuberculinum

Causticum is a polycrest. Select one: True False

Select the emotions associated with causticum. a. Sympathetic b. Pessimists c. Organized d. Sensitive

Sensitive Sympathetic

Select the keynotes associated with causticum. a. Constant desire to clear throat b. Rebellious c. Skin eruptions or warts on the nose d. Each of these is a keynote for causticum

Each of these is a keynote for causticum

Which of the following is the "Portland remedy"? a. Ledum b. Colchicum c. Causticum d. Tuberculinum

Causticum

Causticum is a remedy to consider in individuals who often overreact and have outbursts. Select one: True False

Causticum individuals crave sweets. Select one: True False

Causticum individuals prefer cloudy, wet or rainy weather. Select one: True False

Which remedy is associated with a sensitivity to authority? a. Ledum b. Tuberculinum c. Causticum d. Colchicum

Causticum

What remedy is Causticum similar to? a. Ipecac b. Iris versicolor c. Ignatia d. Ledum

Ignatia

Causticum is indicated for individuals who are closed off and have trouble connecting intimately. Select one: True False

Excessive reactions are commonly associated with causticum. Select one: True False

A causticum picture most often presents after one large grief. Select one: True False

The rheumatic picture most in alignment with cuasticum is a. Progressive stiffness b. Sudden stiffness c. None of these are correct d. Sudden joint pain

Progressive stiffness

Causticum is indicated in individuals with a low sex drive. Select one: True False

Causticum is associated with which constitution a. Warm b. Wet c. Dry d. Damp

Dry

The pains associated with causticum are generally a. Tingling pains b. Stabbing pains c. Tearing pains d. Cutting pains

Tearing pains

Which is the most common of the spondyloarthropathies? a. Inflammatory bowel disease b. Ankylosing spondylitis c. Psoriatic arthritis d. Reactive arthritis

Ankylosing spondylitis

Which bacteria is most associated with Ankylosing spondylitis a. Klebsiella pneumoniae b. Lactobacillus c. Bacteroides oralis d. E. coli

Klebsiella pneumoniae

Ankylosing spondylitis is more common in females than males. Select one: True False

There is a strong genetic link with Ankylosing spondylitis. Select one: True False

Which of the following is not a classification type of ankylosing spondylitis? a. Axial AS b. Peripheral AS c. Non-radiographic AS d. Radiographic AS

Radiographic AS

Which of the following is associated with the low back pain in Ankylosing spondylitis? a. Evening stiffness b. Worse with exercise c. Insidious onset d. Improvement with rest

Insidious onset

Which is not a common joint affected in ankylosing spondylitis? a. Hips b. Metacarpal joints c. Costosternal joints d. Sacroiliac

Metacarpal joints

Which of the following is not a systemic symptom associated with ankylosing spondylitis? a. Microscopic colitis b. Cardiac arrhythmias c. Hair loss d. Cauda equina

Hair loss

What percentage of patients with ankylosing spondylitis present with acute uveitis at some point in their disease? a. 20-40% b. 50-60% c. 10-30% d. 80-90%

20-40%

It is common for patients with spondyloarthropathies to have concomitant GI conditions such as Colitis, Crohns or leaky gut. Select one: True False

Which of the following spinal changes is most directly contraindicated for cervical adjustments? a. Atlantoaxial instability b. Large joint arthritis c. Bamboo spine d. Sacroiliitis

Atlantoaxial instability

History of back pain is one aspect of the diagnostic criteria for Ankylosing spondylitis. Select one: True False

What purpose does the new diagnostic criteria for Ankylosing spondylitis serve? a. There is only one diagnostic criteria b. The lack of treatment goals for the older criteria c. The need for earlier diagnosis before the radiographic changes.

The need for earlier diagnosis before the radiographic changes.

Labs and imaging are required for the diagnosis of Ankylosing spondylitis. Select one: True False

Which of the following are diagnostic criteria for Ankylosing spondylitis? a. Toronto criteria b. Modified Kane's criteria c. Modified New York criteria d. Assessment in Spondyloarthritis International Society Criteria (ASAS)

Modified New York criteria Assessment in Spondyloarthritis International Society Criteria (ASAS)

Which conditions have overlapping symptoms to Ankylosing spondylitis and may be confused with AS? a. DISH b. Chronic lower back pain c. Fibromyalgia d. All of these are true

All of these are true

The changes of Ankylosing spondylitis are a. kyphotic b. Lordotic

kyphotic

The diagnosis of Ankylosing spondylitis requires imaging. Select one: True False

Sacroiliitis on plane films may present as all of the following except a. Blurring of the joint margins b. Widening of the joint space c. Microfractures throughout the pelvis d. Radial opacity in the area around the joint

Microfractures throughout the pelvis

Plane film changes of Ankylosing spondylitis do not become apparent for a. 3-7 years b. 10+ years c. The course is extremely variable d. 6 months - 2 years

3-7 years

Plain film is a more sensitive imaging technique than MRI to detect Ankylosing spondylitis changes. Select one: True False

Whiting on an MRI of the sacroiliac joint of an Ankylosing Spondylitis indicates. a. Calcification of the joint b. Bone resorption c. A bone spur d. Bone edema

Bone edema

A plain film finding associated with Ankylosing spondylitis is the a. stop sign b. Thumbprint sign c. Shiny corner sign d. Steeple sign

Shiny corner sign

Syndesmophytes refer to a. Ossification of the spinal ligament b. Ossification of the annulus fibrosus c. Osteoporosis of vertebrae d. Calcification of the SI junction

Ossification of the annulus fibrosus

Syndesmophytes are distinguished from osteophytes in that a. syndesmophyte growth is slow and progressive whereas osteophyte growth is fairly acute b. Findings of syndesmophytes is pathognomonic for AS whereas osteophytes can occur in many conditions c. Syndesmophyte findings occur in males and osteophytes can occur in both males and females d. Syndesmophytes run parallel to the spine whereas osteophytes protrude perpendicular to the spine

Syndesmophytes run parallel to the spine whereas osteophytes protrude perpendicular to the spine

What finding is pathognomonic of Ankylosing spondylitis a. Shampoo spine b. Bamboo spine c. Tree trunk spine d. Straw spine

Bamboo spine

What is the first-line pharmaceutical treatment for Ankylosing spondylitis? a. Corticosteroids b. TNF inhibitors c. DMARDs d. NSAIDs

NSAIDs

Exercise and cervical spinal adjustments are contraindicated in Ankylosing spondylitis. a. False. Exercise is recommended for AS patients b. True. The risks outweigh the benefits

False. Exercise is recommended for AS patients

The prognosis of Ankylosing spondylitis is a. Good. This condition has a high likelihood of being self-limiting. b. Poor. The condition is often caught too late to achieve any benefit through therapy c. Poor. The disease progresses quickly and therapies are not well matched to the pathophysiology d. Good. As long as AS is caught early and managed with proper treatment

Good. As long as AS is caught early and managed with proper treatment

Some of the newer therapies being researched for Ankylosing spondylitis target the a. Endocrine system b. Lungs c. CNS d. GI tract

GI tract

What PE do you perform on someone with a possible rheumatic conditon?

general skin/nails EENT abdomen Heart lungs psych MSK (insepct, palpate, ROM)

What is included in the SDAI? a. CRP b. patient self-assesment of disease activity c. examiners assesment of diease activity d. all of the above

all

What is included in CDAI? a. pateint self-assesment of disease activity b. evaluator's assesment of disease activity c. ESR d. a and b

a and b