Rheum Exam 6

Question 1

In what way does fibromyalgia differ from other conditions covered in Rheumatology?
a. The pain appears to comes from central sensitization rather than peripheral inflammation
b. It has a well defined etiology
c. The inflammation from fibromyalgia causes diffuse joint destruction rather that presenting with a typical pattern
d. It presents with the same predictable clinical presentation in all patients

Answer 1

The pain appears to comes from central sensitization rather than peripheral inflammation

Question 2

Fibromyalgia typically presents with pain as its only symptom.

Select one:
True
False

Answer 2

F

Question 3

Fibromyalgia is more commonly diagnosed in
a. Males
b. It presents equally in both genders
c. Females

Answer 3

F

Question 4

The peak age of a fibromyalgia diagnosis happens during
a. The ages of 5 and 10
b. The ages of 20 and 50
c. Infancy
d. The seventh decade or greater

Answer 4

The ages of 20 and 50

Question 5

Which of the following can be said about the association of social characteristics of individuals with fibromyalgia?
a. Living with fibromyalgia increases the chance of having certain social demographic characteristics
b. All of these are theories. None are proven.
c. The stress of certain demographic/social characteristics causes an inflammatory response that leads to fibromyalgia
d. There may be additional factors that increase the likelihood of both developing fibromyalgia and having certain demographic/social characteristics

Answer 5

All of these are theories. None are proven.

Question 6

Which of the following is true concerning a possible genetic link to fibromyalgia?
a. The familial association is 8.5 times stronger with fibromyalgia than with rheumatoid arthritis
b. The genetic association is about the same as for rheumatoid arthritis
c. There is no evidence of a genetic factor

Answer 6

The familial association is 8.5 times stronger with fibromyalgia than with rheumatoid arthritis

Question 7

What is the role of the COMT polymorphism in fibromyalgia?
a. Lower production of this enzyme is associated with increased inflammation
b. Greater quantities of this enzyme lead to higher levels of NE/epiLower levels
c. Lower levels of enzyme production is associated with increased pain and central sensitization
d. Increased production of this enzyme is found in individuals with fibromyalgia

Answer 7

Lower levels of enzyme production is associated with increased pain and central sensitization

Question 8

Which of the following in NOT a typical presentation of fibromyalgia related musculoskeletal pain?
a. Pain better with movement
b. pain in muscles
c. Both sides of the body are affected
d. Above and below the waist

Answer 8

Pain better with movement

Question 9

Which type of headaches are associated with fibromyalgia?
a. Tension
b. Sinus
c. Cluster
d. Migraine

Answer 9

tension
Migraine

Question 10

To meet the diagnostic criteria an individual must have widespread pain for greater than
a. 1 month
b. 3 months
c. 6 months
d. 12 months

Answer 10

b. 3 months

Question 11

Palpation of “tender spots” is not reliable for diagnosis because
a. It rarely elicits pain for the patient
b. It is a sensitive but not specific exam
c. Pain from fibromyalgia is too intense for this exam to be applied
d. It is a specific but not sensitive exam

Answer 11

It is a sensitive but not specific exam

Question 12

Which finding on physical exam indicate a diagnosis other than fibromyalgia?
a. pain elicited with pressure applied to “tender points”
b. Synovitis
c. Intact reflexes

Answer 12

Synovitis

Question 13

The American College of Rheumatology utilizes which subjective measurements for a diagnosis of fibromyalgia?
a. Activities of Daily Living Scale
b. Global pain Index
c. Symptom Severity Score
d. Widespread Pain Index
e. Stanford pain scale

Answer 13

Symptom Severity Score
d. Widespread Pain Index

Question 14

Which of the following symptoms are measured in the 2016 Symptom Severity Score?
a. Myalgia
b. Anxiety
c. Fatigue
d. Headaches
e. Cognition
f. Sleep
g. Numbness/tingling
h. Depression

Answer 14

Fatigue
d. Headaches
e. Cognition
depression

Question 15

Which of the following are key differences in the revised 2016 diagnostic criteria from the 2010 diagnostic criteria?
a. The Symptom Severity Score is no longer used
b. Requires pain be present in 4 out of 5 specific body regions
c. Requires the symptoms be present for over 3 months
d. Must score over 7 on the Widespread Pain Index
e. No longer defines fibromyalgia as a diagnosis of exclusion

Answer 15

No longer defines fibromyalgia as a diagnosis of exclusion
Requires pain be present in 4 out of 5 specific body regions

Question 16

Which tool is used to track disease progression/improvement for patients with fibromyalgia?
a. Patient Specific Functional Scale
b. Symptom Severity Score
c. Widespread Pain Index
d. Fibromyalgia Impact Questionnaire

Answer 16

Fibromyalgia Impact Questionnaire

Question 17

Which type of exercise in most beneficial for individuals with fibromyalgia?
a. Aerobic
b. Stretching
c. Strengthening
d. All types of exercise can provide benefit for fibromyalgia

Answer 17

All types of exercise can provide benefit for fibromyalgia

Question 18

Pharmaceutical therapy for individuals with fibromyalgia targets this substance due to its association with pain perception
a. Decreasing dopamine
b. Increasing serotonin
c. increasing dopamine
d. Decreasing serotonin

Answer 18

Increasing serotonin

Question 19

Individuals with fibromyalgia have been found to have significantly higher concentrations of this in muscle biopsies.
a. Advanced glycation end products
b. Mercury
c. Nitric oxide
d. Glutathione

Answer 19

Advanced glycation end products

Question 20

In patients with fibromyalgia, magnesium supplementation has been found to
a. Decrease tension headaches and PMS
b. Resolve chronic muscle pain
c. Improve sleep and decrease fatigue
d. Decrease cognitive symptoms

Answer 20

Decrease tension headaches and PMS

Question 21

This form of thiamine does not require magnesium as a cofactor for it to be utilized.

a. Thiamine mononitrate
b. Thiamine pyrophosphate
c. Thiamine hydrochloride
d. Thiamine propyl disulfide

Answer 21

Thiamine pyrophosphate

Question 22

Myer’s cocktails have been used to treat and cure fibromyalgia.
a. True
b. False

Answer 22

T

Question 23

How is borrelia burgdorferi transmissted?
a. skin to skin contact
b. resporatory doplets
c. tick biting you
d. blood products

Answer 23

tick biting you

Question 24

How dose Lyme evade the immune system?
a. corkscrewing action into the skin
b. degrades fibrin and extracellular matrix
c. inhibits T cell and B cell ativation by its surface protiens
d. all of the above

Answer 24

all

Question 25

What are coifections of lyme disease?

Answer 25

Babesia
Bartonella
Brucella
Chlamydia pneumonia
CMV
Coxsackie
EBV
Ehrlichia
Mycoplasma
Q-fever
Rocky mountain spotted fever

Question 26

what are the vectors of lyme?
a. blacklegged tick
b. deer
c. white footed mice
d. humans

Answer 26

blacklegged tick

Question 27

what are the sx of lyme disease?

Answer 27

Rash
Fatigue
Headaches
Flu
Joint pain
Bell’s palsy
Neurological pain
Fasciitis
Seizures
Miscarriage
Paresthesia

Question 28

which test do you do fist when testing for lyme disease?
a. western blot
b. ELISA
c. Igenex Ab testing- immunoblot
d, RED laboratory lyme and RMSF

Answer 28

ELISA

Question 29

what is standard of care for treating lyme disease?
a. doxycycline
b. Azithromycin
c. ceftriaxone
d. moxifloxacin

Answer 29

doxycycline

Question 30

Lyme disease has associations with autoimmune and neurological disease such as RA, Lupus, Parkinsons, MS

select one
true
false

Answer 30

T

Question 31

Bacteria, virsues, parasites, funagl infections don’t contributing to lyme disease

select one
True
False

Answer 31

F

Question 32

When treating someone with lyme what is the approach?
a. testing for coinfections and treating them
b. improve nutrient defiecnies and digestion
c. treat with samento and cryptolepis
d. all of the above

Answer 32

all