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Internal Medicine Board Exam > Rheum/MSK > Flashcards

Rheum/MSK Flashcards

1
Q

What Rheum disease has daily fever, rash, and arthritis? This eventually resolves but does recur

What lab value is elevated?

A

Adult Still Disease (Ferritin Level)

Pediatric Onset is the Systemic Juvenile Idiopathic Arthritis

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2
Q

Rheumatoid Patients that have chronic steroid use should be evaluated for what?

A

Osteoporosis

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3
Q

Thick skin over the hands, elevated BP, Raynaud Phenomenon, elevated BP 200+, elevated Creatinine, what should be given?

A

Captopril, ACE inhibitor, Scleroderma Renal Crisis

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4
Q

What is positive ANA and positive Anti-centromere?

A

Limited Cutaneous Systemic Sclerosis

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5
Q

Ankylosing Spondylitis have a higher rate of what GI problem?

A

Inflammatory Bowel Disease

Look out for abdominal pain, diarrhea, or change in bowel habits

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6
Q

If patients have Sjogren Syndrome related oral dryness and candy does not work, what is the next best medications?

A

Cevimeline or Pilocarpine

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7
Q

Systemic Sclerosis -> interstitial lung disease, what is the mainstay of treatment?

A

Mycophenolate Mofetil

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8
Q

What rheum pathology has the following:

Renal Vasculature problems (pathology has “beads on a string”, nodular skin lesions, abdominal pain, and mononeuritis multiplex

Usually associated with Hep B and/or Hep C

A

Pan Nodularis

Remember Mesenteric Ischemia can occur as well!

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9
Q

Rheumatoid Arthritis + Neutropenia + Splenomegaly is what?

A

Felty Syndrome

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10
Q

Lupus Nephritis, systemic disease, patient’s get steroids and what two other drugs?

A

Hydroxychloroquine and Mycophenolate

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11
Q

Multiple episodes of abdominal pain, rash, arthritis that resolve after 1 week, grandparents had a similar work up. What is this?

What is a treatment?

A

Familial Mediterranean Fever

Colchicine, decrease inflammation and amyloid protein

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12
Q

Acute gout, without any kidney disease. What is the first line?

A

Colchicine

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13
Q

Proximal and Distal Muscle Weakness, over a long period of time, autoimmune, what might this be?

A

Inclusion Body Myositis

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14
Q

Polymyositis has what distinct muscle characteristic?

A

Proximal Muscle weakness, happens fairly quickly, happens over a period of weeks

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15
Q

Granulomatosis with Polyangitis (GPA), what is the treatment?

A

Steroids and Rituximab

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16
Q

What is this?

A

Discoid subacute cutaneous lupus

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17
Q

Skin and joint problems while taking Minocycline, what is this? Think about autoimmune issues

A

Drug induced Lupus

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18
Q

Patient has mixed osteolytic changes, back pain, and elevated ALP, what is this?

A

Paget Disease of the Bone

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19
Q

Lupus Perino is a skin manifestation seen in some patients with what disease?
Are these rashes photosensitive

A

Sarcoidosis

No

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20
Q

Pustular Lesions and visible telangiectasia that does not spare the nasolabial fold is what?

A

Rosacea

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21
Q

Dermatomyositis patients that are using steroids, what two medications should be looked at to decrease overall steroid use?

A

Methotrexate or Azathioprine

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22
Q

Small Intestinal Bacterial Overgrowth has usual hallmark signs?

A

Explosive diarrhea, right after a meal

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23
Q

Small Intestinal bacteria overgrowth is detected and treated how?

A

Glucose, Hydrogen, and Lactulose Breath Tests

Antibiotics, every month rotating which ones are given

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24
Q

Poorly Controlled Ankylosing Spondylitis, can develop what kidney pathology?

A

Renal Amyloidosis

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25
Q

Poorly Controlled Ankylosing Spondylitis via NSAIDS, what is the next medication?

A

Etanercept

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26
Q

What is this?

A

Acute Lupus Flare

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27
Q

How long after an enteric infection or a bout of nongonococcal urethritis or cervicitis with reactive arthritis occur?

A

2-3 weeks

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28
Q

What two medication groups can cause a dry mouth?

A

Anti-depressants and Anti-histamines, mouth breathing are common causes of dry mouth

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29
Q

Contraindications to allopurinol therapy, what is the next medication?

A

Febuxostat, best in moderate to severe CKD

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30
Q

Fibromylagia, what is the best treatment of choice?

A

Pregabalin

Otherwise, exercise is #1

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31
Q

What type of secondary arthritis should be suspected when arthritis of an early age occurs?

A

Hereditary Hemochromatosis

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32
Q

Pregnant patients having a Lupus flare, what is the best treatment?

A

Prednisone treatment

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33
Q

HLAB 57:01, has be tested for what anti-viral evaluation?

A

Abacavir

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34
Q

HLAB 58:01, has to be tested for what medication evaluation in Hans-Chinese patients?

A

Allopurinol Hypersensitivity

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35
Q

Giant Cell Arteritis/Severe RA treatment, to spare using steroids, what should be used?

A

Tocilizumab

IL-6 inhibitor

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36
Q

Sjogren’s Syndrome, what is the patient at an increased risk for of getting? (Think cancer type)

A

B-cell and MALT Lymphoma

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37
Q

Osteoarthritis, initial treatment, what is the best medication, Tylenol or NSAID?

A

NSAID

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38
Q

Does a patient have to have a positive antibody histone to have and SLE drug induced reaction?

A

No

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39
Q

What is +ANA, +anti-Scl-70, anti-RNA pol III, and anti-topoisomerase I?

A

Diffuse Cutaneous Systemic Sclerosis

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40
Q

What is the anti-U1 RNP and ANA positive?

A

Mixed Connective Tissue Disease

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41
Q

Most likely disease with the following antibodies

+ANA, +anti-jo-1, +anti-synthetase

A

Polymyositis or Dermatomyositis

42
Q

What is a + ANA, + anti-centromere antibodies?

A

Limited Cutaneous SS

43
Q

What is + ANA, + anti-topoisomerase I (anti- scl-70) and anti-RNA polymerase III?

A

Diffuse Cutaneous SS

44
Q

Churg Strauss has a positive what type of antibody?

A

+ Anti-myeloperoxidase antibodies

45
Q

Behcet Disease is associated with what HLA?

46
Q

Anterior Uveitis, chronic oral aphthae, skin hyperpigmentation, erythema nodosum, and autoimmune is what?

A

Behcet Disease

47
Q

Physical exam shows Rash (Silvery scale) on red patches, Nail pitting, Dactylitis, and Arthritis Multilans (Digital Shortening due to resorptive arthritis, pencil in cup), what is this?

A

Psoriatic Arthritis

48
Q

Lymphocytic infiltration of salivary glands and lacrimal glands, collections of focal lymphocyte aggregates, what disease is this?

A

Sjogren Syndrome

49
Q

Hand Xray that has hook-like osteophytes and squared off bone ends as well as chondrocalcinosis, what is this?

What is this?
A

Hemochromatosis Arthropathy/Arthritis

50
Q

What is seen in the XR hand?

A

Gout

XR hand can also show bone erosions with overhanging edges

51
Q

Hand Osteoarthritis of the first CMC joint, what is the first line treatment?

A

Joint Orthoses, hand brace

52
Q

What medication can help with low back pain, not tylenol or NSAID?

A

Duloxetine

53
Q

Patient has an anatomical snuff box fracture, what test should be done after a negative X-ray?

A

MRI Hand, concern for scaphoid fracture

54
Q

Sjogren’s Syndrome has increased risk of what cancer?

A

Non-Hodgkin Lymphoma

55
Q

What is the MOA of Secukinumab? When is it used?

A

IL-17 inhibitor, used with active psoriatic arthritis refractory to 2 different TNF inhibitors

56
Q

What is the first line medication for Fibromyalgia?

A

Amitriptyline

57
Q

Can Methotrexate be continued during pregnancy?

A

No, should be stopped 3 cycles before starting to conceive

58
Q

Tocilizumab can be a treatment for Rheumatoid Arthritis. What is the MOA? What should be monitored while taking the drug?

A

IL-6 inhibitor

Lipid Profile

59
Q

Limited Cutaneous Systemic Sclerosis and Raynaud Phenomenon that has failed multiple therapies, what should be given, almost last line?

A

lloprost
Prostacyclin PGI2 analogue, dilates systemic and pulmonary arterial vascular beds

60
Q

Joint culture that shows cells of 50K to 150K, PMN > 75% is what?

A

Septic Joint

61
Q

Tofacitinib is being considered for RA treatment. The patient has +TB skin test. No active symptoms, what should be done?

A

Latent TB should be treated before Medication initiation

62
Q

Fibromyalgia, what is a mainstay of treatment?

A

Exercise and CBT, is #1

63
Q

Rheumatoid Arthritis that has not improved with max methotrexate. What is the next step?

A

Adalimumab, TNF inhibitor

64
Q

How long must a Fibromyalgia patient have symptoms in order to have the diagnosis?

65
Q

A patient is taking Alemtuzumab for Psoriasis, what is a side effect?

A

Thyroiditis

66
Q

A patient has decreased reflexes what is one or two causes?

Not related to nerve pathways and lesions

A

OTC or elevated Magnesium

67
Q

Autoimmune Hepatitis has what antibody?

A

+Smooth Muscle Antibody titers
+LKM-1

68
Q

What is the first line and second line treatment for Autoimmune Hepatitis?

A

1) Steroids
2) Azathioprine

69
Q

Primary Biliary Cholangitis has what positive antibody?

What is the treatment?

A

anti- Mitochondrial antibody (AMA) titer

Urosodeoxylic acid

70
Q

What is this disease? Think autoimmune

A

Psoriasis “pencil in cup”

71
Q

What is this disease? Think routine patient

A

Osteoarthritis, “sea gull wing”

72
Q

What shoulder pathology has orange/red clumps, hydroxyapatite arthropathy, and history of trauma to the shoulder (sometimes)?

What does the synovial fluid look like?

A

Milwaukee Shoulder, Basic Calcium Phosphate Deposition

73
Q

When Giant Cell Arthritis is being treated what determines if IV steroids will be given or not?

A

eye symptoms

If eye symptoms -> IV steroids
No eye symptoms -> PO steroids

74
Q

Transplant associated gout is associated with the use of what medication?

A

Cyclosporine

75
Q

What is the uric acid goal when patients are treated with allopruinol?

A

Serum Urate level less than 6

76
Q

Calcium Pyrophosphate Deposition can be associated with what 4 underlying metabolic disorders?

A

Hemochromatosis
Hyperparathyroidism
Hypothyroidism
Hypomagnesemia

77
Q

What primary bone cancer has “popcorn calcifications”, treatment is excision only?

A

Chondrosarcomas

78
Q

What primary bone cancer has “sunray spiculation”, “Codman’s triangle”? This disease is biphasic. This disease shows up in the really young and really old.

A

Osteosarcoma

79
Q

What primary bone cancer has “an onion ring sign”? This comes from malignant neural crest cells. This typically high grade.

A

Ewing Sarcoma

80
Q

Primary Bone cancers can metastasize, where do they typically infect? (General Body Part)

81
Q

Anti-Smith antibody is most specific to what disease?

82
Q

Anti-dsDNA antibody correlates with what disease Severity?

A

Lupus Kidney disease

83
Q

Anti-La/SSB antibody correlates to what?

A

Sjogren Syndrome (Sicca Syndrome) and Neonatal SLE

84
Q

What does anti-CCP antibody correlate too?

A

Rheumatoid Arthritis

85
Q

Anti-Jo-1 antibody correlates to what?

A

Polymyositis and Anti synthetase syndrome

86
Q

P-ANCA (anti-MPO antibody) correlates to what?

A

Eosinophilic granulomatosis with polyangiitis (Churg Strauss syndrome) and MPA

87
Q

C-ANCA (anti-PR3 antibody) coreelates to what?

A

Granulomatosis with polyangiitis (Wegner’s Syndrome)

88
Q

Anti-Ro/SSA antibody correlates to what three things?

A

Sjogren Syndrome, Neonatal Heart Block, and subacute cutaneous lupus

89
Q

Anti-histone antibody correlates to what?

A

Drug-induced SLE

90
Q

Anti-SCL-70 antibody correlates to what?

A

Systemic Sclerosis and pulmonary fibrosis/diffuse cutaneous Scleroderma

91
Q

Procainamide
Minocycline
Hydralazine
Quinidine
Isonazid

What can these four drugs cause or be responsible for?

A

Lupus Medication reaction (elevated anti-histone)

92
Q

What medication should a Lupus patient take?

A

Steroids and Hydroxychloroquine, ok for pregnancy

Will take 2 months to 6 months for maximum effect, need eye doctor follow up

93
Q

Lupus Nephritis, what should the patient be on?

A

Cellcept (Mycophenolate)
If proliferative GN -> prescribe IV cyclophosphamide

94
Q

Hydroxychloroquine, azathioprine, cyclosporine, tacrolimus, colchicine, and prednisone are Lupus medications that are safe in what?

95
Q

Methotrexate and leflunomide are not allowed in what female medical state?

96
Q

How long does a women need to be on lupus medications before considering pregnancy?

97
Q

Lupus Flare vs. Pre-Eclampsia, what labs will be seen?

A

Anti-dsDNA is elevated in Lupus, uric acid is low, elevated urine calcium
Lupus will have low C3 and C4, as well

Tx: Given Prednisone -> Lupus Flare

98
Q

Dermatomyositis patients have an increased risk of what?

A

Adenocarcinoma of almost any organ

99
Q

Fibromyalgia, treatment is usually SSRI, CBT, and PT. What is the next step if someone needs further medication?

A

Pregabalin

100
Q

Ankylosing spondylitis can cause kidney problems, long term. How does this occur?

A

Renal Amyloidosis and IgA nephropathy

Internal Medicine Board Exam (22 decks)

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