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USMLE Step 3 > Rheumatology > Flashcards

Rheumatology Flashcards

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USMLE® Step 1 flashcards
1
Q

To diagnose RA, symptoms have to occur for _____ weeks

Extra Joint Symptoms

1) Lungs: Pleural effusion, lung nodules
2) Heart: Pericarditis, auto-immune valvopathy
3) Neuro: Mononeuritis multiplex
4) Joint: Boutanierre, Swan Neck

A

6

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2
Q

RA + Splenomegaly + pancytopenia = _______

A

Felty Syndrome

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3
Q

______ is a backbone DMARD for RA. Other therapies: Anakinra (Anti IL-1), Tocilizumab, sarilumab (anti IL-6), Adalimumab (TNF)

Severe : Tofacitinib : Janus Kinase inhibitor

A

Methotextrate

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4
Q

____ condition has the lowest glucose on pleural effusion

A

RA

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5
Q

Heberden (Distal), Bouchard (Proximal) nodes are features of ______. Best initial test _____

A

Osteoartheritis

CXR

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6
Q

Joint Fluid, OA leukocyte count

A

2000

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7
Q

____ is a flavor of arthritis resulting in spinal fusion, but not degenerative disk changes

A

DISH (Diffuse Idiopathic Spontaneous Hyperostosis)

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8
Q

Seronegative Spondyloarthropathies

1) Ankylosing Spondylitis
2) _______
3) Psoriatic Artheritis
4) Stills Disease

A

Reactive Artheritis (Reiters Syndrome)

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9
Q

_____ occurs among males<40, AM pain at the SA joints, with most common extra joint reaction: Uveitis

A

Ankylosing Spondylitis

Testing: X-ray –> MRI —> HLA-B27 ; in this case serum testing is not done first

Tx: NSAIDS, Adalimumab ; MTX does not work on the spine —> Secukinumab (IL-17)

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10
Q

____ characterized post GI/GU infection with monocular/polyarthicular arthritis, conjunctivitis, genital lesion, psoriasis looking lesion feet . Treated with _____

A

Reactive Artheritis , NSAIDS

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11
Q

Psoriasis Treatment

1) NSAIDS
2) Infliximab
3) _______
4) Ustekinumab (IL 12/23)
5) Orencia: Abatacept (T cell), also for RA

A

Sekukinumab (IL 17)

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12
Q

Salmon rash, polyartheritis, myalgia, lymphadenopathy, hepatosplenomegaly, high Ferritin

A

Juvenile idiopathic arthritis, Stills disease

Tx: NSAIDS, Anakinra

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13
Q

Joint pain + diarrhea + weight loss, PAS (+) bowel stain

Tx:_____

A

Whipple Disease

Bacterim

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14
Q

___ of 11 criteria are needed to diagnose Lupus.

A

4

All you need is rash (photosensitive, malar discoid), joint pain and ANA/dsDNA to get the diagnosis

Lupus leads to complement consumption, low complement is suggestive

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15
Q

____ marker is used to test for CNS lupus

A

Ribosomal P

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16
Q

RA, like downs syndrome, may be associated with _______, need to be careful with intubation

A

C1/C2 cervical spine subluxation

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17
Q

_____ RA drug for mild RA, associated with retinopathy

A

Hydroxychloroquine

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18
Q

Diagnosis of Ankylosing Spondylitis

1) _____ –> MRI –> HLA-b27

A

X-ray

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19
Q

Ankylosing Spondylitis associated with : ____, uveitis

Treatment: NSAID, _____

A

Aortitis

TNF agent, steroids not useful

20
Q

___ characterized by negative ANA, negative RF, high ferritin, arthritis, fever, myalgia, lymphadenopathy, hepatosplenomegaly, salmon rash

A

Still Disease, adult onset juvenile artheritis

Tx: NSAID –> Steroid –> Anakinra

21
Q

Drugs that cause drug induced lupus ___, ____, ____

A

hydralazine, procainamide, isoniazid

22
Q

Treatment for mild lupus _____

A

Hydroxychloroquine —> steroids –> DMARD off flare –> B cell inhibitor (Belimumab)

23
Q

Most accurate test for Sjogrens ____

A

Lip biopsy, Ro/La antibody is suggestive

A subset of people with lupus can have Ro/La, useful for ANA negative lupus

24
Q

Exception to using ACE during pregancy____

A

Schleroderma, very good for HTN/Renal effects, risk outweighs benefits

25
Q

Difference between CREST (Limited Schleroderma vs Systemic Schleroderma)

CREST Antibody____
Systemic Antibody_____

A

Anticentromere

Anti SCL(70): But not reliable, only positive 30% of the time

Systemic disease: Renal hypertension, proteinuria, pulm htn, restrictive cardiomyopathy,

26
Q

Thick orange skin syndrome, eosinophilia, worse when working out ______

A

Eosinophilic Fasciitis

Tx: Steroids

27
Q

Myositis with Jo+ are increased risk of ______

A

Interstitial lung disease

28
Q

Both distal/proximal muscle weakness, elevated CK____

A

Inclusion body myositis

No Treatment

29
Q

_____ is a mixture of SLE, scleroderma, polymyositis, with antibody____ positive

A

Mixed connective tissue disorder

Anti U1 ribonucleoprotein

Tx: Steroid, AZT, MTX,

30
Q

Treatment of fibromyalgia______

A

Duloxetine, CBT, aerobic exercise, NOT NSAID

31
Q

Polymyalgia reumatica vs myositis

A

ESR vs CK , normal electromyogram

Tx: Steroids

32
Q

Best initial test for PAN_____

A

CT Angio Abdomen

33
Q

_____ medication can induce a Churg Struss flare

A

Montelukast (Leukotriene inhibitors)

34
Q

A specific therapy for giant cell arteritis apart from steroids_____

A

Tocilizumab (IL-6 inhibitor)

35
Q

____ is a large vessel vasculitis, famous for causing loss of pulses, increased stroke risk

Most accurate test _____

A

Takayasu

MRA, aortography not biopsy

36
Q

Cryglobinemia associated with vasculitis and _______

A

Hep C

Tx: Rituximab, cyclophosphamide

37
Q

oral/genital ulcers, uveitis, sterile skin abscess, pulmonary artery aneurysm _______

A

Behcet

Steroid /Cyclophosphamide

38
Q

recurrent abdominal pain, tenderness, fever, episodes of joint and chest pain, elevated ESR with history of multiple negative CT scans/Colonoscopy_______

A

Familial Mediterranean Fever

Dx: MEFV gene

Tx: Colchicine,

Cx: Amyloidosis

39
Q

Gout can be induced by this medication_____

A

Thiazide, Nicotinic acid

40
Q

Gout

- Acute Treatment _____

A

NSAID/Colchicine –> Steroids

41
Q

Gout (Chronic Treatments) Mechanisms

  • Allopurinol: _______
  • Febuxistate_______
  • Rasburicase______
  • Probenecid _______
A

Xanthine oxidase inhibitor (reduces uric acid production)

Xanthine oxidase inhibitor

Converts uric acid to allantois

Urinary excretion of uric acid (not for renal failure)

42
Q

__________are disease associated with pseudo gout (calcium pyrophosphate)

A

hemochromatosis, hyperparathyroidism, acromegaly, hypothyroidism

NSAID, colchicine –> steroids

43
Q

You have to stop bisphosponates _____ weeks before dental surgery

A

6

44
Q 
Osteoporosis Treatment 
1) Bisphosphonates + VitaminD/Calcium
2) Denosumab
3) SERM
4) PTH analogs (Teriparatide)
5\_\_\_\_\_\_\_\_\_
A

Calcitonin

45
Q

Pagets disease: high ALP with normal Ca2+/PO43-, urine hydroxyproline

  • Most accurate test_____
  • Treatment____
A

Nuclear bone scan

Bisphosphonates

USMLE Step 3 (19 decks)

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