Rheumatology

Question 1

Medications for fibromyalgia

Answer 1

Cyclobenzaprine (1-4 mg)
Amitriptyline
SSRI/SNRI (less effective than TCA)
- Some evidence for duloxetine
Pregabalin

Question 2

Risk factors for gout

Answer 2

Male sex
CKD, HTN, CAD, DM, DLP, obesity
Drugs: diuretics, ASA, cyclosporine
Foods: purines, meat, seafood, alcohol, sugar

Question 3

Indications for allopurinol

Answer 3

Strong:
- Tophi
- Radiographic damage from gout
- 2+ flares per year

Conditional:
- >1 lifetime flare
- 1 flare + CKD stage 3
- 1 flare + urate >535
- 1 flare + urolithiasis

Question 4

Conditions causing of secondary osteoporosis

Answer 4

DM
Malabsorption
HyperPTH
HyperT4
RA
hypogonadism
MM
IBD
Early menopause

Question 5

Dx criteria for osteoporosis (4 options)

Answer 5

1: fragility fracture of hip or spine
2: T score < -2.5
3: high Frax score and T score < -1
4: fragility fracture and T score < -1

Question 6

Meds for very high risk osteoporosis

Answer 6

abaloparatide, teriparatide
(for up to 2 years, then switch to bisphosphonate or denosumab)

Question 7

Signs + symptoms of PMR

Answer 7

Pain + stiffness of proximal limbs
Morning stiffness in symmetrical proximal muscles
33%: Constitutional (fever, malaise, wt loss)
15-30%: Distal MSK symptoms (swelling, edema, CTS)

Question 8

Treatment for PMR

Answer 8

Pred 15, taper over 2 years, monitoring ESR.
- Stomach + bone protection while on pred.

Question 9

Non-articular changes in RA

Answer 9

Rheumatoid nodules
fatigue
Vasculitis: scleritis, palpable purpura, neuropathy
Lymphocytic: lungs, pericardium, HSM, Hashimoto

Question 10

Dx criteria for rheumatoid arthritis

Answer 10

4 of the following:
- morning stiffness >1h
- arthritis in 3+ joints
- arthritis of hand joints
- symmetric arthritis
- rheumatoid nodules
- elevated RF
- radiographic changes in hand/wrist

Question 11

Advice and monitoring for pts on methotrexate

Answer 11

folate supplement
avoid alcohol
CBC q 4-8w (cytopenia)
LFTs and albumin q 4-8w (LFT elevation, cirrhosis)

Question 12

DMARDs and biologics for RA

Answer 12

DMARDs:
- Methotrexate
- Leflunomide
- Sulfasalazine
- Hydroxychloroquine
- Azathioprine (Imuran)
- Cyclosporine

Biologics:
- Infliximab (Remicade)
- Etanercept (Enbrel)
- Anakinra (Kineret)

Question 13

Labs highly predictive of SLE

Answer 13

Anti-dsDNA (more specific but less sensitive than ANA)
Low complement levels (C3, C4)
Anti-Smith

Question 14

cutaneous manifestations of SLE

Answer 14

Malar rash (acute)
Discoid rash (subacute/chronic)
Photosensitivity
Alopecia
Oral/nasal ulcers
Raynaud’s