Rheumatology

Question 1

_____is a category of cutaneous sclerosis that involves only the skin in the absence of other systemic manifestations of systemic sclerosis

Answer 1

Morphea

Question 2

______ a noncompetitive xanthine oxidase inhibitor. In February 2019, the FDA mandated a boxed warning for febuxostat regarding the increased risk for cardiovascular death and all-cause mortality with the drug

Answer 2

Febuxostat

Question 3

___ is a urate lowering therapy safe in CKD

Answer 3

Allopurinol

Question 4

In 2014, ______and pirfenidone (a synthetic molecule) became available for the treatment of idiopathic pulmonary fibrosis. Both therapies target the fibroblast, which is considered central in the progression of fibrosis

Answer 4

nintedanib (a tyrosine kinase inhibitor)

Question 5

Infectious joint studies usually have WBC>_____

Answer 5

50,000

Question 6

Bisphosphonate use in patients on chronic steroids

Answer 6

Patients at moderate or high 10-year risk for a major osteoporotic fracture taking at least 2.5 mg of prednisone daily for 3 months or more should begin prophylactic bisphosphonate therapy.

Question 7

Toxicity from ______ can cause AKI, rhabdo, bone marrow suppression due to CYP interaction

Answer 7

Colchicine

Question 8

side effects of this nerve pain medication _____ can cause weight gain, peripheral edema, lethargy, and dizziness;

Answer 8

Pregabalin

MTX should be avoided for significant liver/renal disease

Question 9

______ is a RA drug with significant washout time with cholestyramine, that can cause peripheral neuropathy

Answer 9

Leflunomide , can cause rash, diarrhea, transaminitis

Question 10

A common adverse effect of cyclosporine ______

Answer 10

Gout

Question 11

Before considering allopurinol ineffectively as treatment failure, test for_______

Answer 11

HLA-B*5801

Febuxostat is a nonpurine, noncompetitive xanthine oxidase inhibitor that is an option for patients with mild to moderate chronic kidney disease - but has a blackbox warning for cardiac death

Probenecid should be avoided in patients with chronic kidney disease, as the drug requires intact kidney function.

Pegloticase is reserved for severe and/or refractory gout. Because of its extreme potency, mobilization flares of gout are common, and prophylaxis against acute gouty attacks is required

Question 12

RA/SLE drug safe in pregnancy_______

Answer 12

Hydroxychloroquine

Never MTX or Leflunomide

Question 13

______ is one of the most common diseases associated with scleritis, which can be vision-threatening and lead to thinning of the sclera and perforation. Keratitis (corneal inflammation) can occur, which is ulcerative and occurs at the periphery of the cornea; severe keratitis is known as corneal melt.

Answer 13

RA

Keratitis and scleritis are optho emergencies

Question 14

RA with splenomegaly and low WBC (neutropenia) is called_____

Answer 14

Felty syndrome, progression of severe RA

RA increased risk of lymphoma

Low dose prednisone can be a bridge to DMARD in RA for symptom control

Question 15

Even OA can be “erosive”, called erosive osteoarthritis , more central erosion with gulwing sign than margins erosions like____

Answer 15

RA

Question 16

________ is a noninflammatory condition characterized by calcification and ossification of spinal ligaments (especially the anterior longitudinal ligament) and entheses (tendon and ligament attachments to bone)

Answer 16

Diffuse idiopathic skeletal hyperostosis (DISH)

More common in men,

flowing” ossification of at least four contiguous vertebral levels, usually on the right side of the spine.

Question 17

OA effects ____ while RA is more proximal disease

Answer 17

DIP/PIP (Distal joints)

Question 18

Constellation of total body dolor, sleep issues, depression_______

Answer 18

Fibromyalgia

Question 19

Ankylosing spondylitis can also be associated with anterior uveitis, aortitis/valve disease, restricted lung disease

Answer 19

A common manifestation of psoriatic arthritis is achilles tendinopathy

Question 20

First line therapy for Ankylosing Spondylitis _____

Answer 20

NSAID –> Infliximab

Question 21

Lung manifestation of lupus: pleuritis, effusion, DAH

Question 22

GI manifestation of Lupus: Serositis, mesenteric vasculitis, anti ribosomal P hepatitis

Answer 22

Patients with SLE who have Raynaud phenomenon and anti-U1-ribonucleoprotein antibodies can develop esophageal disease and reflux.

ANA plus a negative anti-Ro/SSA essentially rules out SLE, small percent of patients are ANA negative

Question 23

biggest malignancy associated with lupus___________

Answer 23

non hodgkins lymphoma

Question 24

backbone lupus therapy______

Answer 24

hydroxychloroquine

Question 25

Pregnancy during lupus

Answer 25

The best time to consider pregnancy is when SLE is quiescent, and conception should be considered only after at least 6 months of adequate disease control.

Question 26

Sjogren Dx: Can be done by biopsy Tx: ______

Answer 26

Initially supportive

Question 27

____________is characterized by interstitial lung disease, myositis, Raynaud phenomenon, nonerosive inflammatory arthritis, constitutional findings such as low-grade fever, and mechanic's hands; anti-aminoacyl-tRNA synthetases antibodies, such as anti–Jo-1, are highly suggestive of the diagnosis.

Answer 27

Antisynthetase syndrome

Question 28

Most common extra-pulm sign of myositis, is interstitial lung disease

Question 29

____ can cause immune mediate necrotizing myositis or any myositis

Answer 29

Statin, anti HMG coa REductase antibodies

Question 30

Key feature of inclusion body myositis______

Answer 30

involvement of distal muscles, not just proximal muscles Inclusion body myositis often does not respond to immunosuppression, and therapeutic trials should be discontinued if benefit is not appreciated.

Question 31

Steroid induced myopathy can also happen, but steroids are the treatment of choice for other myopathy

Question 32

Gastric antral vascular ectasia (GAVE), also known as watermelon stomach, is most common in patients with DcSSc and those with anti-RNA polymerase III antibodies

Question 33

Small intestine bacterial overgrowth is common and can cause malabsorption and diarrhea. Diagnosis is established by hydrogen breath test, although an empiric trial of antibiotics is often utilized. Small intestine dysmotility can result in pseudo-obstruction. Large intestine dysmotility may lead to constipation, and vascular ectasia can occur in the large intestine (watermelon colon). Some patients may develop fecal incontinence. in the following syndrome_______

Answer 33

Systemic sclerosis ILD is common enough that all patients should undergo pulmonary function tests (PFTs) and high-resolution CT at the time of initial SSc diagnosis, and PFTs with DLCO should be repeated every 6 to 12 months for 5 years.

Question 34

Treatment of ILD with systemic sclerosis_____

Answer 34

Mycophenylate

Question 35

Pregnant patients with systemic sclerosis (SSc) may experience hypertensive disease, preeclampsia, preterm delivery, and low birth weights; contraindications to pregnancy in patients with SSc include pulmonary arterial hypertension and severe restrictive lung disease.

Question 36

Mixed connective tissue disorder is a amalgamation of multiple of Lupus, polymyositis, systemic sclerosis characterized by ________ antibody

Answer 36

Positive anti-U1-ribonucleoprotein (RNP), this antibody can be associated also with systemic sclerosis with GI symptoms Tx: Hydroxychloroquine

Question 37

For patients with severe and refractory gouty attacks or with contraindications to other treatments, off-label use of __________ can be considered.

Answer 37

interleukin-1 inhibitors (anakinra or canakinumab)

Question 38

An uncommon but serious complication of ___________ is a hypersensitive rash that may progress to DRESS (drug reaction with eosinophilia and systemic symptoms) syndrome; the drug should therefore be discontinued in most (if not all) patients who develop a rash.

Answer 38

allopurinol

Question 39

Most common side effect of Colchicine________________

Answer 39

Diarrhea

Question 40

For younger patients with CPPD (Pseudogout), consideration of contributory metabolic disease (hyperparathyroidism, hemochromatosis, hypophosphatasia, hypomagnesemia) is warranted.

Question 41

Treatment options for chronic calcium pyrophosphate arthropathy include low-dose glucocorticoids, low-dose colchicine, or NSAIDs to prevent inflammatory manifestations of the disease

Question 42

Treatment of psoriatic artheritis_____

Answer 42

MTX/TNF-a

Question 43

The most common musculoskeletal manifestation of tuberculosis is vertebral osteomyelitis (Pott's disease), usually resulting from the hematogenous spread of Mycobacterium tuberculosis into the cancellous bone tissue of the vertebral bodies

Question 44

Hepatitis B virus infection causes a self-limited arthritis in up to 25% of infected patients during a prodromal stage prior to the onset of jaundice.

Question 45

60% of adults with parvovirus B19 experience arthritis. It often presents acutely, is symmetric and polyarticular, and typically involves the proximal small joints of the hands. Parvovirus B19 arthritis should be suspected when appropriate clinical features are present in someone who has exposure to children, such as teachers and caregivers

Question 46

Disseminated gonococcal infection may present as the arthritis-dermatitis syndrome (tenosynovitis, dermatitis, and polyarthralgia) or as a purulent arthritis with pain and swelling but usually without skin lesions or fever

Question 47

immunosuppressive therapy with glucocorticoids and rituximab may be needed in refractory hepatitis C–related disease or severe mixed cryoglobulinemia.

Question 48

________ symptoms include headache, scalp pain, and temporal artery tenderness. Symptoms are frequently unilateral but can be bilateral. Aching and fatigue with chewing (jaw claudication) indicates ischemia of the muscles of mastication. Fever, fatigue, and weight loss may be present. The most feared complication is ischemic optic neuropathy, which can cause amaurosis fugax and blindness. Because blindness is usually permanent, early recognition and treatment of any visual change are critical. Subcranial disease involving great vessels in the chest occurs in 25% of cases, resulting in upper extremity claudication. Severe but uncommon complications include aortic aneurysm and dissection.

Answer 48

Giant Cell Arteritis People with giant cell arteritis have a tendency to have polymyalgia rheumatica asymmetric pulses can also be a large vessel vasculitis not just aortic root dilation, aortic stenosis

Question 49

________ is associated with pain and stiffness of the neck, shoulder, and hip girdle. Pain and stiffness are worse after immobility; 1 hour or more of morning stiffness is common.

Answer 49

Polymyalgia Rheumatica Tx: Low dose steroid

Question 50

Hep B associated with ______ medium vessel vasculitis

Answer 50

Polyarteritis Nodosa Characterized by fever/arthralgia/skin nodules, mesenteric ischemia/pancreatitis, cholecystitis, GI bleed, generally lung sparing disease Dx: Biopsy: skin, blood vessel Tx: Steroids, cyclophosphamide, ---> plasmapheresis

Question 51

_________ presents as fever, rash, cervical lymphadenopathy, conjunctival congestion, and mucositis. Coronary vessel vasculitis, aneurysm formation, and other cardiac complications (heart failure, pericarditis, arrhythmias) may develop. Treatment is with intravenous immunoglobulin and aspirin.

Answer 51

Kawasaki Disease

Question 52

Treatment of c-ANCA GPA______

Answer 52

high dose steroid + cyclophosphamide /rituximab GPA is much more common than eGPA and microscopic polyangitis

Question 53

The typical patient with EGPA has a history of asthma (96%-100%), nasal polyps, rhinitis, sinusitis, and/or atopy. A prodromal phase (months to years) consisting of arthralgia, myalgia, malaise, fever, and weight loss may occur. An eosinophilic phase with increased peripheral and tissue eosinophilia follows, with migratory pulmonary infiltrates and, less commonly, endomyocardial infiltration and gastrointestinal disease. The subsequent acute vasculitic phase includes mononeuritis multiplex or peripheral sensorimotor neuropathy (70%), kidney (25%), and skin involvement (60%). Paradoxically, the vasculitis phase is often associated with improvement of asthma.

Answer 53

p-ANCA disease GPA has more systemic, dangerous multi-system effects with highest mortality

Question 54

___________ is associated with cutaneous symptoms, peripheral neuropathy, arthritis, and glomerulonephritis, with 90% of cases related to hepatitis C virus infection; treatment of the underlying disorder causing cryoglobulinemia is required.

Answer 54

Mixed cryoglobulinemia

Question 55

_________ is characterized by inflammation and damage of cartilaginous tissues; tissues most commonly affected include the cartilaginous portions of the external and middle ear, nose, tracheobronchial tree, and joints.

Answer 55

Relapsing polychondritis

Question 56

____ characterizes of high ferritin, salmon rash, arthralgia, cyclic fever, splenomegaly

Answer 56

Adult onset still's Treatment includes NSAIDs, glucocorticoids, DMARDs such as methotrexate, and IL-1 inhibitors

Question 57

bihilar adenopathy, arthritis, and erythema nodosum, consistent with _______

Answer 57

Löfgren syndrome

Question 58

IgG4-related disease are characterized by infiltration and tumefaction of the affected tissue with resultant organ enlargement, fibrosis, and dysfunction; diagnosis is by tissue biopsy.

Question 59

Treatment of scleroderma renal crisis_______

Answer 59

ACE (Captopril) steroids not used to treat scleroderma, symptom based control ---> mycophenylate

Question 60

Two drugs notorious for gout__________________

Answer 60

cyclosporine, HCTZ

Question 61

Gout flare in CKD treatment___________

Answer 61

steroids, not NSAID or colchicine

Question 62

Chronic gout medication for renal patients, or HLA-B5801 patients_______

Answer 62

Febuxostat refractory gout = pegloticase

Question 63

Triad of interstitial lung disease ,inflammatory artheritis, fever, raynauds______

Answer 63

anti-synthetase syndrome ((t-RNA synthase, Jo1)

Question 64

myositis with both proximal and distal involvement______________

Answer 64

inclusion body myositis, less responsive to steroids

Question 65

Treatment of FMF_______

Answer 65

Colchicine