Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

IM Board Review > Rheumatology > Flashcards

Rheumatology Flashcards

1
Q

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

A

Morphea

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

______ 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

A

Febuxostat

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

___ is a urate lowering therapy safe in CKD

A

Allopurinol

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

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

A

nintedanib (a tyrosine kinase inhibitor)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Infectious joint studies usually have WBC>_____

A

50,000

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Bisphosphonate use in patients on chronic steroids

A

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.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

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

A

Colchicine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

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

A

Pregabalin

MTX should be avoided for significant liver/renal disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

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

A

Leflunomide , can cause rash, diarrhea, transaminitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

A common adverse effect of cyclosporine ______

A

Gout

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Before considering allopurinol ineffectively as treatment failure, test for_______

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

RA/SLE drug safe in pregnancy_______

A

Hydroxychloroquine

Never MTX or Leflunomide

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

______ 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.

A

RA

Keratitis and scleritis are optho emergencies

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

RA with splenomegaly and low WBC (neutropenia) is called_____

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

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

A

RA

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

________ 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)

A

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.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

OA effects ____ while RA is more proximal disease

A

DIP/PIP (Distal joints)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Constellation of total body dolor, sleep issues, depression_______

A

Fibromyalgia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

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

A

A common manifestation of psoriatic arthritis is achilles tendinopathy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

First line therapy for Ankylosing Spondylitis _____

A

NSAID –> Infliximab

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Lung manifestation of lupus: pleuritis, effusion, DAH

A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

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

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

biggest malignancy associated with lupus___________

A

non hodgkins lymphoma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

backbone lupus therapy______

A

hydroxychloroquine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Pregnancy during lupus

A

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.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

Sjogren
Dx: Can be done by biopsy
Tx: ______

A

Initially supportive

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

____________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.

A

Antisynthetase syndrome

28
Q

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

A
29
Q

____ can cause immune mediate necrotizing myositis or any myositis

A

Statin, anti HMG coa REductase antibodies

30
Q

Key feature of inclusion body myositis______

A

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.

31
Q

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

A
32
Q

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

A
33
Q

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_______

A

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.

34
Q

Treatment of ILD with systemic sclerosis_____

A

Mycophenylate

35
Q

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.

A
36
Q

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

A

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

Tx: Hydroxychloroquine

37
Q

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

A

interleukin-1 inhibitors (anakinra or canakinumab)

38
Q

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.

A

allopurinol

39
Q

Most common side effect of Colchicine________________

A

Diarrhea

40
Q

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

A
41
Q

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

A
42
Q

Treatment of psoriatic artheritis_____

A

MTX/TNF-a

43
Q

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

A
44
Q

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.

A
45
Q

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

A
46
Q

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

A
47
Q

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

A
48
Q

________ 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.

A

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

49
Q

________ 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.

A

Polymyalgia Rheumatica

Tx: Low dose steroid

50
Q

Hep B associated with ______ medium vessel vasculitis

A

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

51
Q

_________ 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.

A

Kawasaki Disease

52
Q

Treatment of c-ANCA GPA______

A

high dose steroid + cyclophosphamide /rituximab

GPA is much more common than eGPA and microscopic polyangitis

53
Q

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.

A

p-ANCA disease

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

54
Q

___________ 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.

A

Mixed cryoglobulinemia

55
Q

_________ 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.

A

Relapsing polychondritis

56
Q

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

A

Adult onset still’s

Treatment includes NSAIDs, glucocorticoids, DMARDs such as methotrexate, and IL-1 inhibitors

57
Q

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

A

Löfgren syndrome

58
Q

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.

A
59
Q

Treatment of scleroderma renal crisis_______

A

ACE (Captopril)

steroids not used to treat scleroderma, symptom based control —> mycophenylate

60
Q

Two drugs notorious for gout__________________

A

cyclosporine, HCTZ

61
Q

Gout flare in CKD treatment___________

A

steroids, not NSAID or colchicine

62
Q

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

A

Febuxostat

refractory gout = pegloticase

63
Q

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

A

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

64
Q

myositis with both proximal and distal involvement______________

A

inclusion body myositis, less responsive to steroids

65
Q

Treatment of FMF_______

A

Colchicine

66
Q
A

IM Board Review (13 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions