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Internal Medicine > Rheumatology > Flashcards

Rheumatology Flashcards

1
Q

Most common type of arthritis?

A

Osteoarthritis

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2
Q

Most potent risk factor for osteoarthritis?

A

Age

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3
Q

Two major factors contributing to the development of OA?

A

Joint loading
Joint vulnerability

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4
Q

Nodes found in the PIP joint in OA?

A

Bouchards nodes

B Bouchards comes first in the alphabet before H of Heberden

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5
Q

Nodes found on the DIP joint OA?

A

Heberdens nodes

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6
Q

Most common site of symptomatic osteoarthritis?

A

Knee

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7
Q

Pathologic sine qua non of osteoarthritis?

A

Hyaline articular cartilage loss

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8
Q

Mainstay of tx in OA?

A

Nonpharmacologic

Altering joint loading and improving function of joint protection

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9
Q

Initial analgesic of choice for OA ?

A

Acetaminophen

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10
Q

Most common side effects of oral NSAIDs ?

A

Upper GI Toxicity

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11
Q

Maximum dose of Acetaminophen in OA ?

A

1 gram TID

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12
Q

Earliest involved joints in RA?

A

Small joints of hands and feet

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13
Q

Subluxation of the 1st MCP joint with hyperextension of 1st IP joint?

A

Z- line deformity

Inward and Outward

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14
Q

Rheumatoid Arthritis: 2D Echo with doppler

A
  1. Mild left ventricular compliance abnormality
  2. Ejection fraction of 70%
  3. Minimal pericardial effusion
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15
Q

Rheumatoid Arthritis Xray pf hands and feet?

A
  1. Subluxations
  2. Osteopenia
  3. Bony erosions
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16
Q

Nodular RA , Splenomegaly and Neutropenia?

A

Felty’s Syndrome

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17
Q

DMARDs in RA?

A
  1. Methotrexate
  2. Sulfasalazine
  3. Hydroxychloroquine
  4. Leflunomide
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18
Q

Category X DMARDs

A

Methotrexate
Leflunomide

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19
Q

Onset of action of DMARDs ?

A

6 to 12 weeks

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20
Q

Most serious toxicity associated with use of hydroxychloroquine ?

A
  1. Irreversible retinal damage
  2. Cardiotoxicity
  3. Blood dyscrasia
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21
Q

Triple therapy in RA?

A

Methotrexate
Sulfasalazine
Hydroxychloroquine

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22
Q

Monitoring of serum creatinine, CBC, and liver function tests during Methotrexate therapy?

A

2 to 3 months

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23
Q

Biological in RA by inhibiting the co-stimulation of T cells by blocking CD 28- CD 80/ 86 interactions

A

Abatacept

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24
Q

TB screening required prior to initiation of the following biologics?

A
  1. TNF alpha inhibitors: infiximab, etanercept, adalimumab, golimumab
  2. Abatancept
  3. Anakinra
  4. IL-6 Inh: tocilizumab, sarilumab
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25
Q

Hallmark features for psoriatic arthritis?

A

Dactylitis: swelling of fingers and toes “sausage like appearance”
Enthesitis :Swelling / inflammation of more than one enthesis ( joint / tendon area)

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26
Q

Most common acute rash in SLE?

A

Malar Rash

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27
Q

Most common chronic dermatitis in SLE?

A

Discoid Rash

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28
Q

Autoantibodies in subacute cutaneous lupus?

A

Anti-Ro (SS-A)

29
Q

Anti-arrhythmic causing drug-induced lupus? (3)

A
  1. Procainamide
  2. Disopyramide
  3. Propafenone
30
Q

Anti-hypertensives causing drug induced lupus? (4)

A
  1. Hydralazine
  2. Methyldopa
  3. Beta blockers
  4. ACE inhibitors

Anti Hypertensive : HuMBA

31
Q

Antibiotics causing drug induced lupus? (3)

A
  1. Isoniazid
  2. Minocycline
  3. Nitrofurantoin
32
Q

CNS drugs causing drug induced lupus?

A

Chlorpromazine
Lithium

33
Q

Tx for hyperthyroidism that causes drug induced lupus?

A

PTU Propylthiouracil

34
Q

Positively birefringent, rhomboid shaped crystals in synovial fluid?

A

Calcium Pyrophosphate (CPPD)

35
Q

Negative birefringent, needle shaped crystals in synovial fluid?

A

Urate ( Gout)

36
Q

Treatment approach in APAS?

A
  1. Pregnant: LMWH , Aspirin, IVIg
  2. Non-pregnant: Warfarin for life
  3. Positive ACL , Anti-B2GPI and LA: Aspirin & Hydroxychloroquine
  4. Recurrent thrombosis despite anticoagulation: IVIg
37
Q

Color changes in Reynauds phenomenon?

A
  1. White : pallor from vasoconstriction
  2. Blue: cyanosis or ischemia
  3. Red: hyperemia from reperfusion
38
Q

Treatment of Reynauds Phenomenon?

A
  1. Non pharmacologic
    - Dress warmly
    - Avoid cold exposure
    - Avoid drugs that exacerbate vasospasm
  2. Pharmacologic
    - Amlodipine
    - Diltiazem
    - ARBs
    - Alpha blockers
    - PDE 5 Inhibitors
39
Q

Treatment of Sjogren’s Syndrome:
Dry eyes

A
  1. Artificial tears
  2. Ophthalmic solutions
  3. Avoid diuretics, antihypertensive, anticholinergics, and anti-depressants
40
Q

Treatment of Sjogren’s Syndrome:
Xerostomia

A
  1. Best replacement is water
  2. Pilocarpine
  3. Cevimeline
41
Q

Treatment of Sjogren’s Syndrome:
Arthritis

A
  1. Hydroxychloroquine or Methotrexate
  2. Prednisolone
42
Q

Treatment of Sjogren’s Syndrome:
Reynauds

A

Cold protection

43
Q

Treatment of Sjogren’s Syndrome:
Renal tubular acidosis

A

Bicarbonate replacement

44
Q

Treatment of Sjogren’s Syndrome:
Lymphoma

A
  1. Rituximab plus
  2. CHOP
    -Cyclophosphamide
    -Hydroxyurea
    -Vincristine
    -Prednisone
45
Q

Polyarthritis of Rheumatic Fever?

A

Wrists and Elbows to Shoulders and Cervical Area

46
Q

Most appropriate initial pharmacologic tx in symptomatic px with OA in pain?

A

Acetaminophen

47
Q

Most common extra articular manifestations of ankylosing spondylitis?

A

Anterior Uveitis 20-30%

48
Q

Tried to retard progression of Rheumatoid Arthritis?

A

Hydroxychloroquine

49
Q

Sjogren Syndrome features

A
  1. Dry skin, Mouth, Eyes, Nose
  2. Confirmed by Tissue biopsy
  3. Avoid antihistamine like diphenhydramine
50
Q

Most common connective tissue disorders associated with secondary Sjogrens syndrome?

A

Rheumatoid arthritis

51
Q

Scleroderma seen in what conditions? (4)

A
  1. Woman with thickened skin , tight fingers / sclerodactyly
  2. Reynauds phenomenon or Digital pitting scars : dark shiny skin on distal phalanges of both arms
  3. Associated with Sclerodactyly
  4. Associated with Vit D deficiency
52
Q

Effective tx in acute severe allergic reactions? (4)

A
  1. Epinephrine (adrenaline): Reduction of bodys allergic response
  2. Oxygen: to aid in breathing
  3. IV antihistamine and corticosteroids: reduction of inflammation of air passages and improvement of breathing
  4. Beta agonists: relief of breathing symptoms
53
Q

Antibody in allergic reaction?

A

IgE

54
Q

Mechanism of allergic reaction?

A

Immunoglobulin binds to allergen and mast cells

55
Q

Most common presentation of anaphylaxis?

A

Cutaneous manifestations

56
Q

Most practical and useful biomarker in documenting severity of anaphylaxis?

A

Serum tryptase

57
Q

Treatment of first choice in anaphylaxis?

A

IM Epinephrine

58
Q

Failure to use epinephrine within this time period of symptoms of anaphylaxis is associated with poor outcomes?

A

20 minutes

59
Q

Insufficient venous return to the heart from sudden onset of hypotension in anaphylaxis, which can be accelerated by epinephrine administration?

A

Empty heart syndrome

60
Q

Most common form of chronic inflammatory arthritis

A

Rheumatoid arthritis

61
Q

Most common hematologic abnormality in rheumatoid arthritis?

A

Normochromic, Normocytic Anemia

62
Q

Most frequent site of cardiac involvement in Rheumatoid arthritis?

A

Pericarditis

63
Q

Clinical triad of neutropenia, splenomegaly, and nodular rheumatoid arthritis?

A

Felty’s Syndrome

64
Q

Most common cause of death in px with rheumatoid arthritis?

A

Cardiovascular disease ( ischemic heart disease)

65
Q

DMARDs of First choice for initial treatment of Rheumatoid Arthritis?

A

Methotrexate

66
Q

Often the next step for treatment of RA patients with an inadequate response to methotrexate therapy?

A

Methotrexate + Anti-TNF agent

67
Q

Anti-TNF agents used in RA? (5)

A
  1. Certolizumab
  2. Adalimumab
  3. Golimumab
  4. Etanercept
  5. Infliximab

CAGE In by RA Anti-TNF

68
Q

MOA of Abatacept?

A

Blocks CD28 - CD 80/86 interactions

Internal Medicine (12 decks)

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