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RITE/PSBIM review > Rheumatology > Flashcards

Rheumatology Flashcards

1
Q

How do you differentiate articular vs non-articular complaints?

A
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2
Q

Gel phenomenon is seen in inflamm or non inflamm conditions?

A

NON-inflammatory

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3
Q

WBC of 2000-50000 with predominance of PMNs in synovial fluid analysis is commonly seen in what type of dse condition?

A

Inflammatory

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4
Q

Most potent risk factor for OA

A

Age

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5
Q

Joints usually spared in OA

A

Ankle
Wrist
Elbow

AWE-OA

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6
Q

most effective exercise regimens for OA

A

aerobic and/or resistance training

however No evidence that patients with hand OA
benefit from therapeutic exercise

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7
Q

Characteristic xray finding in gout

A

cystic changes, well-defined erosions, with sclerotic margins (often with overhanging bony edges), and soft tissue masses

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8
Q

Characteristic utz finding in gout

A

double contour sign overlying the
articular cartilage

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9
Q

Indications for starting hypouricemic tx in gout

A

After 2 acute attacks
Serum uric acid > 9.0 mg/dL (> 535umol/L)
Presence of uric acid stones (radiolucent)
Chronic gouty arthritis or presence of tophi

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10
Q

Hallmark of rheumatoid arthritis

A

Flexor tendon tenosynovitis

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11
Q

in RA, what do you call the Hyperextension of the PIP joint with flexion of the DIP joint

A

Swan-neck deformity

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12
Q

in RA, what do you call the Flexion of the PIP joint with hyperextension of the DIP joint

A

Boutonnière deformity

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13
Q

in RA, what do you call the Subluxation of the 1st MCP with hyperextension of the first IP joint

A

Z-line deformity

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14
Q

in RA, what do you call the Subluxation of the distal ulna due to inflammation of the ulnar styloid and tenosynovitis of the extensor carpi ulnaris

A

Piano-key movement

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15
Q

most common cardiac manifestation of rheumatoid arthritis?

A

pericarditis

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16
Q

most common pulmonary manifestation of rheumatoid arthritis?

A

pleuritis

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17
Q

DMARD of choice in the treatment of rheumatoid arthritis

A

Methotrexate

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18
Q

antibody is associated with neonatal
lupus with congenital heart block

A

Anti SSA (Ro)

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19
Q

antibody associated with drug induced lupus

A

anti histone

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20
Q

best screening test for SLE

A

ANA

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21
Q

Antibody that is disease specific and correlates with dse activity

A

dsDNA

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22
Q

Antibody that when positive in CSF correlates with active CNS lupus

A

antineuronal antibody including antiglutamate receptor 2

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23
Q

Antibody that when positive in serum correlates with depression or psychosis due to CNS lupus

A

anti ribosomal P

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23
Q

Among the different drugs being used to treat SLE, which drug is specifically indicated in the treatment of lupus dermatitis?

A

Methotrexate

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24
Q

Which features are more common in limited compared to diffuse cutaenous SSc

A

Critical ischemia in digits
Calcinosis cutis

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25
Q

Characteristic autoantibodies in
Limited cutaenous SSc?
diffuse cutaneous Ssc?

A

Limited cutaenous SSc- anticentromere
diffuse cutaneous Ssc - Anti topoisomerase I (Scl 70) and anti RNA pol III

yung may numbers sa diffuse

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26
Q

What is the mainstay of therapy of
scleroderma renal crisis?

A

ACE inhibitors

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27
Q

What is the most common route of
infection in infectious arthritis?

A

Hematogenous

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28
Q

What inflammatory myopathy is not responsive to corticosteroids

A

Inclusion body myositis

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28
Q

The only conventional NSAID for that appears to be safe from a cardiovascular perspective

A

Naproxen

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29
Q

Most frequent early clinical manifestation of gout

A

acute gout

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30
Q

uric acid excretion > ____ mg/day entails overproduction of uric acid

A

800

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31
Q

most frequently affected joint in CPPD

A

knee

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32
Q

________ deposition dse is associated with Milwaukee shoulder

A

Calcium Apatite

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33
Q

cell type that is a predominant source of proinflammatory cytokines (TNF-a, IL-1, IL-6) in the joint and thus considered as the major driver of rheumatoid arthritis

A

macrophage

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34
Q

major genetic risk factor for RA is the ___alleles

A

(HLA-DRB1)

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35
Q

What is the most common cause of
death among patients with RA?

A

cardiovascular dse

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36
Q

What constitutes CREST syndrome?

A

Calcinosis
Raynaud’s
Esophageal Dysmotility
Sclerodactyly
Telangiectasia

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37
Q

Laboratory and Clinical criteria for diagnosing APAS

A

See table

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38
Q

Dose of prednisone that can induce psychosis

A

pred > 40 mg

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39
Q

Most common causes of drug induced lupus

A

procainamide
disopyramide
propafenone

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40
Q

in psoriatic arthritis, which comes first? psoriasis or arthritis?

A

psoriasis

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41
Q

Which dse entity is arthritis mutilans associated?

A

Psoriasis

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42
Q

What are the causative agents associated with Reactive arthritis

A

Enteric causes: Shigella, Salmonella, Yersinia, Campylobacter

Urogenital: Chlamydia

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43
Q

Most serious complication of Ankylosing Spondylitis?

A

fracture

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44
Q

In AS, the earliest change in the sacroiliac joint demonstrable on x-ray is

A

blurring of the cortical margins of the subchondral bone

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45
Q

Which clinical feature of acute rheumatic fever can appear after months after an initial infection?

A

Chorea and indolent carditis

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46
Q

Treatment for severe chorea in acute rheumatic fever

A

Carbamazepine, Sodium Valproate

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47
Q

How long should you give prophylaxis for Acute rheumatic fever

Without carditis
With carditis,no valvular dse
With residual valvular dse

A

Without carditis - 5 yrs after last attack or until 21 yrs old which ever is longer

With carditis,no valvular dse- 10 yrs after last attack or until 21 yrs old which ever is longer

With residual valvular dse- 10 yrs after last attack or until 40 yrs old which ever is longer

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48
Q

in OA, what has the highest % inheritability based on joint involvement?

A

Hip and Hand (50%)

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49
Q

Earliest pathologic finding in OA

A

Fibrillation of cartilage surface

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50
Q

Initial analgesic of choice in px with OA

A

Paracetamol

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51
Q

Most common earliest manifestation of gout

A

Pai and swelling of 1st MTP

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52
Q

Target uric acid level for px with gout

A

5-6 mg/dL or < 300-360 umol/L

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53
Q

Most commonly involved joints in RA

A

wrist , PIP, MCP

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54
Q

Most common chronic dermatitis of SLE

A

Discoid

Circular lesions with slightly raised, scaly, hyperpigmented erythematous rims and depigmented, atrophic centers

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55
Q

Most common hematologic finding in SLE

A

normocytic normochromic anemia

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56
Q

Autoantibody seen in MCTD

A

U1RNP

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57
Q

Diagnostic test of choice for confirming PAH in SLE

A

Cardiac catheterization

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58
Q

Leading cause of death in px with systemic sclerosis

A

ILD

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59
Q

Mainstay of tx for inclusion body myositis

A

PT and OT

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60
Q

Antisynthetase syndrome is associated with this antibody

A

Anti-Jo1

Antisynthetase syndrome- presence of myositis, non erosive arthritis, Raynauds, mechanic hands, fever

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61
Q

Most sensitive laboratory marker of muscle destruction

A

CK

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62
Q

Characteristic laboratory finding in EGPA

A

Eosinophilia > 1000cells/uL

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63
Q

straight-leg-raising maneuver is a sensitive test for nerve root disease, and stretches which nerve roots?

A

L5-S1

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64
Q

Empiric tx for septic arthritis

A

3rd gen IV + Vanco

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65
Q

Most common valvular abnormality in RA

A

MR

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66
Q

earliest plain radiographic finding of
rheumatoid arthritis

A

Periarticular osteopenia

67
Q

most common clinical presentation of
acute rheumatic fever (ARF)

A

polyrthritis (60-75%)

next is carditis (50-60%)

68
Q

Sausage digits are associated with what condition?

A

reactive arthritis and psoriatic arthritis

69
Q

antinuclear antibody (ANA) patterns is most
specific and suggestive of lupus

A

peripheral

70
Q

In px with gout, when can you stop colchicine?

A

until the px is hypouricemic and without gouty attacks for 6mos or as long tophi is present

71
Q

most commonly affected joint in patients
who develop hemarthrosis

A

knee

72
Q

Most commonly affected tendon in rotor cuff tendinitis

A

supraspinatus

73
Q

Most commonly involved part of the spine in psoriatic arthritis

A

cervical

74
Q

All vasculitis patients receiving daily glucocorticoids and immunosuppressive should receive prophylaxis against which organism?

A

P. jiroveci

75
Q

treatment regimen for Psoriatic Arthritis that can paradoxically trigger exacerbation of psoriasis

A

Anti TNF

76
Q

When would you expect clinical response after treatment initiation with cyclophosphamide?

A

3-16 weeks

77
Q

Based on the CASPAR Criteria, what characteristic of psoriasis is assigned 2 points

A

Typical psoriatic nail dystrophy

78
Q

What constitutes the triad of reactive arthritis

A

arthritis, urethritis and conjunctivitis

79
Q

Most common extraarticular manifestation of AS

A

Acute anterior uveitis

80
Q

Chronic nasal carriage of ___ has been reported to be assoc with a higher relapse rate of GPA however there is no rol of this organism in the pathogenesis of this dse

A

S. aureus

81
Q

Tissue that offers the highest diagnostic yield for GPA

A

Pulmonary tissue

82
Q

Tx for GPA

A

Cyclophosphamide + Glucocorticoids

same with MPA

GPA is AKA Wegeners

83
Q

Asians expressing this HLA phenotype has inc risk for allopurinol toxicity

A

HLA B*5801

84
Q

Examples of non hypourecemic agents with mild uricosuric effects

A

Losartan, Amlodipine, Fenofibrate, SGLT2i

85
Q

Most frequent extracutaneous complication of SSc

A

Raynaud’s phenomenon

86
Q

What rare complication that presents as encephalopathy is associated with rituximab therapy

A

PML

87
Q

Most serious manifestation of SLE

A

Nephritis

88
Q

Most common manifestation of diffuse CNS lupus

A

cognitive dysfunction

89
Q

most common type of arthritis

A

OA

90
Q

pathologic sine qua non of OA

A

hyaline articular cartilage loss

91
Q

What does FABER test stand for

A

Flexion, ABduction, External Rotation

Pathologies at the hip, lumbar and sacroiliac region

92
Q

Entry criteria for 2015 ACR/EULAR classification of gout

A

The entry criterion for the new classification criteria requires the occurrence of at least one episode of peripheral joint or bursal swelling, pain, or tenderness.

93
Q

When do we initiate urate lowering drugs?

A

> Hyperuricemia cannot be corrected by nonpharmacological interventions
Consider in those with CKD Stage >3, serum urate levels >9mg/dL, urate nephrolithiasis
More than 2 gout attacks yearly
Those who already has subcutaneous tophi or chronic gouty arthritis
Radiographic evidence of gout arthritis

94
Q

punctate or linear deposits withing the menisci/ articular cartilage in CPPD are AKA

A

Chondrocalcinosis

95
Q

Autoantibodies that are specific and associated with SLE nephritis and correlates with dse activity

A

anti dsdna

antismith–> does not correlated with dse activity

96
Q

Autoantibody in SLE associated with Sicca syndrome

A

Anti Ro

Also assoc in neonatal lupus heart block

97
Q

Autoantibody that correlates with dse in activity of nephritis but NOT specific to SLE

A

AntiC1q

98
Q

Autoantibody more frequent in drug induced lupus than SLE

A

Anti histone

99
Q

positive test in CNS correlates with active CNS lupus

A

Anti neuronal includes antiglutamate receptor 2

100
Q

positive test in SERUM correlates with depression or psychosis in CNS lupus

A

Antiribosomal P

**take note: found in serum not CSF unlike anti neuronal antibody

101
Q

Most serious cardiac manifestation of SLE

A

Myocarditis, Libman Sacks endocarditis

102
Q

Next step when ssx suggestive of SLE but negative ANA, CBC, plt, UA

A

Repeat ANA, add dsDNA and anti Ro

if all negative- not SLE

103
Q

2nd agents that may be used in addition to glucocorticoids in px with SLE with life threatening organ dysfunction

A

MMF/ Cyclophosphamide

in SLE nephritis, may also add calcineurin inhibitors like tacrolimus

104
Q

Treatment for SLE assoc with higher incidence of aseptic meningitis

A

NSAIDs

105
Q

Treatment for SLE assoc with bladder CA

A

cylocphosphamide

106
Q

Treatment for SLE assoc with diffuse yellowing of the skin

A

Quinacrine

107
Q

Treatment for SLE assoc with Progressive multifocal leukoencephalopathy

A

Rituximab

108
Q

Treatment for SLE assoc with hypercholesterolemia

A

MMF

109
Q

Most common venous and aterial consequences of APAS

A

DVT, Stroke

110
Q

Hallmark of rheumatic carditis

A

Valvular damage affecting mitral valves and aortic valves

eg. MR and AR

111
Q

Characteristic echo findings in RHD

A
112
Q

___% of those with chore have carditis

A

50

113
Q

Subcutaneous nodules are Delayed manifestation of RHD occuring __ weeks after the onset of disease last for 3 weeks associated with carditis

A

2-3

114
Q

Lab tests that could signify evidence of strep infection

A

Positive throat swab/ rapid antigen
Anti ASO, anti DNAse

115
Q

Treatment for Acute rheumatic fever

A

Antibiotics: Amoxicillin, 50 mg/kg [maximum, 1 g] daily, for 10 days OR Benzathine Pen G 1.2 million units IM

Salicylates and NSAIDS- Aspirin 50-60mg/kg per day Max 80-100mg/kg/day divided into 4-5 doses; Decrease dose after 2 weeks to 50-60mg/kg/day for 2-4 weeks
Others: Naproxen 10-20mg/kg/day

116
Q

most common form of chronic inflammatory arthritis

A

RA

117
Q

What constitutes Felty’s syndrome?

A

neutropenia, splenomegaly, and nodular RA

118
Q

Oral microbiome associated with RA

A

P. gingivalis

119
Q

Pathologic hallmark of RA

A

Synovial inflammation and proliferation, focal bone erosions, thinning of articular cartilage

120
Q

The presence of serum ____ antibodies has about the same sensitivity as serum RF for the diagnosis of RA.

A

anti CCP

However, its diagnostic specificity approaches 95%, so a positive test for these antibodies in the setting of an early inflammatory arthritis is useful for distinguishing RA from other forms of arthritis

121
Q

ACR/Eular criteria for remission in RA

A
122
Q

Only biologic for RA that is not approved for monotherapy

A

Infliximab

123
Q

Safest DMARD to use in pregnancy

A

HCQ and Sulfasalazine

124
Q

Wright and Moll 5 patterns of psoriatic arthritis

A

(1) arthritis of the DIP joints
(2) asymmetric oligoarthritis
(3) symmetric polyarthritis similar to RA
(4) axial involvement (spine and sacroiliac joints)
(5) arthritis mutilans

(3)- most common, occurs in 40%

125
Q

Radiographic findings associated with peripheral psoriatic arthritis

A

DIP involvement, classic “pencil-in-cup” deformity; marginal erosions with adjacent bony proliferation (“whiskering”); small-joint ankylosis; osteolysis of phalangeal and metacarpal bone, with telescoping of digits; periostitis, “ray” distribution of lesions.

126
Q

What constitutes CASPAR criteria for Psoriatic arthritis

A
127
Q

Oral JAK inhibitor approved for psoriatic arthritis

A

Tofacitinib

128
Q

Monoclonal antibodies approved for psoriatic arthritis

A

Secukinumab and ixekizumab, monoclonal antibodies to IL-17A;

ustekinumab, a monoclonal antibody to the shared IL-23/IL-12p40 subunit.

129
Q

Triad of GPA

A

Upper respiratory tract involvement
Lower respiratory tract involvement
Glomerulonephritis

130
Q

Most common presentation of MPA

A

Glomerulonephritis

does NOT have granulomas and pulmonary involvement

131
Q

Histologic hallmark of GPA

A

Necrotizing small-vessel vasculitis + Granulomas (intravascular or extravascular)

132
Q

Chronic nasal carriage of this bacteria is associated with higher relapse of GPA

A

S. aureus

133
Q

Most common cause of mortality in GPA

A

Renal

134
Q

Most common system involved in GPA

A

ENT particularly sinusitis

135
Q

Most common renal manifestation in GPA

A

Glomerulonephritis

136
Q

Most common lung manifestation in GPA

A

Pulmonary infiltrates

137
Q

Most common eye manifestation in GPA

A

Scleritis

138
Q

Important cause of mortality in EGPA

A

Heart disease (myocardial involvement)

2DECHO should be done in ALL newly diagnosed patients

139
Q

Saddle nose deformity is seen in what ANCA associated vasculitis

A

EGPA

140
Q

Venules are NOT involved in PAN. If present, this would suggest this condition

A

MPA

141
Q

Most common CBC finding in PAN

A

Leukocytosis with neutrophilic predominance

142
Q

Body tissues with the highest yield for biopsy in PAN diagnosis

A

Nodular skin lesions
Painful testes
Nerve/muscle

143
Q

May be performed in the absence of biopsy for diagnosis of PAN

A

Angiographic studies

144
Q

Mortality in PAN is usually due to:

A

GI complaints (bowel infarction, perforation)
Cardiovascular causes

145
Q

Most common artery involved in giant cell arteritis

A

Temporal artery

146
Q

Most common artery involved in takayasu arteritis

A

subclavian artery

147
Q

Treatment for Giant cell arteritis

A

Prednisone (40-60 mg OD x 1 month then taper)
(first-line treatment for general presentation)

Methylprednisolone (1 gram OD x 3 days)
(first-line treatment for ocular presentation)

148
Q

Treatment for Takayasu arteritis

A

Prednisone 40-60 mg OD for symptomatic treatment

149
Q

Most commonly involved vessel in cutaneous vasculitis

A

Postcapillary venules

150
Q

Typical presentation in cutaneous vasculitis

A

Palpable purpura

151
Q

Most common site of cutaneous vasculitis

A

Lower extremities

152
Q

Treatment of cutaneous vasculitis

A

Prednisone

153
Q

Most effective therapy for systemic vasculitis but should almost never be used for cutaneous vasculitis

A

Cyclophosphamide

154
Q

Syndrome that includes the ff ssx:
Interstitial keratitis
Vestibuloauditory symptoms
Aortitis (AV involvement)

A

Cogan syndrome

155
Q

Most involved blood vessel in Kawasaki disease

A

Coronary arteries – beadlike aneurysms and thromboses

156
Q

Drugs associated with ANCA-associated vasculitis

A

Hydralazine
Propylthiouracil

157
Q

Most common clinical presentation of drug-induced vasculitis

A

Palpable purpura of the lower extremities

158
Q

difference between serum vs serum like sickness

A
159
Q

In patients with dermatomyositis, these refer to the raised erythematous rash over the knuckles.

A

Gottron papules NOT sign

160
Q

autoantibody associated with more benign dermatomyositis and a favorable response to treatment

A

Anti-Mi2

161
Q

Associated with increased risk of malignancies in dermatomyositis patients

A

Anti-TIF1 (p155)
Anti-NXP2

162
Q

autoantibody Associated with amyopathic dermatomyositis (rash only) with severe palmar rash, digital ulcers, rapidly progressive ILD

A

Anti-MDA5

163
Q

autoantibody Associated in immune-mediated necrotizing myopathy (NM) in patients taking statins >5 years

A

Anti-HMGCR

164
Q

autoantibody Associated in patients with inclusion body myositis (IBM)

A

Anti-cytosolic 5’nucleotidase 1A (anti-cN-1A)

165
Q

Inclusion body myositis has predilection for involvement of these muscles

A

flexor digitorum profundus, vastus medialis, vastus lateralis

166
Q

Treatment for inflammatory myopathies

A

High-dose glucocorticoids (0.75 – 1 gram mg/kg/day- First-line treatment to steroid-responsive inflammatory myopathies

Methotrexate – second-line treatment

RITE/PSBIM review (19 decks)

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