Brainscape's Knowledge GenomeTM

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


See full index

RITE/PSBIM review > Rheumatology > Flashcards

Rheumatology Flashcards

1
Q

How do you differentiate articular vs non-articular complaints?

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

Gel phenomenon is seen in inflamm or non inflamm conditions?

A

NON-inflammatory

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

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

Most potent risk factor for OA

A

Age

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

Joints usually spared in OA

A

Ankle
Wrist
Elbow

AWE-OA

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

Activities that increase pain in the joint should be avoided, and the exercise regimen needs to be individualized to optimize effectiveness.

Range-of-motion exercises, which do not strengthen muscles, and isometric exercises that strengthen muscles, but not through range of motion, are unlikely to be effective by themselves.

Low-impact exercises, including water aerobics and water resistance training, are often better tolerated by patients than exercises involving impact loading, such as running or treadmill exercises

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

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

Characteristic utz finding in gout

A

double contour sign overlying the
articular cartilage

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

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

Hallmark of rheumatoid arthritis

A

Flexor tendon tenosynovitis

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

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

A

Swan-neck deformity

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

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

A

Boutonnière deformity

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

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

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

most common cardiac manifestation of rheumatoid arthritis?

A

pericarditis

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

most common pulmonary manifestation of rheumatoid arthritis?

A

pleuritis

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

DMARD of choice in the treatment of rheumatoid arthritis

A

Methotrexate

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

antibody is associated with neonatal
lupus with congenital heart block

A

Anti SSA (Ro)

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

antibody associated with drug induced lupus

A

anti histone

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

best screening test for SLE

A

ANA

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

Antibody that is disease specific and correlates with dse activity

A

dsDNA

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

Antibody that when positive in CSF correlates with active CNS lupus

A

antineuronal antibody including antiglutamate receptor 2

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

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

A

anti ribosomal P

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

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

A

Methotrexate

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

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

A

Critical ischemia in digits
Calcinosis cutis

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

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

What is the mainstay of therapy of
scleroderma renal crisis?

A

ACE inhibitors

Avoid steroids. Use only in high risk SSC px only when absolutely required and at low doses <10mg/d

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

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

A

Hematogenous

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

What inflammatory myopathy is not responsive to corticosteroids

A

Inclusion body myositis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

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

A

Naproxen

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

Most frequent early clinical manifestation of gout

A

acute gout

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

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

A

800

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

most frequently affected joint in CPPD

A

knee

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

________ deposition dse is associated with Milwaukee shoulder

A

Calcium Apatite

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

major genetic risk factor for RA is the ___alleles

A

(HLA-DRB1)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

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

A

cardiovascular dse

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

What constitutes CREST syndrome?

A

Calcinosis
Raynaud’s
Esophageal Dysmotility
Sclerodactyly
Telangiectasia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

Laboratory and Clinical criteria for diagnosing APAS

A

See table

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

Dose of prednisone that can induce psychosis

A

pred > 40 mg

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

Most common causes of drug induced lupus

A

procainamide
disopyramide
propafenone

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

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

A

psoriasis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

Which dse entity is arthritis mutilans associated?

A

Psoriasis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

What are the causative agents associated with Reactive arthritis

A

Enteric causes: Shigella, Salmonella, Yersinia, Campylobacter

Urogenital: Chlamydia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

Most serious complication of Ankylosing Spondylitis?

A

fracture

most commonly involved –> lower cervical spine

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
45
Q

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

A

Chorea and indolent carditis

can last up to 6 mos

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
46
Q

Treatment for severe chorea in acute rheumatic fever

A

Carbamazepine, Sodium Valproate

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
48
Q

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

A

Hip and Hand (50%)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
49
Q

Earliest pathologic finding in OA

A

Fibrillation of cartilage surface

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
50
Q

Initial analgesic of choice in px with OA

A

Paracetamol

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
51
Q

Most common earliest manifestation of gout

A

Pai and swelling of 1st MTP

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
52
Q

Target uric acid level for px with gout

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
53
Q

Most commonly involved joints in RA

A

wrist , PIP, MCP

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
54
Q

Most common chronic dermatitis of SLE

A

Discoid

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
55
Q

Most common hematologic finding in SLE

A

normocytic normochromic anemia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
56
Q

Autoantibody seen in MCTD

A

U1RNP

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
57
Q

Diagnostic test of choice for confirming PAH in SLE

A

Cardiac catheterization

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
58
Q

Leading cause of death in px with systemic sclerosis

A

ILD

monitor with PFTs every 6 months
NOT recommended for monitoring: HRCT

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
59
Q

Mainstay of tx for inclusion body myositis

A

PT and OT

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
60
Q

Antisynthetase syndrome is associated with this antibody

A

Anti-Jo1

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
61
Q

Most sensitive laboratory marker of muscle destruction

A

CK

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
62
Q

Characteristic laboratory finding in EGPA

A

Eosinophilia > 1000cells/uL

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
63
Q

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

A

L5-S1

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
64
Q

Empiric tx for septic arthritis

A

3rd gen IV + Vanco

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
65
Q

Most common valvular abnormality in RA

A

MR

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
66
Q

earliest plain radiographic finding of
rheumatoid arthritis

A

Periarticular osteopenia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
67
Q

most common clinical presentation of
acute rheumatic fever (ARF)

A

polyrthritis (60-75%)

next is carditis (50-60%)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
68
Q

Sausage digits are associated with what condition?

A

reactive arthritis and psoriatic arthritis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
69
Q

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

A

peripheral

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
71
Q

most commonly affected joint in patients
who develop hemarthrosis

A

knee

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
72
Q

Most commonly affected tendon in rotor cuff tendinitis

A

supraspinatus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
73
Q

Most commonly involved part of the spine in psoriatic arthritis

A

cervical

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
74
Q

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

A

P. jiroveci

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
75
Q

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

A

Anti TNF a

Also the drugs that are most useful for psoriatic arthritis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
76
Q

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

A

3-16 weeks

Cyclophosphamide + GC are given early to px with renal biopsy of ISN III and IV –> reduce progression to ESRD and death

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
77
Q

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

A

Typical psoriatic nail dystrophy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
78
Q

What constitutes the triad of reactive arthritis

A

arthritis, urethritis and conjunctivitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
79
Q

Most common extraarticular manifestation of AS

A

Acute anterior uveitis

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
81
Q

Tissue that offers the highest diagnostic yield for GPA

A

Pulmonary tissue

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
82
Q

Tx for GPA

A

Cyclophosphamide + Glucocorticoids

same with MPA

GPA is AKA Wegeners

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
83
Q

Asians expressing this HLA phenotype has inc risk for allopurinol toxicity

A

HLA B*5801

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
84
Q

Examples of non hypourecemic agents with mild uricosuric effects

A

Losartan, Amlodipine, Fenofibrate, SGLT2i

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
85
Q

Most frequent extracutaneous complication of SSc

A

Raynaud’s phenomenon

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
86
Q

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

A

PML

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
87
Q

Most serious manifestation of SLE

A

Nephritis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
88
Q

Most common manifestation of diffuse CNS lupus

A

cognitive dysfunction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
89
Q

most common type of arthritis

A

OA

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
90
Q

pathologic sine qua non of OA

A

hyaline articular cartilage loss

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
91
Q

What does FABER test stand for

A

Flexion, ABduction, External Rotation

Pathologies at the hip, lumbar and sacroiliac region

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

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
94
Q

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

A

Chondrocalcinosis

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
96
Q

Autoantibody in SLE associated with Sicca syndrome

A

Anti Ro

Also assoc in neonatal lupus heart block

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
97
Q

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

A

AntiC1q

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
98
Q

Autoantibody more frequent in drug induced lupus than SLE

A

Anti histone

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
99
Q

positive test in CNS correlates with active CNS lupus

A

Anti neuronal includes antiglutamate receptor 2

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
101
Q

Most serious cardiac manifestation of SLE

A

Myocarditis, Libman Sacks endocarditis

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

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

Note: Salicylates and NSAIDs - no value for carditis and chorea

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

167
Q

Which of the following patients with symptomatic gout would require hypouricemic therapy?

a. A 55/M with documented radio-opaque kidney stone
b. A 48/M 2 weeks after resolution of his first acute gouty attack
c. A 38/M with serum uric acid level of 14 mg/dL
d. A 50/M with concomitant osteoarthritis

A

c. A 38/M with serum uric acid level of 14 mg/dL

Since > 9

Why other options are wrong
a. A 55/M with documented radio-opaque kidney stone–> radiolucent
b. A 48/M 2 weeks after resolution of his first acute gouty attack –> should be at least 2 attacks

d. A 50/M with concomitant osteoarthritis- not indicated

168
Q

A 63F recently diagnosed with osteoarthritis of the hip asks you if her children are at higher risk to develop the same condition. Considering her profile, which is the most appropriate response?

a. Her pattern of joint involvement makes heritability more likely
b. Her pattern of joint involvement makes heritability less likely
c. Her age at disease onset makes heritability more likely
d. Her age at disease onset makes heritability less likely

A

a. Her pattern of joint involvement makes heritability more likely

Heritability of OA
o Hip and hand (50%)
o Knee (up to 30%)
o Generalized OA (rarely inherited)
* Growth differentiation factor 5 (GDF5) polymorphism is an associated mutation

169
Q

Obese individuals are at higher risk for osteoarthritis in which joint/s?
a. Hip
b. Knee
c. Hip and knee
d. Hip, knee and hand

A

d. Hip, knee and hand

Obesity and OA
* Risk factor for knee, hip, and hand OA
* Obese persons have more severe OA symptoms
* Not just a consequence of inactivity due to OA
* Stronger risk factor among women
* In women, risk is correlated to weight in a linear fashion
* Weight loss reduces risk for symptomatic OA
* Adipokines may also play a role (note risk for hand OA)

Repetitive joint use and exercise
* Exercise is not associated with OA risk in most people
* Joint injury – involved joints are at greater risk with certain types of exercise
* Recreational runners – modestly increased risk for hip OA (but not knee OA)
* Professional runners – high risk for hip and knee OA
* Workers performing repetitive tasks for many years – high risk for involved joints

170
Q

What happens to the amount of proteoglycan and water in the cartilage of a joint with osteoarthritis?
a. Decrease in proteoglycan, decrease in water content b. Decrease in proteoglycan, increase in water content
c. No change in proteoglycan, decrease in water content
d. No change in proteoglycan, increase in water content Feedback

A

b. Decrease in proteoglycan, increase in water content

Pathology
* Cartilage surface fibrillation → non-uniform erosions → extension to bone
* Injury → chondrocyte mitosis and clustering → catabolic > synthetic activity → negative charges of proteoglycans are exposed → cartilage swelling → vulnerability to injury
* Activation of osteoclasts and osteoblasts in subchondral bone

  • Osteophyte formation at the joint margin – radiologic hallmark of OA
  • Synovial inflammation and proliferation accelerate matrix destruction
  • Capsular edema and fibrosis

*Basic calcium phosphate and calcium pyrophosphate dihydrate crystals in end-stage OA → synovitis

171
Q

A 60F was referred to you for management of diabetes mellitus. On examination, you note foot deformities including loss of the arch of the midfoot and bony prominences. What was the primary predisposing factor that led to this condition?
a. Acute trauma
b. Atherosclerosis
c. Neuropathy
d. Obesity

A

c. Neuropathy

Neuropathic joint disease (Charcot joint) is a progressive destructive arthritis associated with loss of pain sensation, proprioception, or both.

Diabetes mellitus is the most frequent cause of neuropathic joint disease.

Radiographs and physical exam demonstrate loss of the arch due to bony fragmentation and dislocation in the midfoot.

172
Q

A 65F is in your clinic for a wellness check-up. Which intervention is most effective in the prevention of symptomatic knee osteoarthritis?
a. Calcium + Vitamin D supplementation
b. Glucosamine supplementation
c. Quadriceps exercise
d. Smoking cessation

A

c. Quadriceps exercise

173
Q

A 56F consults you for chronic joint pains in her hands as well as difficulty in certain activities such as cooking and doing laundry. You inspect her hands and see nodes on distal interphalangeal joints and the proximal interphalangeal joints. What is the most likely diagnosis?
a. Gouty arthritis
b. Osteoarthritis
c. Psoriatic arthritis
d. Rheumatoid arthritis

A

b. Osteoarthritis

Hand OA affects the distal interphalangeal joints (Heberden’s nodes) and the proximal interphalangeal joints (Bouchard’s nodes). Another common site of bony enlargement in the hands is the thumb base.

Sources of pain in osteoarthritis
* Cartilage loss is NOT accompanied by pain, unless if with neurovascular invasion in advanced OA
* Innervated structures:
o Synovium, ligaments, joint capsule, muscles, subchondral bone
* Severity of X-ray changes does not correlate well with pain severity

Likely sources of pain
* Synovitis
* Joint effusion
* Bone marrow edema (from loading-related bone injury)
* Periarticular sources including bursae (ie. anserine bursitis, iliotibial band syndrome)
* Peripheral and central sensitization

174
Q

In a 55M with knee osteoarthritis, which pattern of symptoms is most consistent with his condition?

a. No morning stiffness; pain is associated with fatigue
b. No morning stiffness; swelling is noted above the joint
c. Morning stiffness for 30 minutes, pain subsides with prolonged activity
d. Morning stiffness for 30 minutes, pain worsens with prolonged activity

A

d. Morning stiffness for 30 minutes, pain worsens with prolonged activity

Clinical features
* Pain is initially episodic, activity-related, triggered by overactive use of involved joint
* Can become continuous pain at progression
* Morning stiffness <30mins

175
Q

A 57M consults you for 1 month history of left knee pain especially when going up and down the stairs. On physical examination, you note swelling and erythema on the inferomedial aspect of the left knee. What is the most likely diagnosis?
a. Anserine bursitis
b. Iliotibial band syndrome
c. Medial meniscus tear
d. Osteoarthritis

A

a. Anserine bursitis

Bursitis occurs commonly around knees and hips.

A physical examination should focus on whether tenderness is over the joint line (at the junction of the two bones around which the joint is articulating) or outside of it.

Anserine bursitis, medial and distal to the knee, is an extremely common cause of chronic knee pain that may respond to a glucocorticoid injection.

175
Q

A 62F consults you for on-and-off right hip pain especially after jogging. Physical examination revealed a loss of internal rotation on passive movement. What is the most likely diagnosis?
a. Ankylosing spondylitis
b. Avascular necrosis
c. Osteoarthritis
d. Trochanteric bursitis

A

c. Osteoarthritis

For hip pain, OA can be detected by loss of internal rotation on passive movement, and pain isolated to an area lateral to the hip joint usually reflects the presence of trochanteric bursitis.

Ankylosing spondylitis: (+) Schober test, (+) sacroiliitis

176
Q

A 50F consults you for episodic knee pain especially after walking long distances. She also reports difficulty in getting up from the bed in the morning. There is no joint swelling or crepitus. An x-ray done recently shows a radiographically unremarkable knee. What is the appropriate next step?
a. Request for a knee ultrasound
b. Request for a knee MRI
c. Prescribe an oral analgesic
d. Refer to Psychiatry

A

c. Prescribe an oral analgesic

in OA, radiographic findings correlate poorly with the presence and severity of pain. Further, in both knees and hips, radiographs may be normal in early disease as they are insensitive to cartilage loss and other early findings.

177
Q

A 65M with knee osteoarthritis follows-up with you in the clinic. You note warmth over the joint and a moderate amount of effusion, which upon aspiration was clear, straw-colored and stringy. What should be the expected result for synovial fluid white count?
a. <100 /uL
b. <1,000 /uL
c. >1,000 /uL
d. >10,000 /uL

A

b. <1,000 /uL

Workup for osteoarthritis
* No routine blood test indicated, unless inflammatory arthritis is suspected
* Synovial fluid WBC <1000/uL

Indications for radiographs
* Symptoms or PE findings are atypical for OA
* Pain persists after initial treatment
* Imaging correlates poorly with presence/severity of symptoms
* May be normal in early knee and hip OA

MRI
* Not part of diagnostic workup for OA
* Meniscal tears, cartilage and bone lesions are common in knee OA
* These findings are also common in older persons who are asymptomatic
* MRI findings almost never warrant a change in therapy

** additional note
Prominent nocturnal pain in the absence of end-stage OA merits a distinct workup

178
Q

A 63M with osteoarthritis reports hip pain whenever he plays tennis. What is the most appropriate advice for this patient?
a. Work through the pain as it will subside eventually
b. Take a dose of analgesic prior to his tennis games
c. Do weighted squats to strengthen his leg muscles
d. Shift to another sport that does not trigger pain

A

d. Shift to another sport that does not trigger pain

Treatment
* Reassurance and non-pharmacologic tx for mild and intermittent symptoms
* Add pharmacotherapy for ongoing, disabling pain o Adjunct for symptomatic relief only
o Does not alter disease process
* The simplest treatment for many patients is to avoid activities that precipitate pain.

179
Q

What is the proper way of using a cane for a patient with hip osteoarthritis?

a. Use the hand contralateral to the affected hip, and the elbow bent by around 15 degrees
b. Use the hand contralateral to the affected hip, and the elbow bent by around 90 degrees
c. Use the hand ipsilateral to the affected hip, and the elbow bent by around 15 degrees
d. Use the hand ipsilateral to the affected hip, and the elbow bent by around 90 degrees

A

a. Use the hand contralateral to the affected hip, and the elbow bent by around 15 degrees

Ways to decrease focal load on joint
* Avoid painful activities
* Improve strength and conditioning of bridging muscles * Redistribute load using a brace or splint
* Unload the joint during weight bearing by using a crane in the opposite hand
* Weight loss – each pound lost has a 3 to 6-fold multiplier effect in unloading knees and hips

180
Q

Which is the most appropriate exercise regimen for an obese patient with symptomatic hip osteoarthritis?
a. Side planks
b. Treadmill exercises
c. Water aerobics
d. Yoga

A

c. Water aerobics

Low-impact exercises (water aerobics, water resistance training) are better tolerated Impact loading exercised (running, treadmill) are less tolerable Tai chi may be effective for knee OA

181
Q

A 58F with hand osteoarthritis complains of pain over the first carpometacarpal joint on her left hand. In addition to analgesics, which is the most appropriate intervention to improve her symptoms?
a. Handgrip exercises
b. Splinting
c. Weight loss
d. Prednisone for 5 days

A

b. Splinting

In hand joints affected by OA, splinting, by limiting motion, often minimizes pain for patients with involvement especially in the base of the thumb. There is no strong evidence that patients with hand OA benefit from therapeutic exercise.

182
Q

A 48M complains of chronic left knee pain. Physical examination reveals varus knee deformity, however the patient is not keen on undergoing surgery. What is an appropriate option for the patient?

a. Lateral unloader knee brace
b. Lateral unloader neoprene sleeve
c. Medial unloader knee brace
d. Medial unloader neoprene sleeve

A

c. Medial unloader knee brace

Correction of malalignment can lessen pain in OA
* Varus-valgus malalignment - surgical correction or fitted knee brace (must not slip)
* Patellar malalignment - patellar brace or tape Other non-pharmacologic approaches to lessen pain (adjuncts)
* Neoprene sleeves – questionable effect on malalignment
* Acupuncture

182
Q

Your patient with hand osteoarthritis experiences worsening of pain over the past week that is not adequately relieved by oral NSAID. You note swelling and tenderness in the area of the 1st carpometacarpal joint. What is the most appropriate intervention?

a. Topical capsaicin
b. Topical NSAID
c. Intraarticular hyaluronic acid
d. Intraarticular steroid

A

d. Intraarticular steroid

Topical NSAIDs are slightly less efficacious than oral agents, but have far fewer GI and systemic side effects. Glucocorticoid injections are useful to get patients over acute flares of pain, but their effects usually last less than 3 months.
Hyaluronic acid injections can be given but there is controversy as to whether they have efficacy versus placebo

183
Q

A 68M with hip osteoarthritis reports moderate episodic pain despite taking paracetamol. Pertinent medical history include an eGFR of 45 mL/min and several episodes of falls. What is the most appropriate pharmacologic agent for the patient?

a. Topical NSAID
b. Chondroitin sulfate
c. Prednisone
d. Oxycodone

A

a. Topical NSAID

Topical NSAIDs are slightly less efficacious than oral agents, but have far fewer GI and systemic side effects.

  • Guidelines recommend against the use of glucosamine or chondroitin for OA. Large trials have failed to show that these compounds relieve pain in persons with disease.
  • Opiates - Common side effects include dizziness, sedation, nausea or vomiting, dry mouth, constipation, urinary retention, and pruritus.
184
Q

Your patient with knee osteoarthritis remains to have difficulty performing ADLs despite optimal non-surgical therapy. What procedure should be recommended for this patient?
a. Arthroscopic debridement & lavage
b. Partial meniscectomy
c. Meniscal transplantation
d. Total knee replacement

A

d. Total knee replacement

Arthroscopic debri¬dement and lavage – no better than sham surgery for relief of pain or disability

Partial meniscectomy in persons with OA and a symptomatic meniscal tear does not relieve knee pain or improve function or even lead to resolution of catching or locking of the knee

Chondrocyte transplantation has not been found to be efficacious in OA, perhaps because OA includes pathology of joint mechanics, which is not corrected by chondrocyte transplants.

185
Q

A 68M consults you for chronic knee pain. He shows you a recent knee MRI which reveals cartilage degeneration and a meniscal tear. What should be recommended to the patient?

a. Optimal non-surgical therapy
b. Optimal non-surgical therapy plus arthroscopic debridement
c. Optimal non-surgical therapy plus partial meniscectomy
d. Optimal non-surgical therapy plus total knee replacement

A

a. Optimal non-surgical therapy

Although MRI may reveal the extent of pathology in an osteoarthritic joint, it is not indicated as part of the diagnostic workup. Findings such as meniscal tears and cartilage and bone lesions occur not only in most patients with OA in the knee, but also in most older persons without joint pain.

MRI findings almost never warrant a change in therapy.

186
Q

A 36F seeks consult for rashes, which were noted to be round lesions on the face with slightly raised and hyperpigmented edges and depigmented centers. Biopsy of the central portion of one of the lesions reveals loss of dermal appendages. She also mentions she has been having on and off pain and swelling in her knees and hands since two months prior. What should be included in the diagnostic workup of this patient?

a. ANA, anti-dsDNA
b. ANA, CBC with platelet, urinalysis
c. ASO, 12L ECG, 2d echo
d. RF, anti-CCP, ESR, CRP

A

b. ANA, CBC with platelet, urinalysis

Discoid lupus erythematosus (DLE) is the most common chronic dermatitis in lupus; lesions are roughly circular with slightly raised, scaly hyperpigmented erythematous rims and depigmented, atrophic centers in which all dermal appendages are permanently destroyed

187
Q

A 32F diagnosed with antiphospholipid syndrome was referred to you after also testing positive for ANA ELISA and anti-RNP. She reports having occasional joint pains but is otherwise asymptomatic. CBC and urinalysis are normal. What is the most appropriate management for the patient?

a. Advise to monitor for symptoms
b. Repeat ANA ELISA after 3 months
c. Request for ANA IF
d. Start mycophenolate mofetil maintenance

A

Advise to monitor for symptoms

The presence in an individual of multiple autoantibodies without clinical symptoms should not be considered diagnostic for SLE, although such persons are at increased risk.

188
Q

A patient with SLE complains of increasing difficulty in climbing stairs and getting up from a chair. She reportedly does not have any myalgia or muscle tenderness, and is otherwise asymptomatic. Her medications include mycophenolate mofetil 1000mg BID and prednisone 20mg BID. CK-MM is normal. What is the appropriate next step in management?
a. Request for EMG/NCV
b. Refer for a muscle biopsy
c. Decrease prednisone dose
d. Decrease mycophenolate mofetil dose

A

c. Decrease prednisone dose

In SLE, myositis with clinical muscle weakness, elevated creatine kinase levels, positive magnetic resonance imaging (MRI) scan, and muscle necrosis and inflammation on biopsy can occur, although most patients have myalgias without frank myositis.

Glucocorticoid therapies (commonly) and antimalarial therapies (rarely) can cause muscle weakness; these adverse effects must be distinguished from active inflammatory disease.

189
Q

Among patients with SLE, disease flare may be heralded by a rise in the levels of which of the following?
a. ANA
b. Anti-dsDNA
c. Anti-Sm
d. C3

A

b. Anti-dsDNA

Titers of anti-dsDNA vary over time. In some patients, increases in quantities of anti-dsDNA herald a flare, particularly of nephritis or vasculitis, especially when associated with declining levels of C3 or C4 complement.

Antibodies to Sm are also specific for SLE and assist in diagnosis; anti-Sm antibodies do not usually correlate with disease activity or clinical manifesta¬tions.

190
Q

A 42F develops malaise, joint pains and a photosensitive rash one month after she started taking hydrochlorothiazide. A drug-induced etiology for her condition is supported by a positive result in which test/s?
a. Anti-histone only
b. ANA and Anti-histone
c. Anti-La only
d. ANA, and Anti-La

A

b. ANA and Anti-histone

Drug-induced lupus: This is a syndrome of positive ANA associated with symptoms such as fever, malaise, arthritis or intense arthralgias/myalgias, serositis, and/ or rash. It is predominant in whites, has less female predilection than SLE, rarely involves kidneys or brain, is rarely associated with anti-dsDNA, is commonly associated with antibodies to histones, and usually resolves over several weeks after discontinuation of the offending medication.

191
Q

Which test should be included in the long-term follow-up of all patients with SLE?

a. C3
b. ESR, CRP
c. Lipid profile
d. Bone densitometry

A

c. Lipid profile

Control of hypertension and appropriate prevention strategies for atherosclerosis, including monitoring and treatment of dyslipidemias, management of hyperglycemia, and management of obesity, are recommended.

Statin therapies reduce all-cause deaths in SLE patients and should be considered in patients with elevated LDL or total cholesterol levels.

192
Q

What targeted therapy in SLE has drug drug interactions with IVIG, live vaccine and tofacitinib

A

Belimumab

human monoclonal antibody that inhibits B-cell activating factor, also known as B-lymphocyte stimulator

193
Q

Px to be given anti TNF a should be tested first for

A

Latent TB via PPD
Hepatitis B

Anti TNF also inc risk for fungal infections

194
Q

Target INR for APAS

A

2-3 if unprovoked or if with arterial thrombosis on VKA and low dose aspirin

3-4 if with arterial thrombosis and only on VKA

195
Q

Treatment for pregnant px with APAS

A

Aspirin + LMWH

196
Q

3 cardinal processes that account for clinical manifestations of Systemic sclerosis

A

Diffuse microangiopathy
Inflammation and autoimmunity
Visceral and vascular fibrosis in multiple organs

197
Q

Pathologic hallmark of systemic sclerosis

A

Widespread capillar loss
Obliterative microangiopathy
Fibrosis in the skin

198
Q

Most common histologic pattern in Systemic sclerosis associated ILD

A

Non specific interstitial pneumonia

199
Q

Most specific finding of ankylosing spondylitis

A

loss of spinal mobility with limitation of anterior and lateral flexion and extension of the lumbar spine and of chest expansion

measured by Schober test (decreased if less than 5)

200
Q

Treatment for AS

A

First line: NSAIDs

May also use
>anti-TNF-a –> induce rapid and sustained reduction in dse activity
> Secukinumab –> IL-17a antibody
> Sulfasalazine–> modest benefit for PERIPHERAL arthritis

No role: MTX, oral glucocorticoids, gold compound

MTX is for RA not AS

201
Q

How do you differentiate reactive arthritis from disseminated gonococcal dse?

A

ReA: lower extremity symptoms predominate
Gonococcal : LE = UE

202
Q

How do you differentiate reactive arthritis from PsA

A

ReA: lower extremity symptoms predominate
PsA: gradual, primarily uppe extremities

203
Q

A patient with systemic sclerosis presents with palpable subcutaneous lumps on her palms and elbows, with some areas having visible whitish deposits. What is the pathophysiology behind the development of these lesions?

a. Chronic inflammation
b. Hyperparathyroidism
c. Hyperuricemia
d. Paraneoplastic deposition

A

a. Chronic inflammation

Calcinosis cutis:
Dystrophic calcifications in the skin, subcutaneous, and soft tissues (calcinosis cutis) in the presence of normal serum calcium and phos-phate levels occur in up to 40% of patients, most commonly in those with long-standing anti-centromere antibody-positive lcSSc. These deposits occur when calcium precipitates in tissue damaged by inflammation, hypoxia, or local trauma.

Common locations include the finger pads, palms, extensor surfaces of the forearms, and the olecranon and prepatellar bursae

204
Q

A 32F consults you after presenting with cyanosis of her hands after carrying a bag of ice. It reportedly lasted 15 minutes and was followed by hyperemia of the involved area. Review of systems was unremarkable and examination of her hands reveal no ulcers or deformities. What is the most appropriate next step in management?

a. Reassure the patient
b. Perform nail microscopy
c. Request for ANA
d. Start metoprolol

A

b. Perform nail microscopy

Primary Raynaud’s disease is a benign condition that must be differentiated from early or limited SSc. Nailfold microscopy is particularly helpful in this situation, because in contrast to SSc, nail¬fold capillaries are normal.

205
Q

Aside from the scalp, where else in the body are the “salt-and-pepper” appearance of the skin most prominent in systemic sclerosis?
a. Face
b. Neck
c. Chest
d. Abdomen

A

c. Chest

Because pigment loss spares the perifollicular areas, the skin may have a “salt-and-pepper” appearance, most prominently on the scalp, upper back, and chest.

206
Q

A 42F consults for joint pains involving her hands. You note that aside from flexion contractures, her skin appears taut and with a loss of transverse creases. She says she has also been having mild heartburn and occasional indigestion over the past 2 months. Which tests should be included in the evaluation of this patient?

a. Anti-centromere, Anti-topoisomerase I
b. Pulmonary function test, 2D echocardiogram
c. Chest radiograph, esophageal manometry

A

b. Pulmonary function test, 2D echocardiogram

The diagnosis of SSc is made primarily on clinical grounds and is generally straightforward in patients with established disease.

Patients with PAH are often asymptomatic in early stages. In light of the poor prognosis of untreated PAH and better therapeutic response in patients with early diagnosis, all SSc patients should be screened for PAH at initial evaluation, followed by annual evaluation. Doppler echocardiography provides a noninvasive screening method for estimating the pulmonary arterial pressure.

Pulmonary involvement can remain asymptomatic until it is advanced. Pulmonary function testing (PFT) is relatively sensitive for detecting early pulmonary involvement.

Chest radiography is relatively insensitive for the detection of early ILD

207
Q

A 45M with systemic sclerosis follows up with you in the clinic. You note increased progression of skin involvement since his previous consult three months ago, as well as palpable tendon friction rubs that were not present previously. What should be monitored closely for this patient?

a. Blood pressure
b. ESR
c. NT-proBNP
d. DLCO

A

a. Blood pressure

Risk factors for scleroderma renal crisis include African-American race, male sex, and diffuse or progressive skin involvement.

Palpable tendon friction rubs, pericardial effusion, new unexplained anemia, and thrombocytopenia may be harbingers of impending scleroderma renal crisis. High-risk patients with early SSc should monitor their blood pressure daily.

208
Q

A 45F presents at the ER for progressive muscle weakness. On examination, the patient has symmetric weakness of both upper and lower extremities, more pronounced on the proximal muscle groups. You also note erythematous discoloration of the eyelids, as well as periorbital and grade II bipedal edema. Creatinine and urinalysis were normal. Which test should be included in the evaluation of this patient?

a. 2D echocardiography
b. Chest CT scan
c. Liver ultrasound
d. TSH

A

a. 2D echocardiography

  • Common associated conditions: myocarditis, ILD, malignancy, vasculitis, other CTDs
209
Q

A 60M presents with proximal muscle weakness, shawl sign and positive anti-TIF1 antibodies. Which of the following tests is most useful in the evaluation of this patient?

a. ANA
b. Colonoscopy
c. EMG/NCV
d. Skeletal MR

A

b. Colonoscopy

There is a higher risk for malignancy in adult onset cases, ~15% within the first 2–3 years. Anti-TIF1 (or p155) antibodies and anti-NXP2 antibodies are associated with an increased risk of cancer. EMG findings are non-specific and can be seen in other myopathies

210
Q

In which subset of patients will gout be an unlikely to occur?

a. Middle aged male
b. Middle aged women
c. Post menopausal women
d. Middle aged women with renal disease

A

b. Middle aged women

Gout is a metabolic disease that most often affects middle-aged to elderly men and postmenopausal women. Women represent only 5–20% of all patients with gout. Most women with gouty arthritis are postmenopausal and elderly, have osteoarthritis and arterial hypertension that causes mild renal insufficiency, and usually are receiving diuretics. Pre-menopausal gout is rare.

211
Q

Which statement is correct in terms of epidemiology of Calcium pyrophosphate deposition disease (CPPD)?

a. CPPD commonly occurs in the middle aged population
b. CPPD commonly occurs in patients with pre-existing joint damage
c. Majority of CPPD patients have metabolic abnormalities such as hyperparathyroidism or hemochromatosis
d. CPPD commonly occurs in chronic renal failure

A

b. CPPD commonly occurs in patients with pre-existing joint damage

The deposition of CPP crystals in articular tissues is most common in the elderly. > 80% of patients are >60 years old and 70% have pre-existing joint damage from other conditions. A minority of patients with CPPD arthropathy have metabolic abnormalities (such as hyperparathyroidism, hemochromatosis, hypophosphatasia, and hypomagnesemia) or hereditary CPP disease.

The presence of CPPD arthritis in individuals aged <50 years should lead to consideration of these metabolic disorders and inherited forms of disease.

212
Q

Which is not an expected site of involvement in Calcium Apatite Deposition Disease?

a. knees
b. Shoulders
c. Hips
d. Ankle

A

d. Ankle

The most common sites of apatite deposition include bursae and tendons in and/or around the knees, shoulders, hips, and fingers.

213
Q

Which of the following is not known to precipitate acute gouty arthritis?

a. Excessive ethanol ingestion
b. Hypouricemic therapy
c. Menstruation
d. Trauma

A

c. Menstruation

Several events may precipitate acute gouty arthritis: dietary excess, trauma, surgery, excessive ethanol ingestion, hypouricemic therapy, and serious medical illnesses such as myocardial infarction and stroke

214
Q

Which microscopy finding correctly matches their corresponding crystal associated arthropathy?

a. Small nonbirefringent globules: Gout
b. Needle-shaped negative birefringent crystals: Calcium pyrophosphate disease
c. Rhomboid-shaped weakly positively crystals: Calcium Apatite Disease
d. Bipyramidal shaped strongly birefringent crystals: Calcium Oxalate deposition Disease

A

d. Bipyramidal shaped strongly birefringent crystals: Calcium Oxalate deposition Disease

Needle- and rod-shaped negative birefringent crystals are consistent with gout.
* Rod-shaped, and rhomboid crystals that are weakly positively or nonbirefringent crystals are consistent with CPPD.
* Small nonbirefringent globules that stain purplish with Wright’s stain and bright red with alizarin red S are consistent with Calcium appatite deposition disease.
* Calcium oxalate deposition disease crystals have variable shape and variable birefringence to polarized light. The most easily recognized forms are bipyramidal, have strong birefringence and stain with alizarin red S.

215
Q

Which radiologic finding correctly matches their corresponding crystal associated arthropathy?

a. Double contour sign on ultrasound: CaOx deposition disease
b. Linear radio dense deposits within articular hyaline carriage: CPPD
c. Periarticular calcifications: Gout
d. Soft tissue masses: Osteoarthritis

A

b. Linear radio dense deposits within articular hyaline carriage: CPPD

CPPD shows radiographs or ultrasound findings of punctate and/or linear radiodense deposits within fibrocartilaginous joint menisci or articular hyaline cartilage (chondrocalcinosis). This can also be seen in Calcium oxalate deposition disease in some patients with chronic renal disease.

Radiographic findings of gout include cystic changes, well-defined erosions with sclerotic margins (often with overhanging bony edges), and soft tissue masses are characteristic radiographic features of advanced chronic tophaceous gout. Ultrasound may aid earlier diagnosis by showing a double contour sign overlying the articular cartilage.

Intra- and/or periarticular calcifications with or without erosive, destructive, or hypertrophic changes may be seen on radiographs of Calcium appatite deposition disease

216
Q

Caution in the colchicine dosage should be practiced when combined with which drug?

a. Amlodepine
b. Clarithromycin
c. Ciprofloxacin
d. Thiazide diuretics

A

b. Clarithromycin

Colchicine should be given in lower doses to the patients with P glycoprotein or CYP3A4 inhibitors such as clarithromycin that can increase toxicity of colchicine.

216
Q

Which statement is true regarding the clinical features of Rheumatoid Arthritis?

a. Incidence increases from 55 years old and above
b. Presenting symptoms commonly involve large joints such as knees and shoulders.
c. Most commonly reported joint involvement are distal interphalyngeal and metatarsophalangeal joints.
d. Extraarticular manifestation are significant and may occur prior to the onset of arthritis.

A

d. Extraarticular manifestation are significant and may occur prior to the onset of arthritis.

Incidence of RA increases between 25 and 55 years of age, after which it plateaus until the age of 75 and then decreases. Patients often complain of early morning joint stiffness lasting more than 1 h that eases with physical activity.

Presenting symptoms typically involve the small joints of the hands and feet, usually in a symmetric distribution. Once the disease process of RA is established, the wrists, metacarpophalangeal (MCP), and proximal interphalangeal (PIP) joints stand out as the most frequently involved joints. Distal interphalangeal joint are usually an manifestation as compared to the ankle and mid tarsal region but is not one of the most common involved joints.

Extraarticular manifestations may develop during the clinical course of RA in up to 40% of patients, even prior to the onset of arthritis

216
Q

Which biologic agent is part of the armamentarium for the management of gout?

a. Anakinra
b. Abatacept
c. Infliximab
d. Tocilizumab

A

a. Anakinra

Based on recent evidence on the essential role of the inflammasome and interleukin 1β (IL-1β) in acute gout, daily anakinra has been used when other treatments have failed or were contraindicated

217
Q

Which of the following joints will rheumatoid arthritis LEAST likely involve?

a. Elbows
b. knees
c. Cervical spine
d. Lumbar spine

A

d. Lumbar spine

The wrists, metacarpophalangeal (MCP), and proximal interphalangeal (PIP) joints stand out as the most frequently involved joints in rheumatoid arthritis. Elbows are commonly involved, and can have rheumatoid nodules.

In the feet, metatarsophalangeal (MTP) involvement are frequent and is an early feature of disease while chronic inflammation of the ankle and midtarsal regions usually comes late.

Large joints such as knees and shoulders are also often affected in established disease.

Cervical spine involvement was more prevalent before and can cause compressive myelopathy and neurologic dysfunction.

Thoracolumbar spine are rarely affected.

218
Q

B.C. is a 55 year old old female who was brought by her daughter to your clinic for a 5 year history of progressive joint stiffness and swelling, It initially starting in the hands and feet and more prominent upon waking up and would resolve with movement. It had gradually involved the knees, elbows and shoulders with the duration of the pain lasting longer and longer. She also had difficulty standing or ambulating due to foot and ankle pain. On review of system, you noted that she has been also been having chronic dry cough x 3 months and progressive shortness of breath. She has no chest pain or orthopnea. You include a chest X-ray in your diagnostic tests and expect to see what finding?

a. Normal findings
b. Pleural thickening
c. Bilateral interstitial infiltrates
d. Pulmonary nodules

A

c. Bilateral interstitial infiltrates

All are potential pulmonary manifestations in RA. Pleuritis is the most common and presents with pleuritic chest pain and dyspnea.

Pulmonary nodules maybe solitary or multiple.

ILD are found in up to 12% of RA patients and is heralded by symptoms of dry cough and progressive shortness of breath.

Diagnosis is readily made by high resolution chest CT scan, which shows infiltrative opacification in the periphery of both lung.

Pulmonary nodules associated with rheumatoid arthritis may be solitary or multiple. They often occur in conjunction with cutaneous nodules.

Bronchiectasis and respiratory bronchiolitis may also be due to rheumatoid arthritis.

219
Q

Which of the type malignancies should be monitored in px with Feltys syndrome

a. Colon cancer
b. Lung cancer
c. Lymphoma
d. Melanoma

A

c. Lymphoma

Felty syndrome, typically occurring in late-stage poorly controlled disease, is characterized by the triad of neutropenia, splenomegaly, and rheumatoid nodules

Large cohort studies have shown a two- to fourfold increased risk of lymphoma in RA patients compared with the general population. The most common histopathologic type of lymphoma is a diffuse large B-cell lymphoma. The risk of developing lymphoma increases if the patient has high levels of disease activity or Felty syndrome

220
Q

Which statement is correct regarding extraarticular manifestation of rheumatoid arthritis?

a. Subcutaneous nodules are the most common extraarticular manifestation of rheumatoid arthritis
b. Subcutaneous Nodules are fluctuant, warm to touch and tender.
c. Subcutaneous nodules are usually in the muscle tissue near the inflamed joints
d. Subcutaneous nodules can become malignant therefore monitoring is advised

A

a. Subcutaneous nodules are the most common extraarticular manifestation of rheumatoid arthritis

Subcutaneous nodules have been reported to occur in 30–40% of patients and more commonly in those with the highest levels of disease activity. the nodules are generally firm; nontender; and adherent to periosteum, tendons, or bursae; developing in areas of the skeleton subject to repeated trauma or irritation such as the forearm, sacral prominences, and Achilles tendon. They may also occur in the lungs, pleura, pericardium, and peritoneum. Nodules are typically benign, although they can be associated with infection, ulceration, and gangrene.

221
Q

Most common pattern of arthropathy in PsA

A

Symmetric polyarthritis (40%)

222
Q

Which of the following statement is true regarding the pathophysiology of rheumatoid arthritis?

a. The preclinical stage of rheumatoid arthritis is characterized by a break-down in self-tolerance of immune cells
b. B cell derived inflammation is the central causative driver of chronic inflammation in Rheumatoid arthritis
c. Activated synovial CD4+ T cells mainly differentiates into T cell helper type 2 cells
d. Synovial cells and osteoclasts are predominant source of pro inflammatory cytokines inside the joints

A

a. The preclinical stage of rheumatoid arthritis is characterized by a break-down in self-tolerance of immune cells

The pathogenic mechanisms of synovial inflammation are likely to result from a complex interplay of genetic, environmental, and immunologic factors that produces dysregulation of the immune system and a breakdown in self-tolerance. Smoking, silicone dust, mineral oil, periodontal pathogens are some of the environmental factors described.

Synovial CD4+ T cells differentiate into TH1 and TH17 cells, each with their distinctive cytokine profile. CD4+ TH cells in turn activate B cells, some of which are destined to differentiate into autoantibody-producing plasma cells. Immune complexes, possibly comprised of rheumatoid factors (RFs) and anti–cyclic citrullinated peptides (CCP) antibodies, may form inside the joint, activating the complement pathway and amplifying inflammation.

T effector cells stimulate synovial macrophages and fibroblasts to secrete proinflammatory mediators, among which is tumor necrosis factor α (TNF-α). TNF-α upregulates adhesion molecules on endothelial cells, promoting leukocyte influx into the joint and stimulates production of other inflammatory mediator. TNF-α also has a role in regulating other mediators in bone destruction and bone formation.

223
Q

Which of the following pathologic findings is consistent with rheumatoid arthritis?

a. Synovial lining hyperplasia
b. Cartilage surface fibrillation and irregularity
c. Increased thickness of subchondral bone plate
d. Osteophyte formation

A

a. Synovial lining hyperplasia

The pathologic hallmarks of RA are synovial inflammation and proliferation, focal bone erosions, and thinning of articular cartilage.

Chronic inflammation leads to synovial lining hyperplasia and the formation of pannus, a thickened cellular membrane containing fibroblast like synoviocytes and granulation-reactive fibrovascular tissue that invades the underlying cartilage and bone. the rest of the pathologic findings are consistent with osteoarthritis.

224
Q

Which statement is true with laboratory features of rheumatoid arthritis?
a. Rheumatoid factor has the most value for predicting worse outcome in rheumatoid arthritis
b. Anti-CCP is more sensitive than anti-rheumatoid factor in diagnosing rheumatoid arthritis
c. A negative anti-rheumatoid factor rules out rheumatoid arthritis
d. Testing for both rheumatoid factor and anti-CCP has added value

A

d. Testing for both rheumatoid factor and anti-CCP has added value

Serum RF and anti-CCP antibodies is important in differentiating RA from other polyarticular diseases. RF (IgM subtype) is found in 75-80% of RA patients; therefore, a negative result does not exclude the presence of this disease. It is also found in other diseases (Sjogren, SLE, type II mixed cryoglobulinemia, subacute bacterial endocarditis and hepatitis B and C) as well as in 1-5% of normal population. anti-CCP is as sensitive as rheumatoid factor, but more specific. Therefore positive anti-CCP in early inflammatory arthritis distinguishes RA from other arthritis.
Both RF and anti-CCP has prognostic significance, with anti-CCP showing the most value for predicting worse outcomes. Lastly, there is some incremental value in testing for the presence of both RF and anti-CCP, as some patients with RA are positive for RF but negative for anti-CCP and vice versa.

225
Q

What is the classic initial radiographic finding in rheumatoid arthritis?

a. Soft tissue swelling
b. Subchondral erosion
c. Symmetric joint space loss
d. Periarticular osteopenia

A

d. Periarticular osteopenia

Joint imaging is for diagnosing RA and for tracking progression of joint damage.
Plain X-ray is the most common imaging modality used, but is limited to visualization of bony structures and inferences on the state father articular cartilages based on the amount of joint space narrowing. Classically in RA, the initial radiographic finding is periarticular osteopenia.

Other findings on plain radiographs include soft tissue swelling, symmetric joint space loss, and subchondral erosions, most frequently in the wrists and hands (MCPs and PIPs) and the feet (MTPs).
MRI and ultrasound techniques offer the added value of detecting changes in the soft tissues such as synovitis, tenosynovitis, and effusions, as well as providing greater sensitivity for identifying bony abnormalities

226
Q

Which statement is true regarding imaging findings of rheumatoid arthritis?

a. MRI and ultrasound has no added value over X-ray in detecting joint abnormalities in rheumatoid arthritis
b. Soft tissue abnormalities on MRI occurs later than osseous changes in rheumatoid arthritis
c. Ultrasound can detect more bone erosions than plain radiography
d. Ultrasound offers the greatest sensitivity for detecting synovitis and joint effusion

A

d. Ultrasound offers the greatest sensitivity for detecting synovitis and joint effusion

MRI and ultrasound offer added value over x-ray in detecting changes in the soft tissues such as synovitis, tenosynovitis, and effusions, as well as providing greater sensitivity for identifying bony abnormalities. MRI offers the greatest sensitivity for detecting synovitis and joint effusions, as well as early bone and bone marrow changes. These soft tissue abnormalities often occur before osseous changes are noted on x-ray. Presence of bone marrow edema has been recognized to be an early sign of inflammatory joint disease and can predict the subsequent development of erosions on plain radiographs as well as MRI scans.

Ultrasound can detect more erosions than plain radiography. It can also reliably detect synovitis, including increased joint vascularity indicative of inflammation. It is technician dependent; however, it does offer the advantages of portability, lack of radiation, and low expense relative to MRI, factors that make it attractive as a clinical tool.

227
Q

A.G. followed up in 3 months with worsening pain and stiffness in her joints. She claims that she was compliant to medications, and takes NSAIDs on top without relief. She is now unable to do household chores and needs assistance on daily activities. ESR and CRP is 2.5xULN and Xray shows new erosions in multiple metacarpal joints. CXR showed What would you advise the patient?

a. Continue current DMARD
b. Switch to another DMARD
c. Continue current DMARD and add on glucocorticoids
d. Continue current DMARD and add on anti-TNF therapy

A

d. Continue current DMARD and add on anti-TNF therapy

Failure to achieve adequate improvement with DMARD monotherapy calls for a change in DMARD therapy, usually a transition to an effective combination regimen. Effective combinations include methotrexate, sulfasalazine, and hydroxychloroquine (oral triple therapy); methotrexate and leflunomide; and methotrexate plus a biological

228
Q

Which of the following conventional DMARD was shown to be ineffective in preventing radiographic progressive disease?

a. Hydroxychloroquine
b. Leflunomide
c. Methotrexate
d. Sulfasalazine

A

a. Hydroxychloroquine

Conventional DMARDs include hydroxychloroquine sulfasalazine, methotrexate, and leflunomide and all have ability to slow or prevent structural progression of RA except for hydroxychloroquine has not been shown to delay radiographic progression of disease and thus is not considered to be a true DMARD.

229
Q

Which of the following is an anti-TNF inhibitor?

a. Anakinra
b. Etanercept
c. Abatacept
d. Tocilizumab

A

b. Etanercept

Anakinra is a recombinant IL-1 receptor antagonist.

Abtacept inhibits the co-stimulation of T cells by blocking CD28-CD80/86 interactions.

Tocilizumab is a humanized monoclonal antibody directed against IL-6 receptor.

230
Q

To decrease the risk of reactivation, antiviral is indicated for hepatitis B patients or those with previous exposure if will receive this medication?

a. Rituximab
b. Hydroxychloroquine
c. Methotrexate
d. Sulfasalazine

A

a. Rituximab

Reactivation of viral hepatitis has been observed in association with some of the DMARDs, such as rituximab.

Antiviral prophylaxis is indicated to prevent hepatitis flares and complications.

231
Q

What are the most common sites of Pott’s disease?

a. Cervical and lumbar spine
b. Thoracic and lumbar spine
c. Atlanto-axial cervical spine
d. Coccyx and sacrum

A

b. Thoracic and lumbar spine

232
Q

Which tests has been shown to be present years before the arthritis manifestations in rheumatoid arthritis?

a. Anti Ro antibody
b. Rheumatoid factor
c. Anti-sm antibody
d. Anti-CCP antibody

A

d. Anti-CCP antibody

233
Q

Which of the following diseases tests positive for ANA?

a. Dermatomyositis
b. Takayasu’s arteritis
c. Microscopic polyangiitis
d. Acute Rheumatic fever

A

a. Dermatomyositis

234
Q

Which of the following joints are also affected most commonly with osteoarthritis, aside from the knees, hips and fingers?

a. shoulders
b. ankles
c. wrists
d. lumbar spine

A

d. lumbar spine

like RA

235
Q

Which drug is best maintained in most patients with SLE regardless of disease activity?
a. Antimalarials
b. Aspirin
c. ACE inhibitors
d. Low dose glucocorticoids

A

a. Antimalarials

236
Q

A 29/F SLE patient was referred for massive pericardial effusion, new-onset LV dysfunction and heart failure. On PE, she had oral ulcers, increased hair loss, synovitis and grade 2 bipedal edema. Work-up showed a WBC of 2.0, Hgb of 101, PC of 50,000/uL and urine protein of 300mg. Which of her manifestations would warrant a trial of high dose steroids?
a. hematologic
b. myocarditis
c. pericarditis
d. nephritis

A

b. myocarditis

237
Q

The number of which cutaneous manifestation of systemic sclerosis is correlated with the severity of microvascular disease and pulmonary hypertension?
a. Calcific deposits
b. Digital pits
c. Rhytides
d. Telangiectasias

A

d. Telangiectasias

238
Q

A patient with systemic sclerosis underwent endoscopy with findings of a watermelon stomach. What would be the best intervention in this case?
a.Endoscopic laser cryotherapy
b.Prokinetic agents
c.Octreotide
d.Rotating antibiotics

A

a.Endoscopic laser cryotherapy

239
Q

Primary Raynaud’s Disease can be differentiated from Raynaud’s phenomenon in early systemic sclerosis by which diagnostic finding?
a. Normal nailfold microscopy
b. Positive antinuclear antibody
c. Decreased DLCO
d. Elevated anti-nuclear antibody

A

a. Normal nailfold microscopy

240
Q

Which drug has been shown to reduce the progression of systemic sclerosis-associated interstitial lung disease?
a. Azathioprine
b. Cyclophosphamide
c. High dose glucocorticoids
d. Methotrexate

A

b. Cyclophosphamide

241
Q

A 42/F was referred for suspected vasculitis after presenting with bloody nasal discharge, progressive ulceration on her nose, eye redness and occasional hemoptysis. On work-up, there was elevated ESR, RBC casts on urinalysis and pulmonary infiltrates on radiograph. Which test has a high likelihood of being positive in this case?

a.Anti-Scl70
b.Anti-myeloperoxidase ANCA
c.Anti-proteinase ANCA
d.Anti-nuclear antibody

A

c.Anti-proteinase ANCA

242
Q

A 24/M consults for inflammatory back pain, sacroiliac tenderness, and asymmetrical arthritis of lower extremity joints. Which pelvic imaging is most useful for the timely diagnosis of this case?

a.CT scan
b.MRI
c.Radiograph
d.Ultrasound

A

b.MRI

243
Q

A 45/F with proximal muscle weakness and myocarditis presents to the clinic with significantly elevated muscle enzymes. Her muscle biopsy showed endomysial and perivascular inflammation with infiltration of CD8+ T cells, macrophages and plasma cells. What inflammatory myopathy is the patient most likely suffering from?

a.Dermatomyositis
b.Polymyositis
c.Inclusion body myositis
d. Necrotizing myopathy

A

b.Polymyositis

244
Q

Triad of GPA

A

Lower respiratory tract involvement
Upper respiratory tract involvement
Kidney involvement

Note GPA was also known as Wegener

245
Q

Difference between GPA and MPA

A

MPA does not have upper respiratory tract involvement and does not present with pulmonary nodules
MPA does not have granulomas

246
Q

2nd most common manifestation of EGPA

A

Mononeuritis multiplex

247
Q

IHC stain positive for myxovirus resistance protein A is seen in what inflammatory myopathy?

A

Dermatomyositis

248
Q

Most common cause of inflammatory myopathy >50y/o

A

Inclusion Body Myositis

M>F
CK levels can be normal or only slightly elevated
+ antibodies against cN-1A

ENDOmysial inflammatory infiltrates

Most sensitive stain for inclusion: p62

249
Q

Common muscles involved in IBM as seen in MRI

A

Muscle MRI may show predilection for flexor digitorum profundus, vastus medialis and lateralis with sparing of rectus femoris

250
Q

Mainstay of tx for IBM

A

PT and OT

Since IBM does not typically respond to any known immunotherapy

251
Q

What tx for inflammatory myopathies may cause stomatitis

A

Methotrexate

252
Q

What tx for inflammatory myopathies may cause pancreatitis

A

Azathioprine

253
Q

What tx for inflammatory myopathies may cause gum hyperplasia

A

Cyclosporine

254
Q

What tx for inflammatory myopathies may cause sinusitus

A

Mycophenolate mofetil

255
Q

Miners are at inc risk of OA in these areas

A

Knee and Spine

Farmers: Hip

256
Q

Runners are at inc risk of OA in these areas

A

RITE/PSBIM review (19 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions