Rheumatology

Question 1

Treat recurrent oral ulcer in Behcet syndrome by apremilast

Question 2

Apremilast is an oral phosphodiesterase 4 inhibitor approved for psoriasis, psoriatic arthritis, prevention oral ulcer in Behcet syndrome

Question 3

Ixekizumab an interleukin 17a inhibitor use for psoriasis psoriatic arthritis and ankylosing spondylitis

Question 4

First line treatment of familial mediterranean fever is lifelong daily prophylaxis with colchicine

Question 5

Granulomatosis with polyangiitis has pauci immune crescentic necrotizing glomerulonephritis

Question 6

Anti U1 ribonucleoprotein antibodies is positive in mixed connective tissue disease

Question 7

Lyme arthritis treat with doxycyline or amox
In pregnancy and lactation use amoxicillin

Question 8

Pseudogout with rhomboid shape crystal and positive birefringent

Question 9

Gout will be will negative birefringent and needle shape crystal

Question 10

Giant cell arteritis can be treated by tocilizumab

Question 11

Acute monoarticular arthritis suggests hemarthrosis, infectious arthritis and gout

Question 12

Urate lowering therapy for CKD is allopurinol and febuxostat

Question 13

Colchicine can interact with tacromilus or cyclosporine via Cypt p450 3a and P glycoprotein inhibitor
Long term use of colchicine with tacrolimus and cyclosporine may cause neuromyopathy

Question 14

Capsaicin is use for knee OA but not for hand OA

Question 15

Treatment of oral dryness in Sjogren syndtome by cevimeline or pilocarpine

Question 16

Sjogren syndrome with cryoglobulinemic vasculitis can be treated by rituximab

Question 17

Dermatomyositis with positive anti Mi 2 ab predict a good prognosis with low risk for interstitial lung disease and cancer

Question 18

Felty syndrome include well established rheumatoid arthritis, neutropenia and splenomegaly

Question 19

Scleritis is associated with RA
Uveitis is associated with ankylosing spondylitis

Question 20

Lupus pernio is a skin manifestation seen in some pts with sarcoidosis

Question 21

Anca associated vasculitis treats with steroid and rituximab for induction

Question 22

C anca, anti proteinase 3 ab is in granulomatosis with polyangiitis
P anca, anti myeloperoxidase ab is in microscopic polyangiitis and eosinophilic granulomatosis with polyangiitis

Question 23

Abatacept cause copd exacerbation
Tocilizumab cause bowel perforation in diverticulitis
Tofacitinib cause thombosis

Question 24

Inclusion body myositis has involvement of distal muscle group, dysphagia and risk of aspiration

Question 25

Polymyositis only involves the proximal muscle

Question 26

Statin myopathy does not cause elevation in CK level

Question 27

Small vessel vasculitis present with rash
Medium vessel vasculitis present with subcu nodule or necrosis, livedo reticularis, painful deep ulcer

Question 28

Rheumatoid vasculitis cause medium vessel vasculitis

Question 29

When use allopurinol, check HLA-B *58:01
On Han chinese, korean, thai and african descent

Question 30

If cant use allopurinol, should use febuxostat
If cant use febuxostat or probenecid will go back and do allopurinol desensitization

Question 31

Before using abacavir, test HLA-B*57:01

Question 32

Indication for urate lowering therapy:
Tophi
Radiographic damage related to gout
Frequent gout flare 2 or more annually
Kidney stone
First flare with ckd stage 3
Uric acid more than 9

Question 33

Probenecid is contraindicated in kidney stone

Question 34

Hip and knee OA, treat with oral NSAIDs, not tylenol

Question 35

Treat severe cryoglobulinemia with high dose glucocorticoid and rituximab

Question 36

Use 11-days chestyramine washout to remove teriflunomide, a leflunomide metabolite, and should be follow up leflunomide level

Question 37

X ray chronic gout will be punched out lesion with overhanging edges of cortical bone

Question 38

Limited cutaneous systemic sclerosis includes calcinosis, raynaud phenomenon, esophageal dysmotity, sclerodactyly, telangiectasia
Anticentromere antibody positive and increase risk of pulmonary hypertension

Question 39

Diffuse cutaneous systemic sclerosis have positive anti scl 70 and have interstitial lung disease

Question 40

Mix connective tissue disorder is a mix of two from three disease: SLE, polymyositis, Systemic sclerosis
Anti U1 ribonuclearprotein positive

Question 41

Before using pegloticase:, check g6pd activity to prevent hemolytic anemia and methemoglobin

Question 42

Using pegloticase can produce antibody and cause severe reaction. Should use it alone and treatment failure if uric acid more than 6 in two test

Question 43

Inclusion body myositis has positive anti NT5c1A autoantibodies

Question 44

Treat igg4 related disease with steroid or rituximab

Question 45

Diagnose sarcoidosis, do skin biopsy
Diagnose sjogren syndrome, do lip biopsy

Question 46

Aggressive treatment of ankylosing spondylitis will not affect the clinical course of the AS related IgA nephropathy

Question 47

First line treatment for ankylosing spodylitis is nsaid

Question 48

Subacute cutaneous lupus erythematosus has two variants: annular and polycystic photosensitive plaques

Question 49

Acute cutaneous lupus erythematosus has butterfly rash, maculopapular rash that is photosensitive

Question 50

Chronic cutaneous lupus erythematosus also called discoid lupus erythematosus

Question 51

Mycophenolate mofetil, cyclophosphamide, MTX, belimumab is teratogenic and could not be used in pregnancy
If want to use, azathioprine can be used low dose

Question 52

Most cryoglobulinemia except type 1 are secondary to hep c and primary autoimmune disease

Question 53

Dx test in sibo
Jejunal aspirate, rarely use
Glucose and lactulose breath tests, commonly use
Treatment sibo: cipro, doxy, augmentin, rifaximin for first 10 days of each month for 4 months

Question 54

Urate level increase in preeclamsia but not in sle flare