rheumatology Flashcards
1
Q
Positive straight leg test
A
disk herniation
2
Q
Rx of acute back pain with no neurologic deficit(4)
A
NSAIDS
Early mobilisation
Mx relaxants
rx dure 4 a 6 semaines
3
Q
Clue for whipple disease (3)
A
Joint pain
Malabsorption
PAS
4
Q
Dx of Whipple(2)
A
Biopsy small intestine
PCR
5
Q
quid of tropherima whippeli
A
Gram positive bacteria
6
Q
xray in osteoarthritis(3)
A
subchondral sclerosis
joint space narrowing
ostophytes
7
Q
joint hand involved in osteoarthritis
A
DIP
8
Q
joint hand involved in RA(2)
A
MCP
PIP
9
Q
Marker of systemic sclerosis
A
antitopoisomerase-I
10
Q
digestive complication of systemic sclerosis(2)
A
GERD
esophageal dismotility
11
Q
Most common cause of death in past from systemic sclerosis and why(2)
A
renal failure
because no ACE inbitor at this time
12
Q
why people with multiple sclerosis can develop right failure
A
because of increase pulmonary artery pressure
13
Q
risk of patient taking chemo in rhumatology
A
gout
14
Q
prophylactic measure to prevent gout in patient taking chemo(2)
A
allopurinol
and
probenicid
15
Q
most common presentation of goutty attack
A
podagra
16
Q
quid of podagra
A
first metatarsophalangeal gouty arthritis
17
Q
characteristic of urate crystals in gout induced by chemo(2)
A
negative birefringent
needled shaped
18
Q
Wbc count in gout arthrocentesis
A
2000-50000
19
Q
what’s allopurinol
A
xanthine oxydase inhibitor
20
Q
Meds used to treat acute attack of gout(3)
A
colchicine
NSAIDS
Steroids
21
Q
Triad of Bechet(3)
A
reccurent painful ulcers
erythema nodosum
ant uveitis
22
Q
localisation of reccurrent ulcers in behcet(2)
A
mouth
penis
23
Q
population touched by Behcet(3)
A
turkish
asian
Middle eastern population
24
Q
clue for compression vertebral fractures
A
local tenderness upon percussion of vertebrae
25
cause of compression fractures(2)
Bone demineralisation
| low bone densitiy
26
cause of osteomalacia(3)
low calcium
low vit D
low phosphore
27
clue for viral arthritis
Multiple joint pain in patient working in day care center
28
cause of viral arthritis
parvovirus B19
29
localisation of pain in hand(3)
like RA
PIP
MCP
30
how long pain last in viral arthritis
2 months
31
patient at risk of vertebral osteomyelitis(3)
IV drugs user
sickle cell diseas
immunodepression
32
Paraclinique of vertebral osteomyelitis
MRI
33
bugs causing vertebral osteomyelitis
staph aureus
34
clue in physical exam in vertebral osteomyelitis
tenderness to gentle percussion of spinous process
35
young patient with low back pain
ankylosing spondylitis
36
Most common extra articular manif of ankylosing spondylitis
Ant uveitis
37
clue for Ankylosing spondylitis(3)
Morning stiffness
improve with exercice
link HLA-B27
38
bone involved in in Ankylosing spondylitis(2)
sacroillitis
| then the spine
39
clue for lumbar stenosis(2)
elder patient
| sitting relieves pain
40
why pain is relieved in lumbar stenosis while sitting
spine flexion open intervertebral space
41
quid of neural claudication
joint disease
42
what could be a complication of RA(2)
cervical subluxation spine
| cervical spinal cord compression
43
clue for RA and pain
morning stiffness improving with activity
44
Marker of RA
anti-CCP
45
which immunoglobulin in RA
IGM
46
first drug used to treat RA
methotrexate
47
second line regimen if failure if no improvement after 6 months of treatment of RA
TNF inhibitor
48
what other drug can be used in adjunction to metotrexate(2)
hydroxychloroquine
or
sulfasalasine
49
quid of non biologic agent in RA(DMARD)(4)
methotrexate
hydroxychloroquine
sulfasalazine
azathioprine
50
quid of biologic effect(3)
ethanercept
infliximab
rituximab
51
mechanism of action of biologic agent in RA
TNF inhibitor
52
before beginning DMARD what to check first(2)
Hep B et C
| TB
53
diasease causing erythema nodosum(7)
```
sarcoidosis
behcet
cocciodomycosis
TB
histoplasmosis
IBD
strep infection
```
54
what to do in presence of erythema nodosum(2)
chest x ray
| search hilar adenopathy
55
erythema nodosum plus hilar adenopathy
sarcoidosis
56
oligoarthritis plus uretritis plus conjunctivitis
reactive arthritis
57
clue for reactive arthritis(3)
oligoarthritis
uretritis
conjunctivitis
58
oligo arthritis plus uretritis plus mouth ulcers
reactive arthritis
59
first line rx of reactive arthritis
NSAIDS
60
quid of enthesitis
Pain in tendon
61
tendon most frequently involved in enthesitis
achilles
62
most commonly involved joint in reactive arthritis(2)
Knee
| sacroilliac
63
fluid synovial examination in gonococcal arthritis
negative or sterile
64
side effects of methotrexate(6)
```
oral ulcers
increase transaminase
pulmonary toxicity
BM suppression
alopecia
anemia
```
65
what the mechanism responsible of side effect in methotrexate
antimetabolite agent
66
patient taking prednisone develops hip pain Dx
avascular necrosis of femoral head
67
the best test to Dx avascular necrosi of femoral head
MRI
or
scintigraphy
68
shoulder pain in tennis player
subacromial bursitis
69
Physical exam finding of subacromial bursitis
pain during rotation and flexion of the shoulder
70
Neer impingement sign? meaning(2)
pain during rotation and flexion of the shoulder
| subacromial bursitis
71
quid of sausage digit or dactylitis
diffusely swollen digit
72
disease causing dactilytis or sausage digit
psoriatic arthritis
73
rx of psoriatic arthritis(3)
NSAIDS
methotrexate
anti TNF agents
74
arthrocentesis finding in pseudogout
rhomboid shaped
| positively birefringent crystals
75
Quid of CPPD
calcium pyrophosphate dihydrate
76
disease with CPPD
chondrocalcinosis in Pseudogout
77
clue for rotator cuff tear
pain not relieved by lidocaine shooting
78
clue for rotator cuff tendinitis
pain relieved by lidocaine shooting
79
best test to DX rotator cuff tear
MRI of shoulder
80
causes of rotator cuff tear(2)
rotator cuff tendinitis
| trauma
81
physical exam clue of rotator cuff tear(2)
lifting the arm above the head causes pain
| no possibility of abduction and external rotation
82
site of lesion in Myasthenia gravis
post synaptic acetylcholine receptor
83
site of lesion in lambert eaton syndrome
presynaptic voltage gated calcium channel
84
site of lesion in dermato myositis or polymyositis
MX fibers
85
clue for dermatomyositis(2)
gottron papules
| heliotrop rash
86
quid of gottron papules
violaceus papules involving dorsum of fingers
87
In Lambert eaton how are reflexes
absent
88
patient of unilateral leg edema and fever(3)
DVT
cellulitis
lymphadenitis
89
clue for cellulitis in unilateral edema(2)
fissured web toe
| macerated
90
clue of anserine bursitis(2)
pain in medial side of the tibia
| just below the knee
91
meaning of valgus test
medial collateral ligament is touched
92
rx of anserine bursitis(2)
ice
| rest
93
cause of anserine bursitis(3)
trauma
overuse
abnormal gait
94
clue of the arthritis in SLE
non deforming arthritis
95
quid of HLA-B27 arthropathy(4)
IBD
Ankylosing spondylitis
Reactive arthritis
psoriatic arthritis
96
point common of any disease with HLA b27
enthesitis
97
most common lieu for enthesitis
heel
98
finding of ankylosing spondylitis
spine limited mobility
99
other sites of enthesitis(2)
illiac crest
| tibial tuberosities
100
clue for fibromyalgia
female with diffuse Mx pain
101
first rx for fibromyalgia
amitryptiline
102
alternative rx for fibromyalgia(3)
duloxetin
pregabalin
milnacipran
103
quid of negative birefringent needle(2)
yellow needle like crystal
when parallel to polarizing axis
blue needle like crystals when perpendicular to polarizing axis
104
crystals causing negative birefringent needle
monosodium urate crustal deposition
105
wbc in osteo arthritis
200-2000
106
arthrocenthesis result in inflammatory arthritis wbc
2000-100000
107
arthrocenthesis result in septic arthritis wbc
> 50000
108
how to differentiate septic arthritis from inflammatory arthritis(2)
PMN>50% inflammatory arthritis
| PMN> 80% septic arthritis
109
risk factor for gout(3)
high meat consumption
excessive alcohol intake
drugs (diuretic)
110
drug causing gout
diuretic thiazide
111
short term rx of gout(3)
NSAIDS
colchicine
corticosteroids
112
long term rx of gout
allopurinol
113
clue for polymyositis et dermatomyositis(3)
elevated CPK
ESR high
proximal mx weakness
114
cause of proximal weakness(4)
drug induced myositis
hypothyroid myopathy
Mx dystrophy
Myathenia gravis
115
Confirmatory dx of polymyositis
Mx Biopsy
116
Drugs causing Myopathy(3)
statin
alcohol
antipsychotics
117
first line of polymyositis
corticosteroids
118
first line rx of fibromyalgia(2)
aerobic exercice
| good sleep hygiene
119
second step of fibromyalgia
amitryptiline
120
lumbar pain during lifting heavy object
lumbar strain
121
what should be done to prevent further back pain
keep the back straight when lifting object
122
patient with back pain worse at night
metastasis cancer
123
first tumor to metastase in bone(5)
```
lung
breast
prostate
thyroid
kidney
```
124
rx for symptomatic sarcoidosis
glucocorticoid
125
workup for sarcoidosis and meaning (3)
chest xray
biopsy
ACE increases
126
chest xray for sarcoidosis
hilar adenopathy
127
biopsy finding for sarcoidosis
non caseiting granuloma
128
xray finding in paget
mosaic pattern of lameller bone
129
physiopatho of paget
bone remodelling
130
why can you have hearing loss in paget
cranial nerve entrapment
131
main cause of paget
osteoclast dysfunction
132
bone reached in paget
femoral bowing
133
clue for inflammatory arthritis(2)
pain worst with rest
| improves with movement
134
first bone touched in ankylosing spondylitis
apophyse joint of axial skeleton
135
triad of gonococcemia(3)
thenosinovitis
polyarthritis
painless vesiculo pustular lesions
136
quid of thenosinovitis
pain along the tendon sheath
137
quid CREST(5)
```
calcinosis
raynaud phenomenon
esophageal dysmotility
sclerodactily
teleangiactasia
```
138
what's the most important guide in the treatment SLE
the grade of lupus nephtitis
139
in front of lupus dx what's the first step
kidney biopsy
140
clue for compression fractures
pain in back without trauma
141
patient with risk for Compression fractures
osteroporosis
142
quid of babinski sign
upper motor neuron problem
143
absent ankle reflex in elderly meaning?
It's normal
144
finding xray in ankylosing spondylitis(2)
fusion of sacroiliac joint
| bamboo spine
145
gender in Ankylosing spondylitis
Male>female
146
why respiratory problem in Ankylosing spondylitis(2)
chest wall motion restriction
| restrictive disease
147
why chest wall motion restriction in ankylosing spondylitis
fusion of costovertebral joints
148
clue of secondary amyloidosis
nephrotic syndrome in the setting of chronic and reccurrent infection
149
cause of secondary amyloidosis
any chronic inflammation
150
other name of secondary amyloidosis
AA
151
causes of secondary amyloidosis(5)
```
infection chronique
inflammatory arthritis
IBD
malignancy(lymphoma)
vasculitis
```
152
dx of AA and finding(2)
fad pad aspiration biopsy
| Amyloid A
153
rx and prevention of AA
colchicine
154
target organs for amyloidosis(4)
rein
foie
coeur
system nerveux autonome
155
two presentation of gonococcal arthritis(2)
polyarthritis with skin rash and thenosinovitis
| monoarthritis
156
cause of CPPD(3)
hyperparathyroidism
hemochromatosis
hypomagnesemia
157
high calcemia plus arthritis
CPPD
158
complication of Paget(2)
osteosarcoma
| pathologic fractures
159
work up for paget(4)
high ALP
High urine hydroxyproline
Normal calcium and
phosphate
160
urinary marker of bone resorption(4)
N telopeptide
C telopeptide
hydroxyproline
deoxypiridinoline
161
Long ter complication of AS
decrease bone density
162
consequence of reduced bone density
fracture for minimal trauma
163
IBD et P anca positif plus arthritis
UC
164
P anca positif plus arthritis
UC
165
extracolonic manif of UC(5)
```
cholangitis
episcleritis
erythema nodosum
pyoderma gangrenosum
arthritis
```
166
disease with P-ANCA positive without vasculitis(2)
UC
| AS
167
why sjogren causes difficulty swallowing
throat dryness because of lack of saliva
168
consequence of lack of saliva in sjogren(3)
high incidence of caries
submandibular swelling
dysphagia
169
cause of lack of saliva in sjogren
lymphocytic infiltration of salivary glands
170
quid of keratoconjonctivitis sicca in sjogren
dry eyes
171
glands problem in sjogren(2)
infiltration of salivary glands
| and lacrymal glands
172
autoantibodies in sjogren
antiRO/SSA
| anti LA/SSB
173
dermatomyositis antibody
anti mi 2
174
what is often associated with Dermatomyositis
malignancy
175
Most common malignancy associated with dermatomyositis(3)
ovarian # 1
breast lung
female urogenital
176
when you dx dermatomyositis what to do?
screen for Cancer
177
the most important surveillance approach in patient taking hydroxychloroquine
eye examination
178
risk with hydroxychloroquine
retinopathy
179
quid of phallen sign
flexion of wrist worsens paresthesia in carpal tunnel syndrome
180
cause of carpal tunnel syndrome
hypothyroidism
181
physiopatho of carpal tunnel syndrome in hypothyroidism
accumulation of matrix substances in the endneurium and perineurium of median nerve
182
quid of matrix substances
it's mucopolysaccharides
183
indication of cyclophosphamide in SLE(2)
severe renal impairement
| CNS impairement
184
side effects of cyclophosphamide(4)
bladder carcinoma
hemorragic cystitis
sterility
myelosuppression
185
cause of bladder carcinoma and hemorragic cystitis in cyclophosphamide
bladder toxicity causes by accumulation of acrolein
186
quid of acrolein
metabolite of cyclophosphamide
187
how to avoid bladder toxicity in cyclophosphamide(2)
lot of fluids
| Mesna
188
patient with history of gout seen with knee swollen ,what test should be done first?(2)
synovial fluid analysis
189
cause of neuropathic joints(6)
```
diabetes
B12
tabes dorsalis
syringomyelie
peripheral nerve damage
spinal cord injury
```
190
consequence of neuropathic joints in diabetes
charcot joint
191
quid of charcot joints
deformed foot
192
cause of baker cyst
inflamed synovium
193
cause of baker cyst(3)
rhumatoid arthritis
osteoarthritis
cartilage tears
194
the most readily modifiable risk factor for OA
obesity
195
study of choice for spiunal stenosis
MRI
196
pain variation in spinal stenosis
worst in standing
| relieved by seating
197
neuropathic claudication /vascular claudication
pain persisting during rest
198
most common extra articular manif of AS
anterior uveitis
199
whtas the most common cause of back pain
lumbar strain
200
straight leg raise test in lumbar strain
Normal
201
neurologic exam in lumbar strain
normal
202
rx of lumbar strain(2)
NSaid
and
early mobilisation
203
mechanism of corticoid related osteonecrosis
disruption of bone vasculature
204
arthritis with no pain after 2 months
viral arthritis
205
cause of positive Rheumatoid factor(4)
viral arthritis
bact arthritis
malignancy
rheumatoid arthritis
206
ANA positive cause(4)
SLE
HIV
Hepatitis
rheumatoid arthritis
207
does a normal individual can have ANA positive
yes
208
other name of rotator cuff impingement
same rotator cuff tendinitis
209
mechanism of kidney damage in SLE(2)
immune complex mediated
| complex antigen antibody activates complement
210
why C3 is decreased in immune complex mediated reaction
activation of complement system
211
cause of low C3
any disease caused by immune complex reaction
212
disease causing low C3(2)
lupus
| GNA
213
articulation touche dans SLE(3)
MCP
PIP
it's like Rheumatoid arthritis
214
blood problem in SLE(3)
anemia
low platelet
low wbc
215
first initial treatment in OA
acetaminophen
216
what the two more common site of atherobolism event secondary to cardiac catheterisation(2)
pedal arteries
| renal arteries
217
consequence of renal arterythrombo embolism post cardiac catheterisation
high creatinine
218
consequence of pedal artery thrombo embolism post cardiac catheterisation
blue toe syndrome
219
what's the cause of thromboembolism in post cardiac catheterisation
cholesterol embolism
220
why chemo causes gout
massive release of acid uric from DNA of destroyed cells
221
quid of acid uric
by product of DNA
222
back pain in OA cause(2)
osteophytes
| hypertrophy of ligamentum flavum
223
dx of degenerative central canal stenosis
MRI
224
cause of Dequervain
inflammation of two muscles
225
Mx inflammed in Dequervain(3)
abductor pollicis longus
extensor pollicis brevis
when passing through fibrous sheath at the radial styloid process
226
quid of finkelstein sign
flexion of thumb into the palm elicit pain
227
Meaning of finkelstein sign
Dequervain
228
person at risk of Dequervain
mother who holds the baby with their thumb outstretched
| abducted et extended
229
rx of polymyalgia rhumatica(PMR)
low dose of prednisone
230
dx criteria for PMR
age >50
Mx ache
ESR> 40
231
localisation of Mx ache in PMR(3)
pelvic girdle
shoulder
neck
232
association of PMR
giant cell arteritis
233
clue for OA
difficulty moving after a period of rest
234
predisposing factor for OA(2)
obesity
| age
235
the most common cause of joint disease
OA
236
greatest risk for patient with rhumatoid arthritis
osteoporosis
237
how does last the morning stiffness in RA
> 1 hour
238
prevention of osteoporosis in rheumatoid arthritis(4)
calcium
vit D
biphosphonate
low glucorticoid use
239
spinal problem in degenerative joint disease
cervical spondylysis
240
clue for cervical spondylisis(2)
neck pain
| sensory problem in forearm
241
xray in cervical spondylisis
bone spur over cervical vertebrae
242
the most common finding in cervical spondylisis
bone spur
243
quid of tennis elbow
lateral epicondylitis
244
cause of tennis elbow
degeneration of extensor carpi radialis brevis tendon
245
Localisation of pain in lumbar strain
perispinal
246
Localisation of pain in compression fracture
directly on vertebrae
247
quid of pain during direct palpation of vertebrae(3)
infection
compression fracture
lytic bone lesion
248
quid of straight leg raise test
herniated disc
249
3 cancer metastasis in the spine
lung
breast
prostate
250
spine involvement in rhumatoid arthritis
cervical spine
251
monoarticular arthritis in elderly with normal lab
OA
252
monoarticular arthritis in elderly with high acid uric and high ESR
gout
253
physical findings in OA
bony crepitus
254
criteria to dx OA(5)
| at least 3 to DX OA
```
bony crepitus
bone enlargement
bone tenderness
lack of warmth
lack of morning stiffness
ahe >50
```
255
why myeloproliferative disorder can cause gout(3)
high turnover
high catabolism of purine
so over production of acid uric
256
example of myeloproliferative disorder causing gout
polycythemia vera
257
why Polycythemia vera produces gout(2)
because of high number of circulating basophiles
| histamine release
258
scleroderma antibody
topoisomerase -I
259
Monoarthritis pain(3)
crystal induced arthritis
septic arthritis
OA
260
predisposing factor for septic arthritis
cartilage destruction(rhumatoid arthritis)
261
Rx of septic arthritis(2)
drainage
| IV antibio
262
patient with AS ,back pain after minimal trauma
rule out vertebal fracture
263
risk of patient with AS
vertebal fracture with minimal trauma
264
red flag for back pain(7)
```
age > 50
pain during night or sleep
neurologic symptom
pain > 1 month
history of previous ca
weight loss
no response to previous rx
```
265
rx of temporal arteritis
high dose of prednisone
266
new headache in patient female > 50 ans
temporal arteritis
267
vessels involved in giant cell arteritis
aorta and its cranial branches
268
know to differentiate gonococcemia from toxic shock syndrome
pustules on extensor surfaces even in woman using tampon=gonococcemia
269
anterior knee pain in young patient(3)
patello femoral syndrome
patellar tendonitis
osgood schlatter
270
who's at risk for patellar femoral syndrome
female
271
who's at risk for patellar tendonitis
athletes
272
who's at risk for osgood schlatter
adolescent
273
clue for patello femoral syndrome
pain during climbing stairs
274
physical exam in patello femoral syndrome(2)
extend the knee while compressing the patella
| patello femoral compressing test
275
rx of patellofemoral syndrome
exercice to stretch and strenghten the mx
276
pain location in patellar tendonitis
inferior patella
277
pain location in osgood schlatter
tibial tubercle
278
cause of lumbar spinal stenosis
spinal canal narrowing
279
cause of neurogenic claudication
spinal canal narrowing
280
mx pain with normal ESR
fibromyalgia
281
mx pain with high ESR
PMR
282
most common complication of giant cell arteritis
aortic aneurism
283
after dx giant cells arteritis next step
serial chest xray
284
specificity of neurogenic claudication
pain when standing
285
difference between anserine bursitis and patellar tendonitis
X?
286
quid of tophi
urate deposition in soft tissue forming tumor
287
HCTZ and gout(2)
hyperuricemia
| can worsen gout
288
biopsy in whipple(2)
PAS positive macrophages in lamina propia
| nonacd fast gram positive bacilli
289
action allopurinol
decrease acid uric production
290
Parvovirus in children
slapped cheek fever
291
risk factor for vertebral osteomyelitis
distant infection
292
Median for AS
20's-30's
293
palinfilm in AS
bilateral sacroilitis
294
quid of trigger finger
thenosinovitis of the palms
295
disease with trigger finger
RA
296
quid of rhumatoid nodules
nontender nodulesnear the elbows over the back the forearm
297
spinal complication of RA(2)
cervical spine subluxation---->
| spinal cord compression
298
limitation of glucocorticoid in rx of RA
doesn't prevent cartilage destruction
299
when can you use glucocorticoid in RA
to provide short term in awaiting response of DMARD
300
quid erythema nodosum
painful reddish multiple on ant surface of legs
301
most common casue of recent infection
recent strep infection
302
patient on rx for RA develops cytopenia and high transminases,what drug he is on
leflunomide
303
quid of leflunomine
pyrimidine synthesis inhibitor
304
action of hydroxychloroquine and sulfasalasine
TNF
| IL-1 suppresor
305
patient on rx for RA develops hemolytic anemia and high transminases and stomatitis,what drug he is on
sulfasalazin
306
TNF inhibitor(6)
```
adalimumab
certolizumab
ethanercept
infliximab
golumumab
```
307
DMARDS
```
adalimumab
certolizumab
ethanercept
infliximab
golumumab
methotrexate
leflunomide
hydroxychloroquine
sulfasalazine
```
308
how to reduce toxicity of metotrexate
folic acid
309
cause of avascular necrosis(3)
corticosteroids
alcoholism
hemoglobinopathies
310
articulation involved in psoriasis
DIP
311
when can occur pseudogout
after recent surgery
| medical illness
312
what about deformity in SLE
deformity is uncommon
313
young patient with articular pain
AS
314
quid of PAget disease
osteoclast hyperfunction
315
hearing loss in paget why
entrapment of 8
316
syndrome nephrotic in a context of hepatomegaly,palpable kidneys,fourth heart sound
amyloidosis
317
quid of 4 heart sound
ventricular hypertrophy
318
tender articulation and fever in young adult sexually active
Neisseria gonorrhea
319
constipation plus hypercalcemia with arthritis
pseudo gout
320
what disease to rule out after dx pseudogout
hyperparathyroidism
321
CPPD
calcium pyrophosphate dihydrate
322
most commonly affected bone in paget
skull
323
cause of charcot joint(2)
complication of neuropathy
| repeated joint trauma in diabetic
324
when baker cyst can be confused with DVT
when rupture
325
profession with risk of lateral epicondylitis
tennis player
| screwdriver
326
initial work up in back pain
xray plain film
327
patient with RA develops swollen knee chills and fever
septic arthritis
328
cause of charcot joint
nerve damage
329
greatest risk of complication in RA
osteoporosis
330
pain during squatting in woman
patellofemoral syndrome
331
quid of Anti CCP
anti cyclic citrulinated peptide
