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Step 2 CK > Rheumatology > Flashcards

Rheumatology Flashcards

1
Q

Patient presents with an inflammatory pustule that progresses to an expanding ulcer with a purulent base and ragged violaceous borders. What underlying conditions might this patient have? Diagnosis? Treatment?

A

He has pyoderma gangrenosum, which can be associated with IBD, RA and myeloid leukemia. Diagnose with skin bx showing PMN infiltrate. Treat with steroids.

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2
Q

Sub specialist that should be tracking patients on hydroxychloroquine

A

Ophtho, they need to be watching out for retinopathy every 5 years

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3
Q

Labs to order in a patient with Raynaud’s phenomenon

A

UA
CBC, CMP
ANA, RF
ESR and plasma C3 & C4 levels

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4
Q

Lab findings in patients with lupus

A

Hemolytic anemia, thrombocytopenia and leukopenia

Low C3 and C4

ANA, Anti-Sm, Anti-ds DNA

UA

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5
Q

Felty syndrome

A

RA with splenomegaly and neutropenia

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6
Q

Triad seen in reactive arthritis? Treatment?

A

Arthritis, uveitis and urethritis. NSAIDs

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7
Q

Morning stiffness seen in OA? RA?

A

OA 30 min

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8
Q

Who gets screening for osteoporosis? What defines osteopenia?

A

Women > 65 years old

Osteopenia = T score of -1 to -2.5

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9
Q

Causes of erythema nodosum

A

1) Recent strep infection

Other: sarcoid, Tb, histoplasmosis and IBD

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10
Q

Preferred diagnostic test in evaluating a patient for suspected avascular necrosis of the femoral head?

A

MRI

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11
Q

Most common cause of isolated elevation of alk phos in the elderly? What urinary findings might you see?

A

Paget’s. Urinary findings include hydroxyproline, deoxypyridinoline, N-telopeptide and C-telopeptide…which are bone degradation markers.

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12
Q

Common extracolonic findings in UC?

A

Positive p-ANCA, erythema nodosum, pyoderma gangrenosum, episcleritis, arthritis and cholangitis.

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13
Q

Bugs that commonly cause reactive arthritis

A

Salmonella, shigella, campylobacter, C. difficile

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14
Q

Conditions associated with pseudo gout

A

Pseudo gout is a result of calcium pyrophosphate crystal deposition. This occurs in hyperparathyroidism, hemochromatosis and hypothyroidism.

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15
Q

How to diagnose fibromyalgia

A

Widespread pain and symptom severity index score

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16
Q

Deadly complication of giant cell arteritis

A

Aortic aneurysm

17
Q

Why do patients with systemic sclerosis get GERD?

A

Smooth muscle atrophy and fibrosis of the lower esophagus results in LES incompetence

18
Q

Plain x-ray findings in patients with advanced avascular necrosis

A

Subchondral lucency (crescent sign)

19
Q

Gout etiologies

A

Increased urate production (high protein diet, trauma/surgery, volume depletion, alcohol consumption, myelo/lympho proliferative disorders, tumor lysis syndrome, HGPRT deficiency)

Decreased urate clearance (CKD, loop and thiazide diuretics)

20
Q

Antibodies present in systemic sclerosis

A

Anti-topoisomerase I

21
Q

Inflammatory symmetric polyarthritis that resolves within 2 months, but had positive RF and weakly positive ANA

A

Viral: parvo, hepatitis, HIV, mumps, rubella, etc.

22
Q

Criteria for diagnosis of OA

A

Age > 50, minimal morning stiffness, no bony tenderness, bony enlargement, crepitus on active motion and no warmth of joint…need 3+ criteria for > 70% specificity.

23
Q

Treatment of fibromyalgia

A

Good sleep hygiene and aerobic exercise. Add TCAs if they do not respond to initial conservative treatment. Pregabalin, duloxetine and milnacipran can be used as 2nd line drugs.

24
Q

Why take MESNA when on cyclophosphamide

A

Cyclophosphamide can produce a metabolite, acrolein, which can cause hemorrhagic cystitis and bladder cancer.

25
Q

First line drug therapy for patients with rheumatoid arthritis

A

1) Methotrexate

Add TNF inhibitors as step up therapy if there is no improvement after 6 months.

26
Q

Labs to run prior to treating a patient with methotrexate for rheumatoid arthritis

A

HBV, HCV and Tb

27
Q

What conditions are associated with Charcot join?

A

B12 def., DM, tertiary syphilis and other nerve injury

28
Q

Sjogren’s antibodies

A

Anti SSA (Ro) and SSB (La) antibodies

29
Q

Conditions associated with enthesitis

A

Spondyloarthropathies (ankylosing spondylitis, psoriatic arthritis and reactive arthritis)

30
Q

Riluzole

A

Blocks Na channels in damaged neurons, used to slow progression of ALS

31
Q

Risk factors for carpal tunnel syndrome

A

Obesity, diabetes, hypothyroidism and pregnancy

32
Q

Auto-antibodies seen in patients with dermatomyositis

A

Anti-RNP, anti-Jo-1 and anti-Mi2

33
Q

Malignancies with increased frequency in patients with dermatomyositis?

A

Ovarian, lung, colon, stomach, pancreas and non-Hodgkin lymphoma.

34
Q

Next step in a patient with suspected giant cell arteritis?

A

Start high dose corticosteroids while awaiting temporal artery biopsy to confirm diagnosis.

Step 2 CK (14 decks)

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