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usmle step 3 > rheumatology > Flashcards

rheumatology Flashcards

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USMLE® Step 1 flashcards
1
Q

which is preferred first-line therapy for active RA?

A

methotrexate

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2
Q

if RA patient fails methotrexate, what is next step?

A

add or switch to anti-cytokine (infliximab, etanercept)

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3
Q

if RA patient fails methotrexate and subsequent anti-cytokine what is next step?

A

cyclosporine

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4
Q

GU infections preceding reactive arthritis

A

chlamydia

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5
Q

GI infections preceding reactive arthritis?

A

shigella, salmonella, yersinia, campylobacter, C diff

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6
Q

circinate balanitis - what is it, when does it happen?

A

painless penile ulcers without LAD, they appear within 1-4 weeks of chlamydia infection. I

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7
Q

how do you treat Paget’s disease?

A

bisphosphonates

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8
Q

disseminated gonorrhea - how present?

A

tenosynovitis
migratory arthritis
rash

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9
Q

pseudogout - what are the crystals?

A

positively birefringent rhomboid crystals

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10
Q

probenecid - what does it do?

A

uricosuric agent

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11
Q

nephrogenic diabetes insipidus - mechanism?

A

renal resistance to ADH

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12
Q

central diabetes insipidus - mechanism?

A

deficient excretion of ADH ( trauma, pituitary surgery, or hypoxic or ischemic encephalopathy)

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13
Q

Lofgren syndome - which disease is it associated with and what is it?

A

SLE:

  • erythema nodosum
  • hilar adenopathy
  • migratory polyarthralgia
  • fever
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14
Q

what is calcitriol?

A

1, 25-dihydroxyvitamin D

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15
Q

what do you send to test for SLE?

A

ANA, anti-dsDNA

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16
Q

what do you send to test for CREST variant of scleroderma?

A

anti-centromere ab

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17
Q

what do you send to test for primary biliary cirrhosis?

A

anti-mitochondrial ab

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18
Q

what is a highly specific but insensitive test for SLE?

A

anti-Smith ab

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19
Q

what do you send to test for sjogren’s?

A

anti-Ro/SSA ab

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20
Q

what do you send to test for scleroderma?

A

anti-centromere ab

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21
Q

if pt w/SLE presents w/complaint that could be flare vs something else, what can you send to tell how active disease is?

A

Anti-dsDNA

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22
Q

when do you use hydroxychloroquine in SLE?

A
  • athralgias
  • serositis
  • cutaneous symptoms
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23
Q

when do you use cyclophosphamide in SLE?

A

patients w/more serious manifestations

  • lupus nephritis
  • CNS involvement
  • vasculitis
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24
Q

when do you use methotrexate in SLE?

A

patients w/significant organ involvement who have had incomplete response to prednisone alone

25
Q

why not use rituximab in SLE?

A

reports of PML (progressive multifocal leukoencephalopathy)

26
Q

benign tumor in the proximal femur of teens

A

osteoid osteoma

27
Q

what do you send to test for RA?

A
  • RF

- anti-CCP

28
Q

AM joint pain in SLE lasts for how long?

A

minutes

29
Q

what are the DMARDs used in RA (5)?

A
  • methotrexate
  • hydroxychloroquine
  • sulfasalazine
  • lefunomide
  • azathioprine
30
Q

what is first-line in RA?

A

methotrexate

31
Q

first diagnostic test for ankylosing spondylitis?

A

SI joint plain film

32
Q

genetic mutation associated w/ankylosing spondylitis?

A

HLA-B27

33
Q

how does anterior uveitis present?

A

acute onset unilateral eye pain, photophobia, and blurring of vision

34
Q

extra-articular manifestations of ankylosing spondylitis?

A
  • anterior uveitis
  • aortic regurg
  • apical pulm fibrosis
  • IgA nephropathy
  • restrictive lung dz
35
Q

what do you send to test for polymyositis?

A

anti-Jo-1, ANA

36
Q

myasthenia gravis - symptoms?

A

weakness that increases with repeated use

37
Q

Henoch-Schonlein purpura - pathogenesis?

A

systemic IgA deposition

38
Q

Henoch-Schonlein purpura - what is it?

A

vasculitis most common in kids

39
Q

Henoch-Schonlein purpura - clinical characteristics?

A

URI (50%) then palpable purpuric rash on legs, abd pain 2/2 intussuception

40
Q

TTP pentad?

A
  • fever
  • MAHA
  • thrombocytopenia
  • renal failure
  • AMS
41
Q

HUS - hallmarks?

A
  • MAHA
  • thrombocytopenia
  • acute renal failure
  • age <5
  • s/p bloody diarrhea
42
Q

HUS typically occurs after what illness?

A

bloody diarrheal illness

43
Q

neurofibromatosis type 1 - body parts affected?

A
  1. skin (cafe au lait macules)
  2. eyes (optic nerve glioma, lisch nodules in iris)
  3. scoliosis
  4. axillary + inguinal freckling
  5. neurofibromas
  6. pseudoarthrosis
44
Q

neurofibromatosis type 2 - how different than type 1?

A
  • type 2 = vestibular schwannomas

- type 2 = no cafe au lait macules

45
Q

cafe au lait macules, fibrous dysplasia precocious puberty - dx?

A

McCune Albright Syndrome

46
Q

sjogren’s syndrome is associated w/which malignancy?

A

B-cell non-Hodgkin’s lymphoma

47
Q

polymyalgia rheumatica is frequently associated with which other rheum dz?

A

GCA

48
Q

drugs associated w/risk of lupus?

A
  • procainamide
  • hydralazine
  • minocycline
  • atanecept/infliximab
49
Q

which autoantibody is associated w/drug inducd lupus?

A

anti-histone

50
Q

mafan is what genetically?

A

autosomal dominant

51
Q

marfan affects which molecule?

A

fibrillin - 1

52
Q

eye complication of marfans?

A

ectopia lentis (lens subluxation)

53
Q

Ehlers-danlos - what vascular complication?

A

berry aneurysm

54
Q

marfans - what vascular complication?

A

aortic root dilation + dissection

55
Q

what use if sarcoid is unresponsive to steroids?

A
  • mtx

- anti-TNF

56
Q

in sarcoid - tender, red nodules on skin what is this called?

A

erythema nodosum

57
Q

what does PTH do to ca and phos?

A
  • phos excretion

- ca reabsorption

58
Q

gout - acute treatment?

A
  • naproxen
  • indomethacin
    • if NSAIDS contraindicated = intraarticular or oral steroids
  • – 3rd line is colchicine

usmle step 3 (14 decks)

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