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usmle step 3 > rheumatology > Flashcards

rheumatology 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
why not use rituximab in SLE?
reports of PML (progressive multifocal leukoencephalopathy)
26
benign tumor in the proximal femur of teens
osteoid osteoma
27
what do you send to test for RA?
- RF | - anti-CCP
28
AM joint pain in SLE lasts for how long?
minutes
29
what are the DMARDs used in RA (5)?
- methotrexate - hydroxychloroquine - sulfasalazine - lefunomide - azathioprine
30
what is first-line in RA?
methotrexate
31
first diagnostic test for ankylosing spondylitis?
SI joint plain film
32
genetic mutation associated w/ankylosing spondylitis?
HLA-B27
33
how does anterior uveitis present?
acute onset unilateral eye pain, photophobia, and blurring of vision
34
extra-articular manifestations of ankylosing spondylitis?
- anterior uveitis - aortic regurg - apical pulm fibrosis - IgA nephropathy - restrictive lung dz
35
what do you send to test for polymyositis?
anti-Jo-1, ANA
36
myasthenia gravis - symptoms?
weakness that increases with repeated use
37
Henoch-Schonlein purpura - pathogenesis?
systemic IgA deposition
38
Henoch-Schonlein purpura - what is it?
vasculitis most common in kids
39
Henoch-Schonlein purpura - clinical characteristics?
URI (50%) then palpable purpuric rash on legs, abd pain 2/2 intussuception
40
TTP pentad?
- fever - MAHA - thrombocytopenia - renal failure - AMS
41
HUS - hallmarks?
- MAHA - thrombocytopenia - acute renal failure - age <5 - s/p bloody diarrhea
42
HUS typically occurs after what illness?
bloody diarrheal illness
43
neurofibromatosis type 1 - body parts affected?
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
neurofibromatosis type 2 - how different than type 1?
- type 2 = vestibular schwannomas | - type 2 = no cafe au lait macules
45
cafe au lait macules, fibrous dysplasia precocious puberty - dx?
McCune Albright Syndrome
46
sjogren's syndrome is associated w/which malignancy?
B-cell non-Hodgkin's lymphoma
47
polymyalgia rheumatica is frequently associated with which other rheum dz?
GCA
48
drugs associated w/risk of lupus?
- procainamide - hydralazine - minocycline - atanecept/infliximab
49
which autoantibody is associated w/drug inducd lupus?
anti-histone
50
mafan is what genetically?
autosomal dominant
51
marfan affects which molecule?
fibrillin - 1
52
eye complication of marfans?
ectopia lentis (lens subluxation)
53
Ehlers-danlos - what vascular complication?
berry aneurysm
54
marfans - what vascular complication?
aortic root dilation + dissection
55
what use if sarcoid is unresponsive to steroids?
- mtx | - anti-TNF
56
in sarcoid - tender, red nodules on skin what is this called?
erythema nodosum
57
what does PTH do to ca and phos?
- phos excretion | - ca reabsorption
58
gout - acute treatment?
- naproxen - indomethacin - - if NSAIDS contraindicated = intraarticular or oral steroids - -- 3rd line is colchicine

usmle step 3 (14 decks)

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