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Master the Boards Step 3 > Rheumatology > Flashcards

Rheumatology Flashcards

1
Q

CBC in RA patients may show

A

anemia with normal MCV

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2
Q

Which finger joints are affected in RA?

A

MCP and PIP
Also:
Boutonnier deformity, Swan neck deformity
Baker’s cysts
C1/C2 subluxation (check before intubation!)

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3
Q

The single most accurate test for RA is

A

anti-cyclic citrulinated peptide (anti-CCP)

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4
Q

Felty’s syndrome consists of what three features?

A

RA
Splenomegaly
Neutropenia

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5
Q

The lowest glucose level on pleural effusion would be in cases of

A

RA

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6
Q

Standard of care for RA is

A

NSAIDs + DMARDs (Methotrexate is the best initial one)

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7
Q

If methotrexate fails in RA, add

A

Anti-TNF agents like infliximab

Test for Hep B and TB before starting

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8
Q

Patients with mild RA on hydroxychloroquine should get an annual __ exam

A

eye; checking for retinopathy

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9
Q

Alternate DMARDs like anakinra (___ receptor antagonist) and rituximab (___antibody) can be used for RA

A

Anakinra is an IL-1 receptor antagonist

Rituximab is an Anti CD-20 antibody (B-cells!)

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10
Q

___ are a bridge to DMARD therapy for RA

A

Steroids. They do not change progression of disease but help in acutely ill patient with severe inflammation

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11
Q

The seronegative spondyloarthropathies are associated with

A

HLA-B27

  • ankylosing spondylitis
  • reactive arthritis
  • psoriatic arthritis
  • JRA
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12
Q

Young man with back pain that is worse at night and is relieved by leaning forward =

A

ankylosing spondylitis

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13
Q

The most sensitive test for ankylosing spondylitis is

A

Sacroiliac joint MRI (years before x-ray)

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14
Q

Do steroids work for ankylosing spondylitis?

A

NO, that’s the most common wrong answer for AS.

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15
Q

Treat AS with

A

NSAIDs
Biological agents
Sulfasalazine
Secukinumab, an IL-17 antagonist

Do not use steroids.

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16
Q

Asymmetric arthritis, urethritis, GI infxn history, genital lesions, conjunctivitis (KNEE, PEE, SEE)=

A

reactive arthritis, a/w chlamydia, shigella, salmonella, yersinia, or campylobacter

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17
Q

Treat reactive arthritis with

A

NSAIDs

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18
Q

Key features of psoriatric arthritis include

A 
Nail pitting
DIP involvement (unlike RA)
Sausage-shaped digits (dactylitis)
Enthesitis (inflammation of tendon insertion sites)
Psoriasis
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19
Q

Treatments for psoriatic arthritis include

A 
NSAIDs
Methotrexate
Infliximab
Secukinumale
Ustekinumab
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20
Q

Fever, salmon-colored rash, polyarthritis, lymphadenopathy, myalgias =

A

JRA

Additional criteria include HSM and elevated LFTs

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21
Q

Biopsy of bowel in Whipple disease shows

A

PAS-positive organisms on PCR

Treat with bactrim (curative!)

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22
Q

The most common presentation of Whipple disease is

A

joint pain

Also diarrhea, fat malabsorption, weight loss

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23
Q

OA affects the ___ joints

A

Distal interphalangeal joints (unlike RA)

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24
Q

For CCS, all of the following tests should be ordered for osteoarthritis diagnosis:

A

ANA
ESR
Rheumatoid factor
Anti-CCP

25
OA does not affect the ___ joint
metacarpophalangeal!
26
Rash + Joint Pain + Fatigue =
Lupus
27
The best initial test for SLE is ___ | The most specific test for SLE is __ or __
ANA is best initial | Anti-DS DNA or Anti-Smith are most specific
28
___ levels drop in an SLE flare up and ___ levels rise in a flare up
Complement levels drop, Anti-DS DNA rises
29
A baby of a mom who has anti-Ro (SSA) antibody is at risk for
heart block
30
Drug-induced Lupus is caused by __, __, and ___
hydralazine, procainamide, and isoniazid
31
What antibodies are found in drug-induced lupus?
Anti-histone antibodies
32
Drug-induced lupus never affects the __ or __
kidneys or CNS | Complement levels and anti-DS DNA are also normal
33
Most accurate test for Sjogren's Syndrome is
Lip biopsy
34
What is the Schirmer test?
Decreased wetting of paper held up to eye to Dx Sjogren's
35
What are the specific tests for Sjogren's?
Anti-Ro/SSA, Anti-La/SSB
36
Treat Sjogren's with
pilocarpine and cevimeline to increase acetylcholine and thus oral/ocular secretions
37
Tight skin + Heartburn + Raynauds =
Scleroderma | There is no specific diagnostic test!
38
The leading causes of death in scleroderma are
Lung fibrosis and pulmonary hypertension
39
Renal involvement in scleroderma can lead to
malignant hypertension
40
The interstitial lung disease caused by scleroderma can be treated with
cyclophosphamide
41
CREST syndrome stands for
``` Calcinosis of the fingers Raynaud's Esophageal dysmotility Sclerodactyly Telangiectasia ```
42
Does CREST present with joint pain, PPH, herat lung or kidney involvement?
NO
43
Anticentromere antibodies =
CREST syndrome
44
Marked eosinophilia + orange peel skin =
Eosinophilic Fasciitis | Treat w/ steroids
45
The main difference between polymyositis and dermatomyositis is
skin involvement in DM
46
Proximal muscle weakness is indicative of
PM and DM Do muscle biopsy Electromyogram will be abnormal
47
The most serious threat associated with PM/DM is
Malignancy of cervix, lungs, pancreas, breasts, or ovaries
48
Age >50 + proximal muscle pain + elevated ESR =
polymyalgia rheumatica Stiffness worse in morning Great response to steroids
49
Polyarteritis nodosa affects ___ but does not affect the ___
PAN causes abdominal pain, renal/ testicular probs, pericarditis, and HTN It does not involve the lungs
50
30% of patients with PAN have
Hepatitis B surface antigen
51
Upper and lower respiratory findings + c-ANCA =
Granulomatosis with Polyangiitis
52
Vasculitis + Eosinophilia + Asthma =
Allergic Angiitis | used to be churg-strauss syndrome
53
Temporal arteritis is associated with ___ and is a type of ___
polymyalgia rheumatica; a type of giant cell arteritis
54
If temporal arteritis is suspected, __ is most important first step
treat with steroids! | Elevated ESR, headache, jaw claudication, visual probs
55
Diagnose Takayasu's arteritis with
aortic arteriography or MRA, NOT biopsy!
56
Cryoglobulinemia is associated with ___ while Polyarteritis Nodosa is a/w __
Hepatitis C and renal involvement | PAN is a/w Hep B!
57
Behcet Disease is more likely in patients of Middle Eastern or Asian ancestry and features __
oral and genital ulcers ocular involvement that can lead to blindness skin lesions (needle sticks are super painful) CNS disease
58
Which joints are affected in pseudogoug?
Knee and wrist, not toes!
59
Best initial test for Paget's Disease of Bone is an elevated
Alkaline phosphatase | Calcium and phosphate will be normal

Master the Boards Step 3 (19 decks)

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