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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
Q

OA does not affect the ___ joint

A

metacarpophalangeal!

26
Q

Rash + Joint Pain + Fatigue =

A

Lupus

27
Q

The best initial test for SLE is ___

The most specific test for SLE is __ or __

A

ANA is best initial

Anti-DS DNA or Anti-Smith are most specific

28
Q

___ levels drop in an SLE flare up and ___ levels rise in a flare up

A

Complement levels drop, Anti-DS DNA rises

29
Q

A baby of a mom who has anti-Ro (SSA) antibody is at risk for

A

heart block

30
Q

Drug-induced Lupus is caused by __, __, and ___

A

hydralazine, procainamide, and isoniazid

31
Q

What antibodies are found in drug-induced lupus?

A

Anti-histone antibodies

32
Q

Drug-induced lupus never affects the __ or __

A

kidneys or CNS

Complement levels and anti-DS DNA are also normal

33
Q

Most accurate test for Sjogren’s Syndrome is

A

Lip biopsy

34
Q

What is the Schirmer test?

A

Decreased wetting of paper held up to eye to Dx Sjogren’s

35
Q

What are the specific tests for Sjogren’s?

A

Anti-Ro/SSA, Anti-La/SSB

36
Q

Treat Sjogren’s with

A

pilocarpine and cevimeline to increase acetylcholine and thus oral/ocular secretions

37
Q

Tight skin + Heartburn + Raynauds =

A

Scleroderma

There is no specific diagnostic test!

38
Q

The leading causes of death in scleroderma are

A

Lung fibrosis and pulmonary hypertension

39
Q

Renal involvement in scleroderma can lead to

A

malignant hypertension

40
Q

The interstitial lung disease caused by scleroderma can be treated with

A

cyclophosphamide

41
Q

CREST syndrome stands for

A 
Calcinosis of the fingers
Raynaud's 
Esophageal dysmotility
Sclerodactyly
Telangiectasia
42
Q

Does CREST present with joint pain, PPH, herat lung or kidney involvement?

A

NO

43
Q

Anticentromere antibodies =

A

CREST syndrome

44
Q

Marked eosinophilia + orange peel skin =

A

Eosinophilic Fasciitis

Treat w/ steroids

45
Q

The main difference between polymyositis and dermatomyositis is

A

skin involvement in DM

46
Q

Proximal muscle weakness is indicative of

A

PM and DM
Do muscle biopsy
Electromyogram will be abnormal

47
Q

The most serious threat associated with PM/DM is

A

Malignancy of cervix, lungs, pancreas, breasts, or ovaries

48
Q

Age >50 + proximal muscle pain + elevated ESR =

A

polymyalgia rheumatica
Stiffness worse in morning
Great response to steroids

49
Q

Polyarteritis nodosa affects ___ but does not affect the ___

A

PAN causes abdominal pain, renal/ testicular probs, pericarditis, and HTN

It does not involve the lungs

50
Q

30% of patients with PAN have

A

Hepatitis B surface antigen

51
Q

Upper and lower respiratory findings + c-ANCA =

A

Granulomatosis with Polyangiitis

52
Q

Vasculitis + Eosinophilia + Asthma =

A

Allergic Angiitis

used to be churg-strauss syndrome

53
Q

Temporal arteritis is associated with ___ and is a type of ___

A

polymyalgia rheumatica; a type of giant cell arteritis

54
Q

If temporal arteritis is suspected, __ is most important first step

A

treat with steroids!

Elevated ESR, headache, jaw claudication, visual probs

55
Q

Diagnose Takayasu’s arteritis with

A

aortic arteriography or MRA, NOT biopsy!

56
Q

Cryoglobulinemia is associated with ___ while Polyarteritis Nodosa is a/w __

A

Hepatitis C and renal involvement

PAN is a/w Hep B!

57
Q

Behcet Disease is more likely in patients of Middle Eastern or Asian ancestry and features __

A

oral and genital ulcers
ocular involvement that can lead to blindness
skin lesions (needle sticks are super painful)
CNS disease

58
Q

Which joints are affected in pseudogoug?

A

Knee and wrist, not toes!

59
Q

Best initial test for Paget’s Disease of Bone is an elevated

A

Alkaline phosphatase

Calcium and phosphate will be normal

Master the Boards Step 3 (19 decks)

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