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AMC MCQ > Rheumatology > Flashcards

Rheumatology Flashcards

1
Q

Most imp findings in x-ray of pt with OA?

A

narrow joint space, osteophytes

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2
Q

Most common risk factor?

A

obesity

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3
Q

Most imp step in life style?

A

lose weight

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4
Q

Sequence of ttt in osteoarthritis:

First line? 2nd 3rd and 4th

A

paracetamol
NSAIDs
opioid
intraarticular steroid

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5
Q

Marked impairment of daily activities due to OA, what to do?

A

replace the joint

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6
Q

Where to hold the stick when i leg is affected?

A

the opposite side with the diseased leg on the ground

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7
Q

What to see in All labs of OA?

A

Normal

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8
Q

Old pt with chronic neck pain, sensory deficit:

A

cervical spondylosis

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9
Q

X-ray findings of OA

A

bony spurs and sclerotic facet joint

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10
Q

first line TTT of OA ?

A

paracetamol 1st

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11
Q

Pt with acutal pain, swelling, redness at 1st MTP joint… Dx:

A

acute gouty arthritis (podagra)

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12
Q

Most imp test for acute gout?

A

Synovial fluid analysis = arthrocentesis = aspiration of joint fluid

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13
Q

Findings in arthrocentesis:

A

WBCs 2000-50000,
NEEDLE shaped,
NEGATIVELY bireferingent crystals

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14
Q

NEGATIVE gram stain & culture

GOUT X-ray —>

A

PUNCHED OUT EROSIONS

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15
Q

++serum Uric acid is neither sensitive nor specific
Management:
Most imp in life style prevention of gout?

A

Stop Alcohol

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16
Q

OTHERS:

A

LOW PURINE DIET AND LOSE WEIGHT.

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17
Q

1st line TTT of acute attack?

A

NSAID

INDOMETHACIN (NOT in RF or GIT bleeding)

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18
Q

PT WITH GOUT , can not use NSAID or STEROIDS?

A

COLCHICINE

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19
Q

Acute attack in pt with renal failure:

A

steroid……..vvvvvvvv imp ( colchicine may e used with half dose )

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20
Q

PREVENTION of gout—>

A

Allopurinol and probenicid

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21
Q

TTT of tophacous gout?

A

allopurinol (NOT surgery)

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22
Q

Tophacous gout no responding to TTT next step?

A

increase the dose

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23
Q

Main side effect of colchicine?

A

diarrhea

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24
Q

Main side effect of allopurinol?

A

rash

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25
Q

If acute attack occurred while the pt is on allopurinol:

A

indomethacin and continue the allopurinol .vvvvvvvvv imp

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26
Q

Most common drug causing attack of gout?

A

Thiazide.VVVVVVV IMP

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27
Q

Main indication for long term use of medications in gout?

A

renal failure

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28
Q

Starting dose of allopurinol?

A

50-100 mg

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29
Q

SIDE EFFECTS OF THIAZIDE?

A

VVVVVVVVVVVVVVVVVVV IMP:
Hyponatremia
Hypokalemia

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30
Q

Hyperglycemia?

A

induce DM ……………………..vvvvvvvv imp

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31
Q

Hyperurecemia?

A

contra-indicated in gout……vvvvvvv imp

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32
Q

Hypercalcemia?

A

hypocalcuria….vvvvvvv imp (prophylaxis against renal stones)

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33
Q

Old Pt with hyper-calcemia develops acute knee joint pain… Dx:

A

pseudo-gout

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34
Q

Arthrocentesis in pseudo-gout?

A

rhomboid- shaped crystals, +ve berferingent

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35
Q

TTT of psudogout?

A

1st line: NSAIDs. If no response: intra-articular steroid

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36
Q

Low Back Pain (LBP)

Pt with LBP not radiating to LL, exam shows para-vertebral ms spasm………. Dx:

A

lumbo- sacral sprain (lumbago).

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37
Q

TTT of lumbo sacral sprain?

A

Analgesic and continue activity BUT no bed rest

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38
Q

Pt with LBP radiating to LL, exam shows +ve straight leg test…Dx:

A

herniated disc

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39
Q

Tx of Herniated disc?

A

1st line: analgesic and continue movement. If no improvement: surgery

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40
Q

Pt with LBP with severe radicular LL pain, LMNL and urine and stool incontinence… Dx:

A

Cauda Equina syndrome

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41
Q

Pt with LBP with severe radicular LL pain, UMNL and urine and stool incontinence… Dx:

A

Conus meddularis syndrome

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42
Q

Inv of choice of both CES and CMS

A

MRI

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43
Q

TTT of choice of both CES and CMS

A

surgery

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44
Q

Post- menopausal pt with severe LBP, exam shows localized pain and tenderness to one vertebra… Dx:

A

vertebral fracture (osteoprotic fracture)

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45
Q

Inv of choice osteoporotic fracture?

A

X- RAY

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46
Q

If no fracture appears?

A

DEXA scan

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47
Q

LBP ++ with leaning forward and walking up hill & – with standing up… Dx:

A

spinal stenosis

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48
Q

Inv of choice and tx choice of spinal stenosis?

A

MRI.

Tx of choice: surgery

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49
Q

Pt with H/O with back pain:

A

metastases until proven otherwise

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50
Q

1st step in management in pt with H/O back pain?
Investigation of choice?
long term tx?

A

IV steroid
MRI
Radiation

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51
Q

Old age male with back pain, anemia and ++ Ca?

A

Multiple Myeloma (MM)

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52
Q

Young male with chronic LBP:

A

Ankylosing Spondylitis (AS) until proven otherwise

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53
Q

Inv of choice AS?

A

X-ray (bamboo spine)

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54
Q

Imp Lab. of AS?

A

+ve HLA-B27 and -ve RF

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55
Q

Imp. Eye affection in AS?

A

Anterior uveitis

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56
Q

Imp chest affection in AS?

A

Chest wall movement restriction

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57
Q

Management:

Non pharmacological of AS?

A

physiotherapy and hydrotherapy

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58
Q

First line medications AS?

A

NSAIDs ( naproxen)

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59
Q

Second line tx for AS?

A

infliximab

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60
Q

Third line for AS?

A

sulphasalazine

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61
Q

fourth line for AS?

A

methotrexate

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62
Q

If failed?

A

infliximab (risk of TB reactivation)

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63
Q

Diseases with pain referred to the back 1-perforated peptic ulcer:
X-ray?

A

air under diaphragm

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64
Q

TTT of perforated PUD?

A

…immediate laparotomy

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65
Q

acute pancreatitis initial -Inv?

most specific inv?

A

amylase and lipase,

CT

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66
Q

TTT of acute Pancreatitis?

A

NPO, analgesic, IV fluid and PPI

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67
Q

aorta( dissection-ruptured TTT?

A

Surgery

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68
Q

acute cholecystitis presentation

A

Female with severe RUQ pain

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69
Q

Inv of cholycystitis

A

US…….stone at cystic duct and

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70
Q

TTT of cholecystitis?

A

conservative then scheduled cholecystectomy

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71
Q

Young male cannot see, pee or climb a tree after history of diarrhea:

A

reiter ( reactive arthritis )

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72
Q

DD of shoulder pain
Pt with shoulder pain, exams show limitation of passive movement BUT no limitation of active movement. After intra-articular lidocaine injection, the pain is markedly relieved…..Dx:

A

rotator cuff tendonitis

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73
Q

Inv of choice for rotator cuff tendonitis?

A

MRI

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74
Q

TTT of choice for rotator cuff tendonitis?

A

NSAIDs

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75
Q

Pt with shoulder pain, exams show limitation of passive movement BUT no limitation of active movement. After intra-articular lidocaine injection, the pain is NOT relieved…..Dx:

A

rotator cuff tear

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76
Q

Inv of choice rotator cuff tear?

Tx?

A

MRI

arthroscopic repair

77
Q

MC injured muscle in shoulder:

A

supra-spinatus

78
Q

Pt with chronic shoulder pain, exam shows limitation of both active& passive movement… Dx:
TTT?

A

adhesive capsulitis…

: physiotherapy

79
Q

Pt with shoulder pain, exam shows NO limitation of active or passive movement… Dx:
TTT?

A

subacromial bursitis…

: NSAIDs

80
Q

DD of muscle pain

Pt with generalized musculo- skeletal pain, disturbed sleep, normal lab……………….Dx:

A

fibro- myalgia

81
Q

TTT of choice for fibromyalgia?

A

Amitryptiline

82
Q

Pt with pain at shoulder & pelvic girdle and morning stiffness> 1h… Dx:

A

polymyalgia rheumatic (PMR)

83
Q

TTT of choice PMR?

A

low dose steroid.

84
Q

If PMR associated with giant cell arteritis?

A

give high dose steroid (risk of blindness)

85
Q

If u suspect giant cell arteritis…
1st step?
2nd step?

A

ESR… if increases: Give high dose steroid

confirm diagnosis by temporal a biopsy

86
Q

Pt with muscle weakness, ++ CK; ++ aldolase… Dx:

A

polymyositis

87
Q

Inv of choice for polymyositis?

A

muscle biopsy

88
Q

TTT of choice polymyositis?

A

cortisone

89
Q

Pt with muscle weakness, ++ CK; ++ aldolase, heliotrope rash and gotron papule… Dx:

A

dermato- myositis

90
Q

Pt with kerato-conjunctivitis, difficult swallowing, dyspareunia and enlaged parotid gland… Dx:

A

Sjogren’s $

91
Q

Pt with Sjogren $ presented with marked enlarged parotid, what to do?

A

Biopsy

92
Q

Most imp inv for sjogrens?

A

anti-SSA (RO) anti-SSB (LA) antibodies

93
Q

TTT sjorgrens?

A

Symptomatic

94
Q

Young pt with fever, arthritis, abdominal pain, foot drop&; +ve C-ANCA… Dx:

A

PAN

95
Q

Inv of choice PAN?

A

sural nerve biopsy

96
Q

Imp Inv to be done in pt with PAN:

A

HBV serology

97
Q

TTT of choice of PAN?

A

cortisone, cyclophosphamide

98
Q

Young female with rash over face and arthralgia:

A

SLE

99
Q

Inv of choice for SLE

A

anti-dsDNA or anti-smith

100
Q

In SLE Mild joint affection, Tx with?

A

hydroxycholoroquine…..vvvvvvvvv imp

101
Q

IN SLE Only skin manifestation, TX with?

A

hydroxycholoroquine……..vvvvvvv imp

102
Q

Young female with chronic dry cough and bilateral hilar lymphadenopathy:

next inv,

A

sarcoidosis……..….

CT chest

103
Q

Inv of choice in sarcoidosis ?

A

biopsy ( lung or skin )

104
Q

Ca level and ACE in sarcoidosis?

A

increased

105
Q

TTT of sarcoidosis ?

A

oral steroid

106
Q

Patient with rheumatoid arthritis now swelling at back of knee:

A

baker cyst …..if rupture……severe pain at calf

107
Q

Young male with severe selling at knee, with redness and fever:
Next step?

A

septic arthritis until proved otherwise:

immediate aspiration

108
Q

Most common organism of septic arthritis?

A

staph aureus

109
Q

Old age female with rheumatoid arthritis now severe swelling and pain at knee joint : next step

A

aspiration to exclude septic arthritis

110
Q

Female with joint pain and morning stiffness that decreases with activity:

A

rheumatoid arthritis

111
Q

Female with treated rheumatoid arthritis now elevated liver enzymes:

A

methorexate induced hepatitis

112
Q

For symptomatic control In acute attack of RA?

A

NSAIDS and splinting

113
Q

Most imp inv for a RA pt will do operation?

A

X-RAY CERVICAL vertebrae……exclude C1-C2 vertebrae

114
Q

Pt with RA died on table while intubation:

A

C1-C2 fracture

115
Q

Most common cause of death with RA?

A

CVS

116
Q

Best drug for RA?

A

methotrexate

117
Q

FELTY’S SYNDROME?

A

RA + Splenomegaly + neutropenia

. methotrexate shouldn’t be used in pregnant

118
Q

DO u do surgery to sc nodules?

A

noooooooo

119
Q

Drugs that can be used safely in pregnancy:

A 
vvvvvvvvvv imp
Prednisone
Sulphasalazine
Hydroxychloroquine
CASH
120
Q

Drugs that affect male fertility????

A

vvvvvvvvvvvvvvv imp
Methotrexate
sulphasalazine
MaleS

121
Q

Test should be done before giving azathioprine:

A

Thiopurine methyltransferase Genotype

Hydroxychloroquine …safe in pregnancy and doesNOT affect male fertility

122
Q

Female with basal crepitations over back, colored fingers with some fingers amputated and difficulty in swallowing»>

A

sclerderma…..anti-scl antibody…..most common cause of death is pulmonary HTN

123
Q

TTT of renal crisis with scleroderma?

A

ACEI

124
Q

CREST $ = LIMITED scleroderma

Ab?

A 
. Calcinosis cutis.
 . Raynaud's phenomenon.
 . Esophageal dysmotility.
 . Sclerodactyly.
 . Telangiectasia.
 . +ve Anti-Centromere
125
Q

Old age male on large dose of cortisone now limping»>

DX of choice?

A

avascular necrosis ….

MRI

126
Q

Patient patient with peripheral neuropathy manifestations now marked swelling and redness at mid foot:

A

charcoat joint ….next step is cast and immobilization

127
Q

Drug of choice”

Rheumatoid arthritis ————–>

A

Methotrexate.

128
Q

. Osteoarthritis ——————–>

A

Weight loss and ; Acetaminophen.

129
Q

. Gout acute attack —————–>

A

NSAIDs (Indomethacin).

130
Q

. Gout prevent. of new attack ——->

A

allopurinol.

131
Q

. CPPD ——————————>

A

NSAIDs.

132
Q

. Disk herniation ——————->

A

paracetamol.

133
Q

. Epidural abscess ——————>

A

Abs “Vancomycin”.

134
Q

. Cord compression ——————>

A

Steroids.

135
Q

. Spinal stenosis ——————->

A

Weight loss & Steroid injection.

136
Q

. Fibromyalgia ———————->

A

Amitriptyline.

137
Q

. Carpal Tunnel. $ ——————>

A

Wrist splint & NSAIDs.

138
Q

. Polymyositis ———————->

A

high dose steroids.

139
Q

. Rotator cuff injury —————>

A

NSAIDs.

140
Q

. SLE ——————————->

A

High dose steroids.

141
Q

Tx of Sjogren $ ————————->

A

Water the mouth & atrificial tears.

142
Q

Tx of Polymyalgia Rheumatica ————>

A

LOW dose steroids.

143
Q

Tx of Temporal “Giant cell” arteritis —>

A

HIGH dose steroids.

144
Q

Tx of Ankylosing Spondylitis ————>

A

NSAIDs.

145
Q

Tx of Psoriatic arthritis —————>

A

NSAIDs.

146
Q

Tx of Reactive arthritis “Reiter’s $” —>

A

NSAIDs.

147
Q

Tx of Septic arthritis ——————>

A

CEFTRIAXONE & VANCOMYCIN.

148
Q

Tx of Gonococcal arthritis ————–>

A

Ceftriaxone or cefotaxime

149
Q

Ab in Rhematoid Arthritis “RA” ————>

A

Anti-Cyclic Citrulinated Peptide “CCP”.

150
Q

Ab in Systemic Lupus Erythematosus “SLE” –>

A

Anti-Double Stranded DNA “DS DNA

151
Q

Ab in Connective tissue disease?

A

anti ribonucleo protein

152
Q

Ab in Scleroderma ————————->

A

Anti-topoisomerase “Scl 70”.

153
Q

.CREST $ —————————–>

A

Anti-centromere.

154
Q

Ab found in Sjogren $ —————————>

A

SS-A “Ro” & SS-B “La”.

155
Q

Ab in Wegener’s granulomatosis –>

A

Anti-neutrophil cytoplasmic Antibody “C-ANCA”.

156
Q

.Ab in Chrug-Strauss ———————–>

A

Anti-myeloperoxidase antibody “P-ANCA

157
Q

Drugs that cause azospermia in males?

A

sulfasalzine and methotrexate

158
Q

Peripheral neuropathy due to prednisone

A

B12 deficiency

159
Q

MCC of peripheral neuropathy

A

DM

160
Q

Take of pancytopenia due to methothrexate

A

FOLINIC ACID

161
Q

Middle aged woman with narrowing of joint space and osteopenia….suspect?

A

RA

162
Q

Single most accurate test for RA

A

Anti CCP

163
Q

Esr and ck raised…think

A

Polymyositis

164
Q

ESR raised ….CK NORMAL think?

A

Polymyalgia rheumatica

165
Q

ESR and Ck NORMAL…think?

A

Drug induced myalgia

166
Q

Pts with sjorgrens should be evaluated for what disease?

A

Lymphoma

167
Q

DMARD safe in pregnancy

A 
CASH for DMARD In pregnancy
Cyclosporin
Azithioprine
Sulfasalazine
Hydroxychloroquin
168
Q

Tx for osteopenia

A

Vit D plus Ca

169
Q

Tx of pagets dusease

A

Pamindronate

P for P

170
Q

Osteoporosis plus PUD TX with

A

Zolindronate

171
Q

Highest risk for developing Osteoporosis?

A

Early menopause

172
Q

Inv of choice for Herniated disk?

A

MRI

173
Q

a‐ stop methotrexate and continue hydroxychloroquine
b‐stop hydroxychloroquine and continue methotrexate
c‐stop both and give leflonomide
d‐stop both and give adalimumab
e‐ stop Mtx and start sulfasalazine

A

Ans. is A
. Mtx is contraindicated in pregnancy but hydroxychloroquine is relatively safe(source
davidson).

174
Q

Patient with RA she takes ibuprofen and methotrexate to control her disease, they mention the
time it was years for both of drugs, patient complains of upper abdominal pain, and her labs are given
ALT, AST, GGT, even bilirubin all were high, which of the following cause this condition?
A. Methotrexate induced hepatitis
B. Ibuprofen induced hepatitis
C. Autoimmune hepatitis
D. Viral hepatitis
E. Alcoholic hepatitis

A

Ans is A .
Drug induced hepatitis AST , ALT and spexy GGT raised .
Ibuprofen is less hepatotoxic than MTX

175
Q

Which of the following is not considered an extra‐articular manifestation of Rheumatoid Arthritis?

a) Osteoperosis
b) Peripheral neuropathy
c) Cutaneous nodules
d) Pericardial effusions
e) Hepatomegaly

A

Answer is E.
Splenomegaly + low cell count== felty’ nodule
Lung involved (nodule in lung)== Caplan’s syndrome

176
Q

A 50 year old man who suffers from rheumatoid arthritis and who has been treated with prednisolone
for 3 years develops peripheral neuropathy of the
lower extremities. This neuropathy is most likely due to?
A. arsenic poisoning
B. thiamine deficiency
C. development of necrotising arteritis
D. ruptured intervertebral disc
E. Vit b12 deficiency

A

Ans is C

177
Q 
4.50 years female with pain in KNEE... there is swelling of knee joints and hand small joints... she has hx 
of morning pain reliefs with activity. RIght knee joint has swelling and thick effusion... she is on some 
medication. Tx 
Allopurinol  
B naproxen 
C paracetamol 
D cholcicine 
E steroid
A

Aready defective joint …. Pseudogout …

B is correct naproxen.

178
Q

Back pain + red eye, think?

A

Ankylosis spondylitis with Uveitis

179
Q

Best diagnostic test for acromegaly

A

OGTT with serial growth hormones

180
Q

best initial test for acromegaly

A

IGF 1

181
Q

pt presents with acute gout, cant use NSAID or steroids, what to use?

A

Colchicine

182
Q

best initial tx for ASpondylitis…

if non responsive

A
  1. exercise and NSAID

2. anti-TNF drugs such as etanercept, adalimumab, or infliximab.

183
Q

best diagnostic test for ASpondylitis

A

MRI

184
Q

Long term management of SLE?

A

immunosuppresives plus antiplatelets

185
Q

Cryoglobinemia is associated with?

A

Hep C

186
Q

Initial investigation for Kawasaki?

Best inv?

A

ESR

Echo

187
Q

Initial Tx for Kawasaki?

Best Tx?

A

Aspirin

IVIG

188
Q

Initial Tx of adhesive capsulitis?

A

Physio

AMC MCQ (14 decks)

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