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ABIM Prep Flashcards > Rheumatology > Flashcards

Rheumatology Flashcards

1
Q

TNF adverse effects to know

A

1) hold in severe infections
2) reactivation of hepatitis B, which can be fatal
3) check for latent TB and screen regularly
4) avoid in class III/IV heart failure
5) Considered safe in pregnancy
6) positive ANA, with lupus-like syndromes
7) demyelination, similar to MS

Warning for lymphoma risk, though this is controversial

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2
Q

anti-smith

A

SLE (specific for diagnosis)

- do not correlate with disease activity, use to diagnose

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3
Q

anti-U1-RNP

A

MCTD

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4
Q

Anticentromere pattern of ANA

A

CREST syndrome, SSc and PH

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5
Q

anti-dsDNA ab

A

correlates with SLE disease activity

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6
Q

anti-smooth muscle

A

autoimmune hepatitis

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7
Q

anti-La/SSB

A

Sjogren syndrome, neonatal lupus

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8
Q

anti-Scl70

A

SSc, pulmonary fibrosis, diffuse cutaneous SSc

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9
Q

Antihistone

A

drug-induced SLE

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10
Q

Anti-Ro/SSA

A

Sjogren syndrome, subacute cutaneous lupus

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11
Q

c-ANCA (anti-PR3)

A

GPA

Need a GPA of 3 to Pass Rheumatology (PR3)

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12
Q

p-ANCA (anti-MPO)

A

Eosinophili granulomatosis with polyangiitis, and MPA

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13
Q

Anti-Jo-1

A

Polymyositis, and antisynthetase syndrome

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14
Q

Anti-CCP

A

RA

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15
Q

Anti-TNF biologics used in RA

A

1) Enteracept
2) Adalimumab
3) infliximab
4) Golimumab
5) Certolizumab

increased risk of infection, avoid live vaccines

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16
Q

Non-TNF biologics used in RA

A

1) Tocilizumab/sorilumab (Anti- IL-6)
2) Abtacept (CTLA-4 IgG)
3) Ritixuimab (B cell agent)
4) Anakinra (IL-1 inhibitor)

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17
Q

Findings in microscopic polyangiitis

A

nongranulomatous necrotizing pauci-immune vasculitis of the small vessels or pauci-immune necrotizing crescenteric GN

Clinical findings: pulmonary hemorrhage, pauci-immune small-vessel necrotizing vasculitis of the skin, proteinuria, inflammatory arthritis, positive p-ANCA (MPO, perinuclear)

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18
Q

histology differences between GPA, MPA, Eosinophilic GPA

A

GPA: granulomatous pauci-immune vasculitis
MPA: nongranulomatous pauci-immune vasculitis
E GPA: granulomatous pauci-immune vasculitis with eosinophilia

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19
Q

In severe refractory tophaceous gout, which IV therapy is indicated

A

Pegloticase infusion (porcine-derived uricase enzyme)

Stop other uric acid treatments, as serum urate levels are trended to screen for antibody development, and this may obscure this screening

Start prophylaxis for gout flares with either NSAIDs, glucocorticoids, or colchicine

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20
Q

Is the presence of HLA-B27 a diagnostic criterion for ankylosing spondylitis?

A

NO

It may be helpful with clinical presentation c/w ankylosing spondylitis, but without classic imaging findings

Diagnostic criteria for Ankylosing Spondylitis

  • younger than 45
  • inflammatory back pain >3 months duration
  • bilateral sacroiliitis on imaging
21
Q

What GI finding is seen in diffuse cutaneous systemic sclerosis?

A

GAVE: Gastric Antral Vascular Ectasia

  • proliferation of blood vessels typically in the antrum, appears like watermelon stripes
  • treat with APC or laser coagulation
22
Q

What agent can be used off label for refractory gout?

A

Anakinra/canakinumab (IL-1 inhibitors)

23
Q

Antibodies associated with neuropsychiatric SLE disease

A

1) antineuronal
2) anti-NMDA receptor
3) antiribosomal P
4) antiphospholipid
5) lupus anticoagulant

24
Q

Drug-induced lupus (antihistone Ab +), culprit drugs

A

1) Hydralazine
2) Provainamide
3) INH
4) Minocycline
5) TNF-alpha inhibitors

25
Q

Drug-induced cutaneous lupus, culprit drugs

A

1) ACE inhibitors
2) HCTZ
3) Hydralazine
4) Griseofulvin
5) NSAIDs
6) PPIs
7) Terbinafine
8) TNF-alpha inhibitors

26
Q

Triad that makes up Felty Syndrome

A

1) Rheumatoid arthritis (usually aggressive, long-standing)
2) Neutropenia
3) Splenomegaly

Other clinical findings:

  • Mononeuritis multiplex
  • Necrotizing skin infections
  • pleuropericarditis
  • lymphadenopathy
  • episcleritis

Associated risk for:

  • severe infections
  • lower extremity ulcers
  • lymphoma
  • vasculitis
27
Q

Causes of acquired PAN

A

1) HBV
2) HIV
3) Hairy cell leukemia

28
Q

Inclusion body myositis findings

A

An inflammatory myopathy involving the proximal and distal muscles

  • typically symmetric (though muscle redistribution may be asymmetric)
  • usually >50 years old
  • Serum CK: 10-12x ULN
  • insidious in onset (different from inflammatory myopathies)
  • EMG: myopathic, neurogenic or mixed changes
  • muscle biopsy: muscle fibers with multiple rimmed vacuoles
29
Q

When to consider systemic therapy for Sjogren syndrome

A

1) Evidence of joint disease (erosions, bone damage)
2) CNS or systemic disease

Consider methotrexate for arthritis
Cyclosporine/rituximab for severe or systemic CNS disease

30
Q

Findings in scleritis

A

1) eye pain
2) pain with gentle palpation of the globe
3) photophobia
4) scleromalacia (thinning of the sclera -> dark area), may lead to perforation

Rheumatoid arthritis is a common inflammatory cause

Note that episcleritis is infrequently associated with inflammatory/rheumatological disease

31
Q

What makes up the arthritis-dermatitis syndrome of disseminated gonococcal infection?

A

1) Tenosynovitis
2) Dermatitis (painless pustular or vesiculopustular lesions)
3) polyarthralgia without frank athritis

Also will see fever, chills and malaise

32
Q

Lofgren syndrome (seen in acute sarcoid arthritis)

A

1) hilar adenopathy
2) Acute arthritis
3) Erythema nodosum

The arthritis is usually oligoarticular

33
Q

Takayasu arteritis vs. subcranial GCA

A

TA is seen in young women (9:1 ratio) between 15 and 24. Affects the aorta and major branches.

Subcranial GCA usually has preceding symptoms c/w PMR, as well as vasculitis affecting the large subcranial vessel. Seen in elderly patients and is a late feature of GCA. May cause heart failure.

34
Q

Secondary causes of Calcium Pyrophosphate (CPP) arthritis (pseudogout)

A

1) hyperparathyroidism
2) Hypothyroidism
3) hypophosphatemia
4) hypomagnesemia
5) hemochromatosis

35
Q

In GPA relapse, what medication is used to introduce remission

A

Rituximab

Shown to be superior to cyclophosphamide for relapsed ANCA vasculitis

36
Q

Treatment for primary angiitis of CNS (PACNS)

A

Cyclophosphamide and high dose glucocorticoids

37
Q

What are the features of Adult-Onset Stills Disease?

A

1) Spiking fevers
2) Pharyngitis
3) Evanescent salmon pink rash
4) Adenopathy, HSM
5) Elevated liver enzymes
6) leukocytosis with neutrophil predominance
7) inflammatory arthritis
8) Myalgias
9) extremely high ferritin

Look for this during pregnancy or in postpartum period

38
Q

Anti-HMG Co-A reductase antibody

A

Seen in immune-mediated nectorizing myopathy

  • consider in patient on a statin presenting with persistent myopathy following discontinuation of statin
  • also use muscle biopsy to aid in diagnosis
39
Q

Anti-cytosolic 5’-nucleotidase 1A antibodies

A

seen in inclusion body myositis (high specificity)

40
Q

Treatment for undifferentiated connective tissue disease (UCTD)

A

Hydroxychloroquine

41
Q

Recommended treatments for SLE nephritis

A

1) Mycophenolate mofetil (class V, if no renal dysfunction)
2) Cyclophosphamide (not preferred d/t SE)
3) Azathioprine
4) Rituximab

Mycophenolate mofetil is teratogenic, must be stopped 3 months prior to anticipated pregnancy

42
Q

Side effects of DMARD therapy in RA

A

Methotrexate: hepatitis, bone marrow suppression
Leflunomide: GI upset, diarrhea, ALT elevation, cytopenias, infection, teratogenesis, and axonal neuropathy

RA patient recently started on leflunomide now with neuropathy symptoms -> stop the leflunomide

43
Q

What class of drug is beliumumab? What is it used for?

A

B-lymphocyte stimulator (BLyS) protein inhibitor

Useful in mild to moderate SLE on glucocorticoids, especially in presence of mucocutaneous or joint symptoms .

44
Q

What are the features of colchicine toxicity?

A

1) Rhabdomyolysis
2) AKI
3) Pancytopenia

Colchicine should be avoided in conjunction with CYP3A4 inhibitors (e.g. clarithromycin, fluconazole)

45
Q

Skin findings in subacute cutaneous lupus

A

Annular with central clearing or papulosquamous with patchy erythematous plaques and papules.

~ 50% of patients with SCLE also have SLE

46
Q

Drug-induced ANCA vasculitis. What drugs are implicated?

A

1) Hydralazine
2) Minocycline
3) PTU, Methimazole, Carbimazole (antithyroid drugs)

Look for double positive titers

47
Q

Longstanding Systemic Sclerosis is a risk factor for what?

A

NHL (B-cell lymphoma)

Particularly if disease present for >6 years

48
Q

How to differentiate between primary and secondary Raynaud’s on exam?

A

Nail fold capillary examination (normal in primary RP)

49
Q

Signs of methotrexate toxicity

A

Somatitis
Megaloblastic anemia

Depletes folic acid stores, make sure folic acid is supplemented for all patients taking MTX

ABIM Prep Flashcards (12 decks)

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