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#‼️INTERNAL MEDICINE - PLE TOPNOTCH 2020 > RHEUMATOLOGY AND IMMUNOLOGY > Flashcards

RHEUMATOLOGY AND IMMUNOLOGY Flashcards

1
Q

Most common type of arthritis

A

Osteoarthritis (OA)

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2
Q

A 35-year-old woman presents with 6-month history of hand stiffness and symmetric polyarticular arthritis. The stiffness is worst in the morning. Joint examination reveals mild swelling and tenderness over MCP joints of both hands and knees. The ESR is elevated.

A

RA

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3
Q

Most serious manifestation of SLE

A

Lupus nephritis

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4
Q

Classification of Lupus Nephritis

A
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5
Q

A 55-year-old obese woman complains that her left knee occasionally “locks up” and hurts after long walks. On examination, there is crepitus and decreased range of motion of the left knee but not warm or erythematous. The right hand reveals non-tender enlargement of distal interphalangeal joint.

A

Osteoarthritis

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6
Q

A 40-year-old woman with morning joint stiffness and bilateral ulnar deviation.

A

Rheumatoid arthritis

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7
Q

NON-GONOCOCCAL ARTHRITIS

A
  • 90% involves single joint– most commonly the knee;
  • Polyarticular infection (in patients with rheumatoid arthritis)
  • Sternoclavicular joints, spine and sacroiliac joints involvement among IV drug user
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8
Q

Formerly viewed as the core of all other RA therapy (but now an adjunct)

A

NSAIDs

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9
Q

SLE in pregnancy should be controlled with ___

A

hydroxychloroquine ± prednisone/prednisolone.

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10
Q

specific for SLE

A

Anti Sm

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11
Q

most common hematologic abnormality of RA

A

Normocytic normochromic anemia

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12
Q

Most useful for confirming an inflammatory arthritis (vs OA), while at the same time excluding infection or gout

A

Synovial fluid analysis

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13
Q

Defined as either keratoconjunctivitis sicca (dry eyes) or xerostomia (dry mouth) with another CTD, such as RA

A

Sjögren syndrome

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14
Q

Jones criteria for ARF

A

o Two major PLUS evidence of preceding GAS infection

o One major + two minor PLUS evidence of preceding GAS infection

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15
Q

What are the differentials for isolated DIP involvement?

A

o Osteoarthritis (Heberden’s nodes) is usually not inflammatory

o Gout involving > 1 DIP joint often involves other sites with tophi

o Others: multicentric reticulohistiocytosis, inflammatory OA

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16
Q

A 23-year-old female presents right arm claudication. She also complains of malaise, fever, and arthralgias. Right brachial and radial pulses are absent.

A

Takayasu arteritis

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17
Q

most popular drugs to treat osteoarthritic pain

A

NSAIDs

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18
Q

DISSEMINATED GONOCOCCAL ARTHRITIS

A

• Migratory arthritis and tenosynovitis (knees, hands, wrist, feet and ankle)

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19
Q

most common early clinical manifestation of gout.

A

Acute arthritis

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20
Q

Early sign of inflammatory joint disease and can predict subsequent development of erosions

A

Bone marrow edema

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21
Q

DMARD of choice for early RA

A

Methotrexate

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22
Q

Most common pulmonary manifestation of SLE

A

Pleuritis w/ or w/o pleural effusion

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23
Q

DURATION OF PROPHYLAXIS

RF with carditis and persistent residual valvular disease

A

10 years after last attack or until 40 years old (whichever is longer, sometimes lifetime)

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24
Q

A 20-year-old female presents with abdominal pain, joint pains, and palpable rashes on the buttocks up to legs

A

HENOCH-SCHÖNLEIN (IgA VASCULITIS)

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25
Q

Population most often affected by gout

A

Middle-aged to elderly men and postmenopausal women

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26
Q

Mainstay of treatment during acute gouty attack:

A

o NSAID (First-line)

o Colchicine

o Glucocorticoids

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27
Q

Commonly affected joints in OA include

A

Cervical/lumbosacral hip, knee, and 1 st MTP

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28
Q

Urticaria vs Angioedema

A
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29
Q

DISCUSS THE ALGORITHM FOR MUSCULOSKELETAL COMPLAINT

A
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30
Q

What is the single most accurate test for RA?

A

Anti-CCP antibodies

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31
Q

most common route of spread of gonococcal arthritis in all age groups.

A

Hematogenous route of infection

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32
Q

Clinical Features of Felty’s Syndrome

A
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33
Q

useful in distinguishing lupus cerebritis and steroid-induced psychosis

A

Anti-neuronal and anti-ribosomal P

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34
Q

negatively birefringent needle-shaped monosodium urate crystals

A

Gout

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35
Q

Simplest effective treatment for OA

A

Avoid activities that precipitate pain

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36
Q

Mainstay tx for Non-life threatening SLE

A

Analgesic and antimalarials

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37
Q

In SLE, most have intermittent polyarthritis, most commonly in _____

A

Hands, wrists, knees

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38
Q

Most popular drugs to treat osteoarthritic pain

A

NSAIDs

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39
Q

What is the pathologic sine qua non of OA?

A

Hyaline articular cartilage loss

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40
Q

Medications approved for use in SLE

A

NSAIDS, salicylates, Hydroxychloroquine, Oral steroids, IV Methylprednisolone

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41
Q

Periarticular osteopenia as the initial radiographic finding

A

RA

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42
Q

Most common affected artery in takayasu arteritis?

A

Subclavian

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43
Q

_____ is more common with mycophenolate mofetil.

______ is more common with cyclophosphamide.

A

Diarrhea is more common with mycophenolate mofetil.

Nausea is more common with cyclophosphamide.

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44
Q

Differentiate OA from RA

A
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45
Q

initial radiographic finding of RA

A

Periarticular osteopenia

Other x-ray findings: Soft tissue swelling, joint space loss, subchondral erosions

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46
Q

Characteristic radiographic features (distinguish PsA from RA)

A

o DIP involvement or Pencil-in-cup deformity

o Marginal erosions with adjacent bony proliferation (“whiskering”)

o Small joint ankylosis

o Osteolysis of phalangeal and metacarpal bone, with telescoping of digits

o Periostitis and proliferative new bone at sites of enthesitis

o Characteristics of axial PsA: asymmetric sacroiliitis

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47
Q

DURATION OF PROPHYLAXIS

RF without carditis

A

5 years after last attack or until 21 years old (whichever is longer)

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48
Q

Frequent hallmark of RA and leads to decreased ROM, reduced grip, and trigger fingers

A

Flexor tendon tenosynovitis

49
Q

What is the mainstay treatment for life-threatening SLE?

A

Systemic glucocorticoid

50
Q

Most commonly used hypouricemic agent & is the best drug to lower urate in overproducers, stone formers, and renal disease

A

Allopurinol

51
Q

Clinical Manifestations of Rheumatoid arthritis

A

• Early morning joint stiffness lasting more than 1 hour (eases with physical activity)

  • Swelling of the hand joints (MCP, PIP) and feet (MTP)
  • Symmetric distribution
  • Flexor tenosynovitis (frequent hallmark)

• “Swan-neck deformity”

• “Boutonniere deformity”

• “Z-line deformity”

  • Ulnar deviation from subluxation of the MCP joints
  • Piano-key movement of ulnar styloid (inflammation about ulnar styloid & tenosynovitis of extensor carpi ulnaris – leads to subluxation of distal ulna)
52
Q

Marginal erosions with adjacent bony proliferation (“whiskering”)

A

Psoriatic arthritis

53
Q

What is your initial treatment of choice for RA?

A

DMARDs (Methotrexate)

54
Q

A 40-year-old man with swollen and painful 1 st MTP joint after a binge drinking.

A

gout

55
Q

most common pulmonary manifestation of RA

A

Pleuritis i

56
Q

How is diagnosis confirmed in takayasu arteritis?

A

Characteristic pattern on arteriography (e.g. irregular vessels walls, stenosis, aneurysm, occlusion)

57
Q

Most important autoantibody to detect in SLE

A

ANA

58
Q

positively birefringent rhomboid-shaped calcium pyrophosphate dehydrate (CPPD) crystals

A

Pseudogout

59
Q

What is the best antibiotic for secondary prophylaxis ARF?

A

Benzathine penicillin G

60
Q

Most common acute rash of SLE

A

Butterfly rash (photosensitive, raised erythema, scaly, on cheeks/nose, ears, chin, V region of neck and chest, upper back, extensor surface of arms)

61
Q

Multiple target-appearing plaque + drug exposure

A

Think of Erythema multiforme

62
Q

Most serious cardiac manifestation

A

Myocarditis, LiebmanSacks endocarditis

63
Q

Sicca syndrome, subacute cutaneous lupus, neonatal lupus with CHB

A

Anti-Ro (SS-A)

Anti-La (SS-B) same as anti-RO (both are associated with DECREASED risk for nephritis)

64
Q

“CREST” syndrome

A
65
Q

Pathologic hallmarks of RA

A

o Synovial inflammation

o Focal bone erosions

o Thinning of articular cartilage

66
Q

differentiate Erythema marginatum vs migrans vs multiforme.

A
67
Q

A 60-year old woman with left hip pain during walking stairs and bony enlargement of the first DIP.

A

OA

68
Q

What is the best initial treatment of OA?

A

Pain management (Acetaminophen or Paracetamol)

69
Q

What test correlates with disease activity in SLE?

A

Anti-dsDNA

70
Q

best screening for SLE

A

ANA

71
Q

Expanding bull’s eye rash + complete heart block + tick bite

A

Think of Lyme disease (Borrelia burgdorferi)

72
Q

Gives examples of MSK disorders according to predilection sites on the hand.

A
73
Q

Clinical manifestations of OA

A
  • Joint pain is activity related.
  • Morning joint stiffness is brief (<30 min)
  • Knee pain arise from knee flexion (stair climbing, arising from chair); knee buckling may occur.
  • Commonly affected joints: Cervical and lumbosacral spine, Hip, Knee, first MTP joint, hand joints (DIP, PIP)
  • Usually spared joints: Wrist, Elbow, Ankle
74
Q

Most common chronic dermatitis in lupus (lesions: circular, slightly raised, scaly hyperpigmented erythematous rims and depigmented, atrophic centers)

A

Discoid lupus erythematosus (DLE)

75
Q

most common clinical features of ARF

A

Polyarthritis (60-75%) and carditis (50-60%)

76
Q

Offers greatest sensitivity for detecting synovitis & joint effusions; and early bone/bone marrow changes

A

MRI

77
Q

Most common form of chronic inflammatory arthritis and often results in joint damage and disability

A

Rheumatoid arthritis

78
Q

hallmark of rheumatic carditis

A

Valvular damage (Mitral valve and sometimes aortic valve)

79
Q

Joint space loss or narrowing

A

OA

80
Q

A 30 year old male with a history of psoriasis sought consult for joint pains, including the DIPs. There is note of dactylitis, with pronounced telescoping of the 2 nd left finger. Hyperkeratosis and onycholysis, nail dystrophy are also noted.

A

Psoriatic arthritis

81
Q

most common valvular abnormality in RA

A

Mitral regurgitation

82
Q

Most common manifestation of diffuse CNS lupus

A

Cognitive Dysfunction

83
Q

drug induced lupus (MC: hydralazine, procainamide, quinidine, INH, minocycline)

A

Anti-histone

84
Q

What is the best initial diagnostic step in OA?

A

X-ray of the affected joint

85
Q

Most common cardiac manifestation of SLE

A

Pericarditis

86
Q

Hallmark features of psoriatic arthritis

A

dactylitis and enthesitis

87
Q

The drug of choice for anaphylaxis is:

A

Epinephrine 0.3 – 0.5 mL 1:1000 IM

88
Q

DIFFERENTIATE ARTICULAR VS NON-ARTICULAR DISORDERS.

A

ARTICULAR DISORDERS

• Deep/diffuse pain or limited ROM during passive and active movement

• Swelling, crepitation, instability, deformity

NONARTICULAR DISORDERS

  • Painful on active (but not passive) ROM
  • Seldom with swelling, crepitus, instability
  • Examples: trauma/fracture, fibromyalgia, polymyalgia rheumatica, bursitis, tendinitis
89
Q

Cystic changes with well-defined erosions and overhanging sclerotic margins and soft tissue masses

A

GOUT

90
Q

Drug-induced lupus causes

A

procainamide, hydralazine, propylthiouracil, lithium, phenytoin, isoniazid, nitrofurantoin, sulfasalazine, statins

91
Q

characteristic radiologic features of gout

A

Cystic changes with well-defined erosions and overhanging sclerotic margins and soft tissue masses

92
Q

Most frequently involved joints in RA

A
  • Wrists, MCP, PIP
  • DIP involvement is usually a manifestation of coexistent OA
93
Q

increased in SLE with overlap features of other CTD’s

A

Anti-RNP

94
Q

Most common cause of death in those with RA

A

Cardiovascular disease

95
Q

DMARDs safe in pregnancy:

A

Hydroxychloroquine and sulfasalazine

96
Q

What joint is not affected in RA?

A

DIP

97
Q

Most frequent site of cardiac involvement in RA

A

Pericardium

98
Q

Most common musculoskeletal manifestation of SLE

A

Arthralgia/ Myalgia

99
Q

A 22-year-old woman cervical discharge, rashes on forearms and elbow swelling and tenderness.

A

Gonococcal arthritis

100
Q

What is the pathophysiology of takayasu arteritis?

A

Inflammation (panarteritis) and stenosis of medium/large sized arteries with predilection for aortic arch and branches

101
Q

differentiate Psoriatic arthritis from RA

A

In psoriatic arthritis: seronegative, often with DIP, spine, and sacroiliac joints; distinctive radiographic features; and familial aggregation

102
Q

Leading causes of mortality on the first decade of SLE

A

Nephritis and infection

103
Q

the most common cause of chronic knee pain in persons >45 years old

A

Osteoarthritis

104
Q

Joint most frequently affected in calcium pyrophosphate deposition disease (CPPD)

A

Knee

105
Q

Most common early clinical manifestation of gout

A

Acute arthritis; usually only 1 joint is affected (metatarsophalangeal joint of 1st toe is often involved)

106
Q

Worst prognosis type of lupus nephritis

A

Crescentic Lupus Nephritis

107
Q

Most common cutaneous manifestation of SLE

A

Photosensitivity

108
Q

Initial analgesic of choice for patients with OA

A

Acetaminophen (Paracetamol)

109
Q

Mainstay tx for Life threatening SLE

A

Systemic glucocorticoids PO/IV

110
Q

Evanescent migrating rash + first degree AV block

A

Think of Rheumatic fever

(Erythema Marginatum)

111
Q

DURATION OF PROPHYLAXIS

RF with carditis, but no residual valvular disease (no clinical or echocardiographic evidence of valvular disease)

A

10 years after last attack or until 21 years old (whichever is longer)

112
Q

Endocardial involvement in SLE can lead to valvular insufficiencies, most commonly of the _____

A

Mitral or aortic valves

113
Q

Most cases of chronic urticaria are

A

Idiopathic

114
Q

Most common of all drug-induced reactions

A

Morbilliform or maculopapular reactions

115
Q

Extent of epidermal detachment in Stevens-Johnson Syndrome:

A

< 10% body surface area

116
Q

A complication of systemic sclerosis presenting with blurring of vision, severe headache and chest pain

A

Scleroderma Renal Crisis

117
Q

The histocompatibility antigen with striking correlation with Ankylosing Spondylitis

A

HLA-B27

118
Q

Punched out lytic lesions with overhanging edges as radiographic findings

A

Gout

119
Q

Most common manifestation of tuberculous arthritis

A

Chronic monoarthritis of large, weight-bearing joints

#‼️INTERNAL MEDICINE - PLE TOPNOTCH 2020 (10 decks)

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