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ABIM UWorld > Rheumatology and Orthopedics > Flashcards

Rheumatology and Orthopedics Flashcards

1
Q

RA step up tx

A

MTX for 6 months

  • persistent sx - add sulfalazine/plaquenil or step up
  • step up = add biologic - TNF inhibitor
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2
Q

before start TNF inhibitor - check?

A

TB, hep C, hep B

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3
Q

target uric acid when treating gout

A

less than 6

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4
Q

4SKIN RASH NIANA

A

Lupus manifestations:

  • 4 rashes - malar, discoid, photosensitive, oral ulcers
  • RASH - renal, arthritis, serositis, hematologic
  • NIANA - neurologic, immunologic, ANA
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5
Q

rash that spares nasolabial folds

A

malar rash

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6
Q

diagnosis of fibro requires

A

symptoms more than 3 months

normal inflammatory markers

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7
Q

tx giant cell arteritis

A

high dose pred

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8
Q

tx PMR

A

low dose pred

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9
Q

pseudogout crystals?

A

calcium pyrophosphate

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10
Q

DIP arthritis and arthritis mutilans

A

psoriatic arthritis

- also - pencil in cup deformity

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11
Q

prognostic factors for erosive RA

A 
anti-CCP and RF
early development affecting multi joints
radiographic erosions
lower SES and education
elevated ESR and CRP 
functional limitations
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12
Q

arthritis at base of thumb

A

OA

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13
Q

5% risk of developing this in sjogrens - commonly in parotid gland

A

non-hodgkin lymphoma

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14
Q

risk fx for developing lymphoma in sjogrens

A 
anti Ro/SSA and La/SSB Abs
RF Ab
cryo
hypocomplement
lymphopenia
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15
Q

negative ANCA and concern for GPA?

A

does NOT rule it out

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16
Q

pain and paresthesias sole of foot, distal foot, toes

A

tarsal tunnel syndrome

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17
Q

locking of knee with extension

A

meniscal tear

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18
Q

ottawa ankle rules

A

X-ray ankle if:

  • pain at malleolar zone
  • tender tip medial malleolus
  • tender tip of lateral malleolus
  • unable to bear weight

X-ray foot if:

  • pain midfoot zone
  • tender at navicular
  • tender base 5th metatarsal
  • unable bear weight
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19
Q

synovial fluid in septic arthritis

A

WBC typically 50-150k

gram stain - negative in 20-30% of cases

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20
Q

primary raynauds work up

A

normal nailfold capillaroscopy
normal ANA and ESR
tx - CCBs

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21
Q

erythema infectiousum

A

fifth disease - parvo b19

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22
Q

parvo b19 in sickle cell

A

aplastic crisis

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23
Q

diagnosis parvo b19

A

acute - B19 IgM in immunocompetent or NAAT for DNA in immunocompromised
prior - B19 IgG
reactivation - NAAT for DNA

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24
Q

progressive osteoporosis management

A

first = oral bispho
if BMD loss less 5% continue and DXA 2 years
if BMD loss more 5% - consider IV bispho, teriparatide, denosumab

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25
Q

severe osteoporosis T score

A

less than -3.5

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26
Q

screen if progressive osteoporisis

A

hyperT, hyperPTH, MM, malabsorption, liver disease, CKD

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27
Q

triad of feltys

A

neutropenia, RA, splenomegaly

in 1% of patients with seropositive advanced RA

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28
Q

extra-articular manifestations of feltys

A

mononeuritis multiplex, necrotizing skin lesions, pleuropericarditis, LAD, episcleritis

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29
Q

sweets syndrome

A

neutrophilic dermatosis associated with malignancy and autoimmune disease
- erythematous plaques with pseudo blistering and pustules - face, necks, chest, extremities

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30
Q

tx of PMR

A

15-20mg / d prednisone

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31
Q

tx of reactive arthritis

A

NSAIDS (abx don’t work)

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32
Q

associations with marfans

A

AO root dilation and dissection
ectopia lentis
mitral valve prolapse
PTX

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33
Q

PAN association

A

hep B

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34
Q

vessels involved in PAN

A

typically - mesenteric and renal vessels (spares pulmonary)

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35
Q

tx PAN

A

pred and cyclophosphamide

ACEI for HTN

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36
Q

essential mixed cryo association

A

hep C

- will see low complement

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37
Q

MAP presentation

A

inflammation of small blood vessels

- GN and pulm findings (hemoptysis, DAH, pulm fibrosis)

38
Q

chondrocalcinosis

A

pseudogout

39
Q

osteitis fibrosa cystica

A

complication of severe primary hyperPTH

  • brown tumors of long bones
  • tapering distal clavicles
  • salt and pepper of skull
  • subperiosteal bone resorption
40
Q

dermatomyositis symptoms

A

gottrons papules
shawl sign
periorbital heliotrope rash

41
Q

increased risk of what in dermatomyositis

A

cancer - need routine screening

42
Q

milwaukee shoulder

A

basic Ca phosphate deposition
hemorrhagic synovial fluid
crystals = hydroxyapatite

43
Q

tx mild RA

A

plaquenil or sulfasalazine

44
Q

tx mod-severe RA

A

MTX is initial drug of choice

45
Q

tx fibro

A

TCA, pregabaline, duloxetine, milnacipran

46
Q

diagnosis of GCA (criteria)

A

need 3 of 5 for 94% SN and 91% SP

  • age greater 50 (greatest risk fx)
  • new onset HA with fever, visual changes
  • ESR over 50
  • tender temporal artery
  • bx with necrotizing arteritis
47
Q

anti-histone Abs

A

drug induced lupus

48
Q

fever, high ferritin, arthritis, salmon colored rash

A

drug induced lupus

49
Q

patient with lupus and has concern for kidney?

A

biopsy it

- if proteinuria greater 500mg/d, elevated Cr, active urine sediment

50
Q

MTX toxicity

A

stomatitis

megaloblastic anemia

51
Q

supp while taking MTX

A

folic acid - 1mg/d (cain increase to 5)

52
Q

prognostic factors for erosive RA

A

anti-CCP

erosions on XR = marginal erosions

53
Q

LE symptoms - worse walking down hill and better rest and bending forward

A

spinal stenosis
aka = pseudoclaudication
diagnosis - MRI

54
Q

young patient with thrombocytopenia, stroke, prolonged PTT

A

test for antiphospholipid syndrome

55
Q

diagnosis of antiphospholipid

A

1 clinical and 1 lab criteria

  • lab - lupus anticoag, anticardiolipin Ab, anti beta-2 glycoprotein
  • clinical - vascular thrombosis or pregnancy issue
56
Q

chronic accumulation of colchicine

A

in CKD patients

  • neuromyopathy
  • resolves with d/c of drug
57
Q

colchicine accumulation on muscle bx finding

A

cytoplasmic vacuolization

58
Q

screening for GCA

A

osteoporosis

yearly - CXR for thoracic aortic aneurysm

59
Q

complex regional pain syndrome types

A 
1 = without definable nerve lesion
2 = associated with known peripheral lesion
60
Q

hook osteophytes 2nd and 3rd MCPs

A

hemochromatosis

elevated serum transferrin saturation

61
Q

rhomboid, positive birefringent, calcium pyrophosphate

A

pseudogout

62
Q

risk of recurrent aspiration PNA

A

dermatomyositis

  • weak oropharyngeal and upper 3rd esophagus
  • can develop ILD
63
Q

target for urate lowering treatment in gout

A

uric acid less than 6

64
Q

symptomatic vertebral compression fracture treatment

A

NSAID, tylenol, opioids

- if this fails - intranasal calcitonin 2-4 weeks

65
Q

hypertrophic osteoarthropathy and associations

A

clubbing and periosteal inflammation

  • common - non small cell lung ca
  • also - CF, chronic lung infection, cyanotic heart disease, cardiac shunts
66
Q

risk of cervical region in RA

A

C1-2 subluxation

67
Q

radiograph with lytic and sclerotic lesions, elevated bone alk phos

68
Q

tx pagets

69
Q

cANCA and anti-PR3

A

GPA - CdefG

- sinus, pulmonary, renal, systemic sx

70
Q

pANCA and anti-MPO

A

MPA - MnoP

71
Q

septic bursitis WBC

A

WBC greater 3k

non-septic - less 1.5k

72
Q

anti topoisomerase

A

scl-70 - systemic sclerosis

73
Q

anti-mitochondrial Ab

74
Q

anti Jo1 and antisynthetase

75
Q

lofgrens syndrome and tx

A

sarcoid variant

  • erythema nodosum, ankle arthritis, hilar adenopathy
  • tx - NSAIDs
76
Q

palpable purpura, arthralgias, MPGN, low serum complement, neuropathy

A

essential mixed cryo - hep C

tx hep C - may reduce the cryoglobulins

77
Q

tx adult onset stills

A

NSAIDs, if bad may need steroids

78
Q

HSP

A

leukocytoclastic vasculitis

IgA

79
Q

presenting skin symptoms of HIV

80
Q

CREST variant of what type SSc

A

limited cutaneous

81
Q

risk for CREST with lungs

82
Q

risk of diffuse SSc with lungs

83
Q

risk fx for avascular necrosis hips

A

chronic steroid, alcohol, sickle cell, SLE

XR - crescent sign - late sign - MRI better

84
Q

synovial WBC if septic arthritis

A

greater 100k WBC and 80-90% PMNs

85
Q

recurrent oral and genital ulcers

A

behcets disease

86
Q

point tenderness along medial knee

A

pes anserine pain syndrome

87
Q

pathergy test

A

2mm papule after inserting needle 5mm into skin

for behcets disease

88
Q

renal manifestations sjogrens

A

chronic interstitial nephritis

89
Q

vertebral compression fracture and activity

A

resume ASAP

  • avoid bed rest
  • if 6 weeks pain - kyphoplasty/vertebroplasty
90
Q

need bisphos in men for prevention ostoeporosis

A

greater 7.5mg/d for greater 3 month of prednisone

91
Q

anti-RNP Abs

A

mixed CTD

- increased mortality and risk pHTN

ABIM UWorld (20 decks)

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