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USMLE Step 2 CK Flash Cards > Rheumatology/Musculoskeletal > Flashcards

Rheumatology/Musculoskeletal Flashcards

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USMLE® Step 1 flashcards
1
Q

What is Felty syndrome?

A
  • Rare complication (<1%) of rheumatoid arthritis:
  • High titer rheumatoid factor
  • Splenomegaly
  • Neutropenia (<1500, <1000→↑risk of clinically significant infection)
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2
Q

Treatment for Felty syndrome

A
  • Gold
  • MTX (second-line Tx for RA)
  • G-CSF for severe neutropenia or unresponsive to Tx for RA, and when splenectomy is contraindicated or not possible
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3
Q

Cardiac manifestation of ankylosing spondylitis

A

Chronic aortic regurgitation (complication)➡Heart failure▶⬇exercise capacity, shortness of breath

*Chronic inflammation of the aortic root and valve cusps▶retraction of valve cusps, impaired valve closure

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4
Q

Which risk of neoplasia do patients with Paget disease of bone have?

A

⬆Bone remodeling and overgrowth➡osteogenic sarcomatous transformation (⬆several thousand times than the general population)

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5
Q

Diseases associated with erythema nodosum

A
  • Streptococcal infection
  • Sarcoidosis
  • Tuberculosis
  • Endemic fungal disease (Histoplasmosis)
  • Inflammatory Bowel Disease
  • Behcet Disease
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6
Q

Primary mechanism underlying the most common cytopenias in SLE

A

Autoantibodies➡Immune-mediated peripheral destruction (in all 3 cell lines)

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7
Q

Which conditions you must study in a patient with pseudogout?

A
  • Hyperparathyroidism
  • Hypothyroidism
  • Hemochromatosis
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8
Q

Sudden posterior knee and calf pain with “crescent sign” most probably may suggest.

A

Ruptured popliteal Baker cyst

*But rule out deep venous thrombosis as well with ultrasound

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9
Q

What should you think in a patient with Rheumatoid arthritis history and worsening of weakness and painless sensation of 4 extremities after intubation?

A

Worsening subluxation of the atlantoaxial joint➡cord compression➡cervical myelopathy

*Atlantoaxial instability due RA

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10
Q

What treatment you should add to treat hypercalcemia from sarcoidosis or any granulomatous disease?

A

Prednisone

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11
Q

Greatest risk factors for curve progression in adolescent idiopathic scoliosis

A
  • Female
  • Age <12 years
  • Early pubertal status (premenarchal)
  • Skeletal immaturity
  • Severe curvature (Cobb angle ≥25 degrees)
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12
Q

Use of extremities arteriogram in a patient with Raynaud phenomenon

A

Diagnose Thromboangiitis obliterans (Buerger disease)

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13
Q

Drugs for chronic treatment of gout to control the high uric acid levels

A
  • Allopurinol: ❌Xanthine oxidase; purine analogue➡inhibit other enzymes▶⬇production of uric acid (safe with renal injury)
  • Febuxostat: ❌XO; not purine analogue➡only inhibit XO (if allopurinol is contraindicated)
  • Pegloticase: dissolves uric acid
  • Probenecid and sulfinpyrazone (uricosuric): ⬆excretion of uric acid in the kidney (contraindicated in renal insufficiency)
  • Lesinurad: ❌reabsorption of uric acid in the proximal tubule
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14
Q

General recommendations to manage chronic gout and prevent attacks recurrences

A
  1. Diet: ⬇alcohol, lose weight, ⬇high-purine foods (meat, seafood)
  2. Stop thiazides, aspirin, and niacin
  3. Colchicine: prevent attacks because of sudden fluctuations in uric acid levels
  4. Drugs to control uric acid levels
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15
Q

Risk factors for calcium pyrophosphate deposition disease (CPDD) or pseudogout

A
  1. Hemochromatosis, Hyperparathyroidism (chronic hypercalcemia)
  2. Diabetes, hypothyroidism, Wilson disease
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16
Q

Most accurate test for pseudogout, and which is the finding?

A

Arthrocentesis➡positively birefringent rhomboid-shaped crystals

17
Q

Best initial treatment for fibromyalgia

A
  • Aerobic exercise

- Tricyclic antidepressant

18
Q

Drugs options for fibromyalgia treatment

A
  • Amitriptyline
  • Duloxetine or venlafaxine (dual reuptake inhibitors)➡who do not respond to tricyclics
  • Milnacipran (serotonin and norepinephrine reuptake inhibitor approved specifically for fibromyalgia)
  • Pregabalin
19
Q

Best initial test for antiphospholipid syndrome

A

Mixing study➡patient’s plasma is mixed with an equal amount of normal plasma:

  • PTT will come down to normal▶⬆PTT is from clotting factor deficiency
  • Remain ⬆PTT▶APL syndrome antibody is present in plasma
20
Q

Most specific test for the lupus anticoagulant

A

Russell viper venom test (RVVT)➡prolonged with APL antibodies and does not correct on mixing with normal plasma

21
Q

Coagulation tests results on antiphospholipid syndrome

A

⬆PTT, normal PT and INR➡only thrombophilia with abnormality in the PTT

*lupus anticoagulant is more often associated with ⬆PTT

22
Q

Most specific antibody for Systemic sclerosis and CREST

A
  • Systemic sclerosis: Anti-Scl-70 (anti-topoisomerase 1)

- CREST: Anti-centromere

23
Q

Best initial test for inflammatory myopathies with proximal muscle weakness

A

CPK, Aldolase

24
Q

Most accurate test for polymyositis and dermatomyositis

A

Muscle Biopsy

25
Q

Most specific test for Mixed connective tissue disease

A

Anti-U1 ribonuclear protein (RNP)

26
Q

Best initial test for seronegative spondyloarthropathies

A

X-ray of the sacroiliac joint▶Narrowing of the joint

27
Q

Treatment options for Psoriatic Arthritis

A
  • NSAIDs➡best initial therapy
  • Methotrexate➡severe disease or no response to NSAIDs
  • Anti-TNF (Etanercept, Infliximab, Adalimumab)➡methotrexate does not control
    disease
  • Anti-IL17 medications (Secukinumab or Ixekizumab) or Anti-IL12/IL23 (Ustekinumab)➡if anti-TNF fails or resistance
  • Apremilast➡oral phosphodiesterase inhibitor

*Steroids are a wrong choice

28
Q

Chronic shoulder pain with decreased active and passive range of motion in multiple planes, with normal x-ray. Cause and risk factors.

A
  • Adhesive capsulitis (“Frozen shoulder”)➡chronic inflammation, fibrosis and contracture▶loss of the distensibility of the glenohumeral joint capsule
  • Diabetes mellitus, thyroid disorders, chronic immobility, rotator cuff tendinopathy, fracture of proximal humerus
29
Q

Which lab test may help you differentiate granulomatosis with polyangiitis (Wegener granulomatosis) and eosinophilic granulomatosis with polyangiitis (Churg-Strauss syndrome)?

A
  • Wegener granulomatosis➡C-ANCA

- Churg-Strauss syndrome➡P-ANCA

30
Q

Biopsy findings of erythema nodosum

A

Septal panniculitis without vasculitis

31
Q

Biopsy findings on a patient with PAH by CREST syndrome

A

Hyperplasia of the intimal smooth muscle layer of the pulmonary arteries

32
Q

Most common cause of nephrotic syndrome in a patient with rheumatoid arthritis

A

Inflammatory Amyloidosis (AA)

33
Q

Next best step in a patient with suspected active rheumatoid arthritis and knee effusion (erythema, swelling, ballotable patella)

A
  • Arthrocentesis➡rule out septic arthritis. RA patients have ⬆risk of septic arthritis
  • Start corticoids is wrong because septic arthritis should be rule out first

USMLE Step 2 CK Flash Cards (17 decks)

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