Step 2 Ck - Rheumatology

Front 1

1. Which viruses cause arthritis with polyarticular distribution (3)?

2. What are the causes of polyarticular distribution of arthritis (3)?

3. What are the causes of migratory arthropathy (3) (Pain and inflammation travels from joint to joint. Presents in one joint -> resolution-> another joint)

Back 1

1. Hep B, EBV, Parvovirus B-19 (causes arthropathy in adults. Look for people in contact with kids)

2. RA, Lupus, Viral causes

3. Lyme ds, Rheumatic fever, Gonococcal (may presents either migratory or monoarticular

Front 2

1. When is joint aspiration contraindicated? What do you test for (3Cs + 1)?

Back 2

1. CI in cellulitis and bleeding diathesis

2. 3 C's (white cell, culture, crystals) and gram stain

In acute monoarticular arthritis always do joint aspiration!!!

Front 3

Give the causes of the following lab findings?

1) WBC < 2000 and no crystals/polarization

2) WBC btw 5000- 50,000 and crystals/polarization (

a)negative

b) needle shaped or negative berefringent

c) Rhomboid or positive birefringent

3) WBC > 50,000 and no crystals and gram stain and cultures usually negative

Back 3

1. Degenerative disc disease

2. a) Rhematoid arthritis

b) Gout

c) CPPD (pseudogout)

3. Septic arthritis

Front 4

100% of Lupus pts have ANA antibodies positive. However if positive doesn't necessarily mean its lupus

1. Anti-ds DNA antibody seen in ____

2. Anti- SM antibody seen in ____

3. Anti-histone antibodies in ____

4. Anti-Ro ab in ____

5. ANti- centromere ab

6. Anti-Jo-1Ab

Back 4

1. Lupus.

2. Lupus

3. Drug induced lupus

4. Neonatal lupus

5. CREST syndrome

6. Dermatomyositis

Front 5

What is the significance of anti-phospholipid antibodies?

Back 5

1. Lupus anticoagulant

2. Anti-cardiolipin antibodies

3. Increased PTT

4. False +ve VDRL

5. Hypercoagulable state

6. Venous and arterial thrombus (one of the few ds with arterial thrombus

7. Spontaneous abortions in otherwise healthy women

Tx = Anticoagulate if symptomatic

Front 6

1. The MCC of death in patients with scleroderma is ____

2. To dx scleroderma what 2 findings must be present:

3. a) Tx of skin manifestations of scleroderma?

b) Tx of Raynaud's

c) Tx of Renal issues with scleroderma(htn)?

4. What is the tx of CREST (aka limited scleroderma)

Back 6

1. Pulmonary fibrosis

2. Raynaud's, skin thickening

3 a): D-Penicillamine

b) CCB

c) ACEI

4. Anti-centromere antibodies

Front 7

1. In pts with Sjogren's syndrome, the glands are infiltrated with these cells?

2. Pts with Sjogren's may develop this cancer?

Back 7

1. lymphocytes. Its an autoimmune exocrine ds.

2. Lymphoma

Front 8

1. What are the extra-articular manifestations of Spondyloarthropathies?

2. What are the causes of Reactive arthritis?

Back 8

1. Erythema nodosum

Oral and genital ulcers

Uveitis, conjunctivitis (Reiter's)

Heart valves

2. After enteroinvasive diarrhea - campylobacter - MCC

After non GC urethritis - Chlamydia

Front 9

Crystal Induced Arthropathies

1. How do we distinguish between them?

2. Which drugs can commonly cause gout (5)?

3. What are the Xray findings of Gout?

4. Describe the crystals in gout?

Back 9

1. Synovial fluid analysis

2. HCTZ, furosemide, Anti-TB (Ethambutol, Pyrazinamide), aspirin

3. Erosions

4. Negative needle shaped birefringent crystals in the joint aspirate

Front 10

5. How do you treat Acute gout?

6. What is the treatment of Chronic gout

Back 10

5.:NSAIDs - high dose of Indomethicin is TOC

Colchicine (2nd Line) - more SE. Choose as answer only if NSAID is not

an answer choice

Steroids - In pts with renal failure and pts with polyarticular gout

6. Allopurinols - Good for both forms of gout (overproduced and under secreter) . Dosed once daily.

Probenecid - undersecreters. Not used as much. tid or qid.

Note: 80 - 90% of patients are undersecreters.

Use Allopurinol only if 2-3 recurrence and pt is sx free at the time.

Front 11

1. In Pseudogout, what is the shape and makeup of the crystals?

2. If pseudo gout is suspected, what is the next step?

Back 11

1. Square/Rhomboid, Calcium pyrophosphate

2. Look for secondary causes. 4Hs

- Hemochromotosis

- Hyperparathyroidism

- Hypophosphatemia

- Hypomagnesemia

Front 12

1.Drug induced lupus in most commonly a/w (4) ?

2. What antibodies to look for in Drug induced lupus?

4. How is it treated.

Back 12

1. Hydralazine, - ANA negative

Isoniazid,

procainamide,

quinidine ANA negative

2. Anti-histone ab

3. Stop the med. Sx should resolve in 1-2 weeks.

Front 13

1. The MCC of death in patients with scleroderma is ____

2. To dx scleroderma what 2 findings must be present:

3. a) Tx of skin manifestations of scleroderma?

b) Tx of Raynaud's

c) Tx of Renal issues with scleroderma(htn)?

4. What is the tx of CREST (aka limited scleroderma)

Back 13

1. Pulmonary fibrosis

2. Raynaud's, skin thickening

3 a): D-Penicillamine

b) CCB

c) ACEI

4. Anti-centromere antibodies

Front 14

1. In pts with Sjogren's syndrome, the glands are infiltrated with these cells?

2. Pts with Sjogren's may develop this cancer?

Back 14

1. lymphocytes. Its an autoimmune exocrine ds.

2. Lymphoma

Front 15

1. What are the extra-articular manifestations of Spondyloarthropathies?

2. What are the causes of Reactive arthritis?

Back 15

1. Erythema nodosum

Oral and genital ulcers

Uveitis, conjunctivitis (Reiter's)

Heart valves

2. After enteroinvasive diarrhea - campylobacter - MCC

After non GC urethritis - Chlamydia

Front 16

Crystal Induced Arthropathies

1. How do we distinguish between them?

2. Which drugs can commonly cause gout (5)?

3. What are the Xray findings of Gout?

4. Describe the crystals in gout?

Back 16

1. Synovial fluid analysis

2. HCTZ, furosemide, Anti-TB (Ethambutol, Pyrazinamide), aspirin

3. Erosions

4. Negative needle shaped birefringent crystals in the joint aspirate

Front 17

5. How do you treat Acute gout?

6. What is the treatment of Chronic gout

Back 17

5.:NSAIDs - high dose of Indomethicin is TOC

Colchicine (2nd Line) - more SE. Choose as answer only if NSAID is not

an answer choice

Steroids - In pts with renal failure and pts with polyarticular gout

6. Allopurinols - Good for both forms of gout (overproduced and under secreter) . Dosed once daily.

Probenecid - undersecreters. Not used as much. tid or qid.

Note: 80 - 90% of patients are undersecreters.

Use Allopurinol only if 2-3 recurrence and pt is sx free at the time.

Front 18

In Septic Arthrits:

a) What is the tx for GC cause:

b) What is the tx for non-GC cause

Back 18

a) Ceftriaxone

b) Vancomycin or nafcicillin because Staph is MCC

Usually Ceftriaxone and Vanc are given simaltaneously till the bug is identified.

Front 19

In which vasculility:

a) May affect multiple organs but never lungs, mononeuropathy, also a/w Hep B

b) How is the ds in (a) diagnosed.

c) How is it tx?

Back 19

a) PAN

b) nerve biopsy

c) Prednisone and cyclophosphamide

Front 20

a) What is the other name for Wegener's granulomatosus?

2 a) In Temporal arteritis, ESR must be higher than?

2 b) What condition is it associated with?

Back 20

2) Granulamotosus with polyangiitis

2 a) ESR > 60. 100% of pts have high ESR. If ESR < 60 then it is NOT Temporal Arteritis.

2 b) Polymyalgia rheumatica

Front 21

Which vasculitis has asthma + eosinophilia?

Back 21

Churg-Strauss.

- Must be considered if asthma appears in a pt without any history of it esp in old age.

Front 22

1. Pain was arm is raised laterally above the level of the shoulder. Dx?

Back 22

1. Subacromial bursitis

Front 23

1. Increased weakness with activity, esp proximal muscles. Cutaneous manifestations,

Back 23

1. Dermatomyositis. To dx ==> EMG.

Note: Malignancy workup is required.

Front 24

1. ____ is the most commonly injured tendon in the rotator cuff

2.

Back 24

1. Supraspinatus