Vivs Mksap Rheumatology

Front 1

Treatment of Giant Cell Arteritis?

Back 1

Methylprednisolone 1g/day or 100 mg iv q 8 hours x 3 d

Hint 1

diagnostic testing should not preclude treatment of the disorder if symptoms are classic.
Biopsy remains positive even 2 weeks after steroids started.

Front 2

What needs to be evaluated for in refractory dermatomyositis?

Back 2

A search for malignancy

Hint 2

Higher incidence of ovarian ca in women with dermatomyositis.

Front 3

What are the disease modifying antirheumatic drugs?

Back 3

Methotrexate
Sulfasalazine
Hydrochlorquine
leflunomide
tnf alpha inhibitors

Hint 3

Methotrexate is usually firstline
Hydroxychlorquine is used for mild, nonerosive disease.
Cytoxan is reserved for rheumatoid vasculitis involvement
Add tnf alpha inhibitor to MTX instead of replacing MTX with it (it is more effective this way).

Front 4

What needs to be evaluated if you combine mtx with leflunomide for rh arthritis

Back 4

hepatic function

Front 5

What should you do if a woman with rh arthritis experiences a severe flare in her rheumatoid while she is breast feeding?

Back 5

discontinue breastfeeding and start a DMARD

Front 6

Which DMARDs are safe in pregnancy?

Back 6

sulfasalazine and hydroxyquinone
can use nsaids in first and second trimesters only.

Front 7

Biologic agents used in rheumatoid?

Back 7

tnf alpha inhibitors
abatacept t cell costimulation inhibitor
rituximab anti-cd20 monoclonal antibody

Front 8

Precipitators of an acute gouty attack?

Back 8

trauma, surgery, diuretics/meds, transplant recipients on cyclosporine

Front 9

When is prophylactic treatment of isolated hyperuricemia indicated?

Back 9

when the renal function is compromised. Uric acid level elevation doesn't necessarily equate to gout attacks.

Front 10

What are disorders associated with
hyperuricemia?

Back 10

tophi
gout
nephropathy due to crystal deposition in the interstitium
nephrolithiasis

Front 11

The diagnosis of gout is definitively made by _______ but a presumptive diagnosis can be made by:

Back 11

aspiration and visualization of crystals (but 25% in acute attacks will lack this)
clinical course and suggestive radiograph

Hint 11

radiograph: overhanging edges and asymnetric erosions.

Front 12

When should colchicine be considered?
When should interarticular steroid be considered?

Back 12

when attack is <24 hours old and the patient has nl renal function
Once infection has been excluded with an arthrocentesis

Hint 12

max colchicine dose 6 mg/day
avoid iv colchicine use (bm toxicity)
oral prednisone requires high dses (>40 mg qd)

Front 13

When is chronic uric acid lowering therapy indicated in gout?

Back 13

after at least two attacks or in patients with renal stones, decreasing periods between attacks or visible tophi.

Hint 13

goal uric acid level <6.0mg/dl.

Front 14

What drugs should be avoided with the use of allopurinol?

Back 14

azathioprine (requires switch to mychophenolate) and thiazide diuretics (may preciptate acute skin necrolysis in the setting of ARF)

Front 15

Other chronic uric acid lowering drugs include:

Back 15

probenecid and sulfinpyrazone (contraindicated in those with renal insufficiency or kidney stones)

Front 16

Drugs to prevent an attack in situations known to precipitate attacks?

Back 16

colchicine, low dose prednisone (<10mg/day) nsaids given one week prior to event

Front 17

Treatment of cns lupus is:
Manifestations on MRI head are:

Back 17

cytoxan plus methylprednisone
mri may be normal or show small areas of ischemia in the periventricular and subcortical white matter

Front 18

Diagnostic criteria for osteroarthirits of the knee
Radiographic findings:

Back 18

age >50, crepitus, bony tenderness, bony enlargement, absence of palpable warmth
Joint cyst formation, sclerosis, joint space narrowing

Front 19

Risk factors of avascular necrosis:

Back 19

alcoholism, steroid use, sle,
radiographs: avascular necrosis, subchondral radiolucency cysts, sclerosis, joint space narrowing a

Front 20

Drugs used for lupus nephritis?
How long to continue cytoxan?

Back 20

azathioprine, mycophenolate, and cytoxan
once remission is achieved; need to swtich to another immunosuppressive 50% relapse. Usually use at least six months of cytoxan.

Front 21

causes of asymmetric arthritis

Back 21

gout, pseudogout, infectious, reactive arthritis, psoriatic, gonococcal, acute rheumatic fever

Front 22

Best test for ankylosing spondylitis?

Back 22

mri sacroiliac joints

Front 23

reactive arthritis occurs within ___time period of a infection or gastroenteritis

Back 23

2 months

Front 24

dactylitis, marked dip joint involvement, asymmetric joint involvement, enthesitis, joint ankylosis: think of what?

Back 24

psoriatic arthritis

Front 25

nsaids can exacerbate the gastrointestinal system in what type of arthritis?

Back 25

inflammatory bowel disease and enteropathic associated arthritis

Front 26

Why should steroids be used cautiously in psoriatic arthritis?

Back 26

It can cause a flare of the skin disease when it is tapered.

Hint 26

arthrocentesis through a pleural plaque is contraindicated

Front 27

Treatment of psoriatic arthritis?

Back 27

methotrexate, sulfsalazine, tnf alpha inhibitors

Other agents: leflunomide, cyclosporine

Front 28

First line therapy for anklyosing spondylitis?

Back 28

tnf alpha inhibitors

Front 29

What drugs are not effective in anklyosing sponylitis axial involvement?

Back 29

methotrexate and sulfsalazine; they are useful for peripheral arthritis associated with anklyosing spondylitis

Front 30

What is the treatment of choice for reactive arthritis?

Back 30

nsaids; steroids can be used for chronic disease or recurrent disease.

Front 31

What is the treatment of enteropathic arthritis?

Back 31

Treat underlying ibd
For axial involvement, use tnf alpha inhibition

Front 32

Why should hydroxychloroquine be used with caution in those with psoriasis?

Back 32

It can cause an acute flare

Front 33

Treatment of choice for fibromyalgia?

Back 33

aerobic activity, CBT
elavil/tricyclics, cyclobenzaprine
pregabalin
duolextine

Hint 33

no proven role for nsaids or prednisone

Front 34

Medications for rheumatoid arthritis?

Back 34

First line: methotrexate
hydroxychlorquine(for mild disease)

Front 35

Hydroxyochlorquine is contraindicated in what patients?
Can it be used in pregnancy?
What needs to be monitored with hydroxychlorquine?

Back 35

those with renal and hepatic failure
Pregnancy class C; benefits outweigh risks
optho exam needed for macular toxicity