Mksap: Rheumatology

Front 1

history of systemic lupus erythematosus (SLE) with deep venous thrombosis, pulmonary embolism or first-trimester miscarriages also is strongly suggestive of ___.

Back 1

antiphospholipid antibody syndrome
(APS)

Front 2

antiphospholipid antibody syndrome (APS) is characterized by the presence of one type of autoantibody known as ___ and at least one recognized clinical feature [venous or arterial thromboses, recurrent fetal loss, or thrombocytopenia].

Back 2

antiphospholipid antibody

Front 3

___ is considered first-line treatment for antiphospholipid antibody syndrome (APS)-related microangiopathy.

Back 3

anticoagulation

Front 4

following arthrocentesis; the presence of a synovial fluid leukocyte count higher than ___ would strongly suggest an infectious process.

Back 4

50,000/µL

Front 5

The differential diagnosis of acute monoarticular arthritis includes infection, ___, ___, and ___.

Back 5

gouty arthritis
fracture
Lyme disease.

Front 6

Extensive new-onset psoriasis accompanied by asymmetric peripheral arthritis (that predominantly involves the small joints) and dactylitis is a constellation of symptoms consistent with ___.

Back 6

psoriatic arthritis

Front 7

___ should be excluded in all patients with new-onset psoriasis or psoriatic arthritis, as well as in those with mild forms of these conditions who experience an explosion of their disease.

Back 7

HIV infection

Front 8

Diagnostic criteria for ___ consist of the presence of oral ulcerations that recur at least three times in 1 year and at least two of the following manifestations: recurrent genital ulcerations, inflammatory eye disease, cutaneous lesions, and positive results on a pathergy test.

Back 8

Behçet disease

[How do you treat?]

Hint 8

steroids (prednisone)

Front 9

What is a pathergy test?

Back 9

characterized by a papule developing 48 hours after insertion of a 20-gauge needle intradermally (used in the dx of Behçet disease).

Front 10

Pseudogout is associated with inflammatory synovial fluid and the presence of ___ that are weakly positively birefringent and rhomboid in shape seen on polarized light microscopy.

Back 10

CPPD (calcium pyrophosphate dihydrate) crystals

Front 11

Treatment of an acute pseudogout attack primarily involves ___.

Back 11

NSAIDs

[corticosteroid or colchicine would be appropriate alternative choices]

Front 12

Osteoarthritis that manifests in patients with CPPD deposition or the presence of chondrocalcinosis on radiography is known as ___.

Back 12

pseudo-osteoarthritis

[mimics osteoarthritis except that it may affect joints not typically involved in osteoarthritis, such as the wrists, metacarpophalangeal joints, shoulders, and ankles]

Front 13

Patients with long-standing rheumatoid arthritis have a significant risk of cervical instability at the ___.

Back 13

atlantoaxial articulation

Front 14

what are the ANCA-associated vasculitides?

Back 14

Wegener granulomatosis
Microscopic polyangiitis
Churg-Strauss syndrome

Front 15

Type ___ cryoglobulinemia is most commonly associated with vasculitis.

Back 15

type 2 cryoglobulinemia

[approximately 85% to 95% of cases of type II cryoglobulinemia are associated with hepatitis C virus infection]

Front 16

Bacterial and fungal arthritis would most likely be associated with a synovial fluid leukocyte count of at least ___ with a predominance of neutrophils.

Back 16

10,000/µL

[leukocyte count in patients with bacterial arthritis often exceeds 100,000/µL]

Front 17

Patient's with Churg-Strauss syndrome who have cardiac, GI, renal or CNS involvement should be treated with high-dose corticosteroids PLUS ___.

Back 17

cyclophosphamide

Front 18

___ is a multisystem disorder characterized by the presence of allergic rhinitis, asthma, and eosinophilia.

Back 18

Churg-Strauss syndrome

Front 19

Churg-Strauss syndrome has a mean age of diagnosis of 48 years, and the most commonly involved organ in affected patients is the ___ followed by the ___.

Back 19

LUNG followed by the SKIN

Front 20

CREST syndrome:

Back 20

Calcinosis
Raynaud phenomenon
Esophageal dysmotility
Sclerodactyly
Telangiectasia

Front 21

___ have been shown to reduce the frequency and severity of attacks in patients with both primary and secondary Raynaud phenomenon, and these agents are frequently used as first-line treatment in this condition.

Back 21

Dihydropyridine calcium channel blockers
[ie amlodipine]

Front 22

headache, temporal artery tenderness, acute visual loss, fever, and mild anemia are strongly suggestive of ___.

Back 22

giant cell arteritis (GCA)

Front 23

Pain in the shoulder and hip girdle accompanied by a significant elevation in the erythrocyte sedimentation rate is consistent with ___.

Back 23

polymyalgia rheumatica

Front 24

Evaluation for a(n) ___ is warranted in patients with dermatomyositis who are refractory to treatment, particularly those who are older than 60 years of age.

Back 24

occult malignancy

Front 25

Use of a ___ in addition to methotrexate is significantly more effective in controlling joint damage and improving function compared with single-agent therapy, and should be added when disease control is not achieved with one or more oral disease-modifying antirheumatic drugs (DMARDs) like methotrexate.

Back 25

tumor necrosis factor α inhibitor
(etanercept / infliximab / adalimumab)

Front 26

The presence of c-ANCA and antiproteinase-3 antibodies is approximately 90% specific for ___.

Back 26

Wegener granulomatosis

Front 27

Many patients who use ___ develop autoantibodies, including antinuclear, anti–double-stranded DNA, and anti-Smith antibodies; rarely, these patients develop drug-induced lupus.

Back 27

tumor necrosis factor α inhibitors
(etanercept / infliximab / adalimumab)

Front 28

___ is a variant of sarcoidosis characterized by acute monoarticular arthritis (typically involving the ankles), erythema nodosum, and hilar lymphadenopathy - and usually has a good prognosis.

Back 28

Löfgren syndrome

Front 29

the rash in ___ is characterized by sharply marginated, red-to-pink indurated papules and plaques that are round, oval, or polycyclic and have an adherent scale involving the face, scalp, and ear canals accompanied by follicular plugging.

Back 29

discoid lupus
[a form of chronic cutaneous lupus]

Front 30

___ usually manifests as fever, arthralgia, and serositis; antihistone antibodies also are universally present.

Back 30

drug-induced lupus
(phenytoin can cause)

Front 31

The presence of acute oligoarticular arthritis involving the lower extremities in a patient with an inflammatory diarrheal illness is suggestive of ___.

Back 31

enteropathic arthritis

Front 32

Whipple disease is an extremely rare infectious syndrome caused by ___.

Back 32

tropheryma whippelii

Front 33

The most common presenting symptom in ___ is arthritis; other symptoms include diarrhea, malabsorption, and central nervous system and constitutional symptoms. Joint involvement is usually migratory and follows a chronic course.

Back 33

whipple disease

Front 34

In patients with central nervous system lupus, aggressive treatment with ___ and ___ is indicated.

Back 34

corticosteroids
monthly pulse cyclophosphamide

Front 35

___ are the treatment of choice for scleroderma renal crisis

Back 35

ACE-I
(enalapril)

Front 36

Once lupus nephritis remission has been induced with 3 to 6 months of cyclophosphamide therapy, patients can safely be switched to ___ or ___.

Back 36

mycophenolate mofetil
or
azathioprine

[or - cyclophosphamide infusions can be reduced to every 3 months for an additional 18 months.]

Front 37

___ is the most common cause of chronic, inflammatory polyarthritis in premenopausal women.

Back 37

rheumatoid arthritis

Front 38

Rheumatoid arthritis commonly affects the ___, ___ and ___ joints.

Back 38

metacarpophalangeal
proximal interphalangeal
wrist

Front 39

Methotrexate is a DMARD that is often used in patients with active rheumatoid arthritis but would be contraindicated in a patient with ___, ___ or ___.

Back 39

abnormal LFT's
underlying liver disease
consume a lot of alcohol

Front 40

Either ___ or ___ would be appropriate as initial therapy to treat early, mild, nonerosive rheumatoid arthritis.

Back 40

sulfasalazine
or
hydroxychloroquine

[start w/in 3 months of diagnosis to prevent irreversible joint damage]

Front 41

___ typically manifests as an insidious onset of asymmetric proximal and distal muscle weakness associated with only moderately elevated creatine kinase levels.

Back 41

Inclusion body myositis

Front 42

Adult-onset ___ is an inflammatory disease characterized by 2 of the 3 major criteria: polyarthritis, fever that spikes 1-2 times daily and/or leukocytosis.

Back 42

Adult-onset Still disease

Front 43

___ classically is characterized by the acute onset of severe hypertension, renal failure, and microangiopathic hemolytic anemia.

Back 43

scleroderma renal crisis (SRC)
(treat with ACEI)

Front 44

In patients with psoriatic arthritis, ___ helps to control cutaneous and musculoskeletal manifestations, slows the progression of joint destruction, and is considered first-line therapy for this condition.

Back 44

methotrexate

Front 45

This constellation of psoriasis, dactylitis, and symmetric peripheral polyarthritis involving the small joints is concerning for ___.

Back 45

psoriatic arthritis

Front 46

Mixed connective tissue disease is characterized by Raynaud phenomenon, arthralgia, and myositis accompanied by high titers of ___ antibodies.

Back 46

antiribonucleoprotein antibodies

Front 47

___ is characterized by Raynaud phenomenon, arthralgia, and myositis accompanied by high titers of antiribonucleoprotein antibodies.

Back 47

Mixed connective tissue disease

Front 48

abdominal pain, symptoms of peripheral neuropathy, testicular tenderness, and skin biopsy specimen showing necrotizing vasculitis are consistent with ___.

Back 48

polyarteritis nodosa

Front 49

patients with polyarteritis nodosa in the acute setting who also have Hep B should undergo ___ accompanied by ___.

Back 49

short term high-dose steroid therapy

long term antiviral agent

Front 50

___ infection in adults typically initially manifests as constitutional symptoms and an erythematous rash followed by symmetric arthritis of the small joints that may mimic RA.

Back 50

Parvovirus B19 infection

Front 51

Parvovirus B19 infection in children characteristically manifests as fever and an erythematous malar rash known as the ___ rash

Back 51

“slapped cheek”

Front 52

The most common antisynthetase antibody is the ___ antibody

Back 52

anti–Jo-1
[Not all patients with anti–Jo-1 antibodies develop the antisynthetase syndrome and not all patients with this syndrome have all of its manifestations, but patients who have anti–Jo-1 antibodies typically have several features of the antisynthetase syndrome in addition to their muscle disease.]

Front 53

The greatest concern in patients with antisynthetase syndrome is the risk for developing ___.

Back 53

interstitial lung disease

Front 54

___ is an appropriate second-line agent in the treatment of osteoarthritis and is particularly useful in patients with osteoarthritis of the knee who are intolerant of or who do not achieve adequate pain control using NSAIDs.

Back 54

tramadol

Front 55

Approximately one third of patients with active systemic lupus erythematosus who have abdominal pain have ___.

Back 55

mesenteric vasculitis
[typically warrants immediate treatment with high-dose corticosteroids and intravenous cyclophosphamide; occasionally, surgical intervention is indicated.]

Front 56

Patients with an inflammatory myopathy and features of systemic sclerosis, systemic lupus erythematosus, and rheumatoid arthritis accompanied by high titers of antiribonucleoprotein antibodies often have ___.

Back 56

mixed connective tissue disease

Front 57

___ is usually effective in managing mild manifestations of systemic lupus erythematosus and helps to prevent disease flares.

Back 57

hydroxychloroquine

Front 58

The most commonly diagnosed systemic illnesses in patients with anterior uveitis are ___, ___ and ___.

Back 58

reactive arthritis
ankylosing spondylitis
sarcoidosis

Front 59

In women treated with cyclophosphamide, coadministration of ___ helps to maintain fertility and provide contraception.

Back 59

leuprolide acetate
(administered 2 weeks before administration of each cyclophosphamide dose)

Front 60

Diagnosis of ___ is based on the presence of inflammation in at least two cartilaginous sites (ie ears, nose, trachea) or the presence of inflammation at one site accompanied by at least two of the following features that need not be present at the same time: ocular inflammation, audiovestibular manifestations, and/or inflammatory arthritis.

Back 60

relapsing polychondritis

Front 61

signs of active SLE disease include:

Back 61

anemia
leukopenia
thrombocytopenia
hypocomplementemia
anti–double-stranded DNA Abs

Front 62

___ typically manifests as subacute migratory polyarthralgia and arthritis; tenosynovitis; and pustular, vesicopustular, or papular lesions.

Back 62

disseminated gonococcal infection

Front 63

The initial manifestations of ___ include fever, arthralgia, myalgia, fatigue, and weight loss and may precede the development of signs and symptoms of large-vessel narrowing by several months.

Back 63

Takayasu arteritis

Front 64

The CDC recommends treatment of latent tuberculosis infection for all patients planning to take a tumor necrosis factor α inhibitor who have a tuberculin skin test result of 5 mm or more of induration or a positive ___.

Back 64

interferon-γ release assay

Front 65

___ are indicated as first-line therapy for ankylosing spondylitis and usually are associated with a degree of symptomatic relief and improvement in inflammatory changes visible on MRI.

Back 65

tumor necrosis factor α inhibitors

Front 66

___ and ___ are approved pharmacologic therapy for the management of fibromyalgia.

Back 66

pregabalin
duloxetine

Front 67

Septic arthritis in patients with systemic lupus erythematosus, AIDS, or sickle cell anemia can be associated with ___ (organism).

Back 67

salmonella

Front 68

Septic arthritis in patients who use illicit injection drugs often have infection with ___(organism).

Back 68

pseudomonas aeruginosa

Front 69

___ is characterized by the presence of inflammatory arthritis that manifests within 2 months of an episode of bacterial gastroenteritis or nongonococcal urethritis or cervicitis in a genetically predisposed patient.

Back 69

reactive arthritis

Front 70

The presence of fatigue and iron deficiency anemia in a patient with systemic sclerosis should raise suspicion for ___.

Back 70

gastric antral vascular ectasia
(GAVE)

aka "watermelon stomach"

Front 71

___ is typically a self-limited condition that is characterized by purpuric rash, arthralgia, abdominal pain, and renal involvement (that may manifest as hematuria and proteinuria).

Back 71

Henoch-Schönlein purpura (HSP)

Front 72

A skin biopsy that shows ___ accompanied by ___, is characteristic of HSP.

Back 72

leukocytoclastic vasculitis
(accompanied by)
perivascular IgA deposition

Front 73

Patients with primary Sjögren syndrome have up to a 44-fold increased incidence of ___.

Back 73

lymphoma

[*should be monitored closely for lymphadenopathy]

Front 74

Testing for ___ and ___ is very useful in confirming a suspected clinical diagnosis of Wegener granulomatosis

Back 74

c-ANCA

antiproteinase-3 antibody

Front 75

A synovial fluid leukocyte count above ___ indicates inflammation and a count above ___ suggests infection.

Back 75

>2000/µL inflammation

>50,000/µL infection

Front 76

___ vaccination is safe in already immunosuppressed patients and is indicated for patients undergoing immunosuppressive therapy.

Back 76

pneumococcal