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Test your basic knowledge |
USMLE Step3 Rheumatology
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Study First
Subjects
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health-sciences
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usmle-step-3
Instructions:
Answer 50 questions in 15 minutes.
If you are not ready to take this test, you can
study here
.
Match each statement with the correct term.
Don't refresh. All questions and answers are randomly picked and ordered every time you load a test.
This is a study tool. The 3 wrong answers for each question are randomly chosen from answers to other questions. So, you might find at times the answers obvious, but you will see it re-enforces your understanding as you take the test each time.
1. MCP joint involvement
Measure ESR; polymyalgia rheumatica; tx prednisone
Symmetrical proximal weakness; increased CPK
1RA look for morning stiffness >30m - joint erosion in radiography - acute onset; pseudogout--stiffness <30min - comorbid conditions eg. hemochromatosis - dm
Spaghetti legs - walking like a drunken sailor; coz patient cannot extend spine
2. right anterior knee pain and provoked by climbing stairs or prolong sitting
Patello femoral pain syndrome
MRI to eval osteonecrosis of femoral head; may also affect humeral head - femoral condyles - vertebra - hands and feet; tx total hip replacemebt
Hypertriglyceridamia and hypercholesterolemia
NSAID if kidney function is OK and no hx of GI bleeding; very important; in kidney transplant patient - NSAID decrease renal PG production - other immunosuppresive like cyclosporine also decreases renal PG; concomitant use will compromise renal funct
3. when SLE patient needs steroid
Hydroxychloroquine and prednison; hydroxychloroquine effective against future damage kidneys and CNS - arthralgia - serositis and cutaneous symptomes. low dose prednisone until hydroxychloroquine ine effect.
Renal biopsy is needed when kidney is involved; Type 1 and type 2 need no tx; type 3 and 4 need immunosuppresion cyclophosphamide; more frequent patter; type 5 needs tx when it is proliferative
Referred pain from cervical spine; due to nerve impingmement due to disc herniation; spinal stenosis at cervical spine levle
Disease when it is idiopathic; phenomenon when 2ndary to connective tissue disease - vascular lesions - medications
4. proximal muscle weakness; decreased tendon reflex; normal creat and ck
Disseminated gonoccal infection
SLE - only minutes; RA; hours;
Check pedal pulses; in claudication pulses should diminish
R/o myopathy; cannot be excluded by ck and creat; next step EMG; then muscle bx
5. Low back pain
Arthritic sweling of DIP
AS; sometime only symptom is uveitis;
Search for fever - hx cancer - IVDA - osteoporois; bowel/bladder incontinece/saddle anesthesia-->suspicion of cauda equina syndrome;
PMR and giant cell arteritis; can be seen both together;
6. What is heliotrope sign
Osteoarthirit (bouchard at pip - b comes first);
Uricosuric. need creatinin clearance >350 or else ineffective; contraindicated in renal failure or post-transplnat
Pt with significant organ involvement and have incomplete response to prednisone alone
Erythematous-violaceous rash on the eyelids
7. primary muscle disease
Patello femoral pain syndrome
Symmetrical proximal weakness; increased CPK
Pain control and physical therapy - if fails - ESR -CRP - lumbar xray;
Dorsum of hands and the Achilies tendon
8. morning stiffness hand joints
Stenosis; pain improves with flexion or sittiing worse in extension; disc herniation opposite
SLE - only minutes; RA; hours;
No NSAID - no colchicine (CI-ARF); r/o septic arthritis - similar presentation; give intraarticular corticosteroid if one joint involvement; if multiple joint involved give oral prednisone
Hypertriglyceridamia and hypercholesterolemia
9. pain in shoulder and pelvic girdle
R/o myopathy; cannot be excluded by ck and creat; next step EMG; then muscle bx
Anti-ds DNA; the levels have been associated iwth development of lupus nephritis; immune complexes of these antibodies are seen glomeruli of patient with lupus nephriis
Measure ESR; polymyalgia rheumatica; tx prednisone
Dermatomyositis - in adult 2ndary to malignancy eg lung ca
10. mcp and PIP joint involvement
Prednisone and cyclophosphamide
ESRD
Think about reiter (cannot see - cannot pee - cannot climb a tree)
Viral arthritis or RA
11. Tx of inflammatory myositis
Search for fever - hx cancer - IVDA - osteoporois; bowel/bladder incontinece/saddle anesthesia-->suspicion of cauda equina syndrome;
Dermatomyositis - in adult 2ndary to malignancy eg lung ca
High dose corticosteroid (prednisone 1mg/kg) if fails - add immunosuppresant`
C for c ; crest syndrome
12. complications of anti-cytokine therapy
Measure ESR; polymyalgia rheumatica; tx prednisone
High incidence of opportunistitc infection; reactivation of TB;
R/o myopathy; cannot be excluded by ck and creat; next step EMG; then muscle bx
A for aortic regurg; s for prolapSe (MVP)
13. When to start DMARD in RA
Spinous process of 5th lumbar disc identified and maked; a point 10cm above the first mark. the patient is asked bend forward; then two points are measured. normal 15 cm
Early in the course of disease; methotrexate doc; if response no adequate add other dmard
Tx ca channel blocker if no improvement look for systemic disease and order ANA - RF CBC - blood
R/o myopathy; cannot be excluded by ck and creat; next step EMG; then muscle bx
14. When to give methotrexate in SLE
Anti-ds DNA; the levels have been associated iwth development of lupus nephritis; immune complexes of these antibodies are seen glomeruli of patient with lupus nephriis
Pt with significant organ involvement and have incomplete response to prednisone alone
Pain control and physical therapy - if fails - ESR -CRP - lumbar xray;
Disseminated gonoccal infection
15. Tx of RA
Decrease urate secretion from kidney
Gout - Reiter's syndrome-->urethritis/conjunctivitis; psoriasis
Tx methotrexate - disesase modifying drugs; if no improvemnet after 6m - anti-cytokine drug infliximab - etanercept;
Disseminated gonoccal infection
16. What should be chekcked before starting infliximab
Pain control and physical therapy - if fails - ESR -CRP - lumbar xray;
PPD
Inflammatory involvement of axial joints; first step - xray lumbosacral spine to demonstate sacrolitis and spondylitis
No NSAID - no colchicine (CI-ARF); r/o septic arthritis - similar presentation; give intraarticular corticosteroid if one joint involvement; if multiple joint involved give oral prednisone
17. increased ALP; liver or bone origin?
Prophylactic agent to prevent recurrent attack; not given during acute attack
Order LFT - heat fractionation (bone burns and liver lives) - GGT
Primary biliary cirrhosis
1RA look for morning stiffness >30m - joint erosion in radiography - acute onset; pseudogout--stiffness <30min - comorbid conditions eg. hemochromatosis - dm
18. Rayanaud's disease vs phenomenon
Biceps tendinitis; seen in patients with acromioclavicular or glenohumeral joint osteoarthritis
Uricosuric. need creatinin clearance >350 or else ineffective; contraindicated in renal failure or post-transplnat
Disease when it is idiopathic; phenomenon when 2ndary to connective tissue disease - vascular lesions - medications
Pain - paresthesia in the medial n distribution; thumb - first two fingers; tx continuous wrist spint-reduce pressure on the nerve.
19. How to monitor disease activity in SLE
If symptoms persist >6weeks
Abx -bedrest - exercise
Viral arthritis or RA
Anti-dSdna and complement levels; they are deposited in mesangium or subendotherlial space and fixed with neutrophil;
20. Management of HTN during acute gout
Decrease urate secretion from kidney
Encroaching osteophytes; hypertrophy of ligamentum flavum - protrusion of intervertevra disks;
If symptoms persist >6weeks
ARBs and clonidine CI: HCTZ - furosemide - increases serum uric acid levels; aspirin decreases renal excretion of uric acid
21. SLE with pleural effusion
NSAID if kidney function is OK and no hx of GI bleeding; very important; in kidney transplant patient - NSAID decrease renal PG production - other immunosuppresive like cyclosporine also decreases renal PG; concomitant use will compromise renal funct
Hydroxychloroquine and prednison; hydroxychloroquine effective against future damage kidneys and CNS - arthralgia - serositis and cutaneous symptomes. low dose prednisone until hydroxychloroquine ine effect.
AS; sometime only symptom is uveitis;
Tinel for tapping; reproduction of symptoms upon tapping or percussing over median n; phalen more sensitive than tinel
22. How to differential lumbar spinal stenosis and disc herniation pain?
Encroaching osteophytes; hypertrophy of ligamentum flavum - protrusion of intervertevra disks;
Calcitonin or bisphosphonate to decrease bone turnover; hearing loss not reversible
Osteoarthirit (bouchard at pip - b comes first);
Stenosis; pain improves with flexion or sittiing worse in extension; disc herniation opposite
23. anti-ds DNA antibody
Renal biopsy is needed when kidney is involved; Type 1 and type 2 need no tx; type 3 and 4 need immunosuppresion cyclophosphamide; more frequent patter; type 5 needs tx when it is proliferative
Tinel for tapping; reproduction of symptoms upon tapping or percussing over median n; phalen more sensitive than tinel
1RA look for morning stiffness >30m - joint erosion in radiography - acute onset; pseudogout--stiffness <30min - comorbid conditions eg. hemochromatosis - dm
Specific of dx of SLE
24. Tx of reiter
Abx -bedrest - exercise
Prednisone and cyclophosphamide
If more than 10 times about the upper limit of normal range; chances of statin myopathy higher if statin is used in combination with fibric acid derivative
Dorsum of hands and the Achilies tendon
25. tinel sign
Tinel for tapping; reproduction of symptoms upon tapping or percussing over median n; phalen more sensitive than tinel
B cell lymphom; sjogren results in polyclonal B cell activation and infiltration in salivary gland; increased lymphocyte activation results in b cell lymphoma
Search for fever - hx cancer - IVDA - osteoporois; bowel/bladder incontinece/saddle anesthesia-->suspicion of cauda equina syndrome;
Anti-ds DNA; the levels have been associated iwth development of lupus nephritis; immune complexes of these antibodies are seen glomeruli of patient with lupus nephriis
26. schirmer test
Pain control and physical therapy - if fails - ESR -CRP - lumbar xray;
To test adequate tear production in sjogren syndrome; filter paper is placed along lower eyelid and wetting of paper measured after a defined period of time.
Tinel for tapping; reproduction of symptoms upon tapping or percussing over median n; phalen more sensitive than tinel
Dermatomyositis - in adult 2ndary to malignancy eg lung ca
27. PIP joint involment
Increased serum ferritin (acute phase protein)
Osteoarthirit (bouchard at pip - b comes first);
C for c ; crest syndrome
Viral arthritis or RA
28. unilateral eye pain - photophobia - blurry vision young patients wih lumbar pain
Prednisone and cyclophosphamide
Calcitonin or bisphosphonate to decrease bone turnover; hearing loss not reversible
Uricosuric. need creatinin clearance >350 or else ineffective; contraindicated in renal failure or post-transplnat
AS; sometime only symptom is uveitis;
29. Finding of MRI in stenosis
Osteoarthirit (bouchard at pip - b comes first);
Encroaching osteophytes; hypertrophy of ligamentum flavum - protrusion of intervertevra disks;
Order LFT - heat fractionation (bone burns and liver lives) - GGT
Arthritis swelling of PIP (remember b comes first or proximal); present both in RA and OA
30. bouchard nodule
Arthritis swelling of PIP (remember b comes first or proximal); present both in RA and OA
Referred pain from cervical spine; due to nerve impingmement due to disc herniation; spinal stenosis at cervical spine levle
Check pedal pulses; in claudication pulses should diminish
Uricosuric. need creatinin clearance >350 or else ineffective; contraindicated in renal failure or post-transplnat
31. SLE patient p/w MI - vent fibrillation
Arthritis swelling of PIP (remember b comes first or proximal); present both in RA and OA
Coronary atherosclerosis due to SLE
Hypertriglyceridamia and hypercholesterolemia
MRI to eval osteonecrosis of femoral head; may also affect humeral head - femoral condyles - vertebra - hands and feet; tx total hip replacemebt
32. phalen test
Prednisone and cyclophosphamide
ESRD
Disease when it is idiopathic; phenomenon when 2ndary to connective tissue disease - vascular lesions - medications
Hyperflexion of both wrists--characteristic pain in one min
33. How often disease activity is monitored in AS?
Reactive arthritis (reiter's syndrome); 80% HLA b27 positive - preceding genitourinary or gi infection eg chlamydia cervicitis or urethritis or shigella salmonesll and campylobacter infection
Dermatomyositis - in adult 2ndary to malignancy eg lung ca
Xray every 3m
Minocyclin - inhibits metalloproteases and slows joint damage
34. How to perform schober test
Spinous process of 5th lumbar disc identified and maked; a point 10cm above the first mark. the patient is asked bend forward; then two points are measured. normal 15 cm
Renal biopsy is needed when kidney is involved; Type 1 and type 2 need no tx; type 3 and 4 need immunosuppresion cyclophosphamide; more frequent patter; type 5 needs tx when it is proliferative
To test adequate tear production in sjogren syndrome; filter paper is placed along lower eyelid and wetting of paper measured after a defined period of time.
ESRD
35. Use of allopurinol after kidney transplant
Measure ca and ALP; increased ALP and normal ca for dx;
Tinel for tapping; reproduction of symptoms upon tapping or percussing over median n; phalen more sensitive than tinel
Azathioprine dose need to be reduced. azathiprine decrease activity xanthine oxidase which also metabolize azathioprine
Pain - paresthesia in the medial n distribution; thumb - first two fingers; tx continuous wrist spint-reduce pressure on the nerve.
36. Gait in spinal stenosis
Hypertriglyceridamia and hypercholesterolemia
Check pedal pulses; in claudication pulses should diminish
Viral arthritis or RA
Spaghetti legs - walking like a drunken sailor; coz patient cannot extend spine
37. who gets reiters syndrome after chlamydia infection
Give calcium and vitamine D therapy ; bisphosphonate may be added if the risk highl bone densitometry
If person is HLA B27 positive
Used in acute attack. contraindicated when patient is taking azathioprine; s/e leukopenia
To test adequate tear production in sjogren syndrome; filter paper is placed along lower eyelid and wetting of paper measured after a defined period of time.
38. colchicine
Used in acute attack. contraindicated when patient is taking azathioprine; s/e leukopenia
Minocyclin - inhibits metalloproteases and slows joint damage
B cell lymphom; sjogren results in polyclonal B cell activation and infiltration in salivary gland; increased lymphocyte activation results in b cell lymphoma
No NSAID - no colchicine (CI-ARF); r/o septic arthritis - similar presentation; give intraarticular corticosteroid if one joint involvement; if multiple joint involved give oral prednisone
39. conjunctivitis - urethritis - and spondyloarthopathy
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40. night back pain
Abx -bedrest - exercise
Spinous process of 5th lumbar disc identified and maked; a point 10cm above the first mark. the patient is asked bend forward; then two points are measured. normal 15 cm
Viral arthritis or RA
Malignancy - infection - vertebral fracture
41. What marker is used to follow up disease activity in SLE
Disease when it is idiopathic; phenomenon when 2ndary to connective tissue disease - vascular lesions - medications
High incidence of opportunistitc infection; reactivation of TB;
Search for fever - hx cancer - IVDA - osteoporois; bowel/bladder incontinece/saddle anesthesia-->suspicion of cauda equina syndrome;
Anti-ds DNA; the levels have been associated iwth development of lupus nephritis; immune complexes of these antibodies are seen glomeruli of patient with lupus nephriis
42. How to differentiate radicular pain with claudication
Order LFT - heat fractionation (bone burns and liver lives) - GGT
Check pedal pulses; in claudication pulses should diminish
Prednisone and cyclophosphamide
To test adequate tear production in sjogren syndrome; filter paper is placed along lower eyelid and wetting of paper measured after a defined period of time.
43. allpurinol
Prophylactic agent to prevent recurrent attack; not given during acute attack
Hyper triglyceridemia
LBP with morning stiffness; limitation of lumbar spine ROM; limitation of chest expansion
To test adequate tear production in sjogren syndrome; filter paper is placed along lower eyelid and wetting of paper measured after a defined period of time.
44. carpal tunnel
Pain control and physical therapy - if fails - ESR -CRP - lumbar xray;
Hypertriglyceridamia and hypercholesterolemia
Anti-dSdna and complement levels; they are deposited in mesangium or subendotherlial space and fixed with neutrophil;
No benefit of nsaid; firstline therapy night time splinting; oral corticosteroid for short term improvment; surgery for moderate to severe symptoms; occupational rehab before surgery eg less typing - less wrist flexion-extension
45. glucocorticoid therapy
Prophylactic agent to prevent recurrent attack; not given during acute attack
No benefit of nsaid; firstline therapy night time splinting; oral corticosteroid for short term improvment; surgery for moderate to severe symptoms; occupational rehab before surgery eg less typing - less wrist flexion-extension
Give calcium and vitamine D therapy ; bisphosphonate may be added if the risk highl bone densitometry
Renal biopsy is needed when kidney is involved; Type 1 and type 2 need no tx; type 3 and 4 need immunosuppresion cyclophosphamide; more frequent patter; type 5 needs tx when it is proliferative
46. criteria for AS
LBP with morning stiffness; limitation of lumbar spine ROM; limitation of chest expansion
Measure ca and ALP; increased ALP and normal ca for dx;
Minocyclin - inhibits metalloproteases and slows joint damage
Check pedal pulses; in claudication pulses should diminish
47. xanthomatous nodule
1RA look for morning stiffness >30m - joint erosion in radiography - acute onset; pseudogout--stiffness <30min - comorbid conditions eg. hemochromatosis - dm
Encroaching osteophytes; hypertrophy of ligamentum flavum - protrusion of intervertevra disks;
Dorsum of hands and the Achilies tendon
Reactive arthritis (reiter's syndrome); 80% HLA b27 positive - preceding genitourinary or gi infection eg chlamydia cervicitis or urethritis or shigella salmonesll and campylobacter infection
48. DIP joint involvement
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49. probenecid
Hypertriglyceridamia and hypercholesterolemia
Tx methotrexate - disesase modifying drugs; if no improvemnet after 6m - anti-cytokine drug infliximab - etanercept;
Uricosuric. need creatinin clearance >350 or else ineffective; contraindicated in renal failure or post-transplnat
LBP with morning stiffness; limitation of lumbar spine ROM; limitation of chest expansion
50. inflamed tendons in wrist - ankle - arms; sexual history
Disseminated gonoccal infection
Dorsum of hands and the Achilies tendon
Uricosuric. need creatinin clearance >350 or else ineffective; contraindicated in renal failure or post-transplnat
Viral arthritis or RA