Test your basic knowledge |

USMLE Step3 Rheumatology

Subjects : health-sciences, 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

Warning: Invalid argument supplied for foreach() in /var/www/html/basicversity.com/show_quiz.php on line 183

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

Warning: Invalid argument supplied for foreach() in /var/www/html/basicversity.com/show_quiz.php on line 183

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