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. anti-mitochondrial
Hyper triglyceridemia
Stenosis; pain improves with flexion or sittiing worse in extension; disc herniation opposite
Primary biliary cirrhosis
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

2. Tx of lupus nephritis
Prednisone and cyclophosphamide
Patello femoral pain syndrome
PMR and giant cell arteritis; can be seen both together;
Malignancy - infection - vertebral fracture

3. patient is having pain when he moves hands above shoulder
Lateral or deltoid shoulder pain; caused by rotator cuff tenditnitis; or tear - impingemen t syndrom or frozen shoulder.
Check pedal pulses; in claudication pulses should diminish
Pain - paresthesia in the medial n distribution; thumb - first two fingers; tx continuous wrist spint-reduce pressure on the nerve.
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

4. When to start DMARD in RA
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
A for aortic regurg; s for prolapSe (MVP)
Used in acute attack. contraindicated when patient is taking azathioprine; s/e leukopenia

5. Use of antibiotic in RA
Primary biliary cirrhosis
Minocyclin - inhibits metalloproteases and slows joint damage
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
Dorsum of hands and the Achilies tendon

6. pagets in xray
Measure ca and ALP; increased ALP and normal ca for dx;
Inflammatory involvement of axial joints; first step - xray lumbosacral spine to demonstate sacrolitis and spondylitis
Viral arthritis or RA
If person is HLA B27 positive

7. criteria for AS
LBP with morning stiffness; limitation of lumbar spine ROM; limitation of chest expansion
Primary biliary cirrhosis
Tx ca channel blocker if no improvement look for systemic disease and order ANA - RF CBC - blood
Nodular lung densitieis with RA;

8. Tx of inflammatory myositis
PPD
Pain control and physical therapy - if fails - ESR -CRP - lumbar xray;
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
High dose corticosteroid (prednisone 1mg/kg) if fails - add immunosuppresant`

9. unilateral eye pain - photophobia - blurry vision young patients wih lumbar pain
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.
AS; sometime only symptom is uveitis;
Decrease ca absorption in the gut; cause renal calcium wasting; direct anti anabolic efects on bone - suppress GnRH-->central hypogonadism--bone loss
Gout - Reiter's syndrome-->urethritis/conjunctivitis; psoriasis

10. inflammatory myositis
Dorsum of hands and the Achilies tendon
LBP with morning stiffness; limitation of lumbar spine ROM; limitation of chest expansion
Nodular lung densitieis with RA;
Increased serum ferritin (acute phase protein)

11. when SLE patient needs steroid
Primary biliary cirrhosis
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
If person is HLA B27 positive
Arthritis swelling of PIP (remember b comes first or proximal); present both in RA and OA

12. Finding of MRI in stenosis
Azathioprine dose need to be reduced. azathiprine decrease activity xanthine oxidase which also metabolize azathioprine
Encroaching osteophytes; hypertrophy of ligamentum flavum - protrusion of intervertevra disks;
Deposition of cholesterol in the periorbital skin
Tinel for tapping; reproduction of symptoms upon tapping or percussing over median n; phalen more sensitive than tinel

13. pain in shoulder and pelvic girdle
Inflammatory involvement of axial joints; first step - xray lumbosacral spine to demonstate sacrolitis and spondylitis
Calcitonin or bisphosphonate to decrease bone turnover; hearing loss not reversible
Anti-dSdna and complement levels; they are deposited in mesangium or subendotherlial space and fixed with neutrophil;
Measure ESR; polymyalgia rheumatica; tx prednisone

14. What is heliotrope sign
Pt with significant organ involvement and have incomplete response to prednisone alone
Erythematous-violaceous rash on the eyelids
Hypertriglyceridamia and hypercholesterolemia
A for aortic regurg; s for prolapSe (MVP)

15. cylosporin used after renal transplantation
Decrease urate secretion from kidney
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
Patello femoral pain syndrome
If person is HLA B27 positive

16. Use of allopurinol after kidney transplant
Abx -bedrest - exercise
Azathioprine dose need to be reduced. azathiprine decrease activity xanthine oxidase which also metabolize azathioprine
Patello femoral pain syndrome
Order LFT - heat fractionation (bone burns and liver lives) - GGT

17. How often disease activity is monitored in AS?
Xray every 3m
ESRD
Deposition of cholesterol in the periorbital skin
A for aortic regurg; s for prolapSe (MVP)

18. inflamed tendons in wrist - ankle - arms; sexual history
LBP with morning stiffness; limitation of lumbar spine ROM; limitation of chest expansion
Disseminated gonoccal infection
Give calcium and vitamine D therapy ; bisphosphonate may be added if the risk highl bone densitometry
Biceps tendinitis; seen in patients with acromioclavicular or glenohumeral joint osteoarthritis

19. carpal tunnel
Anti-dSdna and complement levels; they are deposited in mesangium or subendotherlial space and fixed with neutrophil;
Prednisone and cyclophosphamide
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
Erythematous-violaceous rash on the eyelids

20. MCP joint involvement
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.
1RA look for morning stiffness >30m - joint erosion in radiography - acute onset; pseudogout--stiffness <30min - comorbid conditions eg. hemochromatosis - dm
Dorsum of hands and the Achilies tendon
Anti-dSdna and complement levels; they are deposited in mesangium or subendotherlial space and fixed with neutrophil;

21. management of LBP
Early in the course of disease; methotrexate doc; if response no adequate add other dmard
Pain control and physical therapy - if fails - ESR -CRP - lumbar xray;
Calcitonin or bisphosphonate to decrease bone turnover; hearing loss not reversible
Think about reiter (cannot see - cannot pee - cannot climb a tree)

22. Gait in spinal stenosis
Nodular lung densitieis with RA;
Spaghetti legs - walking like a drunken sailor; coz patient cannot extend spine
Early in the course of disease; methotrexate doc; if response no adequate add other dmard
Coronary atherosclerosis due to SLE

23. When to order MRI in LBP
Tinel for tapping; reproduction of symptoms upon tapping or percussing over median n; phalen more sensitive than tinel
Erythematous-violaceous rash on the eyelids
Hydroxychloroquine and prednison; hydroxychloroquine effective against future damage kidneys and CNS - arthralgia - serositis and cutaneous symptomes. low dose prednisone until hydroxychloroquine ine effect.
If symptoms persist >6weeks

24. caplan syndrom
Deposition of cholesterol in the periorbital skin
Prophylactic agent to prevent recurrent attack; not given during acute attack
Hyperflexion of both wrists--characteristic pain in one min
Nodular lung densitieis with RA;

25. phalen test
Tinel for tapping; reproduction of symptoms upon tapping or percussing over median n; phalen more sensitive than tinel
Primary biliary cirrhosis
Specific of dx of SLE
Hyperflexion of both wrists--characteristic pain in one min

26. bouchard nodule
Anti-dSdna and complement levels; they are deposited in mesangium or subendotherlial space and fixed with neutrophil;
Spaghetti legs - walking like a drunken sailor; coz patient cannot extend spine
Arthritis swelling of PIP (remember b comes first or proximal); present both in RA and OA
Used in acute attack. contraindicated when patient is taking azathioprine; s/e leukopenia

27. When to give methotrexate in SLE
Calcitonin or bisphosphonate to decrease bone turnover; hearing loss not reversible
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
Patello femoral pain syndrome
Pt with significant organ involvement and have incomplete response to prednisone alone

28. bilater shoulder and thigh pain with prolonged morning stiffness - intermitted headache and jaw pain
Increased serum ferritin (acute phase protein)
Supplementation ca and vitamin D
PMR and giant cell arteritis; can be seen both together;
Gout - Reiter's syndrome-->urethritis/conjunctivitis; psoriasis

29. conjunctivitis - urethritis - and spondyloarthopathy

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

30. anti-ds DNA antibody
Measure ca and ALP; increased ALP and normal ca for dx;
Dermatomyositis - in adult 2ndary to malignancy eg lung ca
Specific of dx of SLE
If person is HLA B27 positive

31. role HLA B27 in dx of ankylosing spondylitis
C for c ; crest syndrome
Hypertriglyceridamia and hypercholesterolemia
Presence not specific since it is present in other spondyloarthopathies but absence exclude AS
Prophylactic agent to prevent recurrent attack; not given during acute attack

32. increased ALP; liver or bone origin?
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
Used in acute attack. contraindicated when patient is taking azathioprine; s/e leukopenia
Calcitonin or bisphosphonate to decrease bone turnover; hearing loss not reversible
Order LFT - heat fractionation (bone burns and liver lives) - GGT

33. Low back pain
Inflammatory involvement of axial joints; first step - xray lumbosacral spine to demonstate sacrolitis and spondylitis
Early in the course of disease; methotrexate doc; if response no adequate add other dmard
Coronary atherosclerosis due to SLE
Search for fever - hx cancer - IVDA - osteoporois; bowel/bladder incontinece/saddle anesthesia-->suspicion of cauda equina syndrome;

34. How to prevent glucocorticoid induced bone loss
A for aortic regurg; s for prolapSe (MVP)
Erythematous-violaceous rash on the eyelids
Measure ESR; polymyalgia rheumatica; tx prednisone
Supplementation ca and vitamin D

35. neck mass in sjogren patient
High dose corticosteroid (prednisone 1mg/kg) if fails - add immunosuppresant`
Increased serum ferritin (acute phase protein)
B cell lymphom; sjogren results in polyclonal B cell activation and infiltration in salivary gland; increased lymphocyte activation results in b cell lymphoma
Pseudogout/hemochromatosis;

36. who gets reiters syndrome after chlamydia infection
LBP with morning stiffness; limitation of lumbar spine ROM; limitation of chest expansion
If person is HLA B27 positive
B cell lymphom; sjogren results in polyclonal B cell activation and infiltration in salivary gland; increased lymphocyte activation results in b cell lymphoma
Specific of dx of SLE

37. spondyloarthopathy
Spaghetti legs - walking like a drunken sailor; coz patient cannot extend spine
Pt with significant organ involvement and have incomplete response to prednisone alone
Measure ca and ALP; increased ALP and normal ca for dx;
Inflammatory involvement of axial joints; first step - xray lumbosacral spine to demonstate sacrolitis and spondylitis

38. Tx of gout in patient with ESRD or hx GI bleeding
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
Presence not specific since it is present in other spondyloarthopathies but absence exclude AS
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
Used in acute attack. contraindicated when patient is taking azathioprine; s/e leukopenia

39. patient pw groin pain; on steroid
MRI to eval osteonecrosis of femoral head; may also affect humeral head - femoral condyles - vertebra - hands and feet; tx total hip replacemebt
Deposition of cholesterol in the periorbital skin
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

40. night back pain
ESRD
Prophylactic agent to prevent recurrent attack; not given during acute attack
Malignancy - infection - vertebral fracture
C for c ; crest syndrome

41. SLE patient p/w MI - vent fibrillation
Think about reiter (cannot see - cannot pee - cannot climb a tree)
Coronary atherosclerosis due to SLE
Order LFT - heat fractionation (bone burns and liver lives) - GGT
Encroaching osteophytes; hypertrophy of ligamentum flavum - protrusion of intervertevra disks;

42. What should be chekcked before starting infliximab
Tx ca channel blocker if no improvement look for systemic disease and order ANA - RF CBC - blood
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.
Stenosis; pain improves with flexion or sittiing worse in extension; disc herniation opposite
PPD

43. postoeriod shoulder pain
Referred pain from cervical spine; due to nerve impingmement due to disc herniation; spinal stenosis at cervical spine levle
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
Minocyclin - inhibits metalloproteases and slows joint damage
Hyper triglyceridemia

44. Tx of reiter
Gout - Reiter's syndrome-->urethritis/conjunctivitis; psoriasis
Abx -bedrest - exercise
Coronary atherosclerosis due to SLE
SLE - only minutes; RA; hours;

45. SLE with pleural effusion
Pseudogout/hemochromatosis;
Inflammatory involvement of axial joints; first step - xray lumbosacral spine to demonstate sacrolitis and spondylitis
Measure ca and ALP; increased ALP and normal ca for dx;
Hydroxychloroquine and prednison; hydroxychloroquine effective against future damage kidneys and CNS - arthralgia - serositis and cutaneous symptomes. low dose prednisone until hydroxychloroquine ine effect.

46. mcp and PIP joint involvement
ESRD
Early in the course of disease; methotrexate doc; if response no adequate add other dmard
Abx -bedrest - exercise
Viral arthritis or RA

47. Raynauds phenomenon
Referred pain from cervical spine; due to nerve impingmement due to disc herniation; spinal stenosis at cervical spine levle
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
Increased serum ferritin (acute phase protein)
Tx ca channel blocker if no improvement look for systemic disease and order ANA - RF CBC - blood

48. scaly eczema over knuckles-gottron's sign; proximal muscle weakness
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
Viral arthritis or RA
Dermatomyositis - in adult 2ndary to malignancy eg lung ca
Referred pain from cervical spine; due to nerve impingmement due to disc herniation; spinal stenosis at cervical spine levle

49. tinel sign
Used in acute attack. contraindicated when patient is taking azathioprine; s/e leukopenia
Tinel for tapping; reproduction of symptoms upon tapping or percussing over median n; phalen more sensitive than tinel
Anti-dSdna and complement levels; they are deposited in mesangium or subendotherlial space and fixed with neutrophil;
ESRD

50. Tx of RA
Lateral or deltoid shoulder pain; caused by rotator cuff tenditnitis; or tear - impingemen t syndrom or frozen shoulder.
R/o myopathy; cannot be excluded by ck and creat; next step EMG; then muscle bx
Tx methotrexate - disesase modifying drugs; if no improvemnet after 6m - anti-cytokine drug infliximab - etanercept;
Anti-dSdna and complement levels; they are deposited in mesangium or subendotherlial space and fixed with neutrophil;