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. colchicine
Used in acute attack. contraindicated when patient is taking azathioprine; s/e leukopenia
LBP with morning stiffness; limitation of lumbar spine ROM; limitation of chest expansion
Supplementation ca and vitamin D
Specific of dx of SLE

2. nicotinic acid
Increased serum ferritin (acute phase protein)
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
Hypertriglyceridamia and hypercholesterolemia

3. Tx of inflammatory myositis
LBP with morning stiffness; limitation of lumbar spine ROM; limitation of chest expansion
Symmetrical proximal weakness; increased CPK
High dose corticosteroid (prednisone 1mg/kg) if fails - add immunosuppresant`
Pain control and physical therapy - if fails - ESR -CRP - lumbar xray;

4. Gait in spinal stenosis
Uricosuric. need creatinin clearance >350 or else ineffective; contraindicated in renal failure or post-transplnat
Gout - Reiter's syndrome-->urethritis/conjunctivitis; psoriasis
Measure ESR; polymyalgia rheumatica; tx prednisone
Spaghetti legs - walking like a drunken sailor; coz patient cannot extend spine

5. pain in shoulder and pelvic girdle
Measure ESR; polymyalgia rheumatica; tx prednisone
Pain control and physical therapy - if fails - ESR -CRP - lumbar xray;
Gout - Reiter's syndrome-->urethritis/conjunctivitis; psoriasis
Increased serum ferritin (acute phase protein)

6. mcp and PIP joint involvement
Calcitonin or bisphosphonate to decrease bone turnover; hearing loss not reversible
Give calcium and vitamine D therapy ; bisphosphonate may be added if the risk highl bone densitometry
Disease when it is idiopathic; phenomenon when 2ndary to connective tissue disease - vascular lesions - medications
Viral arthritis or RA

7. tx pagets
Tx methotrexate - disesase modifying drugs; if no improvemnet after 6m - anti-cytokine drug infliximab - etanercept;
Calcitonin or bisphosphonate to decrease bone turnover; hearing loss not reversible
Think about reiter (cannot see - cannot pee - cannot climb a tree)
Check pedal pulses; in claudication pulses should diminish

8. bouchard nodule
Pt with significant organ involvement and have incomplete response to prednisone alone
Viral arthritis or RA
Arthritis swelling of PIP (remember b comes first or proximal); present both in RA and OA
Measure ca and ALP; increased ALP and normal ca for dx;

9. Rayanaud's disease vs phenomenon
Disease when it is idiopathic; phenomenon when 2ndary to connective tissue disease - vascular lesions - medications
Decrease ca absorption in the gut; cause renal calcium wasting; direct anti anabolic efects on bone - suppress GnRH-->central hypogonadism--bone loss
Hyper triglyceridemia
Pain - paresthesia in the medial n distribution; thumb - first two fingers; tx continuous wrist spint-reduce pressure on the nerve.

10. when SLE patient needs steroid
ARBs and clonidine CI: HCTZ - furosemide - increases serum uric acid levels; aspirin decreases renal excretion of uric acid
If person is HLA B27 positive
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
Nodular lung densitieis with RA;

11. conjunctivitis - urethritis - and spondyloarthopathy

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

12. DIP joint involvement

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

13. tinel sign
If person is HLA B27 positive
Tinel for tapping; reproduction of symptoms upon tapping or percussing over median n; phalen more sensitive than tinel
Calcitonin or bisphosphonate to decrease bone turnover; hearing loss not reversible
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

14. How glucocorticoid leads to bone loss
Prophylactic agent to prevent recurrent attack; not given during acute attack
Decrease ca absorption in the gut; cause renal calcium wasting; direct anti anabolic efects on bone - suppress GnRH-->central hypogonadism--bone loss
Arthritic sweling of DIP
Prednisone and cyclophosphamide

15. caplan syndrom
PPD
Nodular lung densitieis with RA;
Erythematous-violaceous rash on the eyelids
C for c ; crest syndrome

16. criteria for AS
Specific of dx of SLE
Viral arthritis or RA
Search for fever - hx cancer - IVDA - osteoporois; bowel/bladder incontinece/saddle anesthesia-->suspicion of cauda equina syndrome;
LBP with morning stiffness; limitation of lumbar spine ROM; limitation of chest expansion

17. probenecid
Symmetrical proximal weakness; increased CPK
Uricosuric. need creatinin clearance >350 or else ineffective; contraindicated in renal failure or post-transplnat
SLE - only minutes; RA; hours;
Osteoarthirit (bouchard at pip - b comes first);

18. primary muscle disease
Hyperflexion of both wrists--characteristic pain in one min
Disease when it is idiopathic; phenomenon when 2ndary to connective tissue disease - vascular lesions - medications
Disseminated gonoccal infection
Symmetrical proximal weakness; increased CPK

19. spondyloarthopathy
Inflammatory involvement of axial joints; first step - xray lumbosacral spine to demonstate sacrolitis and spondylitis
PPD
Prophylactic agent to prevent recurrent attack; not given during acute attack
ARBs and clonidine CI: HCTZ - furosemide - increases serum uric acid levels; aspirin decreases renal excretion of uric acid

20. patient pw groin pain; on steroid
Search for fever - hx cancer - IVDA - osteoporois; bowel/bladder incontinece/saddle anesthesia-->suspicion of cauda equina syndrome;
Arthritis swelling of PIP (remember b comes first or proximal); present both in RA and OA
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
MRI to eval osteonecrosis of femoral head; may also affect humeral head - femoral condyles - vertebra - hands and feet; tx total hip replacemebt

21. postoeriod shoulder pain
Referred pain from cervical spine; due to nerve impingmement due to disc herniation; spinal stenosis at cervical spine levle
Think about reiter (cannot see - cannot pee - cannot climb a tree)
Minocyclin - inhibits metalloproteases and slows joint damage
Order LFT - heat fractionation (bone burns and liver lives) - GGT

22. Tx of gout
Patello femoral pain syndrome
Minocyclin - inhibits metalloproteases and slows joint damage
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
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.

23. gemfibrozil
Hyper triglyceridemia
Prophylactic agent to prevent recurrent attack; not given during acute attack
Check pedal pulses; in claudication pulses should diminish
Abx -bedrest - exercise

24. heberdeen nodes
Pseudogout/hemochromatosis;
Arthritic sweling of DIP
Prednisone and cyclophosphamide
Calcitonin or bisphosphonate to decrease bone turnover; hearing loss not reversible

25. schirmer test
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
Arthritis swelling of PIP (remember b comes first or proximal); present both in RA and OA
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.
Lateral or deltoid shoulder pain; caused by rotator cuff tenditnitis; or tear - impingemen t syndrom or frozen shoulder.

26. inflamed tendons in wrist - ankle - arms; sexual history
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
Disseminated gonoccal infection
Decrease ca absorption in the gut; cause renal calcium wasting; direct anti anabolic efects on bone - suppress GnRH-->central hypogonadism--bone loss
ARBs and clonidine CI: HCTZ - furosemide - increases serum uric acid levels; aspirin decreases renal excretion of uric acid

27. Use of allopurinol after kidney transplant
LBP with morning stiffness; limitation of lumbar spine ROM; limitation of chest expansion
Azathioprine dose need to be reduced. azathiprine decrease activity xanthine oxidase which also metabolize azathioprine
Anti-dSdna and complement levels; they are deposited in mesangium or subendotherlial space and fixed with neutrophil;
Used in acute attack. contraindicated when patient is taking azathioprine; s/e leukopenia

28. management of LBP
Malignancy - infection - vertebral fracture
Pain - paresthesia in the medial n distribution; thumb - first two fingers; tx continuous wrist spint-reduce pressure on the nerve.
Pain control and physical therapy - if fails - ESR -CRP - lumbar xray;
Xray every 3m

29. right anterior knee pain and provoked by climbing stairs or prolong sitting
Tinel for tapping; reproduction of symptoms upon tapping or percussing over median n; phalen more sensitive than tinel
Pt with significant organ involvement and have incomplete response to prednisone alone
Symmetrical proximal weakness; increased CPK
Patello femoral pain syndrome

30. phalen test
Uricosuric. need creatinin clearance >350 or else ineffective; contraindicated in renal failure or post-transplnat
Osteoarthirit (bouchard at pip - b comes first);
Increased serum ferritin (acute phase protein)
Hyperflexion of both wrists--characteristic pain in one min

31. When to give methotrexate in SLE
Pt with significant organ involvement and have incomplete response to prednisone alone
AS; sometime only symptom is uveitis;
Inflammatory involvement of axial joints; first step - xray lumbosacral spine to demonstate sacrolitis and spondylitis
High dose corticosteroid (prednisone 1mg/kg) if fails - add immunosuppresant`

32. Use of antibiotic in RA
Tx ca channel blocker if no improvement look for systemic disease and order ANA - RF CBC - blood
Minocyclin - inhibits metalloproteases and slows joint damage
1RA look for morning stiffness >30m - joint erosion in radiography - acute onset; pseudogout--stiffness <30min - comorbid conditions eg. hemochromatosis - dm
Increased serum ferritin (acute phase protein)

33. Finding of MRI in stenosis
Calcitonin or bisphosphonate to decrease bone turnover; hearing loss not reversible
Prednisone and cyclophosphamide
Encroaching osteophytes; hypertrophy of ligamentum flavum - protrusion of intervertevra disks;
Tinel for tapping; reproduction of symptoms upon tapping or percussing over median n; phalen more sensitive than tinel

34. What should be chekcked before starting infliximab
SLE - only minutes; RA; hours;
Referred pain from cervical spine; due to nerve impingmement due to disc herniation; spinal stenosis at cervical spine levle
Minocyclin - inhibits metalloproteases and slows joint damage
PPD

35. role HLA B27 in dx of ankylosing spondylitis
If person is HLA B27 positive
Presence not specific since it is present in other spondyloarthopathies but absence exclude AS
Malignancy - infection - vertebral fracture
Anti-dSdna and complement levels; they are deposited in mesangium or subendotherlial space and fixed with neutrophil;

36. proximal muscle weakness; decreased tendon reflex; normal creat and ck
R/o myopathy; cannot be excluded by ck and creat; next step EMG; then muscle bx
Viral arthritis or RA
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
Presence not specific since it is present in other spondyloarthopathies but absence exclude AS

37. who gets reiters syndrome after chlamydia infection
Increased serum ferritin (acute phase protein)
Xray every 3m
Abx -bedrest - exercise
If person is HLA B27 positive

38. allpurinol
Nodular lung densitieis with RA;
Prophylactic agent to prevent recurrent attack; not given during acute attack
Uricosuric. need creatinin clearance >350 or else ineffective; contraindicated in renal failure or post-transplnat
Pseudogout/hemochromatosis;

39. cylosporin used after renal transplantation
Decrease urate secretion from kidney
SLE - only minutes; RA; hours;
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
Stenosis; pain improves with flexion or sittiing worse in extension; disc herniation opposite

40. patient is having pain when he moves hands above shoulder
Spaghetti legs - walking like a drunken sailor; coz patient cannot extend spine
Measure ESR; polymyalgia rheumatica; tx prednisone
Pt with significant organ involvement and have incomplete response to prednisone alone
Lateral or deltoid shoulder pain; caused by rotator cuff tenditnitis; or tear - impingemen t syndrom or frozen shoulder.

41. Tx of reiter
Patello femoral pain syndrome
Tx ca channel blocker if no improvement look for systemic disease and order ANA - RF CBC - blood
Abx -bedrest - exercise
Tx methotrexate - disesase modifying drugs; if no improvemnet after 6m - anti-cytokine drug infliximab - etanercept;

42. glucocorticoid therapy
Give calcium and vitamine D therapy ; bisphosphonate may be added if the risk highl bone densitometry
Dorsum of hands and the Achilies tendon
Supplementation ca and vitamin D
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

43. What marker is used to follow up disease activity in SLE
If symptoms persist >6weeks
High incidence of opportunistitc infection; reactivation of TB;
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
Hypertriglyceridamia and hypercholesterolemia

44. complications of anti-cytokine therapy
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;
Xray every 3m
Uricosuric. need creatinin clearance >350 or else ineffective; contraindicated in renal failure or post-transplnat

45. How to differential lumbar spinal stenosis and disc herniation pain?
Dorsum of hands and the Achilies tendon
Uricosuric. need creatinin clearance >350 or else ineffective; contraindicated in renal failure or post-transplnat
Nodular lung densitieis with RA;
Stenosis; pain improves with flexion or sittiing worse in extension; disc herniation opposite

46. inflammatory myositis
Increased serum ferritin (acute phase protein)
ARBs and clonidine CI: HCTZ - furosemide - increases serum uric acid levels; aspirin decreases renal excretion of uric acid
Pain - paresthesia in the medial n distribution; thumb - first two fingers; tx continuous wrist spint-reduce pressure on the nerve.
Inflammatory involvement of axial joints; first step - xray lumbosacral spine to demonstate sacrolitis and spondylitis

47. SLE patient p/w MI - vent fibrillation
High incidence of opportunistitc infection; reactivation of TB;
Coronary atherosclerosis due to SLE
Used in acute attack. contraindicated when patient is taking azathioprine; s/e leukopenia
Decrease urate secretion from kidney

48. xanthomatous nodule
Disease when it is idiopathic; phenomenon when 2ndary to connective tissue disease - vascular lesions - medications
Anti-dSdna and complement levels; they are deposited in mesangium or subendotherlial space and fixed with neutrophil;
Supplementation ca and vitamin D
Dorsum of hands and the Achilies tendon

49. Tx of lupus nephritis
Pt with significant organ involvement and have incomplete response to prednisone alone
Prednisone and cyclophosphamide
A for aortic regurg; s for prolapSe (MVP)
C for c ; crest syndrome

50. pagets in xray
Measure ca and ALP; increased ALP and normal ca for dx;
Give calcium and vitamine D therapy ; bisphosphonate may be added if the risk highl bone densitometry
Hypertriglyceridamia and hypercholesterolemia
Tinel for tapping; reproduction of symptoms upon tapping or percussing over median n; phalen more sensitive than tinel