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. xanthomatous nodule
Symmetrical proximal weakness; increased CPK
Arthritic sweling of DIP
Dorsum of hands and the Achilies tendon
Pt with significant organ involvement and have incomplete response to prednisone alone

2. Tx of RA
Tx methotrexate - disesase modifying drugs; if no improvemnet after 6m - anti-cytokine drug infliximab - etanercept;
High dose corticosteroid (prednisone 1mg/kg) if fails - add immunosuppresant`
Dorsum of hands and the Achilies tendon
Xray every 3m

3. Raynauds phenomenon
Disseminated gonoccal infection
Tx ca channel blocker if no improvement look for systemic disease and order ANA - RF CBC - blood
Inflammatory involvement of axial joints; first step - xray lumbosacral spine to demonstate sacrolitis and spondylitis
Referred pain from cervical spine; due to nerve impingmement due to disc herniation; spinal stenosis at cervical spine levle

4. bouchard nodule
Coronary atherosclerosis due to SLE
Osteoarthirit (bouchard at pip - b comes first);
Arthritis swelling of PIP (remember b comes first or proximal); present both in RA and OA
Check pedal pulses; in claudication pulses should diminish

5. How to perform schober test
Early in the course of disease; methotrexate doc; if response no adequate add other dmard
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
Nodular lung densitieis with RA;
Azathioprine dose need to be reduced. azathiprine decrease activity xanthine oxidase which also metabolize azathioprine

6. criteria for AS
LBP with morning stiffness; limitation of lumbar spine ROM; limitation of chest expansion
Presence not specific since it is present in other spondyloarthopathies but absence exclude AS
Stenosis; pain improves with flexion or sittiing worse in extension; disc herniation opposite
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

7. patient is having pain when he moves hands above shoulder
Osteoarthirit (bouchard at pip - b comes first);
Tx ca channel blocker if no improvement look for systemic disease and order ANA - RF CBC - blood
Nodular lung densitieis with RA;
Lateral or deltoid shoulder pain; caused by rotator cuff tenditnitis; or tear - impingemen t syndrom or frozen shoulder.

8. PIP joint involment
Disease when it is idiopathic; phenomenon when 2ndary to connective tissue disease - vascular lesions - medications
B cell lymphom; sjogren results in polyclonal B cell activation and infiltration in salivary gland; increased lymphocyte activation results in b cell lymphoma
Osteoarthirit (bouchard at pip - b comes first);
Primary biliary cirrhosis

9. DIP joint involvement

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

10. tx pagets
Calcitonin or bisphosphonate to decrease bone turnover; hearing loss not reversible
High dose corticosteroid (prednisone 1mg/kg) if fails - add immunosuppresant`
B cell lymphom; sjogren results in polyclonal B cell activation and infiltration in salivary gland; increased lymphocyte activation results in b cell lymphoma
Xray every 3m

11. proximal muscle weakness; decreased tendon reflex; normal creat and ck
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
ESRD
Pseudogout/hemochromatosis;

12. How often disease activity is monitored in AS?
Prednisone and cyclophosphamide
Increased serum ferritin (acute phase protein)
Xray every 3m
Presence not specific since it is present in other spondyloarthopathies but absence exclude AS

13. pain in shoulder and pelvic girdle
High dose corticosteroid (prednisone 1mg/kg) if fails - add immunosuppresant`
Malignancy - infection - vertebral fracture
Measure ESR; polymyalgia rheumatica; tx prednisone
Presence not specific since it is present in other spondyloarthopathies but absence exclude AS

14. painless ulcer over glans penis and inflammatory arthritis
Tinel for tapping; reproduction of symptoms upon tapping or percussing over median n; phalen more sensitive than tinel
Xray every 3m
Coronary atherosclerosis due to SLE
Think about reiter (cannot see - cannot pee - cannot climb a tree)

15. SLE with pleural effusion
Hydroxychloroquine and prednison; hydroxychloroquine effective against future damage kidneys and CNS - arthralgia - serositis and cutaneous symptomes. low dose prednisone until hydroxychloroquine ine effect.
Disease when it is idiopathic; phenomenon when 2ndary to connective tissue disease - vascular lesions - medications
LBP with morning stiffness; limitation of lumbar spine ROM; limitation of chest expansion
Abx -bedrest - exercise

16. Finding of MRI in stenosis
Erythematous-violaceous rash on the eyelids
Pain - paresthesia in the medial n distribution; thumb - first two fingers; tx continuous wrist spint-reduce pressure on the nerve.
Tinel for tapping; reproduction of symptoms upon tapping or percussing over median n; phalen more sensitive than tinel
Encroaching osteophytes; hypertrophy of ligamentum flavum - protrusion of intervertevra disks;

17. glucocorticoid therapy
High dose corticosteroid (prednisone 1mg/kg) if fails - add immunosuppresant`
A for aortic regurg; s for prolapSe (MVP)
MRI to eval osteonecrosis of femoral head; may also affect humeral head - femoral condyles - vertebra - hands and feet; tx total hip replacemebt
Give calcium and vitamine D therapy ; bisphosphonate may be added if the risk highl bone densitometry

18. primary muscle disease
LBP with morning stiffness; limitation of lumbar spine ROM; limitation of chest expansion
Viral arthritis or RA
Symmetrical proximal weakness; increased CPK
Decrease ca absorption in the gut; cause renal calcium wasting; direct anti anabolic efects on bone - suppress GnRH-->central hypogonadism--bone loss

19. Low back pain
Osteoarthirit (bouchard at pip - b comes first);
Pt with significant organ involvement and have incomplete response to prednisone alone
Search for fever - hx cancer - IVDA - osteoporois; bowel/bladder incontinece/saddle anesthesia-->suspicion of cauda equina syndrome;
If symptoms persist >6weeks

20. heberdeen nodes
Viral arthritis or RA
Arthritic sweling of DIP
Arthritis swelling of PIP (remember b comes first or proximal); present both in RA and OA
Hyper triglyceridemia

21. When to stop statin if cpk elevated
Pseudogout/hemochromatosis;
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 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

22. gemfibrozil
Tx methotrexate - disesase modifying drugs; if no improvemnet after 6m - anti-cytokine drug infliximab - etanercept;
MRI to eval osteonecrosis of femoral head; may also affect humeral head - femoral condyles - vertebra - hands and feet; tx total hip replacemebt
Xray every 3m
Hyper triglyceridemia

23. When to start DMARD in RA
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
Calcitonin or bisphosphonate to decrease bone turnover; hearing loss not reversible
Pt with significant organ involvement and have incomplete response to prednisone alone
Early in the course of disease; methotrexate doc; if response no adequate add other dmard

24. Tx of lupus nephritis
Prednisone and cyclophosphamide
High incidence of opportunistitc infection; reactivation of TB;
AS; sometime only symptom is uveitis;
Lateral or deltoid shoulder pain; caused by rotator cuff tenditnitis; or tear - impingemen t syndrom or frozen shoulder.

25. postoeriod shoulder pain
Symmetrical proximal weakness; increased CPK
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.
Referred pain from cervical spine; due to nerve impingmement due to disc herniation; spinal stenosis at cervical spine levle
Presence not specific since it is present in other spondyloarthopathies but absence exclude AS

26. neck mass in sjogren patient
Decrease ca absorption in the gut; cause renal calcium wasting; direct anti anabolic efects on bone - suppress GnRH-->central hypogonadism--bone loss
Symmetrical proximal weakness; increased CPK
Patello femoral pain syndrome
B cell lymphom; sjogren results in polyclonal B cell activation and infiltration in salivary gland; increased lymphocyte activation results in b cell lymphoma

27. mcp and PIP joint involvement
Uricosuric. need creatinin clearance >350 or else ineffective; contraindicated in renal failure or post-transplnat
Early in the course of disease; methotrexate doc; if response no adequate add other dmard
High dose corticosteroid (prednisone 1mg/kg) if fails - add immunosuppresant`
Viral arthritis or RA

28. night back pain
Check pedal pulses; in claudication pulses should diminish
Prophylactic agent to prevent recurrent attack; not given during acute attack
Prednisone and cyclophosphamide
Malignancy - infection - vertebral fracture

29. anterior shoulder pain
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
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
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

30. conjunctivitis - urethritis - and spondyloarthopathy

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

31. Use of allopurinol after kidney transplant
Increased serum ferritin (acute phase protein)
Malignancy - infection - vertebral fracture
Azathioprine dose need to be reduced. azathiprine decrease activity xanthine oxidase which also metabolize azathioprine
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

32. Tx of reiter
Anti-dSdna and complement levels; they are deposited in mesangium or subendotherlial space and fixed with neutrophil;
Tx ca channel blocker if no improvement look for systemic disease and order ANA - RF CBC - blood
Abx -bedrest - exercise
1RA look for morning stiffness >30m - joint erosion in radiography - acute onset; pseudogout--stiffness <30min - comorbid conditions eg. hemochromatosis - dm

33. Rayanaud's disease vs phenomenon
If symptoms persist >6weeks
Disease when it is idiopathic; phenomenon when 2ndary to connective tissue disease - vascular lesions - medications
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
Early in the course of disease; methotrexate doc; if response no adequate add other dmard

34. carpal tunnel syndrom
Pseudogout/hemochromatosis;
Presence not specific since it is present in other spondyloarthopathies but absence exclude AS
Pain - paresthesia in the medial n distribution; thumb - first two fingers; tx continuous wrist spint-reduce pressure on the nerve.
Uricosuric. need creatinin clearance >350 or else ineffective; contraindicated in renal failure or post-transplnat

35. cylosporin used after renal transplantation
SLE - only minutes; RA; hours;
Pt with significant organ involvement and have incomplete response to prednisone alone
Prednisone and cyclophosphamide
Decrease urate secretion from kidney

36. probenecid
Pseudogout/hemochromatosis;
Uricosuric. need creatinin clearance >350 or else ineffective; contraindicated in renal failure or post-transplnat
Calcitonin or bisphosphonate to decrease bone turnover; hearing loss not reversible
PMR and giant cell arteritis; can be seen both together;

37. spondyloarthopathy
Search for fever - hx cancer - IVDA - osteoporois; bowel/bladder incontinece/saddle anesthesia-->suspicion of cauda equina syndrome;
Coronary atherosclerosis due to SLE
High dose corticosteroid (prednisone 1mg/kg) if fails - add immunosuppresant`
Inflammatory involvement of axial joints; first step - xray lumbosacral spine to demonstate sacrolitis and spondylitis

38. How to prevent glucocorticoid induced bone loss
Deposition of cholesterol in the periorbital skin
Biceps tendinitis; seen in patients with acromioclavicular or glenohumeral joint osteoarthritis
Order LFT - heat fractionation (bone burns and liver lives) - GGT
Supplementation ca and vitamin D

39. morning stiffness hand joints
SLE - only minutes; RA; hours;
Tx ca channel blocker if no improvement look for systemic disease and order ANA - RF CBC - blood
Prednisone and cyclophosphamide
Hyper triglyceridemia

40. phalen test
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
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
Hyperflexion of both wrists--characteristic pain in one min
Prednisone and cyclophosphamide

41. How to differentiate radicular pain with claudication
Check pedal pulses; in claudication pulses should diminish
Viral arthritis or RA
Measure ca and ALP; increased ALP and normal ca for dx;
Referred pain from cervical spine; due to nerve impingmement due to disc herniation; spinal stenosis at cervical spine levle

42. allpurinol
Prophylactic agent to prevent recurrent attack; not given during acute attack
AS; sometime only symptom is uveitis;
ARBs and clonidine CI: HCTZ - furosemide - increases serum uric acid levels; aspirin decreases renal excretion of uric acid
Pain control and physical therapy - if fails - ESR -CRP - lumbar xray;

43. anti-centromere ab
Prophylactic agent to prevent recurrent attack; not given during acute attack
C for c ; crest syndrome
Order LFT - heat fractionation (bone burns and liver lives) - GGT
Inflammatory involvement of axial joints; first step - xray lumbosacral spine to demonstate sacrolitis and spondylitis

44. Tx of inflammatory myositis
R/o myopathy; cannot be excluded by ck and creat; next step EMG; then muscle bx
Give calcium and vitamine D therapy ; bisphosphonate may be added if the risk highl bone densitometry
High dose corticosteroid (prednisone 1mg/kg) if fails - add immunosuppresant`
Arthritic sweling of DIP

45. scaly eczema over knuckles-gottron's sign; proximal muscle weakness
Osteoarthirit (bouchard at pip - b comes first);
Spaghetti legs - walking like a drunken sailor; coz patient cannot extend spine
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

46. caplan syndrom
Viral arthritis or RA
Nodular lung densitieis with RA;
Erythematous-violaceous rash on the eyelids
Pt with significant organ involvement and have incomplete response to prednisone alone

47. 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
Prednisone and cyclophosphamide
Dorsum of hands and the Achilies tendon
Calcitonin or bisphosphonate to decrease bone turnover; hearing loss not reversible

48. nicotinic acid
Pt with significant organ involvement and have incomplete response to prednisone alone
Measure ca and ALP; increased ALP and normal ca for dx;
Hypertriglyceridamia and hypercholesterolemia
Tx methotrexate - disesase modifying drugs; if no improvemnet after 6m - anti-cytokine drug infliximab - etanercept;

49. who gets reiters syndrome after chlamydia infection
If person is HLA B27 positive
SLE - only minutes; RA; hours;
Hydroxychloroquine and prednison; hydroxychloroquine effective against future damage kidneys and CNS - arthralgia - serositis and cutaneous symptomes. low dose prednisone until hydroxychloroquine ine effect.
Symmetrical proximal weakness; increased CPK

50. schirmer test
Pain control and physical therapy - if fails - ESR -CRP - lumbar xray;
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
Uricosuric. need creatinin clearance >350 or else ineffective; contraindicated in renal failure or post-transplnat
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.