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MTB3 Flashcards

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1
Q

Joint findings in RA?

A
  • c1-c2 sublaxation
  • Swan neck deformity - knee invovement
  • Botunier deformity
  • Becker cyst
  • MCP and PIP swelling and pain
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2
Q

Alternates for DMARDS:

A
  • Rituximab
  • Anakinra: IL 1 receptor antagonist
  • Abatacept: Inhibits Tcell activation
  • Leflunamide: Primidine Antagonist
  • Tocilizumab: IL6 receptor Antagonist
  • Gold salt
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3
Q
  • an important charactristic of whipple disease other than GI symptoms?
A

Joint pain

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4
Q

Joints involved in OA?

A
  • PIP=> Buchard’s nodes

- DIP=> Heberden nodes

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5
Q

Tx for whipple disease?

A

TMX-SMX

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6
Q

TX for OA?

A

Acetaminophen

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7
Q

WBCs in RA and in OA?

A

In OA

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8
Q

Best initial test for OA?

A

Xray

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9
Q

Tests need to be ordered in OA?

A
  • ESR
  • ANA
  • RF
  • Anti-CCP
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10
Q

Presence of Anti Ro or Anti SSA antibody in SLE is the indication of:

A

Heart block

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11
Q

Which tests are diagnostic for Lupus flates?

A
  • Anti DS DNA

- low complement

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12
Q
  • best initial test to diagnose Reumatoid Arthritis?
  • most accurate and specific test to diagnose RA?
  • best initial test to diagnose Ankylosing Sponylitis?
  • best initial test to diagnose Reactive Arthritis?
  • best initial test to diagnose SLE?
  • best initial test to diagnose psoriatic arthritis?
  • best initial test to diagnose OA?
  • best specific test to diagnose SLE?
A
  • ESR, CRP, RF
  • Anti CCP
  • MRI
  • no diagnostic test for reactive arthritis
  • ANA
  • no test to diagnose psoriatic arthritis
  • xray
  • Anti smith Ab
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13
Q
  • Drugs cause SLE?

- charactristics of drug induced SLE?

A
  • Procain amid, Hydralazine, Isoniazide
    positive anti histon antibody
    No renal or neurological symptoms
    Complement levels and anti Ds- DNA are normal
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14
Q

Most accurate test for sjogren syn?

A

Lip biopsy

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15
Q

What is shirmer test?

A

A test to dx sojgren .. Decreased wetting of the papr held to the eye shows decreased lacrimation

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16
Q 
Tx for renal involvement in sclerodermia?
Tx for raynauds in sclerodermia?
Tx for GERD in sclerodermia?
Tx for lung fibrosis in sclerodermia?
Tx for pulmonary HTN in sclerodermia?
A
  • ACE inh.
  • Ca- channel blocker
  • PPI
  • Cyclophosphamide
  • Bosentan( anti- endothelium )/ Prostaglandines analogues( Epoprostenol, Treprostinil, iloprost) / Sildenafil
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17
Q

What disease we see giant capillaries in the nail folds?

A

Scleroderma

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18
Q

Tx of Anaphylaxis?

A

1- Epinephrine 1/1000
2- corticosteroids
3- Antihistamines ( Hydroxyzine and Diphenhydramine)

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19
Q

Difference between Joint fluid leukocyte count in OA and RA?

A

In OA

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20
Q

Tx for Sjogren disease?

A
  • keep the eyes and mouth moist

- Pilocarpin & Cevimeline => theyveill increase Acetylcholin

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21
Q

What is Eosinophilic Fascitis?

A

Thickening of the skin/ DDX with Scleroderma/ no systemic involvement/ no raynaud or hand involvement/ skin looks like podo orange/

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22
Q

Diagnostic tests for Polymyositis and Dermatomyositis?

A

EMG/ increased Aldolase and CPK/ for ccs order ANA and liver function tests.

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23
Q

Tx for eosinophilic fasciitis?

A

Corticosteroids

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24
Q

Polymyositis / Dermatomyositis with high anti JO?
Seriuse complication of Polymyositis Dermatomyositis?
Tx for PM / DM?

A

Interstitial nephritis
Malignancy
Corticosteroids

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25
How to diiferentiate between chronic fTigue syndrome, fibromyalgia and Polymyalgia Rheumatica?
In chronic fatigue syn. The patient has fatigue for more than 6 months. In Fibromyalgia there are trigger points, in polymyalgia Rheumatica there is high ESR. No TX for chronic fatigue syndrome, Fibrolmyalgia TX is pain relief, Polymyalgia Rheumatica TX is Corticosteroids.
26
- the most accurate test for vasculitis? - vasculitis TX? - what if steroids are not effective?
- Biopsy - Steroids - Methtroxate/ Azatiprine - 6 Mercaptopurine/ Cyclophosphamide
27
PAN charactristics?
- Abdominal pain - Renal involvement - Testicular involvement - HTN - Pericarditis
28
Which Ag is positive in PAN?
Hepatitis B surface Ag
29
How to differenciate PAN, Wegner, Churchstrauss?
There is abdominal involvement in PAN, in Wegner there is upper or lower respiratory involvement and c- ANCA is positive/ in Churg strauss the patient has asthma and eosiniphilia and positi
30
Lab tests in Vasculitis?
Normochrom normocytic anemia Thrombocytosis Elevated ESR
31
Charactristics of Takayaso Arthritis in Lab?
- Anemia / elevated ESR
32
Complications of Takayasu Arthritis?
TIA/Stroke
33
Behcet charactristics:
- oral and genital ulcers - ocular involvement - Pathergy
34
Clinical manifestations of all vasculitis diseases?
- Malaise - weight loss - Fatigue - Neuropathy - Arthralgia - skin rash - Fever
35
Joint cells in Septic Arthritis, Inflammatory ( gout/ pseudo gout) and infections ?
NL 50.000
36
What are Rasburicase and Pegloticase?
They break uric acid to Allantoin. We use it when Allopurinol and Febuxostat are not useful.
37
Triggers for gouty attacks?
1- Alcohol 2- thiazide diuretics 3- Nicotinic Acid
38
What's the first step after suspeciouse of gout and before starting the TX?
- you should tap the joint
39
Management of acute attacks in pseudogout?
NSAIDS and Steroids
40
Prenentive meds for Gout?
- Allopurinol if no response=> Febuxostat
41
Empiric therapy for septic Arthritis?
- Ceftriaxone and Vancomycine
42
Charactristics of Morton Neuroma?
Painful burning sensation in the interdigital web space 3rd and 4th Tenderness on the head of 3 and 4 Sharp intermittent pain radiating into toes and feel better when shoes are taken off
43
Best initial test and most accurate test in Pagets disease?
Best initial test: AlkP | Best accurate test: xray
44
Charactristics of plantar fasciitis and tarsal tunnel syn?
Plantar fasciitis is ginna be better with walking but tarsal tunnel syn. Getting worse with walking.
45
Best initial diagnostic test to Dx iron defficiency, Anemia of chronic diseases, Thalassemia, Sideroblastic Anemia:
- Iron defficiency anemia: low ferritin/ high TIBC/ low Fe/ low Fe sat/ high RDW - thalassemia: NL - Sideroblastic Anemia: high Fe - Anemia of chronic diseases: high ferritin, low TIBC, Low Fe and NL to low Fe sat
46
What is the main cause of signs and symptoms in Sideroblastic Anemia?
Iron build up in mitochondria
47
What is HbH?
3 gene deletion in alpha thalassemia and Beta-4 tetrads.
48
What are the other charactristics beside megaloblastic anemia in patients with B12 defficiency?
Glossitis/ Diarrhea/ Neurologic signs and symptoms.
49
What is the medication that blocks B12 absorbtion and will cause macrocytic anemia?
Metformin
50
After B12 therapy which signs and syptoms will retun first and last?
First=> Retic count | Last=> Neurologic
51
In B12 defficiency anemia B12 is really low? | What is the best test to DX B12 defficieny macrocytic anemia?
No bcz B12 is a phase reactant and any form of stress will increase it. Methyl malonic test
52
What are the two tests after Measuring B12 level and Methylmalonic acid level to confirm the Dx of B12 defficiency macrocytic anemia?
Anti- Intrinsic factor Ab / Anti Parietal cell Ab
53
Which electrolyte abnormality should we aware of with B12 therapy?
Ilow Ptassium
54
What kind of disease other than hereditary spherocytosis give us the spherocytes?
Autoimmune hemolysis
55
How is the clinical definition of the SCD case ?
Pain in the chest, back, tighs that is very severe.
56
How is the approach to SCD patients?
First hydration, Analgesics, Oxygen to reduce fever. If fever exist then antibiotics: Ceftriaxone, Levofloxacin, Moxifloxacin
57
What is the sudden derops in the hematocrit indication of?
UpParovirus B19 infection or folate defficiency.
58
What kind of supplement should be hiven to the patients with SCD?
Folic acid
59
Which drugs will cause hemolythic Anemia?
- Penicillin -Dapson - Alpha methyl dopa - Quinidin - Sulfa drugs - Primaquine
60
What are TX options for Hemolytic Anemia?
1- steroids 2- IVIG if there is no response to Prednisone 3- Splenectomy for recurrent episodes
61
Why is Rituximab effective against RA and cold and warm hemolythic anemia?
Because Rituximab is anti CD20 which affect on the CD20 lymphocytes that make IgG and IgM.
62
What kind of test should be done before prescribing Dapson?
G6PD
63
What is Heinz body?
Percipitated oxidased HB in RBC membrane.
64
1- what is the best test to Dx G6PD? | 2- TX of G6PD?
1- G6PD level after 6 months | 2- no Tx
65
- what is the TX for TTP- HUS? | - why is it helpful?
- plasmaphresis | - because it will replace the ADAM13 which will break down the VWF . No platelet infuion is indicated.
66
Charactristics of TTP and HUS?
-ART( Autoimmune Hemolysis)/ ( Renal insufficiency)/ ( Thrombocytopenia)
67
-Etiologies of TTP and HUS?
``` TTP= decrease level of Adam 13/ like Ticlopidine HUS= E.colin0157H7 ```
68
PNH can transforms into two things.. What are those?
- Aplastic Anemia | - AML
69
What is the charactristic of myoglobine in urine? | Tx of Methemoglobinemia?
Brown blood | Methylene blue
70
What kind of medications are associated with Methemoglobinemia?
- Nitroglycerine - Amylnitrite - dapson - Nitroprusside - caine - drugs
71
Leukemia Tx?
- Idarubicin - Daunorubicin - Cytosin Arabinoside - also ATRA for AML M3 - also Mthotroxate for ALL
72
Charectristic of Myelodysplastic synd.?
Pelger Huet cells ( Neutrophils wit 2 lobes)
73
Clinical manifestation of Myelodysplastic Syn.?
- Pancytopenia - elevated MCV - low Retic - Macroovalocyte
74
Tx of Myelodysplasia?
- transfusion as needed - azacitadine - Decitabine - Lenalidomide
75
- Bone Osteolytic leision in: | - Bone osteoblastic leision in:
- Bone Osteolytic leision in MM | - Bome Osteoblastic leisions in Prostate cancer metastasis
76
What are the CML medications beside Imatinib?
Nilotinib/ Dasatinib
77
Difference between dysphagia & Odynophagia? | Causes of Odynophagia?
- Dysphagia= difficulty swallowing - Odynophagia= painfull swallowing - infections: CMV, HSV, Candida, HIV
78
Diagnostic methods for esophageal pathologies and stomach pathologies?
Esophageal pathologies= Barium study Stomach pathologies= Endoscopy Exceptions: cancer & Pre cancerouse leisions in Esophagus=> endoscopy n biopsy
79
Difference between TIA and stroke?
TIA is less than 24 hours . It affects the face and causes aphasia. Stroke is more permenant. More than 24 hours and have seriouse consequences.
80
When do we use Brain CT with conrast?
When there is infection or cancer
81
First step when you suspeciouse of TIA?
Non-conrast CT to R/O hemorrhagic stroke.
82
Approach to TIA?
First step is non contrast head CT . If it's not hemorrhagic and it's within 3 hours start throbmolytic, if it's more than 3 hours and it's not hemorrhagic start ASA. If the patient is already on ASA then switch to clopidogrel or add Dypiridamole. Start Statin for all non- hemorrhagic stroke patients.
83
Contraindications of thrombolytic therapy?
- HX of hemorrhagic stroke - trauma or injury within 6 months - intracranial mass - aortic dissection - active bleeding or surgery within 3 weeks - CPR within 3 weeks - bleeding disorder - stroke within 1 year
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