Rheumatology
Hematology
Rheumatology 2
GI
Endocrine
100
Boggy sensation in joints and periarticular osteopenia is usually seen with this rheumatolical disease
RA- Marginal bony erosions in PIP and MCP
OA- Central bony erosions in DIP and PIP on X-ray. Subchondral sclerosis
Pseudogout- Chondrocalcinosis.
100
Patients with Pulmonary embolism severity index < ? can be treated as outpatient for PE
65
Patients with a PESI score less than 65 are very low risk for 30-day mortality (0%), and those with a score less than 85 are low risk for 30-day mortality (1%); patients in these categories can be considered for outpatient management.
Dabigatran and edoxaban require bridging with parenteral anticoagulation, whereas apixaban and rivaroxaban can be used as monotherapy in the treatment of VTE.
100
Which antibody marker is specifically used for following up of disease activity in Lupus(SLE)
Anti-dsDNA is more specific than Anit-Smith for following disease activity
Remember ds stands for disease.
Drug induced Lupus- both are negative and will have normal complement level. ANA is high. Positive- anti histone.
100
Patients with selective Ig A are at increased risk of this infection?
Giardia.
100
2nd Test to do in female with Secondary Ammenorrhea
1st test is Pregnancy test.
If negative- do TSH/ Prolactin/ LH and FSH levels.
200
This term is used when all 3 joints swollen- DIP, PIP and MCP.
Dactylitis- Sausage digits seen in -
Seronegative Spondyloarthropathies- Rh Factor negative and HLA B27+
Enthesitis- inflammation of ligaments, tendons and joint capsule)
Dactylitis- Sausage digits. All 3 joints swollen- DIP, PIP and MCP.
AS
PA
IBD associated Arthritis
Reactive Arthritis( Arthritis, Urethritis,Diarrhea)
200
This deletion in MDS when present improves survival
5q
Treat with lenalidomide.
Goals of treatment in MDS- decrease transfusion dependence and prevent transformation to AML.
200
Increased risk of Scleroderma renal crisis is seen in patients with this ab positive in scleroderma?
Anit-RNA polymerase III
Also predicts increased mortality.
Treatment - Ace inhibitors. Steroids make it worse.
200
Age at which you start screening EGD in patients with FAP?
Age 25-30 years. Start screening for gastric and proximal small bowel tumors. Also at risk for ampulla of vater cancer.
200
Treatment of Paget's ds of bone with normal ALP levels.
No treatment
Treat only if increased ALP levels with IV zolendronic acid and f/u on ALP levels.
300
An electric shock-like sensation in the neck radiating down the spine or into the arms, produced by forward flexion of the neck is called?
Lhermitte's phenomenon
Atlanto Axial Instability-Diagnosis of AAI is made when the space between the posterior aspect of the anterior arch of the atlas and the anterior aspect of the odontoid process is greater than 3 mm in adults.
300
This subset of AML is associated with DIC
APML
Treat with ATRA and Arsenic trioxide
300
Diagnostic test for Sjogrens if Screening antibody is positive for SS-A and SS-B
Shirmer Test( Blotting paper test)- if <5mm wetting in 5 min ( Normal 15mm in 5 min)
Diagnostic test if screening ab's are negative- Lip Biopsy on minor salivary glands.
Dry eyes treatment- 1st line- artificial tears. 2nd choice- Topical cyclosporine or Lifitegrast.
Dry Mouth- Sugar free candy or chewing gum.
300
Small intestine bacterial overgrowth can be confirmed with this test?
Glucose Hydrogen Breath Testing or Jejunal aspirate cultures.
Decreased B12 level and Increased Folate levels.
300
Most common cause of Primary Adrenal Insufficiency
Autoimmune adrenalitis- Check for 21- hydroxylase antibodies ( positive in 90 % of cases). If abs are negative then do abdominal CT.
400
Pleural effusion characteristics for Glucose and pH in patients with rheumatoid arthritis?
Exudative
Protein >3 g/dL
Glucose <29 mg/dL *** Could be <60 mg/dL
LDH >700 U/L, consistent with an exudate
Cholesterol >200 mg/dL
pH <7.20 ***
Rheumatoid factor >240 IU/mL (>1:320)
Complement Low
Cytology Cell number: <5000/mm3
Rheumatoid pleuritis and pleural effusions usually do not require specific treatment as they commonly resolve spontaneously or with treatment of RA joint disease, over 1 to 36 months (mean 14 months) - When treatment needed- start with NSAIDS- indomethacin.
400
This complication of ATRA happens in quarter of patients treated with ATRA for APML
Differentiation syndrome (DS; originally called "retinoic acid syndrome") is a potentially fatal complication of treatment of acute promyelocytic leukemia (APL) with all-trans retinoic acid and/or arsenic trioxide, treatment of acute myeloid leukemia (AML) with inhibitors of isocitrate dehydrogenase (IDH; eg, IDH2 inhibitor, enasidenib; IDH1 inhibitor, ivosidenib), and treatment of AML with mutant FLT3 (Fms-related tyrosine kinase 3) with gilteritinib.
Typical clinical findings of DS include dyspnea, fever, peripheral edema, hypotension, weight gain, pleuro-pericardial effusion, acute renal failure, musculoskeletal pain, and hyperbilirubinemia
400
This type of UV therapy is used for Psoriasis treatment.
Narrow band UV ( 311nm)
400
EGD shows ring and furrows in esophagus in this condition?
Eosinophilic Esophagitis- When the gastrointestinal eosinophilia is limited to the esophagus, is accompanied by characteristic symptoms, and other causes of esophageal eosinophilia have been ruled out, it is termed eosinophilic esophagitis.
Presents as- Dysphagia, Food impaction, Chest pain that is often centrally located and may not respond to antacids or Gastroesophageal reflux disease-like symptoms/refractory heartburn.
Proton pump inhibitors (PPIs) are among first line treatment options, together with dietary modification ( elemental diet or six food elimination diet) and topical glucocorticoids.
400
Treatment of patients with primary adrenal failure
Combination of Glucocorticoid and Mineralocorticoid- hydrocortisone plus fludrocortisone
Tx of Secondary Adrenal failure- Pituitary cause- Only need glucocorticoids.
Adrenal insufficiency can be caused by diseases of the adrenal gland (primary), interference with corticotropin (ACTH) secretion by the pituitary gland (secondary), or interference with corticotropin-releasing hormone (CRH) secretion by the hypothalamus (tertiary).
500
Antibody when present in pregnant women with systemic lupus erythematosus (SLE) increases the risk of congenital complete heart block in the newborn.
Anti-Ro (SSA antibody)
500
Patient presents with SDH and has h/o afib on warfarin with INR Of 4. Pt currently has AMS and has got vit K IV at presentation.
What would be the next step in treatment?
K Centra or prothrombin complex concentrate. Works faster than FFP.
500
Which sign is seen here and is seen in which condition?
Groove Sign seen in Eosinophilic Fasciitis-The onset is typically acute, and findings include erythema, swelling, and induration of the extremities that is accompanied by a peripheral blood eosinophilia. The skin of the hands and feet is generally spared. Diagnosis of EF is confirmed with a full skin-to-muscle biopsy .
Initial management with systemic glucocorticoids, usually starting at doses equivalent to prednisone 1 mg/kg per day
Forearm of a patient with eosinophilic fasciitis shows a linear depression in the skin parallel to the course of the superficial veins, more obvious on raising the arm.
500
Prophylactic cholecystectomy is needed in these 3 conditions- Name two of these.
GB polyp >1 cm
Polyp any size with gallstones
Polyp >8mm Plus PSC
500
This hormone level is used to check ovarian reserve and to assess the chances to concieve ?
Anit Mullerian Hormone levels
It is expressed by the small (<8 mm) preantral and early antral follicles. The AMH level reflects the size of the primordial follicle pool, and may be the best biochemical marker of ovarian function across an array of clinical situations . In adult women, AMH levels gradually decline as the primordial follicle pool declines with age; AMH is undetectable at menopause