Common Rheumatologic Disorders Flashcards
7 cards from real Internal Medicine Exam practice questions. Tap to flip, then mark Knew It or Still Learning — missed cards come back until you master them.
Read the first 7 Common Rheumatologic Disorders flashcards as text
A patient with RA fails methotrexate monotherapy. Anti-CCP antibodies are strongly positive. Before starting a TNF inhibitor, which screening test is absolutely required?
Answer: Tuberculin skin test or IGRA for latent TB
TNF inhibitors cause reactivation of latent tuberculosis, so screening with TST or IGRA and treating latent TB before initiation is mandatory.
A 55-year-old woman with limited cutaneous systemic sclerosis has esophageal dysmotility and Raynaud's phenomenon. Which antibody is most specific for CREST syndrome?
Answer: Anti-centromere antibody
Anti-centromere antibody is highly specific for limited cutaneous systemic sclerosis (CREST syndrome) and associated with a better prognosis than diffuse disease.
A 45-year-old man with gout fails allopurinol due to severe hypersensitivity reaction. His eGFR is 35 mL/min. Which urate-lowering agent is preferred?
Answer: Febuxostat
Febuxostat is a non-purine xanthine oxidase inhibitor that can be used in patients with allopurinol hypersensitivity and is safer than probenecid in CKD.
A 38-year-old woman presents with diffuse alveolar hemorrhage, glomerulonephritis, and positive c-ANCA (PR3-ANCA). Renal biopsy shows pauci-immune crescentic GN. What is the induction therapy?
Answer: Cyclophosphamide + high-dose glucocorticoids
Granulomatosis with polyangiitis (Wegener's) with organ-threatening disease requires induction with cyclophosphamide plus high-dose glucocorticoids (or rituximab as alternative).
A 62-year-old man presents with bilateral hip pain that worsens with activity. X-ray shows joint space narrowing, subchondral sclerosis, and osteophytes. Laboratory workup is normal. Which pharmacologic therapy is first-line?
Answer: Acetaminophen or NSAIDs
Osteoarthritis first-line pharmacologic therapy includes acetaminophen for mild pain and NSAIDs for more severe symptoms, as DMARDs have no role.
A 50-year-old woman with SLE develops a blood pressure of 170/110 mmHg, serum creatinine rising to 2.8 mg/dL, and thrombocytopenia. Anti-dsDNA is markedly elevated. Which intervention is most urgently needed?
Answer: Start high-dose methylprednisolone IV pulse therapy
Active lupus nephritis with rising creatinine and serologic flare requires prompt initiation of high-dose IV methylprednisolone pulse therapy followed by cyclophosphamide or mycophenolate.
A patient with ankylosing spondylitis has failed two NSAIDs over 4 weeks each. Which biologic class is first-line for axial spondyloarthropathy?
Answer: TNF inhibitors or IL-17 inhibitors
TNF inhibitors (etanercept, adalimumab, infliximab) and IL-17 inhibitors (secukinumab, ixekizumab) are the approved first-line biologics for NSAID-refractory axial spondyloarthropathy.