Rheumatology and Orthopedics 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 Rheumatology and Orthopedics flashcards as text
A 65-year-old woman on long-term prednisone for polymyalgia rheumatica develops vertebral compression fractures. Which medication should have been initiated at the start of corticosteroid therapy?
Answer: Calcium, vitamin D, and bisphosphonate
Current guidelines recommend calcium, vitamin D, and bisphosphonate prophylaxis for patients on chronic corticosteroid therapy to prevent glucocorticoid-induced osteoporosis.
A 55-year-old woman presents with bilateral hand pain, Heberden's nodes at the DIP joints, and Bouchard's nodes at the PIP joints. X-ray shows joint space narrowing without erosions. What is the most likely diagnosis?
Answer: Osteoarthritis
Osteoarthritis characteristically involves DIP joints with Heberden's nodes and PIP joints with Bouchard's nodes, with joint space narrowing but no erosions.
A 40-year-old man with psoriasis develops asymmetric oligoarthritis with 'pencil-in-cup' deformity on X-ray. Which joint pattern is characteristic of this condition?
Answer: DIP joint arthritis with nail changes
Psoriatic arthritis characteristically involves DIP joints with associated nail changes (pitting, onycholysis) and can show pencil-in-cup deformities on X-ray.
A patient with Sjögren's syndrome develops peripheral neuropathy and purpura. Serum protein electrophoresis shows a monoclonal spike. Which complication should be suspected?
Answer: Cryoglobulinemic vasculitis
Sjögren's syndrome is associated with type II cryoglobulinemia, which can present with purpura, peripheral neuropathy, and a monoclonal protein.
A 72-year-old man presents with new severe headache, jaw claudication, and a tender, nodular temporal artery. ESR is 110 mm/hr. What is the most immediate concern requiring treatment?
Answer: Permanent vision loss from ischemic optic neuropathy
Giant cell arteritis can cause sudden, permanent vision loss due to anterior ischemic optic neuropathy, requiring immediate high-dose corticosteroid therapy.
A 30-year-old woman with SLE develops worsening renal function, proteinuria of 3.5 g/day, and active urinary sediment. Renal biopsy shows diffuse proliferative glomerulonephritis. Which WHO/ISN class is this?
Answer: Class IV
ISN/RPS Class IV (diffuse proliferative) lupus nephritis is the most severe form, involving >50% of glomeruli and requiring aggressive immunosuppression.
A 45-year-old woman presents with Raynaud's phenomenon, dysphagia, skin thickening of the fingers (sclerodactyly), and telangiectasias. Anti-centromere antibody is positive. What is the most likely diagnosis?
Answer: Limited cutaneous systemic sclerosis (CREST)
Anti-centromere antibody is strongly associated with limited cutaneous systemic sclerosis (CREST syndrome), which has a better prognosis than diffuse scleroderma.