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 43-year-old woman with RA is on methotrexate 20mg/week. She develops mouth sores, macrocytic anemia, and fatigue. What is the most appropriate management?
Answer: Add folic acid 1mg daily and continue methotrexate
Methotrexate toxicity (mucositis, megaloblastic anemia) is reduced by supplemental folic acid 1-5mg daily without significantly impairing its efficacy.
A 35-year-old woman presents with livedo reticularis, recurrent spontaneous abortions, thrombocytopenia, and a prolonged PTT that does not correct with mixing study. Which antibody panel is most diagnostic?
Answer: Lupus anticoagulant, anticardiolipin IgG/IgM, and anti-β2-glycoprotein I
Antiphospholipid syndrome is diagnosed by the combination of clinical criteria (thrombosis or pregnancy morbidity) and confirmed positive antiphospholipid antibodies on two occasions 12 weeks apart.
A 72-year-old woman on long-term prednisone for polymyalgia rheumatica presents with sudden severe back pain. Spine X-ray shows a wedge compression fracture at T12. What is the most important preventive measure that should have been initiated?
Answer: Calcium and vitamin D supplementation plus bisphosphonate therapy
Glucocorticoid-induced osteoporosis prevention requires calcium, vitamin D, and a bisphosphonate (or other anti-resorptive) starting with chronic steroid use.
A 58-year-old woman with RA presents with a painless effusion in her right knee. Joint aspiration yields 80 mL of clear, straw-colored fluid with WBC 1,200/mm³ and glucose equal to serum. What does this synovial fluid analysis indicate?
Answer: Noninflammatory (Group I) fluid consistent with RA remission or osteoarthritis overlay
Noninflammatory synovial fluid (WBC <2,000/mm³, clear, normal glucose) suggests inactive RA or a concurrent non-inflammatory process like OA.
A 29-year-old man with IBD-associated arthritis has asymmetric oligoarthritis of large joints that parallels bowel disease activity. Which treatment is most appropriate for both his arthritis and bowel disease?
Answer: Infliximab
Infliximab (anti-TNF chimeric antibody) is effective for both IBD and its associated peripheral arthritis, making it the preferred biologic in this setting.
A 66-year-old woman presents with symmetric polyarthritis, bilateral parotid enlargement, hypercalcemia, and hilar lymphadenopathy on CXR. Serum ACE level is elevated. Which rheumatologic manifestation is most common in this condition?
Answer: Acute migratory polyarthritis (Löfgren syndrome)
Löfgren syndrome (acute arthritis, erythema nodosum, bilateral hilar adenopathy) is the most common rheumatologic presentation of sarcoidosis and carries an excellent prognosis.
A 48-year-old woman presents with muscle weakness, dysphagia, and anti-Jo-1 antibody positivity. Pulmonary function tests show a restrictive pattern. What is the most likely pulmonary complication?
Answer: Interstitial lung disease
Anti-Jo-1 antibody (antisynthetase syndrome) is strongly associated with interstitial lung disease, which is the leading cause of morbidity and mortality in polymyositis/dermatomyositis.