1. most accurate test for osteoarthrits?
    Best initial step in management>?
    Best initial analgesic Therapy?

    when are steroids used?
    • Xray
    • weightloss and moderate exercise
    • tylenol
    • when medical therapy is not helpful
  2. Most accurate test for gout?
    Best initial rx?
    when are steroids used?
    • fluid aspiration---pmn <50,000
    • nsaids
    • when medical therapy fails
  3. Chronic management of gout?
    • stop diuretics, aspirin, niacin
    • probenecid for undersecretion
    • allopurinol for overproducers
    • colchicine to prevent second attack
  4. most accurate test for pseudogout?
    best initial therapy?
    when are steroids given?
    how do you prevent the second attack?
    • joint fluid aspiration
    • nsaids
    • in nsaid refractory cases
    • colchicine
  5. what systemic dz predispose to pseudogout?
    • hemochromatosis
    • hyperparathyrodism
  6. 4 oncologic emergencies?
    • spinal cord compression
    • superior vena cava syndrome
    • hypercalcemia
    • leukocytosis
  7. what 3 entities of lower back pain can present with spinal cord compression?
    best initial therapy?
    most effective therapy?
    • cancer
    • cauda equina
    • epidural abscess
    • steroids
    • surgical decompression
  8. the best initial test for compression of spinal cord with focal neurological findings is?
    most accurate test?
    cant do mri?
    • xray
    • mri
    • ct myelogram
  9. what root is for knee reflex?
    ankle reflex?
    • L4
    • S1
  10. Rx for epidural abcesss?
  11. Best initial rx for sciatica?
    when are steroids used?
    when is surgery done?
    • nsaids with continued normal physical activity
    • if refractory cases
    • in focal neurological defects
  12. when do you not do imaging studies for back pain?
    • in absence of focal neurological defects
    • or 
    • in hte absence of radicular/radiating pain
  13. Differences between pad and spinal stenosis?
    pulses and abi index is normal in spinal stenosis and pain occurs with walking down the hill vs pain occuring walking up the hill in pad
  14. the most accurate test for spinal stenosis ?
    • mri
    • weightloss/steroids
  15. best initial rx for fibromyalgia?
    fda approved drug for fibromyalgia?
    • amitryptilline
    • milnacipram
  16. most accurate test for carpal tunnel syndrome'?
    best initial therapy?
    when are steroids used?
    most effective therapy?
    • Electromyography studies
    • wrist splints and nsaids
    • when nsaids and splints fail
    • surgery
  17. Rx for Duptureyen contacture?
    when is surgery done?
    • steroids
    • when function is impaired
  18. best initial therapy for rotator cuff tear?
    when is surgery used?
    • nsaid
    • rest
    • physical therapy
    • steroids
    • with complete tears and refractory cases of rotator cuff injuries
  19. what is patello femoral syndrome?
    best initial test?
    • anterior proximal tibial pain from trauma, quadricep muscle instability or meniscal tear
    • radiological imaging isnormal
    • physical therapy
  20. how is plantar fascitis differentiated from tarsal tunnel syndrome?
    best initial rx?
    • plantar fascitis improves with activity
    • stretching exercises and nsaid
  21. best initial therapy for ra?
    when are steroids used?
    best initial DMARD?

    nsaids are not effective or as a bridge to dmard

  22. what stops progression of ra?
  23. which patients with ra need dmard?
    • erosive--xray changes
    • joint space narrowing
    • physical deformity
  24. when are anti-tnf agents used?
    when are rituximab used?
    • when mtx doesnt work  or together
    • with mtx when anti-tnf doesnt work
  25. toxcity of hydroxycholoquine?
    retinal toxicity
  26. when are rituximab, hydroxychloroquine, sulfasalazine, leflunomide, abatacept used?
    when anti-tnf agents are not working
  27. moa of mtx, hydroxyurea,,6mp?
    • dihydrofolate reductase inhipitor
    • ribonucleotide reductace
    • thymidylate synthase
  28. side effects of gold salts for ra?
    nephrotic syndrome
  29. 2 features of juvenile rheumatoid arthritis?
    best initial rx?
    when are steroids used?
    • rash
    • spiking fever
    • joint pain
    • nsaids
    • in refractory cases
  30. 2 markers for acute flare up of sle?
    decreased complement, increase in Anti-ds DNA
  31. rx for acute flare up of sle?
  32. what bleeding profile is seen with antiphospholipid syndrome?
    increased clotting and increased aptt
  33. best initial study for antiphospholipid syndrome?
    most accurate test for apl?
    • mixing study
    • russel viper venom test
  34. when is apl syndrome treated?
    when it is symptomatic after a thrombosis with warfarin for 6 months
  35. who should be investigated for anticardiolipid syndrome?
    pt with 2 or more 1st trimester abortions or 1 2nd trimester abortion
  36. rx for prevent recurrence of abortions from anticardiolipin syndrome
    heparin or aspirin
  37. most specific test for diffuse scleroderma?
    most specific test for limited scleroderma?
    • anti-scl70
    • anti-centromere
  38. how are manifestations such as
    esophageal dysmotlity
    • ace
    • ccb
    • cyclophosphamide and bosentan for primary pulmonary hypertension
    • ppi for gerd
  39. difference between polymyositis and dermatomyositis?
    • polymyositis--proximal muscle weakness
    • dermatomyositis- polymyositis +
    • shawl--erythema of neck
    • heliotrope---erythema around the eyes
    • gottron papules---plaques on dorsum of the hands
  40. polymyositis or dermatomyositis is associated with cancer?
  41. best initial test?
    most accurate test?
    • cpk and aldolase
    • muscle biopsy
  42. what antibodies are associated with polymyositis/dermatomyositis?
  43. hydroxychloroquine is used in autoimmune inflammatory disorders to primarily control what manifestations?
    skin manifestations
  44. rx for polymyositis/dermatomyositis?
    • steroids
    • if not effective use..mtx, azathioprine, mycophenolate, IVIg
  45. best initial test for sjogrens?
    best initial blood test?
    most accurate test?
    • schirmer test--tearing quantification
    • ss-a ss-b
    • lip or parotid gland biops
  46. best inital therapy for sjogrens?
    pharmacologic therapy for sjogrens?
    • address symptoms of dry mouth, dry eyes--with water and artifical tears
    • pilocarpine or cevimeline
  47. what 2 autoimmune inflammatory disorders can cause cancer?
    • dermatomyosits
    • sjogrens
  48. What is the most accurate test for pan?
    when do u use cylcophosphamide?
    • biopsy of the affected site
    • angiogram of affected artery
    • steroids
    • in severe disease
  49. what 2 disease produces muscle pain but have normal cpk?
    • fibromyalgia
    • polymyalgia rheumatica
  50. most accurate test for giant cell arteritis?
  51. best initial test for wegeners?
    most accurate test for wegeners?
    • c-anca
    • lung biopsy
  52. most accurate test for churg-strauss?
  53. most accurate test for henoch schloein purpura?
  54. what is the rx for hsp?
    when it is severe and involves the kidneys and other systems
  55. how are cryoglobulins and cold agglutinins similar?
    • both are igm and neither responds to steroids
    • cryoglobulins are from hep c, give gn, arthritis, neuropathy, treated with interferon and ribavirin
    • cold agglutinins---produce hemolysis, treated with immunosuppression rituximab, cyclophosphamide, cyclosporine
  56. Hep B is associated with pan while Hep C is associated with?
  57. Cryoglobulinemia is associated with what factor?
    rheumatoid factor
  58. What are pathergies?
    sterile skin pustules from minor trauma
  59. manifestations of behcet diseaes?
    • vasculitis causing arthritis
    • eye conditions
    •  cns conditions
  60. Best initial test for AS?
    most accurate test:?
    best initial rx?
    when are anti-tnf agents used?
    • xray
    • MRI
    • nsaids and exercise
    • in nsaid refractory diseases
  61. best initial test for psoriatic arthritis?
    best initial therapy?
    when is mtx used?
    when are anti-tnf agents used?
    • xray
    • nsaids
    • no response to nsaids
    • no response to mtx
  62. are steroids a good rx for seronegative aspondyloarthropathy?
  63. reactive arthritis occurs secondary to what 3 conditions?
    best initial rx ?
    when is sulfasalazine used?
    • IBD
    • diarrheal infections
    • genital infections like with chlamydia
    • nsaids
    • when refractory to nsaids
  64. what screening is recommended for women over 65, men over 65?
    • women---osteoporosis
    • men--AAA
  65. Most accurate test for Osteoporosis?
    dexa scan
  66. a dexa score of 1 to 2.5 deviations below the normal is?
    more than 2.5
    • osteopenia
    • osteoporosis
  67. what decreases the risk of vertebral fractures in  osteoporosis?
    calcitonin--nasal spray
  68. best initial therapy for osteopororisis?
    • vit d and calcium
    • bisphosphonates
  69. what predisposes to septic arthritis?
    damaged joint
  70. best initial and most accurate test for septic arthritis is ?
    joint aspiration
  71. best initial empiric therapy for septic arthritis?
    ceftriaxone and vanco
  72. Rx of septic arthritis in a prostethic joint?
    removal of join---treatment--replacement of the joint with a new one
  73. what areas must be cultured to confirm gonoccocal arthritis?
    • pharynx
    • cervic
    • urethra
    • rectum
  74. how is gonnoccal arthritis different from other forms of septic arthritis?
    • rash
    • tenosynovitis
    • polyarticular involvement
  75. recurrent gonorrhea infections, test for?
    late c5-c9 complement deficiency
  76. best initial test for osteomyeltiis?
    if xray if unequivical
    most accurate test?
    • xray
    • mri
    • biopsy
  77. what is the only oral antibiotic for osteomyelitis against gram negatives rods?
  78. fluoroquinolones are contraindicated in what patients?
    • pregnant
    • childern 
    • bc it causes achiles tendon rupture
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