4 Review
(Allopurinol / Feboxostat) dosing should be decreased in renal insufficiency
Allopurinol
Which bisphosphonate has the longest half life? A) Risedronate (Actonel) B) Alendronate (Fosamax) C) Zolendronic Acid (Reclast) D) Ibandronate (Boniva)
B
Which (2) test markers are often positive in SLE? A) P-ANCA B) ANA C) anti-dsDNA D) RF
B (ANA) C (anti-dsDNA) (*The antibodies mediate tissue injury by forming immune complexes, which promote inflammation)
How should you treat major organ involvement with or without immunosuppressive therapy in SLE? A) Hydroxychloroquine B) Azathioprine C) Methotrexate with corticosteroids D) chronic corticosteroid
B (Azathioprine - 1mg/kg daily in 1-2 divided doses)
Which medication used in acute gouty attacks commonly causes GI intolerance and should be reduced in hepatic dysfunction? A) NSAIDS B) Colchicine C) Steroids
B (Colchicine)
All of the following are criteria for the diagnosis of SIADH EXCEPT: A) Hyponatremia with plasma hypo-osmolality B) volume overload C) Inappropriately concentrated urine (>100mosm/kg) D) Absence of renal, adrenal, or thyroid disease
B (EUvolemia) (Thyroid disease and adrenal disease can cause hyponatremia and renal disease can impact ADH function at the kidney)
All of the following are seen in hyperaldosteronism EXCEPT: A) hypertension B) hyperkalemia C) low plasma renin D) elevated plasma and 24-hour urine aldosterone
B (HYPOkalemia) (increased aldosterone drives up blood pressure due to increased sodium uptake and increased potassium excretion)
All of the following are seen in myxedema crises EXCEPT: A) Anemia B) hyperthermia C) cardiomegaly D) hyponatremia E) large tongue and slowed speech F) mental apathy G) coarse/ thick skin; carotenemic color
B (HYPOthermia) (will also see bradycardia and hypoglycemia) (low lab values and vitals + drunk) (may also see thinning of eyebrows)
hich of the following is false regarding acromegaly? A) results from an excess of growth hormone secretion after bone growth is completed B) acute onset C) often due to macroadenomas involving the sella and cavernous sinuses D) causes hypogonadism
B (INSIDIOUS onset >10yrs) (hypogonadism due to compression from macroadenoma inhibiting secretion of LH and FSH - causes erectile dysfunction and amenorrhea)
What is the appropriate treatment for an acute adrenal crisis? A) IVF and IV prednisone B) IVF and IV hydrocortisone C) fludrocortisone
B (IVF and IV hydrocortisone) (also get blood cultures and start IV antibiotics)
Inflammatory arthritis in SLE affects all of the following EXCEPT: A) MCP joints B) DIP joints of the hands C) Wrists D) knees
B (PIP joints of the hands)
Which pituitary tumor is the most common? A) Corticotroph adenomas B) Prolactinomas C) Thyrotroph adenomas D) Gonadotroph adenomas
B (Prolactinomas - 40-45%)
Which DMARD should you avoid using in patients with ASA sensitivity? A) Plaquenil B) Sulfasalazine C) Methotrexate D) Etanercept E) all of the above
B (Sulfasalazine)
Neutropenia, Thrombocytopenia, hemolytic anemia (G6PD deficiency), abnormal liver function tests are adverse reactions of which DMARD? A) Plaquenil B) Sulfasalazine C) Methotrexate D) Etanercept E) all of the above
B (Sulfasalazine) (Benefit in 1-3 months)
Which of the following is the most common cause of primary hyperaldosteronism? A) localized hyperplasia B) adrenal adenoma C) bilateral hyperplasia
B (adrenal adenoma - Conn's syndrome)
Which of the following cause decreased thyroid binding globulin? A) high estrogen states B) androgens C) infectious hepatitis D) all of the above
B (androgens)
How should you treat gram negative cocci (non-gonococcal) septic arthritis? A) erythromycin and tetracycline B) ceftazidime and aminoglycoside C) cefazolin and vancomycin D) penicillin and ceftriaxone
B (ceftazidime and aminoglycoside) (this would be for Pseudomonas aeruginosa and Escherichia coli)
How is ACTH deficiency treated? A) endogenous ACTH replacement B) cortisol replacement C) radiation and chemotherapy D) no treatment
B (cortisol replacement)
Apathetic hyperthyroidism with a flat affect, emotional lability, weight loss, muscle weakness, congestive heart failure, and atrial fibrillation resistant to standard therapy is common in what population? A) children B) elderly C) diabetics D) immunosuppressed
B (elderly) (pg 363)
Treat GI telangiectasias with: A) pulsed-dye laser treatments B) estrogen-progesterone C) steroids D) all of the above
B (estrogen-progesterone) (treat cutaneous telangiectasias with pulsed-dye laser treatments)
A patient presents with a palpable thyroid nodule which was shown to be >10mm on US. What should you do? A) thyroidectomy B) fine needle aspiration C) start PTU D) TSH and T4
B (fine needle aspiration -Indicated for all palpable nodules and all incidentalomas > 10 mm or with risk factors for malignancy) (if incidentaloma <10mm, use US features to guide whether or not to do a FNA)
Which of the following is helpful in the diagnosis of acromegaly? A) 24-hour urine B) glucose suppression test C) lumbar puncture with CSF analysis D) colonoscopy with biopsy
B (glucose suppression test - 75g glucose test - should suppress growth hormone levels while IGF-1 remains stable; elevation indicates a positive test)
What is the gold standard stimulatory test for diagnosing GH deficiency? A) glucose tolerance test B) insulin-induced hypoglycemia C) administration of endogenous GRHR D) serum GH levels
B (insulin-induced hypoglycemia) (pg 627)
Pituitary macroadenomas require: A) ophthalmology B) neurophthalmology referral D) neurology referral E) optometry referral
B (neurophthalmology referral) (for macroadenomas or clinical evidence of visual field defects)
What is the most common cause of GH deficiency? A) failure of the hypothalamus to secrete GRHR B) pituitary macroadenomas C) excess somatostatin D) functional microadenomas
B (pituitary macroadenomas and their treatment) (pg 627)
What is the main function of IGF-1? A) increases the uptake of insulin into cells B) promotes growth under GH as well as fuel storage C) stimulates osteoclastic activity D) promotes fatty deposition and elongation of long bones
B (promotes growth under GH as well as fuel storage)
Niacin should be avoided in those with chronic gout as it: A) inhibits uric acid excretion B) raises levels of uric acid C) increases uric acid excretion D) decreases uric acid levels
B (raises levels of uric acid)
A 75yo patient presents with new onset mild RA. He has a h/o of PUD and currently takes warfarin. How should be treated? A) NSAIDs B) salicylate or low-dose prednisone C) hydroxychloriquine / sulfasalazine D) MTX lefunomide
B (salicylate or low-dose prednisone) (do not use NSAIDs in those over 75, h/o ulcer, steroid or anticoagulant use, high dose NSAID use) (treat with non-acetylated salicylate - trilisate - low dose prednisone, NSAID + misoprostil or PPI, or COX-2 inhibitor)
A patient presents to your office following discovery of an incidental adrenal mass. Work up shows the mass to be non-functional and >5cm. What would be the appropriate next step? A) repeat CT in 3 months B) surgical excision C) fine needle biopsy D) any of the above
B (surgical excision) (excise if found to be functional, >5cm, or if there is evidence of growth on f/u CT)
How should you treat ocular complaints in spondylarthropathies? A) erythromycin and tetracycline B) systemic corticosteroids C) topical corticosteroids D) methotrexate
B (systemic corticosteroids)
Which of the following is false regarding gonococcal arthritis? A) Follows dissemination from cervix, pharynx, urethra, or rectum B) Purulent joints follow vesiculopustular skin lesions C) occurs in young, healthy sexually active individuals. D) treat with ceftriaxone and azithromycin
B (vesiculopustular skin lesions is stage 1 followed by purulent joints which is stage 2)
Paget's disease most often affects the: A) femur B) skull C) sacrum and spine D) pelvis
C
Measurement of ________ best reflects the vitamin D status of an individual A) D2 B) D3 C) 25Hydroxy (OH) Vitamin D D) 1,25 (OH)2 Vitamin D
C (25Hydroxy Vitamin D) (normal is 30-80) (>150 = toxic) (Levels of 25-OH vitamin D should be maintained > 32 ng per mL to maximize bone health.)
What is the most common cause of adrenal insufficiency? A) infections B) adrenal hemorrhage C) Addison's disease D) meningococcemia
C (Addison's disease - autoimmune destruction of the adrenal gland) (can also be caused by drugs, malignancy, and infiltrative disease such as hemochromatosis)
Which of the following is NOT seen in primary hyperparathyroidism? A) bone pain B) calcium stones C) Chvostek's sign D) fatigue and nausea
C (Chvostek's sign - this hypoparathyroidism) ("bones" / "groans" / "stones" are seen in hyperparathyroidism)
What is true about drug induced SLE? A) occurs in men more than women B) nephritis and CNS systems predominantly present C) hypocomplementemia and antibodies to double-stranded DNA are absent D) clinical manifestations remain after offending drug has been removed
C (Hypocomplementemia and antibodies to double-stranded DNA are absent) (A - genders are equally effective | B - nephritis and CNS involvement is usually absent | D - symptoms resolve after drug removed)
All of the following should be monitored with corticosteroid use EXCEPT: A) Blood pressure B) annual UA for glucose C) LFTs D) bone density E) electrolytes
C (LFTs)
Which of the following describes MEN 2B? A) Autosomal dominant disorder causing medullary carcinomas of the thyroid, pheochromocytomas, and/or hyperplasia or multiple adenomas causing hyperparathyroidism B) familial autosomal dominant multiglandular syndrome causing tumors of the pituitary adenomas, pancreatic tumors, and / or parathyroid tumors C) Manifests as tumors of the medullary carcinomas of the thyroid, mucosal neuromas, bilateral adrenal pheochromocytomas and / or Marfan-like habitus
C (Manifests as tumors of the medullary carcinomas of the thyroid, mucosal neuromas, bilateral adrenal pheochromocytomas and / or Marfan-like habitus) (screen for ret proto-oncogene)
How should you treat Refractory Arthritis in SLE? A) Hydroxychloroquine B) Azathioprine C) Methotrexate with corticosteroids D) chronic corticosteroid
C (Methotrexate 7.5mg with corticosteroids 10mg until methotrexate becomes affective)
Elevated LFT, thrombocytopenia, pancytopenia, and cirrhosis are adverse reactions seen with which DMARD? A) Plaquenil B) Sulfasalazine C) Methotrexate D) Etanercept E) all of the above
C (Methotrexate) (1-3% pancytopenia, 15% elevated LFT) (may cause ILD -- especially those with myositis)
Which of the following lab results is NOT consistent with Paget's disease? A) elevated alkaline phosphatase B) normal phosphate C) decreased calcium D) elevated urine hydroxyproline
C (NORMAL or elevated calcium) (alklaline phosphatase and urine hydroxyproline can be used as markers to monitor therapy)
What is the first line of treatment for Graves disease? A) Radioactive iodine 131 B) surgery C) PTU/methimazole D) levothyroxine
C (PTU/methimazole - for only 12-18 months, then check to see if symptoms have resolved)
Technetium Bone Scans are used for: A) hyperparathyroidism B) osteopenia C) Paget's disease D) osteoporosis
C (Paget's disease - increased activity visible with increased uptake of bone seeking isotope)
Which of the following is FALSE regarding serum aldosterone testing? A) plasma should be taken with the patient recumbent at 8am and again 4 hours later with the patient upright B) Patients should have a liberal NaCl diet C) Patients should be testing only after fasting D) all of the above are true
C (Patients should be testing only after fasting) (patients require a liberal NaCl diet as a low Na diet can reduce renal potassium secretion and inhibit manifestation of hypokalemia)
What is a side effect of allopurinol? A) hepatic failure B) headache C) Stevens-Johnson syndrome D) meningitis
C (Stevens-Johnson syndrome and vasculitis) (more common in persons with reduced renal function and Asian populations)
All of the following are bisphosphates EXCEPT: A) Risedronate (Actonel) B) Alendronate (Fosamax) C) Teriparatide (Forteo) D) Ibandronate (Boniva) E) Zolendronic Acid (Reclast)
C (Teriparatide is a PTH analog that stimulates osteoblastic activity) ("Bisphosphonates RAIZ the bone density")
What does NOT need to be monitored with Methotrexate use in RA? A) CBC B) SrCr C) UA D) LFTs E) chest XR
C (UA) (CBC, SrCr, LFTs should be monitored monthly for 1st 6 months and then q1-2months / also need baseline and annual CXR)
Which bisphosphonate can be given IV q12 months? A) Risedronate (Actonel) B) Alendronate (Fosamax) C) Zolendronic Acid (Reclast) D) Ibandronate (Boniva)
C (Zolendronic Acid / Reclast) - more expensive) (*caution in renal disease)
Which of the following drugs is implicated in the development of hyperprolactinemia? A) cabergoline B) bromocriptine C) amitriptyline D) all of the above
C (amitriptyline - a TCA - others include phenothiazines which end in -azine, SSRIs, and metoclopramide)
All of the following are associated with Sjogren's Syndrome EXCEPT: A) more common in women B) Autoimmune disorder C) average age of diagnosis is 20yo D) usually associated with RA
C (average age of diagnosis is 50yo)
Diffuse scleroderma characteristically causes: A) lung and cardiac disease B) lung and renal disease C) cardiac and renal disease D) cutaneous and cardiac disease
C (cardiac and renal disease) (treat renal obstruction with ACE inhibitors)
How should you treat gram positive cocci (non-gonococcal) septic arthritis? A) erythromycin and tetracycline B) ceftazidime and aminoglycoside C) cefazolin and vancomycin D) penicillin and ceftriaxone
C (cefazolin and vancomycin) (this would be for s. aureus, MRSA, and group B strep)
Secondary Hyperparathyroidism is commonly seen in: A) chronic liver failure B) heart failure C) chronic renal failure D) diabetics
C (chronic renal failure)
What is the mechanism of action of democlocycline (Declomycin) in the use of SIADH? A) increases ADH secretion B) increases plasma sodium levels C) decreases renal sensitivity to ADH D) increases insertion of aquaporins at distal convoluted tubules causing increases urine production
C (decreases renal sensitivity to ADH) (can also use lithium carbonate) (this is in addition to fluid restriction)
Cushing's syndrome is a syndrome of _______ excess A) mineralcorticoid B) androgen C) glucocorticoid D) catecholamine
C (glucocorticoid)
The zona fasiculata secretes: A) mineralcorticoids B) androgens C) glucocorticoids D) catecholamines
C (glucocorticoids - cortisol) (sugar)
What is the hallmark clinical finding of thyroid storm? A) N/V B) tachycardia C) hyperpyrexia D) facial flushion
C (hyperpyrexia out of proportion to other clinical findings - pg 365)
What is the most common cause of hypoparathyroidism? A) magnesium deficiency preventing PTH secretion B) Autoimmune failure C) iatrogenic due to thyroid or parathyroid surgery D) congenital E) heavy metal toxicity or infiltrative disease
C (iatrogenic due to thyroid or parathyroid surgery)
What is the most common cause of Cushing's syndrome? A) primary adrenal tumors B) ACTH pituitary tumor C) iatrogenic D) ectopic ACTH
C (iatrogenic)
All of the following require Methotrexate dose adjustment EXCEPT: A) renal impairment B) hepatic impairment C) immunosuppression D) elderly
C (immunosuppression)
All of the following are signs and symptoms of thyroid storm EXCEPT: A) arrhythmia B) hyperthermia C) large tongue and slowed speech D) confusion, seizure, coma
C (large tongue and slowed speech - this is myxedema crisis) (can be precipitated by surgery, radioactive iodine therapy, or severe stress - e.g., uncontrolled diabetes mellitus, myocardial infarction, acute infection). (Patients develop fever, flushing, sweating, significant tachycardia, atrial fibrillation, and cardiac failure - pg 365)
ACTH deficiency causes adrenal insufficiency and decreased levels of all of the following EXCEPT: A) cortisol B) androgens C) mineralcorticoids D) all of the above are decreased
C (mineralcorticoids - salts / aldosterone)
Which of the following is FALSE regarding cortisol replacement with hydrocortisone acetate? A) must increase dose in times of acute stress or illness B) continue increased dose until resolution of the stressor C) monitor with serum cortisol levels D) administer as a divided dose
C (monitor with 24 hour urine free cortisol)
What is NOT a treatment for calcinosis in CREST? A) corticosteroids B) calcium channel blockers C) nitroglycerin D) surgery
C (nitroglycerin - this is used in severe, acute cases of Raynaud's in CREST)
Teriparatide (Forteo) is indicated for all of the following situations EXCEPT: A) postmenopausal osteoporosis B) male hypogondal osteoporosis C) paget's disease D) it is indicated for all of the above
C (paget's disease - contraindicated; also contraindicated in bone metastatic disease and hypercalcemia) (increased osteosarcoma risk)
What is the most common type of thyroid cancer? A) anaplastic B) follicular C) papillary D) medullary
C (papillary at 80%)
Which medication for acromegaly is a growth hormone receptor antagonist acting to decrease IGF-1 production at the level of the liver, reducing the effects of acromegaly, but not shrinking tumor size? A) carbergoline B) octreotide C) pegvisomant
C (pegvisomant / somavert) (administered qdaily SQ) (indicated for patients who have persistent elevation in IGF-I even with maximum doses of SRLs)
Which of the following is NOT a common fracture site in patients with osteoporosis? A) hip B) wrist C) proximal humerus D) vertebral column
C (proximal humerus) (hip and wrist fx due to falls; vertebral fx due to carrying weight)
Which of the following is FALSE regarding Teriparatide (Forteo) use? A) contraindicated in Paget's and hypercalcemia B) May help healing of chalk-stick fractures associated with bisphosphanate use C) risk of osteonecrosis of the jaw D) increases the risk of osteosarcoma
C (risk of osteonecrosis of the jaw - this is seen with bisphosphonates)
Growth hormone stimulates _________ in the liver to release IGF-1 A) somatostatins B) somatotrophs C) somatomedins D) hepatocytes
C (somatomedins)
All of the following are absolute contraindications to GH therapy, used in GH deficiency, EXCEPT: A) active neoplasm B) intracranial hypertension C) uncontrolled diabetes D) proliferative diabetic retinopathy
C (uncontrolled diabetes and untreated thyroid disease are relative contraindications) (pg 627)
Calcification of lateral spinal ligaments as seen in ankylosing spondylitis is termed: A) sacroilitis B) sclerosis C) vertebral squaring D) syndesmophytes
C (vertebral squaring)
What would be correct, important educational material to give your patient regarding their hypothyroidism therapy? A) "This medication may cause immunosuppression, so be sure to call if you are feeling ill" B) "This medication is unsafe to take while pregnant" C) "This medication should not be taken with alcohol" D) "This medication should be taken first thing in the morning, 30 minutes prior to eating"
D ("This medication should be taken first thing in the morning, 30 minutes prior to eating") (also, doses need to be increased in pregnancy - Cat. A drug)
What is the appropriate treatment for vitamin D deficiency due to fat malabsorption? A) D2 B) D3 C) 25Hydroxy (OH) Vitamin D D) 1,25 (OH)2 Vitamin D
D (1,25 (OH)2 Vitamin D) (as per the change in class)
How do you treat gonococcal arthritis? A) 1gm of Ceftriaxone IV q 24-48 hrs B) 1gm azithromycin orally as single dose C) erythromycin and tetracycline D) A and B
D (1gm of Ceftriaxone IV q 24-48 hrs AND treat Chlamydia as well with 1gm PO azithromycin)
Which of the following is an IL-1 receptor antagonist that is beneficial in patients who have not responded to or are intolerant of MTX, leflunomide, or TNF antagonists in RA? A) Adalimumab/ Humira B) Infliximab C) etanercept D) Anakinra / Kineret
D (Anakinra / Kineret) (Do not use with TNF antagonist due to risk of infection - should also be off MTX)
You have a female patient presenting for treatment of Graves Disease. What test must you get before pursuing treatment? A) PPD B) chest XR C) pregnancy test D) CBC
D (CBC - PTU and methimazole can cause agranulocytosis - more common with PTU)
Regulation of calcium reabsorption by PTH at the kidney occurs at the: A) PCT B) ascending loop of Henle C) descending loop of Henle D) DCT
D (DCT) (90% of calcium is reabsorbed at the PCT and is not under the influence of PTH / 10% is reabsorbed at the DCT and is influenced by PTH)
All of the following are signs or symptoms of scleroderma EXCEPT: A) Polyarthragia B) Raynaud's Phenomenon C) Subcutaneous edema D) Dysuria with normal urinalysis E) Fever and malaise
D (Dysuria with normal urinalysis - this is fibromyalgia)
Which of the following is FALSE regarding Infiximab use? A) It is a DMARD that interferes with endogenous TNF-alpha, used in RA B) Must be used in combination with MTX C) adverse effects include acute or chronic infection, headache, nausea, fatigue D) lowest cost drug
D (HIGHEST cost drug) (Monitoring parameters: signs of infection)
How is Cushing's syndrome due to primary adrenal tumors treated for non-resectable tumors? A) adrenalectomy of cortisol secreting adenomas and carcinomas B) transsphenoidal resection the pituitary tumor C) dexamethasone supplementation D) Ketoconazole or Metyrapone to block 11-hydroxylase enzyme in the pathway of cortisol production
D (Ketoconazole or Metyrapone to block 11-hydroxylase enzyme in the pathway of cortisol production)
All of the following should be monitored with leflunomide use in RA EXCEPT: A) CBC B) serum Creatinine C) LFTs monthly for the first 6 months then q1-2 months there after D) PPD
D (PPD) (60% of patients on MTX + leflunomide have elevated LFTs)
Which of the following is NOT a sign or symptom seen in growth hormone deficiency? A) muscle weakness and fatigue B) depression and social isolation C) hypertension and mild obesity D) large heart E) lipid abnormalities F) osteoporosis
D (SMALL heart with decreased cardiac output) (non-specific symptoms in adults as growth hormone is simply a maintenance hormone)
All of the following are associated with diffuse scleroderma EXCEPT: A) poor prognosis B) proteinuria C) less common than limited scleroderma D) affects hands and face
D (affects trunk and proximal extremities)
Which of the following is FALSE? A) Surgical excision of aldosterone secreting adenomas is curative B) Spironolactone is a potassium sparing diuretic used in the treatment of adrenal hyperplasia causing hyperaldosteronism C) Spironolactone is used in poor surgical candidates D) all of the above are true
D (all of the above are true)
What is NOT an adverse effect of sulfasalazine, used in RA? A) headache B) diarrhea C) myelosuppresion D) alopecia E) orange-yellow discoloration to urine and skin
D (alopecia - this is hydroxychloroqunie) (sulfasalazine causes photosensitivity)
Which supplements should be given in long term corticosteroid use? A) calcium and phosphorus B) B12 and vitamin D C) Vitamin C and zinc D) calcium and vitamin D
D (calcium and vitamin D)
All of the following are signs and symptoms of hypothyroidism EXCEPT: A) weight gain B) dry skin C) hair loss and brittle nails D) dermopathy E) decreased appetite F) goiter G) delayed reflexes
D (dermopathy - seen in hyperthyroidism) (may also see increased prolactin and LDL /TGs)
How is hGH deficiency treated? A) surgery B) chemotherapy and radiation C) endogenous insulin therapy D) endogenous GH or somatotropin
D (endogenous GH or somatotropin) (SQ) (very expensive)
All of the following are common side effects of dopamine agonists (used in the treatment of hyperprolactinemia) EXCEPT: A) nausea B) orthostasis C) dizziness D) headache E) fatigue F) hypersexuality G) all of the above are common SEs
D (headache) (usually wane over time) (more common with cheaper version, bromocriptine)
Which of the following is NOT seen in SLE? A) swan neck deformity B) ulnar deviation C) tendon ruptures D) Heberden's nodes
D (heberden's nodes)
Which of the following is NOT a relative contraindication to methotrexate use in RA? A) liver disease B) renal impairment C) significant lung disease D) immunosuppression E) alcohol abuse F) noncompliance with monitoring
D (immunosuppression)
Which DMARD may be used either as an alternative with MTX or in conjunction with MTX and acts to inhibit pyrimidine synthesis in RA? A) sulfasalazine B) hydroxychloroquine C) etanercept D) leflunomide
D (leflunomide) (CYP 2C8/9 modulator — use with NSAIDS may increase toxicity) (60% of patients on MTX + leflunomide have elevated LFTs)
Which type of thyroid cancer is associated with ret oncogene and MEN syndrome? A) anaplastic B) follicular C) papillary D) medullary
D (medullary)
Which of the following causes of adrenal insufficiency is an acute failure of the adrenal gland due to meningitis? A) infections B) adrenal hemorrhage C) Addison's disease D) meningococcemia
D (meningococcemia - AKA Waterhouse-Friderichsen)
What is NOT a side effect of Leflunomide which is used in RA? A) diarrhea B) alopecia or rash C) liver toxicity D) nephrolithiasis E) headache F) immunosuppression
D (nephrolithiasis)
What is NOT a contraindication for prebenocid use? A) in a patient with 24 hour uric acid excretion >800mg B) in patients taking ASA C) in patients with allergy to Sulfa D) patients taking allopurinol or febuxostat
D (patients taking allopurinol or febuxostat) (May be added in this case for additional efficacy)
All of the following are causes of hyperprolactinemia, EXCEPT: A) pituitary tumors B) metoclopramide C) pregnancy D) pituitary apoplexy E) primary hypothyroidism F) liver or renal disease
D (pituitary apoplexy)
Which lab result would be consistent with Scleroderma? A) positive scleroderma antibody B) negative ANA C) hematuria D) positive anticentromere antibody
D (positive anticentromere antibody) (may also see positive ANA and proteinuria)
Which of the following is NOT consistent with hypoparathyroid presentation? A) fatigue and irritability B) convulsions C) circumoral tingling D) psychosis and depression E) cataracts F) thinning eyebrows
D (psychosis and depression - seen in hyperparathyroidism)
Systemic Lupus Erythmatosus affects all of the following systems, EXCEPT: A) Musculoskeletal B) Renal C) Cutaneous D) Pulmonary
D (pulmonary)
Which of the following is NOT a physiologic effect of corticosteroids? A) increased gluconeogenesis and glycogen synthesis B) increased insulin levels C) increased lipid levels D) increased sodium and water excretion E) delayed growth F) muscle wasting and skin atrophy G) osteoporosis
D (sodium and water RETENTION)
Ossification of the outer fibers of the annulus fibrosis of the spine resulting in bridging of the corners of one vertebra to another as seen in ankylosing spondylitis is termed: A) sacroilitis B) sclerosis C) vertebral squaring D) syndesmophytes
D (syndesmophytes)
(D2 / D3) comes from milk products and sunlight; (D2 / D3) comes from plant based products
D3; D2
(D2/ D3) is converted to 25 OH Vitamin D in the _______, which is then converted to 1,25 OH2 Vitamin D in the ______
D3; liver; kidneys (functions to increase GI absorption of calcium)
All of the following are complications of long standing RA, EXCEPT: A) subluxation B) tenosynovitis and tendon rupture C) muscle atrophy D) decreased activities of daily living E) all of the above occur
E
Which of the following causes an increased thyroid binding globulin level? A) Liver Disease B) Malnutrition C) Protein losing nephropathy D) Androgens E) Infectious hepatitis F) Estrogen deficiency menopause G) Major stress
E (Infectious hepatitis) (Decreased levels mnemonic "low protein MEALS") (protein losing nephropathy, Malnutrition, Estrogen deficiency, Androgens, Liver dz, Stress)
Which of the following is NOT consistent with primary hyperparathyroidism? A) hypercalcemia B) hypophosphatemia C) elevated PTH D) decreased 25 OH vitamin D E) decreased urine calcium
E (decreased urine calcium - will be normal or increased) (also get renal CT to look for stones)
Which of the following is FALSE regarding Anakinra (Kineret)? A) used when RA patient is intolerant of MTX, leflunomide, or TNF antagonists B) adverse effects include skin irritation and infection C) requires CBC monitoring D) administered as daily injectable dose E) dose reduction is required for severe hepatic impairment
E (dose reduction is required for severe RENAL impairment) (Monitoring: CBC at baseline, every month for the 1st 3 months, then every 3 months) (High cost treatment)
All of the following are adverse effects of Densosumab (Prolia) EXCEPT: A) osteonecrosis of the jaw B) hypocalcemia C) serious infections D) dermatologic infections E) pulmonary fibrosis
E (pulmonary fibrosis) (Second-line therapy to bisphosphonates and in high-risk patients due to cost considerations and limited long-term exposure data.)
What is NOT a side effect of methotrexate? A) GI distress B) thrombocytopenia and leukopenia C) hepatic fibrosis and cirrhosis D) pulmonary fibrosis E) renal failure F) rash and alopecia G) stomatitis
E (renal failure) (however renal impairment is a relative contraindication and dosing should be adjusting with use in renal impairment)
Which of the following is NOT associated with fibromyalgia? A) Stiffness B) Fatigue C) Numbness in hands or feet D) Dysuria with normal urinalysis E) subcutaneous edema F) Irritable Bowel Syndrome
E (subcutaneous edema- this is scleroderma)
All of the following may cause SIADH EXCEPT: A) small cell lung cancer B) oxytocin C) CNS trauma D) TB E) untreated diabetes mellitus
E (untreated diabetes mellitus)
All of the following are adverse effects of Bisphosphonates EXCEPT: A) GI upset B) esophagitis with increased risk of esophageal CA C) gastric ulcer D) atypical chalk-stick fxs E) osteonecrosis of the jaw F) hypocalcemia
F (HYPERcalcemia) (Any complaint of hip pain should be investigated for atypical chalk-stick fracture
Which of the following is NOT a complication of corticosteroid use? A) iatrogenic Cushing's B) HPA axis suppression C) peptic ulcer D) psychosis E) glaucoma F) all of the above are possible complications
F (all of the above are possible complications) (be sure to frequently check blood sugars and blood pressure, encourage glaucoma screening, and give osteoporosis prophylaxis - calcium with vitamin D and bisphosphonates)
(Allopurinol / Feboxostat) requires LFT monitoring
Feboxostat (Uloric)
RA with splenomegaly and cytopenias is termed ________ syndrome
Felty's (monitor WBC and plts) (Will also see vasculitis and leg ulcers)
(PTU / methimazole) prevents synthesis (not secretion) of thyroid hormones and inhibits peripheral conversion of T4 to T3
PTU (DOC for thyroid storms) (however Now a black box warning about hepatic failure)
Osteitis Deformans is also termed ________ disease
Paget's
Jaccoud's Arthropathy (5-40%) is laxity of ligaments and tendons and can occur in any joint associated with _______
SLE
Hypersecretion of which hormone results in goiter?
TSH
A non-compliant patient with a history of Addison's presents with a headache, N/V, fever, hypotension, hypoglycemia, and purpura. What do you suspect?
acute adrenal crisis (in this case due to undertreated adrenal insufficiency) (can also present in cases of acute stress, adrenal hemorrhage or infection, or undiagnosed adrenal insufficiency)
(allopurinol / febuxostat) requires decreased dosing for renal insufficiency (GFR 30-45)
allopurinol (cut doses by 50%)
Dopamine (agonists / antagnoists) such as metoclopramide, phenothiazines, TCAs, and SSRIs would cause hyperprolactinemia
antagonists (dopamine inhibits prolactin -- these drugs inhibits dopamine)
(cabergoline / bromocriptine) is the preferred dopamine agonist used to treat prolactinomas as it has fewer side effects
cabergoline
Female patients taking Methotrexate and/or Leflunomide for RA should be taking _________ prior to starting therapy
contraceptives (leflunomide is a cat X)
Growth hormone (increases / decreases) the effects of insulin
decreases (it is diabetogenic and causes a rise in blood sugars) (thus, long standing acromegaly causes diabetes mellitus)
T/F ADH levels are helpful in diagnosing SIADH
false
T/F TSH levels are used to monitor secondary hypothyroidism
false (must measure thyroid hormone levels)
What is the most common inflammatory form of arthritis?
gouty arthritis (Prevalence has increased over the past 30-40 years)
(hyper-/hypo-)prolactinemia causes infertility and amenorrhea
hyperprolactinemia (Always get prolactin level with infertility or amenorrhea )
A thyroid storm occurs with severe (hyper / hypo) thyroidism
hyperthyroidism (treatment include beta blockers and IV PTU)
A Myxedema crisis refers to severe (hyper / hypo) thyroidism
hypothyroidism (progressive over months) (Myxedema coma requires emergent treatment - IV levothyroxine, rewarming, glucose, cardiac stabilization)
Calcitonin is used to screen for _________ carcinomas of the thyroid and tumor marker after treatment
medullary (calcitonin is made by C cells in the thyroid)
(PTU / methimazole) prevents synthesis (not secretion) of thyroid hormones, however it does not inhibit peripheral conversion of T4 to T3
methimazole
(PTU / methimazole) can be dosed once daily, compared to 2-3x daily and is less likely to cause agranulocytosis
methimazole (however PTU is DOC in pregnancy)
Sulfasalazine may increase the toxicity of _______ and azathioprine
methotrexate
Most prolactinomas (prolactin secreting pituitary tumors) are (micro-/macro-)adenomas
microadenomas
Defective mineralization of the skeleton in adults is termed _________
osteomalacia (termed Rickets in children)
You have administered a cosyntropin (ACTH stimulation) test to a patient with suspected adrenal insufficiency. Cortisol levels rise <10mcg/dL. This is consistent with (primary / secondary) adrenal insufficiency
primary (Addison's)
(primary / secondary) hypothyroidism is more common
primary (at the level of the thyroid) (Hashimoto's)
Hyperpigmentation and salt cravings are only seen in (primary / secondary) adrenal (excess / insufficiency)
primary; insufficiency (stimulation of melanocytes by ACTH causes bronzed skin; salt cravings due to loss of salt with low aldosterone levels)
_________ is a group of disorders characterized by renal resistance to PTH
pseudohypoparathyroidism (Parathyroid hormone works, but kidney PTH receptors do not)
(Primary / Secondary) hyperparathyroidism causes hyperphosphatemia, decreased renal production of vitamin D, and decreased serum calcium levels
secondary (Results in increased parathyroid activity in an attempt to increase Vitamin D and serum calcium)
Carbergoline, Lanreotide, and octreotide (sandostatin) are ______ analogs which work by inhibiting the secretion of growth hormone to reduce tumor size (by about 30%)
somatostatin (administered IM q4weeks)
Growth hormone is (stimulated / suppressed) by hypoglycemia
stimulated (as GH causes rise in blood sugar)
Growth hormone is (stimulated / suppressed) by hyperglycemia
suppressed (as GH causes rise in blood sugar)
T/F Nephrogenic diabetes insipidus due to primary hyperparathyroidism is resistant to diuretics
true
T/F Only 30% of patients with Paget's disease are symptomatic
true
T/F RA is the most common systemic inflammatory disease
true
T/F TSH deficiency causes secondary hypothyroidism
true
T/F The rheumatoid factor is more commonly positive in patients with rheumatoid nodules
true
T/F Anti-CCP is present in most patients with RA
true (70-80%) (50% sensitive and 95% specific)
T/F Liver and kidney disease may cause a rise in growth hormone
true (check glucose, LFTs, and renal function when a patient presents with signs of acromegaly)
T/F Paget's disease increases the risk for osteosarcomas and chondrosarcomas
true (may also see high-output CHF due to increase vascularity of involved bone)
What is the dosing for Allopurinol?
100mg/day (increased every 2-4wks to max of 800mg/day)
You have a 70yo patient with a history of atrial flutter and newly diagnosed Hashimoto's. What dose of levothyroxine should you start her on?
12.5 (mcg/day) (go slow in elderly and those with CVD and rhythm disturbances)
You have a 45yo patient with newly diagnosed Hashimoto's. What dose of levothyroxine should you start her on?
50-100 (mcg/day)
What is the dosing for methotrexate in RA?
7.5-20mg/wk (or given over 36hr - i.e. 2.5 mg Q12 x 3 doses each week) (Start at 7.5-15 mg and increase in increments of 5 mg q month to 20-30 mg per week)
All of the following indicate chronic treatment for gout EXCEPT: A) one gouty attack in one year B) Renal insufficiency C) Nephrolithiasis D) tophi
A (3+ gouty attacks annually)
All of the following are associated with psoriatic arthritis EXCEPT: A) symmetric oligoarthritis B) Achilles tendinitis C) HLA-B27 positive D) plantar fasciitis
A (ASYMMETRIC oligoarthritis) (HLA-B27 - 50%)
Which of the following describes MEN 2a (Sipple's syndrome)? A) Autosomal dominant disorder causing medullary carcinomas of the thyroid, pheochromocytomas, and/or hyperplasia or multiple adenomas causing hyperparathyroidism B) familial autosomal dominant multiglandular syndrome causing tumors of the pituitary adenomas, pancreatic tumors, and / or parathyroid tumors C) Manifests as tumors of the medullary carcinomas of the thyroid, mucosal neuromas, bilateral adrenal pheochromocytomas and / or Marfan-like habitus
A (Autosomal dominant disorder causing medullary carcinomas of the thyroid, pheochromocytomas, and/or hyperplasia or multiple adenomas causing hyperparathyroidism) (screen patients for ret proto-oncogene; those + should have siblings and children tested)
What is the appropriate supplementation for a vitamin D-deficient diet? A) D2 B) D3 C) 25Hydroxy (OH) Vitamin D D) 1,25 (OH)2 Vitamin D
A (D2)
Which of the following is NOT a consequence of a pheochromocytoma? A) hypoglycemia B) seizures C) psychosis D) hypertensive crisis E) cardiomyopathy F) pulmonary edema
A (HYPERglycemia)
Which of the following is a monoclonal antibody derived biologic that interferes with endogenous TNF-alpha activity and is used in RA? A) Adalimumab/ Humira B) Infliximab C) etanercept D) leflunomide
A (Humira)
How should you treat minor organ involvement such as to the skin or oral mucosa in SLE? A) Hydroxychloroquine B) Azathioprine C) Methotrexate with corticosteroids D) chronic corticosteroid
A (Hydroxychloroquine)
Which is NOT seen in reactive arthritis? A) painful oral ulcers B) balanitis C) conjunctivitis D) uveitis E) diarrhea F) urethritis or cervicitis G) asymmetric arthritis
A (PAINLESS oral ulcers)
Which of the following is a Selective Estrogen Receptor Modulator (SERM) that is less potent than a bisphosphnate, acts to reduce vertebral fractures, and has been found to be protective against breast CA? A) Raloxifene (Evista) B) Alendronate (Fosamax) C) Teriparatide (Forteo) D) Denosumab (Prolia) E) Zolendronic Acid (Reclast)
A (Raloxifene / Evista) (no breast tenderness or endometrial effects) (increased risk of thromboembolism and hot flashes)
All of the following are radiographic findings in ankylosing spondylitis EXCEPT: A) Asymmetric Sacroiliitis B) Sclerosis, articular erosions, and bony fusion across the joint C) Vertebral squaring of the vertebral bodies D Syndesmophytes
A (SYMMETRIC Sacroiliitis)
Which medication for acromegaly shrinks 1/3rd of residual tumors by 50% and is the most effective in tumors that also secrete prolactin? A) carbergoline B) octreotide C) pegvisomant
A (carbergoline) (the most efficacious of the dopamine agonists for treatment of acromegaly, but it is effective in fewer than 10% of patients - pg 628)
How should you treat urethritis in spondylarthropathies? A) erythromycin and tetracycline B) systemic corticosteroids C) topical corticosteroids D) methotrexate
A (erythromycin and tetracycline)
Which is FALSE regarding abatacept (Orencia)? A) first line of treatment for RA B) inhibits co-stimulation and activation of T cells (known as a selective co-stimulation modulators) C) May be given as self-injection (like Enbrel) or as IV infusion (like Remicade) D) Should not be used in conjunction with anakinra or anti-TNF agents E) Most common adverse effects include increased risk of infection and infusion/injection side reaction
A (first line of treatment for RA -- Reserved for use in patients not tolerating or responding optimally to MTX and/or other biologics)
What is the appropriate medical therapy for nephrogenic diabetes insipidus? A) indomethacin B) desmopressin (DDAVP) C) fluid restriction D) psychiatric management
A (indomethacin)
Thiazides should be avoided in those with chronic gout as it: A) inhibits uric acid excretion B) raises levels of uric acid C) increases uric acid excretion D) decreases uric acid levels
A (inhibits uric acid excretion)
The zona glomerulosa secretes: A) mineralcorticoids B) androgens C) glucocorticoids D) catecholamines
A (mineralcorticoids - aldosterone) (salt)
Which of the following is NOT a symptom of primary hyperaldosteronism? A) oliguria B) headache C) muscle weakness, fatigue, lethargy D) may be asymptomatic
A (polyuria and polydipsia in cases of severe hypokalemia)
Which lab result is consistent with Sjogren's syndrome? A) positive RF B) negative ANA C) positive anticentromere antibody D) proteinuria
A (positive RF - seen in 70% of patients) ( 95% of those with sjogren's syndrome have a positive ANA)
All of the following are associate with reactive arthritis EXCEPT: A) seropositive arthritis lasting >1 month B) urethritis C) conjunctivitis or uveitis D) positive HLA-B27
A (seroNEGATIVE arthritis lasting >1 month) (75% HLA-B27 positive)
All of the following may be seen in SLE EXCEPT: A) leukocytosis (unexplained) B) hemolytic anemia C) proteinuria d) hematuria with RBC casts
A (unexplained LEUKOPENIA) (with hemolytic anemia, may see increased potassium and increased reticulocytes)
Nephrogenic diabetes insipidus results from decreased _____ effect on the kidney
ADH