ABIM UWorld Rheum questions and correct
answers (100%)
1. Stage 1 Complex Regional Pain Syndrome-ANSWER- limb pain (burning,
throbbing, aching, sensitive to cold and touch)
local edema in extremity
changes in color and temp across >1 nerve root distribution
patch bone demineralization on XR
- early disease
2. Stage 2 CRPS-ANSWER- Progressively worsening edema, skin thickening,
muscle wasting
- subacute disease for 3-6 months
3. Stage 3 CRPS-ANSWER- severely limited movement (shoulder,
hand, etc) digit contractures, brittle nails, skin changes
severe bone demineralization on XR
- chronic disease
4. How do you diagnose complex regional pain syndrome?-ANSWER-
suggested clinically by symptoms and abrupt symptom relief with a local
anesthetic block
5. Type I vs Type II complex regional pain syndrome-ANSWER- Type 1 (90%)
= without a definable nerve lesion (aka reflex sympathetic dystrophy)
Type II = known peripheral nerve injury
6. Bilateral shoulder girdle stiffness and ashiness in a patient >50 yo-
ANSWER- polymyal- gia rheumatica
7. Most common type of osteoporotic fracture-ANSWER- vertebral compressio
fracture
8. vertebral compression fracture 2/2 osteoporosis pain that is refractory to
NSAIDs, acetaminophen and opioids... what can you give them?-ANSWER-
intranasal calcitonin
9. gout prophylaxis-ANSWER- Allopurinol or febuxostat
10. 1st line therapy for gout
- contraindications?-ANSWER- NSAIDs ie indomethacin
- PUD, CKD, HF
11. NSAID intolerance in acute gout patient?
- contraindications?-ANSWER- Colchicine
,- CKD
12. 1-2 inflamed joints acute gout pt with NSAID/colchicine contraindication
- contraindications?-ANSWER- intra-articular steroids
- drug HS
13. >2 joints involved in acute gout patient with NSAID/colchicine contraindi-
cation
- contraindications?-ANSWER- systemic steroids (but there's a risk of rebound
attacks once the drug is discontinued)
- drug HS
, 14. 1st line for SLE dermatitis-ANSWER- sunscreens/sun
protective clothing topical steroids
15. 2nd line for SLE dermatitis-ANSWER- antimalarial drugs (hydroxychloroquine
16. 3rd line for SLE dermatitis-ANSWER- immunosuppressive drugs and retinoid
- methotrexate
- isotretinoin
- azathioprine
- cyclophosphamide
- cyclosporine
These are rarely needed except for severe or bulls lesions.
17. methotrexate patient with sore throat, several shallow ulcer on the buccal
mucosa and hard palate, mild pharyngeal erythema-ANSWER- stomatitis
18. tx for methotrexate induced stomatitis-ANSWER- folate
All patients taking MTX should receive folic acid at 1m/day with dose increases to
5mg/day based on symtpoms
19. 2nd and 3rd MCP joint pain, hip pain, knee pain, shoulder pain with
hook-like osteophytes on the MCP heads on XR-ANSWER- Secondary
osteoarthritis caused by Hemochromatosis
20. Lab to order to confirm secondary OA caused by hemochromatosis-
ANSWER- ele- vated serum transferrin saturation
21. HLA B27-ANSWER- Ankylosing spondylitis, reactive arthritis, ulcerative colitis,
psoriasis
22. Bone erosions with thin "overhanging" edges on XR-ANSWER- Chronic
tophaceous gout
23. 1st line tx for reactive arthritis-ANSWER- NSAIDs
24. preceding infections that cause reactive arthritis-ANSWER- Gastroenteritis
- salmonella, shigella, yersinia, campylobacter, C. diff
GU
- Chlamydia
25. What is hypertrophic osteroarthropathy?-ANSWER- clubbing of fingers with
symptoms of periosteal inflammation (synovitis of knees, ankles and fingers)
26. Most common cause of hypertrophic osteroarthropathy
- and other causes-ANSWER- intrathoracic neoplasm (non-small cell lung cancer
- cystic fibrosis, chronic lung infections, and cyanotic heart disease with R to L
intracardiac shunts
27. What to screen for in patients with GCA?-ANSWER- Osteoporosis
screening when starting steroids
answers (100%)
1. Stage 1 Complex Regional Pain Syndrome-ANSWER- limb pain (burning,
throbbing, aching, sensitive to cold and touch)
local edema in extremity
changes in color and temp across >1 nerve root distribution
patch bone demineralization on XR
- early disease
2. Stage 2 CRPS-ANSWER- Progressively worsening edema, skin thickening,
muscle wasting
- subacute disease for 3-6 months
3. Stage 3 CRPS-ANSWER- severely limited movement (shoulder,
hand, etc) digit contractures, brittle nails, skin changes
severe bone demineralization on XR
- chronic disease
4. How do you diagnose complex regional pain syndrome?-ANSWER-
suggested clinically by symptoms and abrupt symptom relief with a local
anesthetic block
5. Type I vs Type II complex regional pain syndrome-ANSWER- Type 1 (90%)
= without a definable nerve lesion (aka reflex sympathetic dystrophy)
Type II = known peripheral nerve injury
6. Bilateral shoulder girdle stiffness and ashiness in a patient >50 yo-
ANSWER- polymyal- gia rheumatica
7. Most common type of osteoporotic fracture-ANSWER- vertebral compressio
fracture
8. vertebral compression fracture 2/2 osteoporosis pain that is refractory to
NSAIDs, acetaminophen and opioids... what can you give them?-ANSWER-
intranasal calcitonin
9. gout prophylaxis-ANSWER- Allopurinol or febuxostat
10. 1st line therapy for gout
- contraindications?-ANSWER- NSAIDs ie indomethacin
- PUD, CKD, HF
11. NSAID intolerance in acute gout patient?
- contraindications?-ANSWER- Colchicine
,- CKD
12. 1-2 inflamed joints acute gout pt with NSAID/colchicine contraindication
- contraindications?-ANSWER- intra-articular steroids
- drug HS
13. >2 joints involved in acute gout patient with NSAID/colchicine contraindi-
cation
- contraindications?-ANSWER- systemic steroids (but there's a risk of rebound
attacks once the drug is discontinued)
- drug HS
, 14. 1st line for SLE dermatitis-ANSWER- sunscreens/sun
protective clothing topical steroids
15. 2nd line for SLE dermatitis-ANSWER- antimalarial drugs (hydroxychloroquine
16. 3rd line for SLE dermatitis-ANSWER- immunosuppressive drugs and retinoid
- methotrexate
- isotretinoin
- azathioprine
- cyclophosphamide
- cyclosporine
These are rarely needed except for severe or bulls lesions.
17. methotrexate patient with sore throat, several shallow ulcer on the buccal
mucosa and hard palate, mild pharyngeal erythema-ANSWER- stomatitis
18. tx for methotrexate induced stomatitis-ANSWER- folate
All patients taking MTX should receive folic acid at 1m/day with dose increases to
5mg/day based on symtpoms
19. 2nd and 3rd MCP joint pain, hip pain, knee pain, shoulder pain with
hook-like osteophytes on the MCP heads on XR-ANSWER- Secondary
osteoarthritis caused by Hemochromatosis
20. Lab to order to confirm secondary OA caused by hemochromatosis-
ANSWER- ele- vated serum transferrin saturation
21. HLA B27-ANSWER- Ankylosing spondylitis, reactive arthritis, ulcerative colitis,
psoriasis
22. Bone erosions with thin "overhanging" edges on XR-ANSWER- Chronic
tophaceous gout
23. 1st line tx for reactive arthritis-ANSWER- NSAIDs
24. preceding infections that cause reactive arthritis-ANSWER- Gastroenteritis
- salmonella, shigella, yersinia, campylobacter, C. diff
GU
- Chlamydia
25. What is hypertrophic osteroarthropathy?-ANSWER- clubbing of fingers with
symptoms of periosteal inflammation (synovitis of knees, ankles and fingers)
26. Most common cause of hypertrophic osteroarthropathy
- and other causes-ANSWER- intrathoracic neoplasm (non-small cell lung cancer
- cystic fibrosis, chronic lung infections, and cyanotic heart disease with R to L
intracardiac shunts
27. What to screen for in patients with GCA?-ANSWER- Osteoporosis
screening when starting steroids
