CMN 574.1 EXAM QUESTIONS AND CORRECT ANSWERS
The most SPECIFIC lab for rheumatoid arthritis is? - Answer anti-CCP antibodies
Rheumatoid factor maybe misleading b/c it can also be positive in what conditions? -
Answer syphilis, Hep C, TB, subacute endocarditis, or elderly
Labs in Early RA disease may only have what percent sensitivity? - Answer 50%
Which joints are affected the most in RA? - Answer PIP, MCP, wrists, ankle, knee, MTP
RA can also affect what other systems besides the joints? - Answer ocular, cardiac,
pulmonary, small vessels, subcut tissues(nodules)
Osteoarthritis spares which joints? - Answer wrist & MCP
Symmetric AM stiffness is associated with what? - Answer RA
T or F: OA/DJD shows less signs of articular inflammation - Answer True
A syndrome consisting of RA, neutropenia, & splenomegaly - Answer "Felty syndrome"
FACT: Early Gout will be monoarticular + urate crystals in the synovial fluid - Answer
Later, it may involve multiple joints
1st line Tx for RA? - Answer DMARDS
,DMARD of choice for RA is? - Answer Methotrexate
Absolute contraindications for Methotrexate therapy? - Answer Any chronic hepatitis
What should be Rx with Methotrexate to prevent gastric irritation, stomatitis,
cytopenias, and hepatotoxicity? - Answer Folate daily 1mg OR weekly leucovorin
calcium (24hrs after meth dose)
Most frequent SE of Methotrexate is? - Answer gastric irritation and stomatitis
What should be avoided in those on methotrexate therapy? - Answer Alcohol &
Probenecid, and other folate antagonist drugs (i.e. TMP-SMX)
Methotrexate increases the risk of which cancers? - Answer B cell lymphomas
How long does it take to give DMARDS to take affect? - Answer 2-6 weeks
NSAIDS can provide symptomactive RX for RA pain but what should also be Rx with
them? - Answer PPI for stomach protection
T or F: all NSAIDS are equal in terms of efficacy - Answer T, however may work
differently for different people. GIve it 2-3 weeks before trying another NSAID.
Using a COX-2 inhibitor for RA may be better than NSAIDS b/c why? - Answer Less likely
to have upper GI adverse events (bleeding, ulceration)
Drawback for COX-2 use? - Answer Increased concern for cardiovascular events (MI,
stroke) due to impaired platelet effects
Which medicine may be used as a "bridge" to reduce RA disease activity while waiting
, for DMARDs to work? - Answer Prednisone- no more than 10mg day
Intra-articular corticosteroids (triamcinolone) may be helpful in specific joints with RA,
and should not be used more than _______times per year. - Answer 4
LFTs and CBCs should be checked atleast every______weeks while on Methotrexate. -
Answer 12 weeks- for hepatotoxicity and cytopenias
2nd line agent for RA? - Answer Sulfasalazine
Sulfasalazine can cause hemolysis in which genetic d/o? - Answer G6PD- check for this
prior to Rx
SE of Sulfasalazine? - Answer neutropenia & thrombocytopenia
Check CBCs Q______in those on Sulfasalazine therapy - Answer 2-4weeks Xfirst 3
months, then Q3months
Your patient with new Dx RA has an Aspirin sensitivity/allergy, you know they are
contraindicated for which drug? - Answer Sulfasalazine
Men and women on Methotrexate should have effective birth control! - Answer TRUE
Which antimalarial agent is useful in RA? - hydroxychloroquine sulfate- only use in those
with mild disease b/c only some respond, and it may take 3-6 months. Can be used in
combination with sulfasalazine or DMARDs.
SE of hydroxychloroquine sulfate (rare at low doses, but important!) - Pigmentary
retinitis=> blindness. Inform patient for eye exam Q12months!
FACT: Minocycline has also been shown to be effective in mild RA (1st year of dz) - Due
to anti-inflammatory properties of the tetracyclines. AE is dizziness.
The most SPECIFIC lab for rheumatoid arthritis is? - Answer anti-CCP antibodies
Rheumatoid factor maybe misleading b/c it can also be positive in what conditions? -
Answer syphilis, Hep C, TB, subacute endocarditis, or elderly
Labs in Early RA disease may only have what percent sensitivity? - Answer 50%
Which joints are affected the most in RA? - Answer PIP, MCP, wrists, ankle, knee, MTP
RA can also affect what other systems besides the joints? - Answer ocular, cardiac,
pulmonary, small vessels, subcut tissues(nodules)
Osteoarthritis spares which joints? - Answer wrist & MCP
Symmetric AM stiffness is associated with what? - Answer RA
T or F: OA/DJD shows less signs of articular inflammation - Answer True
A syndrome consisting of RA, neutropenia, & splenomegaly - Answer "Felty syndrome"
FACT: Early Gout will be monoarticular + urate crystals in the synovial fluid - Answer
Later, it may involve multiple joints
1st line Tx for RA? - Answer DMARDS
,DMARD of choice for RA is? - Answer Methotrexate
Absolute contraindications for Methotrexate therapy? - Answer Any chronic hepatitis
What should be Rx with Methotrexate to prevent gastric irritation, stomatitis,
cytopenias, and hepatotoxicity? - Answer Folate daily 1mg OR weekly leucovorin
calcium (24hrs after meth dose)
Most frequent SE of Methotrexate is? - Answer gastric irritation and stomatitis
What should be avoided in those on methotrexate therapy? - Answer Alcohol &
Probenecid, and other folate antagonist drugs (i.e. TMP-SMX)
Methotrexate increases the risk of which cancers? - Answer B cell lymphomas
How long does it take to give DMARDS to take affect? - Answer 2-6 weeks
NSAIDS can provide symptomactive RX for RA pain but what should also be Rx with
them? - Answer PPI for stomach protection
T or F: all NSAIDS are equal in terms of efficacy - Answer T, however may work
differently for different people. GIve it 2-3 weeks before trying another NSAID.
Using a COX-2 inhibitor for RA may be better than NSAIDS b/c why? - Answer Less likely
to have upper GI adverse events (bleeding, ulceration)
Drawback for COX-2 use? - Answer Increased concern for cardiovascular events (MI,
stroke) due to impaired platelet effects
Which medicine may be used as a "bridge" to reduce RA disease activity while waiting
, for DMARDs to work? - Answer Prednisone- no more than 10mg day
Intra-articular corticosteroids (triamcinolone) may be helpful in specific joints with RA,
and should not be used more than _______times per year. - Answer 4
LFTs and CBCs should be checked atleast every______weeks while on Methotrexate. -
Answer 12 weeks- for hepatotoxicity and cytopenias
2nd line agent for RA? - Answer Sulfasalazine
Sulfasalazine can cause hemolysis in which genetic d/o? - Answer G6PD- check for this
prior to Rx
SE of Sulfasalazine? - Answer neutropenia & thrombocytopenia
Check CBCs Q______in those on Sulfasalazine therapy - Answer 2-4weeks Xfirst 3
months, then Q3months
Your patient with new Dx RA has an Aspirin sensitivity/allergy, you know they are
contraindicated for which drug? - Answer Sulfasalazine
Men and women on Methotrexate should have effective birth control! - Answer TRUE
Which antimalarial agent is useful in RA? - hydroxychloroquine sulfate- only use in those
with mild disease b/c only some respond, and it may take 3-6 months. Can be used in
combination with sulfasalazine or DMARDs.
SE of hydroxychloroquine sulfate (rare at low doses, but important!) - Pigmentary
retinitis=> blindness. Inform patient for eye exam Q12months!
FACT: Minocycline has also been shown to be effective in mild RA (1st year of dz) - Due
to anti-inflammatory properties of the tetracyclines. AE is dizziness.
