SLE

1. Which statement is correct regarding hydroxychloroquine use in the rheumatic diseases

A. Effective for psoriatic arthritis
B. Helps reduce disease flares in SLE pregnancy
C. Inhibits Interleukin 6 receptor
D. Requires regular CBC monitoring for side-effects
2. Which statement is correct regarding glucocorticoid therapy
A. Betamethasone is inactivated in the placenta
B. Dexamethasone has high mineralocorticoid activity
C. Hydrocortisone is long acting
D. Prednisone 5 mg is equivalent to methylprednisolone 4 mg
3. Which urinalysis findings is most compatible with a 28 year old newly diagnosed lupus with Class IV or diffuse
proliferative nephritis?
A. Albumin 2+, rbc >50/lpf, wbc 40-50/lpf, pus casts 2-4/lpf, squamous cells few, epithelial cells few,
bacteria few
B. Albumin 4+, rbc 30-35/lpf, wbc 15-20/lpf, hyaline casts 3-5/lpf, granular casts 3-5/hpf epithelial cells
few, bacteria few
C. Albumin (-), rbc 2-4/lpf, wbc 0-1/lpf, hyaline casts 1-2/lpf, epithelial cells many, bacteria few
D. Albumin 1+, rbc 1-5/lpf, wbc 70-80/lpf, no casts, epithelial cells many, bacteria many
4. A 38 year old female who was diagnosed with SLE 8 years ago is seen at emergency. Which of the following
additional data will indicate institution of aggressive immunosuppressive therapy
A. Complains of back pain due to steroid-induced osteoporotic vertebral fracture
B. Discoid lesions on the scalp with scarring alopecia
C. Low serum complement and Coombs positive anemia
D. Visual blurring assessed to be drug-induced
5. Lupus nephritis stage that does NOT warrant aggressive therapy with systemic glucocorticoids
and a cytotoxic agent:
A. Stage III C. Stage V
B. Stage IV D. Stage VI
6. G.B. a 45-year-old female has SLE. For the past months, she is maintained on prednisone 5
mg/day and hydroxychloroquine 100 mg/day until today when she presents in the ER with
hypertension, hematuria, proteinuria and creatinine elevation 2.6 mg/dL (previously normal).
What is the most appropriate management?
A. Start cyclophosphamide and mycophenolate mofetil
B. Start high dose steroid and mycophenolate mofetil
C. Initiate renal replacement therapy (RRT)
D. Withhold therapy until renal biopsy is done
PRETEST AND LECTURE

OSTEOPOROSIS UPDATE

DR. MILLICENT TAN-ONG OCTOBER 3,2020

LECTURE :

https://au-lti.bbcollab.com/recording/8410d2cf51344907a8cc339b949fd812
PRETEST

1) VFA Testing is done to the following except:

A. Women >= 60
B. Men >=80
C. Women 65-69 with Tscore <-1.5
D. Women 50-64 with low trauma fracture

2) Which should be the desirable Vitamin D level?

A. 30nmol
B. 75nmol
C. 75ng/ml
D. 30mcg

3) Drug which can reduce vertebral fractures and non-vertebral fractures:

A. Alendronate
B. Estrogen
C. Teriparatide
D. Calcitonin
 4) Osteoporotic drug which bypasses the GI tract

A. Alendronate
B. Raloxifene
C. Teriparatide
D. Zoledronic acid

5) Which one of the patients below should undergo BMD testing.(feel free to spice up the choices)

A. A 63 year old asymptomatic woman

B. A 69 year old asymptomatic male
C. A 55 year old woman with history of fracture when she was 28
D. A 52 year old woman with rheumatoid arthritis on prednisone

6) According to the National Osteoporosis Foundation, the following are non-controllable risk factors
for Osteoporosis, except:

A. Height loss
B. Menopause
C. Anorexia nervosa
D. Broken bones

7) Which of these can’t establish osteoporosis by radiograph?

A. High-impact fracture falling from a two-storey building

B. Patient stood up, walked and fell from a standing height

C. Fragility fracture of the spine & hip, in absence of other conditions

D. Patient slipped in the bathroom causing a hip fracture

8) Which is not a risk factor for falls?

A. Chronic Hypertension - answer

B. Anemia
C. Arthritis
D. Balance Problem
9) Universal recommendations for osteoporotic patients except
 A. Weight lifting activities
B. Weight bearing activities
C. Fall prevention
D. Identification of risk factors

10) 65 YO female, height loss of 3.5 inches, (+) smoking history, BMD T-spine score: -2.0, Hip T-score -2.7,
(+) compression fractures. What management will you give?

A. Estrogen
B. Calcitonin
C. Teriparatide
D. Alendronate
Rheumatologic manifestations of Systemic Diseases
Dr. Julie Yu

https://au-lti.bbcollab.com/recording/ed0472e980a843d2a7aaf7a0d7e76815

Rheumatologic manifestations of Systemic Diseases Answer Pretest

1. What is the most likely clinical condition of a patient manifesting with back pains, bony lytic
lesions on radiograph, anemia, and renal dysfunction?
A. Osteoporosis
B. Rheumatoid arthritis
C. Hyperparathyroidism
D. Multiple Myeloma

2. Which of the following is a rheumatologic manifestation of Hyperthyroidisim?

A. Dupuytren’s contracture
B. Adhesive capsulitis
C. Chondrocalcinosis
D. Pseudo-widening of SIJ

3. The pain, paresthesia, and numbness in Meralgia paresthetica occurs in which area:
A. Lower outer thigh
B. Lower inner thigh
C. Upper outer thigh
D. Upper inner thigh

4. Which virus is strongly associated with SLE?

A. Herpex Simplex
B. EBV
C. CMV
D. Zika virus

5. Which of the following is a musculoskeletal manifestation of Hyperparathyroidism?

A. Dupuytren’s contracture
B. “salt and pepper” skull
C. Adhesive capsulitis
D. Muscle wasting

6. Which structure is affected in soft tissue rheumatism?

A. cartilage
B. subchondral bone
C. retinaculum
D. synovial fluid

7. Which of the following conditions is characterized by the presence of trigger points and deep
aches with burning or stinging sensation?
A. meralgia paresthetica
B. fibromyalgia
C. myofascial pain syndrome
D. myositis

8. Which pathogen triggers autoimmune disease by inducing polyclonal activation of B-cells?

A. S. aureus
B. Zika
C. CMV
D. EBV

9. Disease caused by MTB that manifests as an acute onset polyarthritis that resolves without
sequelae
A. Pott’s Disease
B. Poncet’s Disease
C. Joint TB
D. Miliary TB

10. Which of the ff is a prominent clinical manifestation of Diffuse Infiltrative Lymphocytosis

Syndrome (DILS) in HIV?
A. Salivary gland atrophy
B. Sicca symptoms
C. Arthralgia
D. renal failure
Rheumatology Plenary: Rheumatic Disorders in the Eyes of a Rheumatologist
10-item questions:

1. Which of the following arthropathy does not lead to deformities?

a. Osteoarthritis c. Gouty arthritis
b. Rheumatoid arthritis d. Reactive arthritis
2. Which of the following is a characteristic feature of inflammatory back pain in ankylosing
spondylitis?
a. Acute in onset c. no improvement with rest
b. Difficulty initiating sleep d. age onset >40 years

3. Which of the following is characteristic of non-articular origin of a musculoskeletal

complaint?
a. Limited passive mov’t c. presence of swelling
b. Presence of crepitations d. limited movt in all ranges of
motion

4. Which of the following best differentiates joint involvement in PsA vs RA?

a. asymmetric pattern c. arthritis mutilans
b. polyarthritis d. monoarthritis

5. Which of the following laboratory parameters is most helpful in following treatment

response in a 25 year old female with rheumatoid arthritis given prednisone 10 mg/day
and methotrexate10 mg/week?
a. liver function test c. chest radiograph
b. acute phase reactant d. complete blood count

6. Which of the following situations warrant high dose glucocorticoid therapy at

2mg/kg/day?
a. 35 year old male with left podagra and right wrist synovitis
b. 40 year old pregnant female with Raynaud’s phenomenon due to scleroderma
c. 28 year old female with active urinary sediments and proteinuria due to lupus
nephritis
d. 38 year old male with arthritis, conjunctivitis, and urethritis

7. Which of the following are irreversible adverse effect of corticosteroids?

a. Infection c. hirsutism
b. obesity d. aseptic necrosis

8. Prior to initiation of biologic therapy in patients with inflammatory arthropathies, which

of the following should be in place?
a. screen patient for infection c. body weight should be <60 kgs
b. BP should be controlled d. patient should stop smoking

9. Which of the following situation is considered red flag of back pain?

a. difficulty of rising from bed following long drive 5 days ago
b. pain exacerbated by movement
c. intermittent stiffness or gel phenomenon
d. awakened at night due to pain

10. Which of the ff radiographic characteristic describes osteoarthritis?

a. asymmetric joint space narrowing c. pencil- in- cup appearance
b. cartilage calcification d. overhanging edges with bone erosions