BONES AND JOINT COMPLICATIONS - 1 File Download



BONES AND JOINT COMPLICATIONS

1- Osteoporosis is a disease characterized by loss of bone mass and may be aggravated by:

I-Corticosteroids

II-Menopausa

III-Grave’s disease

a) I only

b) III only

c) I and II only

d) II and III only

e) All are correct

2- A patients with allergy to Sulphonamides (i.e.: Sulphametoxazole) can take all of the following medications, EXCEPT:

a) Penicillin

b) Lidocaine

c) Celecoxib

d) Clindamycin

e) Tetracycline

3- All of the following are examples of DMRA-Disease Modifying Antirheumatic Agents, EXCEPT

a) Methothrexate

b) Sulfasalazine

c) Organic Gold Compounds

d) Sulfinpyrazone

e) Penicillamine

4- Calcitonin is mainly classified as hormone liberated by thyroid gland. Which stimulate the release of calcitonin?

a) Hypercalcemia

b) Hypocalcemia

c) Hypophosphatemia

d) Hyperphosphatemia

e) High concentration of Vit. D

5- Which of the following statements is/are right regarding CALCITONIN

I- It secretion is normally stimulated during feeding, particularly of high calcium meals

II- Prevents hypercalcemia by inhibiting the transport of Ca intro extra cellular fluid and by increasing the renal clearance of calcium

III- It is a vitamin D derivative

a) I only

b) III only

c) I and II only

d) II and III only

e) All are correct

6- The level of which drug should be adjusted during treatment with allopurinol

I- Mercapturic acid

II- Theophillin

III- Anticoagulants

a) I only

b) III only

c) I and II only

d) II and III only

e) All are correct

7- Uricosuric agents are used in gout treatment by inhibiting the uric acid re-absorption in the proximal tubules, the best example of a uricosuric agent is:

a) Allopurinol

b) sulphinpyrazone

c) Indomethacin

d) Penicillamine

e) Methotrexate

8- An oral chelating agent used in the treatment of rheumatoid arthritis is:

a) Allopurinol

b) Sulphinpyrazone

c) Indomethacin

d) Penicillamine

e) Methotrexate

9- In the treatment of rheumatoid arthritis the salicylates:

a) Stop and often reverse the progressive joint involvement

b) Specifically reverse the cause of the disease

c) Provide only analgesic effect

d) Are effective because they are uricosuric agents

e) Are more effective when given with allopurinol

10- Importance of Vitamin D in osteoporosis:

I- Increase the absorption of calcium from the small intestine

II- The best vitamin D analog to treat osteoporosis is calcitriol

III- Antacids containing aluminum and magnesium may interfere with proper activity of vitamin D.

a) I only

b) III only

c) I and II only

d) II and III only

e) All are correct

11- Drug that inhibits xanthine oxidase and affect the metabolism of 6-mercaptopurine:

a) Sulfinpyrazone

b) Allopurinol

c) Penicillamine

d) Purinethol

e) Celecoxib

12- Pannus is an inflammatory exudates characterized by:

I- Synovial cell proliferation inside of a joint

II- Normally occurs in patients with rheumatoid arthritis

III- An immunologic complication

a) I only

b) III only

c) I and II only

d) II and III only

e) All are correct

13- Intra-articular means:

a) In the joint space

b) In the tissues space

c) In the spinal fluid

d) In the spinal column

e) In the dermis

14- Colchicines, a widely drug used in gout treatment, can give false results of:

a) Glucose

b) Uric acids

c) Urates

d) Ketones

e) RBCs

15- Colchicine is used as anti-inflammatory agent in the acute treatment of:

a) Osteoporosis

b) Rheumatoid arthritis

c) Osteomyelites

d) Gout

e) Pressure atrophy

16- The use of indomethacin in gout treatment:

a) Inhibit the acute gout arthritis inflammation by inhibition of prostaglandin formation

b) Inhibits tubulin synthesis

c) Accelerate renal excretion of uric acid

d) Inhibit uric acid synthesis

e) Inhibit the reabsorption of uric acid by the kidney

17- Allopurinol, a xanthine oxidase inhibitor, is a derivative of:

a) Uric acid

b) Purine

c) Pyridine

d) Pteridine

e) Urate salts

18- Goals of gout treatment may include:

I- Reduce inflammation during acute attacks

II- Accelerate renal excretion of uric acid

III- Reduce the conversion of purine to uric acid

a) I only

b) III only

c) I and II only

d) II and III only

e) All are correct

19- Characteristics of GOUT, a group of disorders of purine and pyrimidine metabolism may include:

I- Hereditary metabolite disease marked by inflammation of the joints

II- The joint inflammation is caused by precipitation of uric acid crystals

III- It is a type osteoporosis

a) I only

b) III only

c) I and II only

d) II and III only

e) All are correct

20- Allopurinol, xanthine oxidase inhibitor, used in gout treatment may produce all the following side effects, EXCEPT:

a) Increase in protrombin time

b) Hypersensitivity rashes

c) GIT intolerance

d) Peripheral neuritis

e) Necrotizing vasculitis

21- Use of estrogen in osteoporosis:

I- Estrogen enhance calcium retention and retard bone loss

II- Estrogen is useful in treat osteoporosis associated to menopause

III- Estrogen is not effective at increasing bone mass that has already been lost.

a) I only

b) III only

c) I and II only

d) II and III only

e) All are correct

22- Osteoporosis is mainly characterized by:

a) Loss of joint movements

b) Loss of bone mass

c) Imbalance of uric acid

d) Hormonal imbalance

e) All are correct

23- Antimalarial drug used in the treatment of rheumatoid arthritis as DMRA-Disease-Modifying Antirheumatic Drug

a) Chloroquine

b) Quinine

c) Sulfasalazine

d) Hydroxycloroquine

e) Primaquine

24- Which is the correct start dose of methothrexate in the treatment of rheumatoid arthritis?

a) 7.5mg once a week

b) 15mg once a week

c) 7.5mg daily

d) 15mg daily

e) 22mg once a week

25- Correct administration of Penicillamine in the treatment of rheumatois arthritis include:

a) With meals

b) In emptying stomach

c) With plenty of water

d) With orange juice

e) Before bedtime

26- Which of the following agents is the best choice of treatment for an asthma patient with rheumatoid arthritis who is considered to have aspirin sensitivity?

a) Ibuprofen

b) Acetaminophen

c) Gold therapy

d) Azathioprine

e) Cyclophosphamide

27- Diflunisal is most likely to be prescribed for the treatment of:

a) Wilson’s disease

b) Rheumatoid arthritis

c) Cysteinuria

d) Psoriasis

e) Hansen’s disease

1- E

Comments: Osteoporosis is a disease characterized by the loss of bone mass. Substances or conditions that alter the metabolism of bones may predispose or aggravated osteoporosis. Example: Corticosteroids, menopause and Grave’s disease.

2- C

Comments: There is a cross-sensitivity drug interaction between sulphonamides and celecoxib

3- D

Comments: Sulphynpyrazone is an uricosuric acid agent used in the treatment of gout.

4- A

Comments: Calcitonin is a hormone elaborated by the thyroid gland in response to hypercalcemia.

5- C

Comments: Calcitonin is not a vitamin D derivative. It is a hormone elaborated by the thyroid gland in response to hypercalcemia, lowering plasma calcium and phosphate levels.

6- E

Comments: Allopurinol may inhibit enzymatic metabolism of anticoagulants, leading to potentiation of the anticoagulant effect. Mercapturic acid dosage should be reduced with concomitant use with allopurinol because it induced inhibition of xanthine oxidase decreasing metabolism of mercapturic acid and potentiating therapeutic and toxic effects. Allopurinol decrease theophyllin clearance resulting in increased serum theophyllin concentrations

7- B

Comments: Allopurinol and indomethacin are used in gout treatment however not as uricosuric agent but as xanthine oxidase inhibitor and NSAID respectively. Methotrexate is used to treat rheumatoid arthritis as DMRA agent.

8- D

Comments: Allopurinol and sulphynphyrazone are only used in gout treatment. Indomethacin can be used in rheumatoid arthritis however as NSAID and Methotrexate is used as DMRA agent.

9- C

Comments: Salicylates in the treatment of rheumatoid arthritis provides only analgesic effect by reducing prostaglandin synthesis.

10- E

Comments: Osteoporosis is characterized by the loss of bone mass. Vitamin D supplements have been used in the treatment of osteoporosis because vitamin D increases the absorption of calcium that is essential to reduce bone loss. Antacids interact with vitamin D in many ways, magnesium containing antacids may lead to hypermagnesemia and aluminum containing antacids have its levels increased leading to aluminum bone toxicity when currently used with vitamin D.

11- B

Comments: Allopurinol inhibit xanthine oxidase enzyme therefore the conversion of 6-mercaptopurine to uric acid inhibiting the uric acid synthesis-formation

12- C

Comments: Pannus is an inflammatory exudates overlying the lining layer of synovial cells on the inside of a joint, usually occurring in patients with rheumatoid arthritis or related articular rheumatisms, and sometimes resulting in fibrous ankylosis of the joints.

13- A

Comments: Intra-articular is normally referred to a kind of injection given within a joint.

14- E

Comments: Colchicine may cause false-positive test results of red blood cells-RBC and hemoglobin in urine. It may also cause decrease in platelet count.

15- D

Comments: Cochicine is only used in gout treatment. It has no effect on uric acid therefore it is used just in the acute treatment of gout by inhibiting the migration of leukocytes, phagocytes and leukotrienes B4 to the affected joint.

16- A

Comments: Indomethacin is a potent NSAID that inhibits the acute gout arthritis inflammation by inhibition of prostaglandin formation and inhibition of crystals phagocytes by macrophages.

17- B

Comments: Allopurinol is a purine derivative working as xanthine oxidase enzyme inhibitor responsible for the conversion of 6-mercaptopurine to uric acid.

18- E

Comments: The gout disease is normally controlled by three different mechanisms: 1- Control the inflammatory response by inhibition of leukocytes, macrophages and leukotrienes migration to the affected joint. 2- Increase the renal clearance of uric acid by inhibiting the reabsorption of uric acid by the kidney and 3- Reduce the conversion of 6-mercaptopurine to uric acid by inhibition of the enzyme xanthine oxidase.

19- C

Comments: Gout is a group of disorders of purine and pyrimidine metabolism. It is manifested by hyperuricemia, recurrent characteristic arthritis induced by deposit of crystals in and around the joint of the extremities, which may lead to destruction and severe crippling of joints.

20- A

Comments: Main side effects of allopurinol therapy include: Steven-Johnson’s hypersensitivity rashes reactions, gastro-intestinal intolerance, peripheral neuritis and necrotizing vasculitis.

21- E

Comments: Estrogen is widely used to prevent bone loss after menopause. Estrogen can enhance calcium retention and retard bone loss but does not increase bone mass that has already been lost.

22- B

Comments: Osteoporosis is mainly characterized by the loss of bone mass. It is the most common of the metabolic bone diseases and is an important cause of morbidity in elderly.

23- D

Comments: Cloroquine and primaquine are normally used together only in the treatment and prevention of malaria. Quinine and hydroxycloroquine are antimalarial agents and alternatively used in prophylaxis and treatment of muscle cramps leg and rheumatoid arthritis respectively.

24- A

Comments: Methotrexate is a Disease-Modifying rheumatoid arthritis agent normally used orally, 7.5mg once a week or 2.5mg every 12hours for 3 doses given as a course once weekly, increased 15mg per week after 6 weeks, if necessary.

25- B

Comments: In the treatment of rheumatoid arthritis penicillamine should be administrated in an empty stomach. Improvement of the condition may take up to 2 to 3 months of therapy

26- C

Comments: Gould therapy would be the best choice for this particular patient because the other drugs may have cross-sensitivity with aspirin and/or induce brochospasm.

27- B

Comments: Diflunisal is a NSAID used for both acute and chronic anti-inflammatory treatment of rheumatoid arthritis.

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