Question 1

What is a pannus?

Accepted Answer

A pannus is excessive proliferative and invasive granulation tissue.With rheumatoid arthritis,primary changes occur within the synovium causing edema,followed by thickening and folding of tissue,a pannus.In addition,marked infiltration of lymphocytes and plasma cells into the capsule occurs.Eventually,granulation tissue covers the articular surfaces and destroys the cartilage and subchondral bone through enzymatic activity.

Question 2

Which of the following characteristics is used to distinguish fibromyalgia (FM)from myofascial pain syndrome (MFP)?

Accepted Answer

The pain in FM is relatively stable and consistent in contrast to MFP,which can vary in intensity and location depending on which muscles are involved.When the muscle pain is primarily due to the FM,it may not respond as well as the jaw pain from MFP because FM is a systemic and not a local condition,and muscle pain is a typical presentation in FM.Regional pain is found with MFP and needs to be distinguished from the widespread muscular pain associated with FM.

Question 3

What is the primary difference between aspirin and other nonsteroidal anti-inflammatory drugs (NSAIDs)in regard to platelets?

Accepted Answer

The effects of aspirin are irreversible for the life of the platelet (10 to 12 days),and this effect continues until new platelets have replaced the old.The effect of the other NSAIDs on platelets is reversible and lasts only as long as the drug is present in the plasma.All NSAIDs can cause a qualitative platelet defect that may result in prolonged bleeding,especially when given in high doses.

Question 4

Which of the following is the most common manifestation of systemic lupus erythematosus (SLE)?

Accepted Answer

The most common manifestation of SLE is arthritis,which is seen in 76% of patients.Neuropsychiatric symptoms are common and include organic brain syndrome,psychosis,seizures,stroke,movement disorders,and peripheral neuropathy.Serious renal abnormalities occur in less than one third of patients with SLE,although most show some abnormality on renal biopsy.A clinically detectable heart murmur is found in 18.5% of SLE patients.Approximately 4% of patients had cardiac valve abnormalities that placed them in the moderate risk group for endocarditis.

Question 5

Which of the following medications is the usual initial therapy for giant cell arteritis?

Accepted Answer

The universal treatment for GCA is glucocorticoid therapy.Prednisone (60 mg per day)is the usual initial therapy.Once the immune response has subsided and symptoms diminish,the prednisone may be reduced by 10% per week.Adjunctive therapy with aspirin also is quite helpful.

Question 6

Giant cell arteritis (GCA)most commonly affects branches of the ___________ artery.

Accepted Answer

GCA is a systemic vasculitis involving medium-sized and large arteries,most commonly the extracranial branches of the carotid artery.GCA is the most common form of vasculitis.This inflammatory disorder affects women more often than men,almost exclusively after 50 years of age,and the average age is 72 years.Because of the occlusive nature of the narrowing of the vascular lumen,cranial pain,blindness,trAnswerient ischemic attacks (TIAs),and other strokes are common complications in patients with GCA.

Question 7

Which of the following is/are true of systemic lupus erythematosus (SLE)?

Accepted Answer

The etiology of SLE is unknown,although it is clearly an autoimmune disease.It predominantly affects women of childbearing age,with a female-to-male ratio of 5:1; it is more common and more severe among African AmericAnswer and Hispanics than among whites.On the basis of 2007 American Heart Association guidelines,none of these patients are recommended for antibiotic prophylaxis for invasive dental procedures.

Question 8

What is synovial fluid derived from?

Accepted Answer

Synovial fluid is derived from the synovium primarily as an ultrafiltrate of plasma.The synovium also secretes specialized molecules into the synovial fluid,such as hyaluronic acid.The cartilage has a high water content and obtains its nutrition solely from the synovial fluid.Cartilage loss may occur secondarily to synovial inflammation or trauma.

Question 9

The 2003 joint advisory statement by the American Dental Association (ADA)and the American Academy of Orthopedic Surgeons (AAOS)indicated that antibiotic prophylaxis prior to dental treatment can be considered for ________.

Accepted Answer

The statement indicated that antibiotic prophylaxis can be considered for patients whose joint replacement has been in place for less than 2 years and for patients at increased risk to infection who are undergoing invasive dental procedures.No evidence suggests that even these patients are at increased risk for infection from dentally induced bacteremia and,in fact,the microbiology of late prosthetic joint infection (LPJI)in these patients is the same in other patients with LPJI.

Question 10

The tongue is commonly infected (in as many as 83%)with _________ in patients with Sicca syndrome (SS).

Accepted Answer

The tongue is commonly infected with Candida albicAnswer in patients with Sicca syndrome.Not only must the acute candidal infection be treated,but some type of maintenance therapy must be provided to prevent recurrence of the fungal infection.As long as the oral environment is adversely affected by hyposalivation,susceptibility to recurrence of the oral infection and continued deterioration occur.

Question 11

Which of the following is the most significant oral complication of rheumatoid arthritis?

Accepted Answer

The most significant complication of the oral and maxillofacial complex in rheumatoid arthritis is TMJ involvement,which is found in 45% to 75% of patients with rheumatoid arthritis.This may present as bilateral preauricular pain,tenderness,swelling,stiffness,and decreased mobility of the TMJ,or it may be asymptomatic.Fibrosis or bony ankylosis can occur.Clinically,patients may present with tenderness over the lateral pole of the condyle,crepitus,limited opening,and radiographic evidence of structural change.Radiographic changes initially may show increased joint space due to inflammation of the joint.

Question 12

Which of the following is true regarding antibiotic prophylaxis for dental treatment of a patient with osteoarthritis (OA)?

Accepted Answer

These patients usually do not require antibiotic prophylaxis for dental treatment except for the first 2 years or unless a concomitant condition,such as diabetes mellitus,exists,or the patient is otherwise immune suppressed.

Question 13

The "gold standard" agent for treatment of patients with early rheumatoid arthritis is ________.

Accepted Answer

Methotrexate is the "gold standard" agent for the treatment of patients with early rheumatoid arthritis.The newer biologic agents etanercept and infliximab have been shown to also be highly effective relative to methotrexate.Penicillamine also is used in the treatment of patients with rheumatoid arthritis; however,both antimalarials and penicillamine are associated with significant toxicity,which limits their use.The combination of methotrexate,hydrochloroquine,and sulfasalazine is among the most popular regimens.

Question 14

Which of the following is the causative agent of Lyme disease?

Accepted Answer

Lyme disease is a multisystemic inflammatory disease caused by the tickborne spirochete Borrelia burgdorferi.The disease was first identified in the United States in 1975 during an outbreak around Lyme,Connecticut,of an inflammatory condition presumed to be juvenile rheumatoid arthritis.The classical pattern of Lyme disease is a characteristic macular skin rash (erythema migrAnswer)that appears within one month after the tick (Ixodes dammini)bite.

Question 15

Which of the following is recommended as a first-line drug for the treatment of osteoarthritis (OA)?

Accepted Answer

Acetaminophen frequently is effective in the management of OA and is recommended as a first-line drug.Aspirin or NSAIDs also are commonly employed when acetaminophen is not effective.Narcotic analgesics are generally used only for acute flares for short periods.Intra-articular steroid injections also may be used intermittently to reduce acute pain and inflammation.

Question 16

For patients with osteoarthritis (OA)with a temporomandibular joint reducing anterior disk displacement,about a __% chance exists that no progression of the disorder will occur.

Accepted Answer

About a 50% chance exists that no progression of the disorder will occur,nor will any significant radiographic changes happen in the TMJ hard- or soft-tissue structures.For the remaining 50%,progression to nonreducing disk displacement or dislocation (closed lock)is likely.

Question 17

Which of the following is the most common form of arthritis?

Accepted Answer

Osteoarthritis (OA)is the most common form of arthritis.Almost everyone older than 60 years of age develops OA to some degree.OA usually affects often-used joints,such as hips,knees,feet,spine,and hands.The TMJ also is affected.Women are affected twice as often as men; however,men are affected at an earlier age.

Question 18

Sicca syndrome (SS)is characterized by enlargement of which of the following salivary glands?

Accepted Answer

Sicca syndrome is characterized by eye dryness,hyposalivation,and enlargement of the parotid glands.Secondary outcomes of persistent oral dryness are angular cheilosis,dysgeusia,secondary infection,and a significantly increased caries rate.

Question 19

Secondary Sjögren syndrome (SS-2)is characterized by a triad of clinical conditions that consist of keratoconjunctivitis sicca,a connective tissue disease (usually rheumatoid arthritis),and ________.

Accepted Answer

Secondary SS (SS-2)manifests as the presence of keratoconjunctivitis sicca or xerostomia in the presence of a diagnosed systemic connective tissue disease.The connective tissue disorder from which SS develops most commonly is RA; SLE,primary biliary cirrhosis,fibromyalgia,mixed connective tissue disease,polymyositis,Raynaud's syndrome,and several others are among the associated inflammatory conditions.

Question 20

Which of the following is the most common form of psoriatic arthritis?

Accepted Answer

The most common form of psoriatic arthritis,with which 30% to 50% of patients are affected,is an asymmetric oligoarthritis that may involve both large and small joints.Dactylitis,arising as sausage digits,can be seen in fingers and toes and actually represents an enthesitis.In the second subset,there is selective targeting of the distal interphalangeal joints,seen in 10% to 15% of patients.The third subset has a symmetric polyarthritis that mimics RA in many ways except for the absence of rheumatoid nodules and rheumatoid factor.The fourth clinical variant is psoriatic spondylitis.Finally,arthritis mutilAnswer is a destructive,erosive arthritis that affects large and small joints.

Quiz 20: Rheumatologic and Connective Tissue Disorders

What is a pannus?

Which of the following characteristics is used to distinguish fibromyalgia (FM) from myofascial pain syndrome (MFP) ?

What is the primary difference between aspirin and other nonsteroidal anti-inflammatory drugs (NSAIDs) in regard to platelets?

Which of the following is the most common manifestation of systemic lupus erythematosus (SLE) ?

Which of the following medications is the usual initial therapy for giant cell arteritis?

Giant cell arteritis (GCA) most commonly affects branches of the ___________ artery.

Which of the following is/are true of systemic lupus erythematosus (SLE) ?

What is synovial fluid derived from?

The 2003 joint advisory statement by the American Dental Association (ADA) and the American Academy of Orthopedic Surgeons (AAOS) indicated that antibiotic prophylaxis prior to dental treatment can be considered for ________.

The tongue is commonly infected (in as many as 83%) with _________ in patients with Sicca syndrome (SS) .

Which of the following is the most significant oral complication of rheumatoid arthritis?

Which of the following is true regarding antibiotic prophylaxis for dental treatment of a patient with osteoarthritis (OA) ?

The "gold standard" agent for treatment of patients with early rheumatoid arthritis is ________.

Which of the following is the causative agent of Lyme disease?

Which of the following is recommended as a first-line drug for the treatment of osteoarthritis (OA) ?

For patients with osteoarthritis (OA) with a temporomandibular joint reducing anterior disk displacement,about a __% chance exists that no progression of the disorder will occur.

Which of the following is the most common form of arthritis?

Sicca syndrome (SS) is characterized by enlargement of which of the following salivary glands?

Secondary Sjögren syndrome (SS-2) is characterized by a triad of clinical conditions that consist of keratoconjunctivitis sicca,a connective tissue disease (usually rheumatoid arthritis) ,and ________.

Which of the following is the most common form of psoriatic arthritis?