Monster Joint Jam

Monster Joint Jam

Get all the candy!

start

Monster Joint Jam

You've stumbled into a village where the helpful apothecary witch is taking care of the local residents. Help her deliver her medications to treat the villagers while filling up your candy bag with as much candy as you can!!!🎃👻🍬

go!

Go house to house!

Candy obtained

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Witch's Warm-up

The first house you find is the Witch's house and she needs your help to figure out which medications to prescribe for her patients, who have illnesses similar to ones we've previously encountered...

knock

D) Diphenhydramine

C) Tenofovir

1/4

Wolfie the wolf has had a persistent high fever and watery diarrhea for the past 4 days. He had previously contracted salmonella from the chickens he ate and was treated with levofloxacin. What should I give him to treat his illness?

A) Albendazole

B) Vancomycin

knock

knock

A) Rituximab

D) Ibuprofen

2/4

Frankie the monster has an uncomplicated UTI, probably caused by E. coli. He is currently on warfarin therapy for his blood clotting. What should I give him to treat his infection?

B) Nitrofurantoin

C) TMP/SMX

B) Acyclovir

A) Vancomycin

3/4

Martha the mummy's 4 year old daughter has a morbilliform rash, red and cracked lips, and a fever for the past four days. We've ruled out bacterial and viral illnesses. What can we give her?

D) High dose aspirin

C) TMP/SMX

A) Tenofovir and Celecoxib

D) Tenofovir and Tacrolimus

4/4

Dracula came in wanting to discuss prophylaxis. He drinks a lot of blood, which puts him at risk for severe infections. What can I prescribe him?

B) Tenofovir and Emtricitabine

C) Tenofovir and Cetirizine

Spooktacular!

You've passed the first test! Would you be so kind as to deliver the medications to my patients?

Candy obtained

continue

Go to the next house!

Candy obtained

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They say my bark is worse than my bite, What symptoms present rheumatoid arthritis outright?

House of the Wolf

You make your way to Wolfie's house to give him the vancomycin. As you're about to knock, you see a sign on the door

knock

House of the Wolf

Presentation and Diagnosis time:

To answer Wolfie's questions, use boardwork to find out the following: Karim, Grace: Describe the likely course and progression of rheumatoid arthritis and the recommended resources for lifestyle modification from the American College of Rheumatology. Ayo, Salma: Describe the American College of Rheumatology guidelines for diagnosis rheumatoid arthritis. Cheyenne, Chi: Describe the risk factors and clinical presentation of RA

knock

1/3

According to the American College of Rheumatology, which of the following is recommended for lifestyle modification in rheumatoid arthritis patients?

A) Avoiding all physical activity

B) Following a high-fat diet

C) Regular exercise, including aerobic and resistance training

knock

knock

2/3

Which of the following is NOT typically part of the diagnostic criteria for rheumatoid arthritis according to clinical practice guidelines?

A) Body mass index (BMI)

B) Symmetrical joint involvement

C) Duration of symptoms

3/3

Which of the following is NOT considered a risk factor for developing rheumatoid arthritis?

A) Genetic factors

B) Smoking

C) Physical exercise

Awesome!

Wolfie thanks you for the vancomycin and gives you some candy. But that's not candy, it's... Ibuprofen?

Candy obtained

continue

Go to the next house!

Candy obtained

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My joints are stitched, but pain still jolts, How does RA wreak havoc on my bolts?

Frankenstein's House

Frankie's house also seems to have a sign on the door. It's clear you will have to earn the monster's trust before he opens the door⚡

knock

Frankenstein's House

Pathophysiology time:

You remember that the pathophysiology involves an aberrant immune response where autoantibodies, such as rheumatoid factor (RF) and anti-citrullinated protein antibodies (ACPAs), target synovial tissues, resulting in chronic inflammation and pannus formation. This process is mediated by pro-inflammatory cytokines, including TNF-α, IL-1, and IL-6. To answer Frankie's questions, explore the following details: Karim, Chi: Describe the extra articular manifestations of rheumatoid arthritis Ayo, Grace: Define the interaction between antibodies and citrullination in the pathophysiology of rheumatoid arthritis Cheyenne, Salma: Explore the immune cells and soluble factors along with the processes that underlie the loss of bone density.

knock

1/3

Which of the following is NOT a common extra-articular manifestation of rheumatoid arthritis?

A) Cardiovascular disease

B) Interstitial lung disease

C) Diabetic nephropathy

knock

knock

2/3

What is the relationship between antibodies and citrullination in rheumatoid arthritis?

A) Antibodies prevent citrullination

B) Citrullination leads to the production of anti-citrullinated protein antibodies (ACPAs)

C) Citrullination neutralizes antibodies in RA

D) Neutrophils and interferon-γ

3/3

Which of the following combinations of immune cells and soluble factors is most directly involved in the loss of bone density in rheumatoid arthritis?

A) B cells and interleukin-4

C) Osteoclasts and RANKL

B) T cells and transforming growth factor-β

You rock!

Frankie thanks you for the nitrofurantoin and gives you some methotrexate. Maybe that's what he eats for candy.

Candy obtained

continue

Go to the next house!

Candy obtained

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My daughter's sick and I don't have time to think of a rhyme and I'm worried about histoplasmosis and tuberculosis

House of the Mummy

You're getting tired from all of these questions about rheumatoid arthritis and start to wonder why everyone's so interested about the disease when you make it to Martha the mummy's house

knock

House of the Mummy

Histoplasmosis and Tuberculosis time:

Remembering that Martha's daughter is sick and understanding they spend a lot of time underground, you completely understand that she has more pressing concerns than a fun rhyme. Karim, Salma: PUMAC itraconazole Cheyenne, Grace: Describe the epidemiology, presentation, pathophysiology, and diagnosis of histoplasmosis. Ayo, Chi: Describe the impact of anti-TNF-alpha therapies used to treat rheumatoid arthritis with the reactivation of tuberculosis (if you finish early help the other groups)

knock

1/3

What is the primary mechanism of action of itraconazole?

A) Inhibition of cell wall synthesis

B) Interference with protein synthesis

C) Inhibition of ergosterol synthesis

knock

knock

2/3

Which of the following statements about the epidemiology of histoplasmosis in the United States is correct?

A) It is a nationally reportable disease

B) Around 60-90% of people living in the Mississippi and Ohio River valleys are exposed to Histoplasma in their lifetime

C) The average annual incidence is between 10 to 20 cases per 100,000 population

3/3

How does anti-TNF therapy affect the risk of tuberculosis (TB) reactivation in patients with rheumatoid arthritis?

A) It increases the risk of TB reactivation by up to 25 times

B) It has no effect on TB reactivation

C) It only affects latent TB, not active TB

Fantastic!

Martha thanks you for the aspirin and gives you some corticosteroids. When you try to ask for some candy she hurries back inside.

Candy obtained

continue

There is only one house left!

Candy obtained

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Myjoints ache worse than garlic's sting, What potions can relief now bring?

Dracula's house

Last stop, Dracula's House! You're getting tired from all of these riddles and walking

knock

Dracula's house

knock

Drugs time:

Wow there are a lot of treatments for rheumatoid arthritis!! It'll be all hands on deck for this one: Philip: PUMAC Ibuprofen Karim, Ayo: PUMAC Naproxen Salma, Grace: PUMAC Methotrexate Cheyenne, Chi: PUMAC Adalimumab

1/4

Which medication has a half-life of 1-2 hours and primarily works by inhibiting cyclooxygenase (COX) enzymes to reduce pain and inflammation?

A) Naproxen

B) Ibuprofen

C) Methotrexate

D) Adalimumab

knock

knock

2/4

Which medication is a fully human monoclonal antibody that inhibits tumor necrosis factor-alpha (TNF-α)?

A) Ibuprofen

B) Naproxen

C) Methotrexate

D) Adalimumab

3/4

Which medication works in part by increasing adenosine levels, leading to anti-inflammatory effects?

A) Ibuprofen

B) Naproxen

C) Methotrexate

D) Adalimumab

4/4

Which medication has a half-life of 12-17 hours and primarily works by inhibiting cyclooxygenase (COX) enzymes to reduce pain and inflammation?

A) Ibuprofen

B) Naproxen

C) Methotrexate

D) Adalimumab

knock

knock

You're a legend!

Dracula thanks you for the PrEP, and gives you... adalimumab?? You start to suspect something strange might be going on...

Candy obtained

continue

continue

Truth time...

The monsters gather to tell you why they've posted riddles and given you drugs instead of candy. The Witch has developed rheumatoid arthritis and they're relying on you to help them find a treatment for her!! As a group, we need to compare and contrast the use of NSAIDs, disease-modifying antirheumatic drugs (DMARDs), corticosteroids (prednisone is most commonly used), and biologic therapies in the treatment of rheumatoid arthritis and answer their questions.

The group decided they liked your answers then ran home to prepare some questions to test your understanding. Answer each monster's question to make your way back to the Witch's house to counsel her on her RA treatment.

continue

Truth time...

B) DMARDs

1/4

Which class of medication primarily targets pain and inflammation in rheumatoid arthritis but does not significantly alter the course of the disease?

A) NSAIDs

C) Corticosteroids

D) Biologic therapies

D) Biologic therapies

2/4

Which treatment option typically has the fastest onset of action for potent severe symptom relief in rheumatoid arthritis?

A) NSAIDs

C) Corticosteroids

B) DMARDs

A) NSAIDs

3/4

Which class of medication is most commonly administered via subcutaneous injection or intravenous infusion?

D) Biologic Therapies

B) DMARDs

C) Corticosteroids

A) NSAIDs

Which class of medication is most effective in slowing or halting the progression of joint damage in rheumatoid arthritis?

B) DMARDs

C) Corticosteroids

D) Biologic therapies

4/4

Witch's Warm-up

You and your newfound friends make your way back to the witch's house with the methotrexate, adalimumab, naproxen, and corticosteroids in hand, ready to counsel her about treatment procedures.

knock

Spooktacular!

The Witch thanks you for your assistance and for finding her a treatment and gives you some magic muffins that will help you pass the FOD exam!

Candy obtained

continue

You did it!

Your journey has been fang-tastically amazing, and while your candy bag is sparse, you've made some amazing friends on the way! Hopefully Halloween will bring you more candy

Are you sure you want to go out?

If you exit you will return to the start of the game and you will lose your progress

back

exit

Oh! You have failed...

try again!