Rheum

Question 2

Normal ESR

Answer 2

(Age + 10)/2

Question 3

Complex Regional Pain Syndrome I

Answer 3

Formerly Reflex Sympathetic Dystrophy

Neuropathic pain with associated with vasomotor changes, swelling, redness, usually along peripheral nerve distribution.

Question 4

Complex Regional Pain Syndrome II

Answer 4

Causalgia

Nerve pain along nerve distribution from unknown cause.

Question 5

How many mg Lidocaine in 1 mL of 1%?

Answer 5

10 mg

Question 6

Max Lidocaine for local infiltration

Answer 6

• *Without Epi:** 5 mg/kg (35 cc for 70 kg), lasts ~ 1h
• *With Epi:** 7 mg/kg (~50 cc for 70 kg), lasts 2-6h

Question 7

Max Bupivacaine for local infiltration

Answer 7

• *Without epi:** 2 mg/kg (~50 mL in 70 kg), lasts 2-4h
• *With epi:** 3 mg/kg (~90 mL in 70 kg), lasts 3-7h

Question 8

Types of Immunologic Reactions

Answer 8

Type I: Anapylactic - IgE–>mast cells –>inflammation (asthma, allergic rhinitis)

Type II: Cytotoxic - Ab formation –>attack cells with Ag (MAHA, Grave’s, pernicious anemia)

Type III: Immune complex - Ag-Ab complexes –> complement –>attract inflammatory cells (SLE, post-strep GN, serum sickness)

Type IV: Cell-mediated/delayed hypersensitivity - release of cytokines by sensitized T-cells (contact dermatitis)

Question 9

Gout vs. pseudogout crystals

Answer 9

Gout = monosodium urate, needle-shaped, negatively birefringent (bright yellow)

Pseudogout = calcium pyrophosphate dihydrate, rhomboid-shaped, positively birefringent (pale blue)

Question 10

Hallmark radiographic findings of OA

Answer 10

• joint space narrowing
• subchondral sclerosis
• subchondral cysts
• osteophytes

Question 11

Felty’s Syndrome

Answer 11

RA Syndrome

• arthritis, splenomegaly, neutropenia

Question 12

RA Joint involvement, Testing, Tx

Answer 12

Testing: ESR, CRP, RF, anti-CCP (more points for >3X ULN for RF + CCP)

Tx: DMARDS (must), NSAIDS, Tylenol, low-dose pred (5-10 mg/d) to control flares

Joint involvement symmetric, erosive

Question 13

SLE Diagnostic Criteria

Answer 13

Question 16

Adult Onset Still’s Disease

Answer 16

Question 17

SLE Testing

Answer 17

ANA (98% sens) –> anti-dsDNA, anti-Sm (95-99% spec), C3, C4 (decreased)
andi-dsDNA and C3, C4 useful to monitor treatment response
antiphospholipid Ab (anticardiolipin Ab, lupus anticoagulant), VDRL

Question 18

PMR Treatment

Answer 18

Prednisone 15-20 mg PO daily, taper slowly over 2 year period