Rheumatology

Question 1

Heberden v. Bouchard Nodes

Answer 1

Heberden = DIP joint (DISTAL) - “heberden at the end”

Question 2

Gout Tx

Answer 2

Acute - NSAIDs or steroids (if NSAIDs not working or renal insufficiency)

Chronic - allopurinol / febuoxstat if production problem
OR probenecid if excretion problem

Colchicine helps prevent subsequent attacks

Question 3

What anti-hypertensive can contribute to gout? What should patient’s be switched to?

Answer 3

HCTZ

Switch to losartan (lowers uric acid)

Question 4

What conditions are associated w/ pseudo gout?

Answer 4

Hemochromatosis & hyperparathyroidism

Question 5

When should you image someone with lower back pain/

Answer 5

Hx cancer

Focal neuro deficits

Point tenderness along spine, fever, high ESR w/ sensory level (suggests possible epidural abscess)

Cauda equina - bowel/bladder problems, saddle anesthesia

NOT FOR SCIATICA ALONE (+ straight leg raise)

Question 6

What is the first step in someone with signs of SC compression?

Answer 6

STEROIDS (dexamethasone) b/f imaging

Even if 2/2 tumor or epidural abscess

Question 7

Tx of Dupuytren Contracture

Answer 7

Early - collagenase injection

Later - triamcinolone or lidocaine injections

Question 8

Planter Fasciitis

Answer 8

Severe pain at bottom of foot near fascia insertion at calcaneus

Worst in morning, improves w/ few steps

Tx = stretch, arch supports, NSAIDs, later steroid injection if needed

Question 9

Felty Syndrome

Answer 9

RA

Splenomegaly

Neutropenia

Question 10

Caplan Syndrome

Answer 10

RA

Pneumoconiosis

Lung nodules

Question 11

What is the most common cause of death in RA?

Answer 11

CAD

Question 12

RA Treatment (common side effects / considerations)

Answer 12

1 = Methotrexate (liver, lungs, BM suppression)

Acute - NSAIDs and steroids

DMARDs - hydroxychloroquine if mild (retinal exam)

THEN anti-TNF (check Tb) or rituximab (risk infections)

Question 13

Presentation of Juvenile Rheumatoid Arthritis

Answer 13

High fever w/o known origin + rash

Question 14

STILLS

Answer 14

Salmon-colored rash

High temp

Lymphadenopathy and leukocytosis

Splenomegaly

Inc Ferritin (acute phase reactant)

Tx - ASA or NSAIDs –> steroids if no response

Question 15

Which markers correlate w/ disease activity in SLE?

Answer 15

Dec in complement

Inc in anti-DS DNA

NOT ANA

Question 16

What do you do if you find + anti-SSA or anti-Ro in pregnant woman?

Answer 16

Means high risk passing SLE to baby

Check baby EKG b/c at risk for heart block

Question 17

Labs in Anti-phospholipid Syndrome

Answer 17

Elevated aPTT (normal PT / INR)

False pos VLDR or RPR

No correction w/ mixing study

Prolonged RVVT

Question 18

When should you test for anti-cardiolipin in relation to abortions?

Answer 18

If 2 1st trimester losses OR 1 2nd trimester loss

Question 19

How do you treat moms w/ anti-cardiolipin to prevent abortion?

Answer 19

Heparin + ASA (no warfarin in pregnancy)

Question 20

Scleroderma Renal Crisis

Answer 20

Sudden hypertensive crisis

Treat w/ ACE (even if high Cr)

Question 21

Inclusion Body Myositis

Answer 21

Weakness of proximal AND DISTAL muscles (esp upper extremity flexors)

Diagnose w/ muscle biopsy

No Tx

Question 22

What is the specific antibody associated w/ mixed connective tissue disease?

Answer 22

anti-U1-RNP

Question 23

What is the most dangerous complication of Sjogrens?

Answer 23

lymphoma

Question 24

What is PAN associated with?

Answer 24

Hep B and C - test and treat

NO LUNGS INVOLVED

Question 25

What is the best test to diagnose GPA/Wegener’s?

How does it often present?

Answer 25

Lung biopsy&raquo_space; kidney or sinus biopsy

Presents as pneumonia not responding to abx

Question 26

Which specific complement protein is associated w/ SLE? Hep C?

Answer 26

SLE = C3

Hep C = C4

Question 27

Ankylosing Spondylitis

Answer 27

Young men

Lower back pain & stiffness; better w/ use (like RA)

Dec chest expansion and fusion of lumbar spine

Enthesopathy of achilles tendon (inflammation at attachment point)

Uveitis

Arthritis (transient)

AV block or aortic insufficiency

Dx - xray sacroiliac joint first; then MRI, ESR

Tx - exercise and NSAIDs; later anti-TNF, NO STEROIDS

Question 28

Classic Triad of Reiter + 3 Things it’s 2/2

Answer 28

1 - joint pain
2 - ocular findings (uveitis)
3 - GU problems (urethritis)
“can’t see, can’t pee, can’t bend my knee”

Associated w/ … IBD, STDs, GI infection like Yersinia, Campylobacter, salmonella

Question 29

Joint Fluid WBC Count in Septic Arthritis

Answer 29

> 50,000 (neutrophils)

Question 30

How do you treat infected prosthetic joint?

Answer 30

Remove joint –> treat w/ abx for 6-8 wks –> replace joint

Question 31

Gonococcal Arthritis (how does it present and what should you do?)

Answer 31

1 - STD in hx
2 - polyarticular sepsis
3 - Tenosynovitis
4 - rash - petechial

Swab rectum, pharynx, urethra and cervix for culture

Tx = ceftriaxone, cefotaxime

If recurrent … test for terminal complement deficiency