Awesome Review

Question 1

Patient with Rheumatoid Arthritis for preoperative clearance

Answer 1

Check flexion/extension of cervical spine

Question 2

Name 2 poor prognostic factors for RA

Answer 2

Elevated ESR
Elevated Rh factor (= nodules!)
Joint space loss/erosions
Progressive synovitis

Question 3

Name 3 side effects of MTX

Answer 3

Hypersensitivity Pneumonitis! 
Pancytopenia 
Hepatotoxicity
Nephrotoxicity 
Neurotoxicity/Seizures 
Pulmonary Fibrosis 

Follow up labs every 3 months

Question 4

Treat MTX induced Acute Renal Failure

Answer 4

Glucarpidase

Question 5

Name the 5 TNF Alpha Inhibitors

Answer 5

Adalimumab 
Etanercept 
Infliximab 
Golimumab
Certolizomab

Question 6

If your rheumatoid patient on leflunomide, surprisingly gets pregnant, what can you give?

Answer 6

Cholestyramine to accelerate metabolism

Question 7

If your patient has been taking 5 mg prednisone for 3 months, what diagnostic do you need to order?

Answer 7

DXA scan

Question 8

Diagnose this:
Triad is fever, joint pain, salmon bumpy Rash
Associated with leukocytosis and increased ferritin, LAD

Answer 8

Still’s disease

Tx- steroids and Anakinra (IL1 receptor inhibitor)

Question 9

Sjögren’s syndrome has increased risk of… (2) and associated with which NAGMA

Answer 9

Lymphoma including B cell and MALT
And
Celiac sprue

And distal Type 1 RTA

Question 10

What is Schober Test and what disease is it associated with?

Answer 10

Ankylosing Spndylitis

While bending forward, there is no intervertebral space when there is normally 5 cm
Due to bamboo spine

Question 11

What is Keratoderma Blenorrhagica and what disease is it associated with?

Answer 11

Hyperkeratotic rash on soles and palms, associated with reactive arthritis

Question 12

Diagnose this:
Recurrent painful aphthous stomatitis, genital aphthous ulcers, joint pain, erythema nodosum
HLA B5
Pathergy

Answer 12

Behçet’s disease
If only mucocutaneous disease, use colchicine
If moderate to severe disease, use steroids

Question 13

Diagnose this:
Xray of T spine shows:
Flowing ossification of anterior longitudinal ligaments

Answer 13

DISH

Diffuse Idiopathic Skeletal Hyperostosis

Question 14

Diagnose this:

MRI showing double line sign

Answer 14

Avascular Necrosis or Bone Infarct

Question 15

Type of crystals in Gout

Answer 15

Mono sodium urate

Question 16

2 causes of Pseudo gout

Answer 16

Hyperparathyroidism and Hemochromatosis

Question 17

Diagnose this: 
Shoulder pain 
XRAY- calcification of peri-articular cartilage/ligaments 
Blood tinged effusion 
Crystals on alizarin red stain

Answer 17

Milwaukee shoulder

Question 18

Most commonly affected muscle in lateral epicondylitis

Answer 18

Extensor Carpi Radialis Brevis

Question 19

Treat Dupuytren’s contracture

Answer 19

Collagenase injection

Otherwise surgery

Question 20

Polymyalgia Rheumatica is also associated with which vasculitis?

Answer 20

Temporal arteritis

Tx PMR with low dose prednisone
Tx Temporal Arteritis with high dose prednisone

Question 21

What is Crowned Dens Syndrome?

Answer 21

Neck pain, elevated inflammatory markers
XRAY showing calcification of cervical ligaments (eg- transverse of atlas and calcium deposits surrounding odontoid)
Made of hydroxyapatite or calcium pyrophosphate dihydrate

Question 22

How to diagnose Takayasu disease?

Answer 22

Aortography which shows stenosis

Question 23

What’s the diagnosis and treatment?
Fever, polyserositis, arthritis, erysipeloid rash around ankles
MEFV1 gene

Answer 23

Familial Mediterranean Fever

Colchicine to decrease cytokines

Question 24

Long term complication of Familial Mediterranean Fever

Answer 24

AA amylodosis

Question 25

Which Vasculitis? Saddle Nose Deformity Subglottic stenosis Pulmonary Hemorrhage Hint- affects sinus, lung and kidney

Answer 25

Granulomatosis with Polyangiitis/Wegners

Question 26

pANCA | Also known as

Answer 26

Anti-myeloperioxidase Seen in Churg Strauss/eosinophilia granulomatosis with polyangiitis & ulcerative colitis

Question 27

c-ANCA | Also known as

Answer 27

Antiproteinase 3 Seen in Wegners/granulomatosis with polyangiitis

Question 28

``` Which vasculitis? Migratory Pulmonary infiltrate Mononeuritis Multiplex Purpuric skin rash Seen with asthma, eosinophilia, allergic rhinitis ```

Answer 28

Eosinophilia granulomatosis with polyangiitis/Churg Strauss

Question 29

Describe complement levels in SLE

Answer 29

Everything decreased But C3 is more decreased than C4 CH50 is decreased

Question 30

What serology test correlates with disease activity in SLE?

Answer 30

Anti double stranded DNA

Question 31

Patient on Cyclosporine, develops HA, AMS, Seizures, Visual Loss MRI shows enhancement in occipital lobes Diagnosis and Treatment?

Answer 31

Posterior Reversible Encephalopathy Syndrome Control BP

Question 32

Serology in Generalized Systemic Sclerosis

Answer 32

ANA Scl 70 Anti-topoisomerase Antipolymerase III antibody

Question 33

Anti Polymerase III antibodies predict increased risk for...? (3)

Answer 33

Diffuse thickening of skin Cancer Renal crisis

Question 34

Serology and MHC for Polymyositis | Major Histocompatibility Complex

Answer 34

Anti Jo | HLA DR3

Question 35

Serology for Dermatomyositis

Answer 35

Anti Mi2

Question 36

If only ONE joint involved in acute gouty attack, what's the treatment?

Answer 36

Intra-articular glucocorticoids

Question 37

IgA deposition in skin is?

Answer 37

Henoch Schlonein- small vessel vasculitis

Question 38

Polymyositis is associated with what lung disorder?

Answer 38

Interstitial Lung Disease | Must check CXR especially if (+) transfer RNA synthetase, anti Jo-1 Abs

Question 39

Goal urate level in gout

Answer 39

Less than 6 However if you have tophaceous gout, keep your urate lowering agent despite the serum urate level

Question 40

In giant cell arteritis aka temporal arteritis, what else can you give (in addition to prednisone) to decrease risk of visual loss?

Answer 40

Low Dose ASA

Question 41

Diagnose this: Lymphoplasmacytic infiltration and enlargement of pancreas, lymph nodes, salivary glands, periaortic region causing retroperitoneal fibrosis, kidneys and skin

Answer 41

IgG4 related disease

Question 42

Patient with SLE | Presents with triad- hypoxemia, new pulmonary infiltrates, and decreasing hematocrit is what?

Answer 42

Diffuse Alveloar Hemorrhage | Dx via Bronch and Lavage

Question 43

Dermatomyositis have increased risk of...? | Cancer!

Answer 43

Solid malignancies and NHL

Question 44

If you have gout and HTN, what antihypertensive do you recommend?

Answer 44

ARB (Losartan) and CCB, lowers urate levels

Question 45

Patient with diffuse cutaneous systemic sclerosis is at risk for malabsorption from what?

Answer 45

Bacterial overgrowth due to impaired peristalsis from underlying fibrosis