First Aid Rheum

Question 1

Joint findings in osteoarthritis

Answer 1

subchondral cysts, sclerosis, osteophytes, eburnation, Heberden nodes (DIP) and Bouchard notes (PIP)

Question 2

Joints findings in rheumatoid arthritis

Answer 2

Pannus formation (MCP, PIP), subcutaneous rheumatoid nodules (fibrinoid necrosis), ulnar deviation of fingers, subluxation, baker cyst

Question 3

Classic presentation of osteoarthritis

Answer 3

pain in weight-bearing joints after use, improves with rest, bowlegged, non-inflammatory, no systemic symptoms

Question 4

Classic presentation of rheumatoid arthritis

Answer 4

morning stiffness lasting more than 30 minutes, improves with use, symmetric joint involvement, systemic symptoms

Question 5

treatment of osteoarthritis

Answer 5

NSAIDs, intra-articular glucocorticoids

Question 6

treatment of rheumatoid arthritis

Answer 6

NSAIDs, glucocorticoids, disease-modifying agents

Question 7

disease modifying agents

Answer 7

methotrexate, sulfasalazine, TNF-alpha inhibitors

Question 8

predisposing factors to osteoarthritis

Answer 8

age, obesity, joint deformity, trauma

Question 9

predisposing factors for rheumatoid arthritis

Answer 9

female, +RF, anti-cyclic citrullinated peptide antibody more specific, HLA-DR4

Question 10

Findings in Sjogren’s syndrome

Answer 10

xerophthalmia (decreased tear production/corneal damage)
xerostomia (decreased saliva production
SS-A (anti-Ro) and SS-B (anti-La) antinuclear antibodies
bilateral parotid enlargement

Question 11

definition of sjogren’s syndrome

Answer 11

autoimmune disorder characterized by destruction of exocrine glands

Question 12

Treatment of gout

Answer 12

Acute: NSAIDs, glucocorticoids, colchicine
Chronic: xanthine oxidase inhibitors (allopurinol, febuxostat)

Question 13

overproduction of uric acid can be caused by

Answer 13

Lesch-Nyhan syndrome, PRPP excess, increased cellular turnover (cancer), von Gierke disease

Question 14

diseases that may be associated with pseudogout

Answer 14

hemochromatosis, hyperparthyroidism, hypoparathyroidism

Question 15

treatment of pseudogout

Answer 15

NSAIDs for sudden severe attacks; steroids; and colchicine

Question 16

common causes of infectious arthritis

Answer 16

S. aureus, Streptococcus, and Neisseria gonorrhoeae

Question 17

Gonococcal arthritis presents as

Answer 17

migratory arthritis with an asymmetric pattern

synovitis, tenosynovitis, and dermatitis

Question 18

Seronegative spondyloarthropathies

Answer 18

HLA-B27: more often in males
psoriatic arthritis
ankylosing spondylitis
IBS
Reactive arthritis (Reiter syndrome)

Question 19

findings in psoriatic arthritis

Answer 19

asymmetric and patchy involvement, dactylitis (sausage fingers), pencil in cup deformity

Question 20

findings in ankylosing spondylitis

Answer 20

stiff spine due to fusion of joints, uveitis, aortic regurgitation, bamboo spine

Question 21

classic triage with reactive arthritis

Answer 21

conjunctivitis and anterior uveitis
urethritis
arthritis
“can’t see, can’t pee, can’t bend my knee”

Question 22

classic presentation of SLE

Answer 22

rash, joint pain, fever in females of reproductive age and of african descent

Question 23

treatment of SLE

Answer 23

NSAIDs, steroids, immunosuppressants, hydroxychloroquine

Question 24

sarcoidosis is characterized by

Answer 24

immune-mediated, widespread noncaseating granulomas and elevated serum ACE levels

Question 25

sarcoidosis is associated with

Answer 25

restrictive lung disease, erythema nodosum, lupus pernio, bell palsy, epithelioid granulomas containing micrscopic SChaumann and asteroid bodies, uveitis and hypercalcemia

Question 26

treatment of sarcoidosis

Answer 26

steroids

Question 27

polymyositis

Answer 27

progressive symmetric proximal muscle weakness, characterized by endomysial inflammation with CD8+T cells (most often involves shoulders)

Question 28

dermatomyositis

Answer 28

similar to polymyositis but also invovles malar rash, Gotron papules, heliotrope (erythematous periorbital) rash, perimysial inflammation and atropy with CD4+ T cells

Question 29

Lab findings in polymyositis/dermatomyositis

Answer 29

increased CK, +ANA, +anti-Jo-1, +anti-SRP, + anti-Mi-2 antibodies

Question 30

treatment of polymyositis/dermatomyositis

Answer 30

steroids

Question 31

pathophysiology of myasthenia gravis

Answer 31

autoantibodies to postsynaptic ACh receptor

Question 32

Scleroderma

Answer 32

excessive fibrosis and collagen deposition throughout the body

Question 33

manifestations of scleroderma

Answer 33

sclerosis of skin, manifesting as puffy and taut skin with absence of wrinkles

Question 34

diffuse scleroderma

Answer 34

widespread skin involvement, rapid progression, early visceral involvement anti-Scl-70 antibody (anti-DNA topoisomerase I antibody)

Question 35

limited scleroderma

Answer 35

``` Calcinosis Raynaud phenomenon Esophageal dysmotility Sclerodactyly Telangiectasia (associated with antiCentromere antibody) ```