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Question 1

What is the etiology of acute-onset monoarthritis with chondrocalcinosis and CPP crystals?

Answer 1

Acute CPP crystal arthritis, previously known as pseudogout

Chondrocalcinosis on radiography indicates the presence of calcium pyrophosphate crystals.

Question 2

What systemic therapies can be pursued if multiple joints are involved in acute CPP crystal arthritis?

Answer 2

• Nonsteroidal antiinflammatory drug (e.g., ibuprofen)
• Glucocorticoid (e.g., prednisone)
• Colchicine

These options are considered when the condition affects multiple joints.

Question 3

In the context of renal impairment and diabetes, what is the preferred treatment ?

Answer 3

Intra-articular glucocorticoid injection.

Question 4

True or False: Colchicine is the preferred treatment for a single joint affected by acute CPP crystal arthritis.

Answer 4

False

The preferred treatment for a single joint is intra-articular glucocorticoid injection.

Question 5

What condition is characterized by recurrent miscarriages and thrombosis?

Answer 5

Antiphospholipid syndrome (APS)

APS is diagnosed when specific antibodies are present along with pregnancy morbidity or thrombosis.

Question 6

What is required for the diagnosis of antiphospholipid syndrome?

Answer 6

Positive tests for at least one of the following on two occasions 12 weeks apart:
* anti-beta2-glycoprotein antibody
* high-titer anticardiolipin antibody
* lupus anticoagulant

These tests must be combined with pregnancy morbidity or thrombosis.

Question 7

What defines APS-related pregnancy morbidity?

Answer 7

Any of the following:
* An otherwise unexplained fetal death at ≥10 weeks’ gestation
* One or more premature births before 34 weeks’ gestation due to eclampsia, preeclampsia, or placental insufficiency
* Three or more unexplained embryonic pregnancy losses (<10 weeks’ gestation)

These criteria help in identifying APS-related complications in pregnancies.

Question 8

What does an ulcerating skin rash without palpable nodules or papules suggest?

Answer 8

More suggestive of an occlusive vasculopathy, such as APS, than vasculitis

Skin biopsies are often performed when such rashes are observed.

Question 9

What could a rising serum creatinine level indicate in a patient with APS?

Answer 9

APS-related thrombotic vasculopathy in the kidneys

This often shows minor or no abnormalities on urinalysis.

Question 10

What is Giant-cell arteritis (GCA)?

Answer 10

GCA is the most common systemic vasculitis in adults, occurring almost exclusively in patients older than age 50.

Question 11

What is the age group at highest risk for GCA?

Answer 11

The highest risk for GCA is among patients aged 75 to 85.

Question 12

Is GCA commonly associated with stroke?

Answer 12

GCA is only rarely associated with stroke.

Question 13

Where are strokes most commonly found in GCA patients?

Answer 13

Strokes in GCA patients are most commonly found in the vertebrobasilar circulation.

Question 14

What is the most common symptom of GCA?

Answer 14

Headache is the most common symptom of GCA, reported by about 80% of patients.

Question 15

What symptoms occur in about 40% of GCA patients?

Answer 15

Symptoms of polymyalgia rheumatica, such as pain and morning stiffness in the shoulders, neck, and hip girdle.

Question 16

What systemic symptoms are common in GCA?

Answer 16

Systemic symptoms include fever, malaise, weight loss, and sweats, which are nonspecific.

Question 17

What should heighten suspicion for GCA in older adults?

Answer 17

Prolonged fever or unexplained elevation of acute-phase reactants should heighten suspicion for GCA.

Question 18

What percentage of fever of unknown origin in older adults is attributed to GCA?

Answer 18

GCA accounts for 17% of cases of fever of unknown origin in older adults.

Question 19

What is the recommended procedure to diagnose GCA?

Answer 19

Temporal artery biopsy is the recommended procedure to diagnose GCA.

Question 20

What is the negative result rate for temporal artery biopsy in GCA?

Answer 20

The temporal artery biopsy may be negative in at least 15% of cases.

Question 21

What can be done if the temporal artery biopsy is negative but suspicion of GCA is high?

Answer 21

The biopsy can be repeated on the contralateral side, or noninvasive vascular imaging can be obtained.

Question 22

What noninvasive imaging techniques can be used for GCA?

Answer 22

Techniques include ultrasound of the temporal arteries, MR or CT angiography of the torso, or 18F-fluorodeoxyglucose positron emission tomography.

Question 23

What is relapsing polychondritis?

Answer 23

An inflammatory disease characterized by recurrent inflammation in cartilaginous tissues

Affects areas such as the ears, nose, trachea, bronchi, and joints

Question 24

Which part of the ear is most commonly affected by relapsing polychondritis?

Answer 24

The external ear, sparing the lobule

The lobule does not contain cartilage

Question 25

What symptoms can result from inflammation in the inner ear due to relapsing polychondritis?

Answer 25

Hearing loss, tinnitus, and vertigo ## Footnote These symptoms are often mistaken for infection

Question 26

True or False: Ear inflammation in relapsing polychondritis responds to antibiotics.

Answer 26

False ## Footnote Ear inflammation fails to respond to antibiotics

Question 27

What type of vasculitis can be seen in relapsing polychondritis?

Answer 27

Systemic vasculitis involving vessels of any size ## Footnote Can affect various organs and systems

Question 28

What ocular condition is common in patients with relapsing polychondritis?

Answer 28

Episcleritis ## Footnote Patients should also be evaluated for scleritis

Question 29

What antibodies are associated with GPA?

Answer 29

Antineutrophil cytoplasmic antibodies (ANCA) ## Footnote ANCA testing may be negative in limited cases of GPA

Question 30

What is dermatomyositis characterized by?

Answer 30

Proximal muscle weakness and a characteristic cutaneous eruption ## Footnote Dermatomyositis is an autoimmune condition that affects the skin and muscles.

Question 31

What is a heliotrope eruption?

Answer 31

Erythema and edema of the eyelids ## Footnote This is a common skin finding in dermatomyositis.

Question 32

What are Gottron papules?

Answer 32

Pink to violaceous papules over the knuckles ## Footnote Gottron papules are a hallmark of dermatomyositis.

Question 33

What is the V-neck sign associated with?

Answer 33

Photodistributed erythema and/or poikiloderma of the chest ## Footnote This sign indicates skin involvement due to sun exposure in dermatomyositis.

Question 34

What does the shawl sign indicate?

Answer 34

Photodistributed erythema and/or poikiloderma of the upper back ## Footnote The shawl sign is characterized by a rash that appears on the back and shoulders.

Question 35

What is the holster sign?

Answer 35

Poikiloderma of the lateral thighs ## Footnote This is a specific skin finding in dermatomyositis.

Question 36

What does the Gottron sign refer to?

Answer 36

Pink to violaceous patches or papules on extensor joints such as elbows and knees ## Footnote This sign is significant in diagnosing dermatomyositis.

Question 37

What are nail-fold capillary changes?

Answer 37

Changes including dilated capillary loops, dropout of capillaries, and cuticular hypertrophy ## Footnote These changes can be indicative of dermatomyositis.

Question 38

What are mechanic's hands?

Answer 38

Hyperkeratosis and fissuring on the lateral fingers and palms ## Footnote This finding may indicate a higher risk for pulmonary involvement in dermatomyositis.

Question 39

What is a severe complication of inflammatory myopathies?

Answer 39

Interstitial lung disease ## Footnote This condition can significantly affect patients with dermatomyositis.

Question 40

What screening should all adult patients with dermatomyositis undergo?

Answer 40

Pulmonary function tests with diffusion capacity of carbon monoxide ## Footnote This screening helps detect potential lung complications early.

Question 41

What should be done if abnormalities are found in pulmonary function tests?

Answer 41

The patient should have a high-resolution chest CT with interstitial lung disease protocol ## Footnote This helps in assessing the extent of pulmonary involvement.