Rheum 1

Question 1

Small joint polyarthritis, fever, rash, exposure to children. Dx? What test for active dz?

Answer 1

Parovirus B19. anti-parovirus IgM antibodies, igG (old previous infection)

Question 2

Spiking fever, Salmon Colored Rash on trunk (pink maculopapular rash) and extremities, fever, Arthritis, lymphadenopathy, Elevated WBC, HIGH FERRITIN. Dx?

Answer 2

Adult-onset still disease

Question 3

Athritis with radiographic evidence of Articular surface Erosions. Dx?

Answer 3

Erosive osteoarthritis

Question 4

Hx of TB + Arthritis.

Test?

Answer 4

TB arthritis- Chronic inflammatory Monoathritis ( Can occur with latent TB).

Synovial biopsy

Question 5

Blood test for Sjogren Syndrome?

Test for definitive diagnosis for Sjogren syndrome?

Rx?

Answer 5

Anti-Ro/SSA antibodies.

Lip Biopsy or minor Salivary gland Biopsy

Artificial Tears, Lubricants, Periodontal care every 6 months

Question 6

Pt is Febrile, with R knee Swollen and Tender for 2 days duration. Next step?

What constitutes as inflammatory?
What constitutes as infectious?

Answer 6

Aspirate Knee (Arthrocentesis) 200-2000 WBCs noninflammatory.

WBC > 2000 Inflammatory

WBC > 50,000 Infectious

Question 7

Hx of Limited Cutaneous Sclerosis presents with Dyspnea, normal CXR, but increase P2 with wide split s2.

Dx?

Answer 7

Pulmonary HTN

Question 8

Hx of gout, presenting withLeg pain, Swelling and Redness
Non-Responsive to abx. Blood cultures negative. Dx?

Answer 8

Gouty Cellulitis

Question 9

Raynaud phenomenon, inflammatory arthritis, positive ANA, negative anti-double stranded antibodies, anti-smith, Anti-CCP, Anti-U1-Ribonucleoprotein, Anti-Ro/SSA, Anti-la/SSB.
Dx? Rx?

Answer 9

Undifferentiated Connective Tissue Disease

Hydroxycholorquine

Question 10

Pain and swelling of Wrist and Knees. Xray shows chondrocalcinosis.
Dx?

Answer 10

Calcium Pyrophosphate Crystal Arthritis (Psuedogout)

Question 11

1. Rx of RA for quick relief
2. Rx for erosive disease?
3. Hx of RA presenting with pleural effusions, lights criteria showing exudative effusion. Dx?

Answer 11

1. NSAID
2. Methrotrexate, start immediately in patients with Erosive disease
3. Rheumatoid Pleuritis (rheumatoid lung)

Question 12

1. Skin thickening distal elbows and knees, Absent renal crisis, PH, CREST syndrome is Absent.
   Dx?
2. Hx of Diffuse Cutaneous Systemic Sclerosis + AKI, Severe HTN, mild Proteinuria, Microangiopathic hemolytic anemia, Thrombocytopenia Dx? Rx?

Answer 12

1. Limited Cutaneous Systemic Sclerosis
2. Scleroderma Renal Crisis
   RX: Catopril (ACE inhibitor).
   • Diffuse Cutaneous Systemic Sclerosis has the Renal Crisis

Question 13

Painful Oral and Genital mucosal ulcerations with inflammatory eye disease and pathergy (inflammatory response to skin prick with sterile needle.)
Dx?
Complication?

Answer 13

Bechet syndrome

Thrombosis

Question 14

Chronic Granulomatous Vasculitis seen in Asian women. They present with Claudication in the extremities, Discrepancy in Blood Pressure btw arms and reduced pulses.
Dx?

Answer 14

Takayasu Arteritis

Question 15

Acute arthritis, Bilateral hilar Adenopathy and Erythema Nodosum. Dx? Test?

Answer 15

Logren syndrome

When all 3 features are present. No further testing is warranted

Question 16

Rx for Class V Lupus Nephritis?

Diagnostic test for lupus nephritis?

Answer 16

Mycophenolate Mofetil

Kidney Biopsy

Question 17

Bright erythematous Rash over both Cheeks and Nasal bridge sparing the Nasolabial folds. Dx?

Answer 17

Acute Cutaneous Lupus Erythematous which will develop into SLE.

Question 18

Pt presents with intermittent sensory loss of hands and occasional shock like sensation from neck down the back with neck flexion. Has 15 year hx of RA.

Test?

Answer 18

Xray of neck with flexion/extension of Cervical Spine. R/O C1-C2 subluxation

Question 19

Hx of SLE presenting with HA, Mild Cognitive Dysfunction and Mood disorder?

Complication?

Answer 19

Neuropsychiatric SLE

Pt can develop seizure and psychosis

Question 20

1. Name the 4 Sponylarthritis:
2. Pt presents with psoriasis, enthesitis, dactylitis, tenosynovitis and arthritis. (pencil in cup ) deformity on xray.
   Dx? Rx?
3. RX for IBD Associated Arthritis?
4. Rx for Ankylosing Spondylitis?
5. Management of Reactive arthritis ?

Answer 20

1. Psoriatic Arthritis
   Reactive Arthritis,
   Ankylosing Spondyltiis
   IBD-Associated Arthritis
2. Psoriatic Arthritis. NSAID, Methotrexate and/or Anti-TNF (Can eventually discontinue methotrexate)
3. Adalimumab and Infliximab
4. NSAIDs, Steroid Injections, Anti-TNF
5. Test for GU and GI infections, self limited.

Question 21

Side effect of Leflunomide?

Answer 21

Peripheral neuropathy

Question 22

Management of inadequately treated Tophaceous Gout?

Answer 22

Increase allopurinol in 100 mg increments. Total dose is 800mg.

Question 23

Rx for pt with SLE who still has moderate disease while on appropriate immunosuppressive agents?

Answer 23

Belimumab

Question 24

What abx should NOT be used with colchicine ?

Answer 24

Clarithromycin

No colcha with Claritha

Question 25

Digital Clubbing, Painful Periostosis of Long Bones, Synovial effusion and Periosteal bone formation. Dx? What is the next step in Management? What is it commonly associated with?

Answer 25

Hypertrophic Osteoarthropathy CXR or CT to r/o Malignancy (Non-Small Cell Lung Cancer commonly associated)

Question 26

Raynaud Phenomenon, arthritis, puffy fibers, sclerodactly, serositis, esophageal dysmotility, myositis, ILD, PAH. Dx? Rx ?

Answer 26

Mixed Connective Tissue Disease. Anti-U1RNP Antibodies. Fulfills criteria for at least two of the following SSc, Polymyositis, SLE. Rx is organ specific DMARDs for arthritis, Vasodilators for PAH, PPI for esophageal issues

Question 27

Older adults with Aching and Morning stiffness in the proximal muscles of the Shoulder and Hip girdle. ESR > 50 Dx? Rx?

Answer 27

Polymyalgia Rheumatica Low dose Prednisone

Question 28

HTN, Renal insuffiency, Arterial aneursym (Non glomerular kidney disease) , Mononeuritis Mutiliplex, Skin lesions (Ulcers, Purpura, Livedo Reticularis, Nodules), Mesenteric Ischemia (Post-prandial Abd pain), Orchitis. Dx? Test? What Viral infection is commonly associated? Rx?

Answer 28

1. Polyarteritis Nodosa ( MultiSystem Necrotizing Vasculitis of Small-Medium Sized Vessels) 2. Biopsy of Involved Tissue & Renal Angiography. 3. Hep B or C Prednisone and Cyclophosphamide or Rituximab

Question 29

Recurrent Middle Ear Infections, Destructive rhinitis, sinusitis, saddle-nose deformity, tracheal collapse, pulmonary infiltrates, cavities, hemoptysis and pauci-immune GN. Dx? Test? Rx?

Answer 29

Granulomatosis with Polyangitis ( Wegners) C- ANCA and Anti-RP3 antibody assay. Prednisone and Cyclophosphamide or Rituximab

Question 30

Pulmonary infiltrates, Palpable Purpura, and Rapidly progressive Pauci-Immune GN. Dx? Test? Rx?

Answer 30

Microscopic polyangiitis (Small-Medium Sized Vessels) P-ANCA and Anti-MPO Antibody Assay Prednisone and Cyclophosphamide or Rituximab

Question 31

Asthma, Eosinophilia, Elevated IgE and Pulmonary infiltrates/hemoptysis Dx? Test? Rx?

Answer 31

Eosinophilic Granulomatosis with polyangiitis P-ANCA and Anti-MPO antibody assay and biopsy. Prednisone and Cyclophosphamide or Rituximab

Question 32

Palpable Purpura, Joint and Abdominal pain, Glomerulonephritis (RBCs in Urine) after URI. Dx? Test? Rx?

Answer 32

IgA Vasculitis/Henoch-Schonlein purpura Skin biopsy (IgA immune Complex Deposition) Kidney biopsy showing IgA Nephropathy Self Limited

Question 33

22 yo girl presents with Conjunctival injection and Swelling in her left knee for 3 days. She had diarrhea 1 month ago and tested positive for the past 3 days. Knee Aspiration has 4,000 WBC. Dx? Rx?

Answer 33

Reactive Arthritis Clinical Diagnosis Rx: NSAIDs, Self Limiting

Question 34

Management of Severe Osteoporosis: Initial Management? If there is < 5% BMD ? If there is > 5% BMD?

Answer 34

1. Oral Bisphosphenate & Repeat DXA 2. BMD < % Continue with Bisphosphenate and Repeat DXA in 2 years 3. BMD> 5% Switch to IV Bisphosphenate, Teriparatide or Denosumab

Question 35

Name the Condition: 1. DNA Histone Complex Antibody 2. Double-stranded DNA Antibody 3. RNA Polymerase I& III (scl 70)Antibody, Anti-topoisomerase 4. Ribonucleoprotein (RNP) Antibody 5. SS-A/Ro, SS-B/La Antibody 6. Centromere Antibody 7. Aminoacyl--Transfer RNA Synthetases (Jo-1) Antibody 8. Myeloperoxidase Antibody (MPO) 9. Proteinase 3 (RP3) Antibody

Answer 35

1. Drug induced lupus 2. SLE 3. Systemic sclerosis 4. Mixed connective tissue disease 5. Sjorgen Syndrome 6. Limited Scleroderma 7. Polymyositis, Dermatomyositis 8. Microscopic with polyangiitis 9. Granulomatosis with polyangiitis (Wegners)