Rheum/Derm

Question 1

Uricosuric agents and allopurinol toxicity

Answer 1

Hypersensitivity- rash, hemolysis, allergic interstitial nephritis

SJS, toxic epidermal necrolysis

Question 2

Colchicine toxicity

Answer 2

Diarrhea

Supression of WBC production

Question 3

Older, slow worse with use

DIP, PIP, hip, and knee joints affected

Answer 3

Osteoarthritis

Dx:
<200 WBC in synovial fluic

X-ray: osteophytes and narrowing of joint space

Question 4

Men, acute, associated with over-eating and binge drinking

1st big toe affected

Answer 4

Gout

Dx:
2000-50000 WBC
Negatively biofringent needles

Question 5

Hemachromatosis
Hyperparathyroidism

Wrist and knees

Answer 5

CPPD

Dx:
2000-50000 WBC
Positively biofringent rhomboids

Question 6

Young female with morning stiffness that improves with use

Multiple joints of hands and feet

Answer 6

RA

Anti-cyclic citrulinated peptide (anti-CCP)

Question 7

High fever, very acute

single joint affected

Answer 7

Septic arthritis

Dx:&raquo_space;50000 neutrophils, culture fluid

Question 8

Back pain
History of cancer
PE: vertebral tenderness, sensory level, hyperreflexia

Answer 8

Cord compression

Question 9

Back pain
Fever
High EST
PE: vertebral tenderness, sensory level, hyperreflexia

Answer 9

Epidural abscess

Question 10

Back pain
Bowel/bladder incontience
Erectile dysfunction
PE: bilateral leg weakness, saddle area anesthesia

Answer 10

Cauda equina syndrome

Question 11

Back pain
Male under 40yo, pain worsens with rest and improves with activity
PE: decreased mobility in chest

Answer 11

Ankylosing spondylitis

Question 12

Back pain
Pain and numbness of medial calf or foot
PE: loss of knee and ankle reflex, positive straight leg raise

Answer 12

Disk herniation

Question 13

Anti-TNF AE

Answer 13

Reactiviation of tuberculosis

Question 14

Hydroxychoroquine AE

Answer 14

Ocular

Question 15

Sulfasalazine AE

Answer 15

Rash and hemoptysis

Question 16

Rituximab AE

Answer 16

Infection

Question 17

Gold Salt AE

Answer 17

Nephrotic syndrome

Question 18

Methotrexate AE

Answer 18

Liver, lung, BM

Question 19

Young person
High spiking fevers (104)
Rash-salmon colored on chest and abdomen

Splenomegaly
+/- pericardial effusion
+/- mild joint symptoms

Answer 19

JRA

Dx:
anemia 
hypoalbuminemia
leukocytosis 
Ferritin markedly elevated 

Tx: NSAID - steroids- anti-TNF

Question 20

Cancers associated to with dermatomyositis

Answer 20

Ovary
Lung
GI
Lymphoma

Question 21

Diagnosis of Poymyositis or dermatomyositis

Answer 21

Initial tests: CPK and aldolase
Accurate test: Lung bx

Anti-Jo associated with lung fibrosis

Question 22

Diagnosis of Sjogren

Answer 22

Initial- Schrimer test (filter paper)
Accurate- lip or parotid gland biopsy

Initial blood test- SS-A (Ro) and SS-B (La)

Evaluate for lymphoma

Question 23

Glomerulonephritis 
Foot drop 
Stroke in a young person 
Abdominal pain worse with eating 
Lower extremity ulcers

Answer 23

Polyarteritis nodosa

Dx:
Most accurate- bx of symptomatic site

Angiography of renal, mesenteric, hepatic artery- beading
p-ANCA <20% (anti-myeloperoxidase Ab)

Tx: prednisone and cyclophosphamide

Question 24

URI: sinusitis, otitis media, mastoiditis, oral or gingival involvment
Lower respiratory tract infections
Renal insufficiency

Answer 24

Wegner’s (granulomatosis with polyangitis)

Dx:
Best initial - c-ANCA (anti-proteinase 3 Ab)
Accurate: Bx Lung>Renal>Sinus

Tx: prednisone and cyclophosphamide

Question 25

Lung disease Renal disease Asthama Eosinophilia

Answer 25

Churg-Strauss DX: p-ANCA, bx Treat: prednisone and cyclophosphamide

Question 26

``` Kiddo GI- pain bleeding intususseption purpura arthralgias hematuria ```

Answer 26

Henoch-Schnolein Clinical dx, bx most accurate- leukoclastic vasculitis Resolve spontaneously, steroids if severe

Question 27

``` Hepatitis C: Joint pain Glomerulonephritis Purpuric skin lesions Neuropathy ```

Answer 27

Cryoglobulinemia- IgM Ab Dx: positive RF factor and cold precipitable immune complexes No use in steroids, treat underlying cause- HCV

Question 28

Septic arthritis etiology

Answer 28

1. Staph 2. Strep 3. Gram -ve rods Empiricially treat with ceftriaxone and vancomycin

Question 29

Prosthetic joint infection

Answer 29

Lucency around implantation of joint on imaging Joint is physically loose Treat: remove the joint, treat with abx for 6-8 weeks, replace joint Recently placed joint with infection = s. epi