Rheumatology

Question 1

Pneumonic for possible SLE symptoms?

Answer 1

MD SOAP BRAIN

Question 2

List some possible SLE symptoms?

Answer 2

MD SOAP BRAIN
- Malar/Discoid rash
- Serositis - chest pain
- Oral ulcers
- Arthritis
- Photosensitivity
- Blood - anemia
- Renal failure
- ANA (+)
- Immunologic
- Neuro = cerebritis

Question 3

List some possible SLE symptoms?

Answer 3

MD SOAP BRAIN
- Malar/Discoid rash
- Serositis
- Oral ulcers
- Arthritis
- Photosensitivity
- Bleeding - anemia
- Renal failure
- ANA (+)
- Immunologic
- Neuro - cerebritis

Question 4

What are 4 possible antibodies seen with SLE?

Answer 4

ANA
dsDNA
Anti-Smith
Anti-Histone

Question 5

Levels of ESR/CRP and C3/C4 with SLE?

Answer 5

ESR/CRP = High
C3/C4 = LOW

Question 6

What is the treatment for SLE?

Answer 6

Hydroxychloroquine +/- steroids during flare

Question 7

What are 3 possible medicines that commonly cause Drug-Induced SLE?

Answer 7

Hydralazine
Procainamide
Alpha-Methyldopa

Question 8

What specific antibody is often positive with Drug-Induced SLE?

Answer 8

Anti-Histone

Question 9

Treatment for Drug-Induced SLE?

Answer 9

Discontinue causative medication

Question 10

With SLE, it can commonly cause Renal manifestations. What is the treatment?

Answer 10

IV Cyclophosphamide

Question 11

With SLE, it can commonly cause Renal manifestations. What is the treatment?

Answer 11

IV Cyclophosphamide

Question 12

Where will the RA present?

Answer 12

Smaller joints - hands/feet and SYMMETRIC!

Question 13

If the ____ joint is involved… it is NOT RA

Answer 13

DIP

Question 14

Common characteristic of pain with RA?

Answer 14

Long-lasting morning stiffness

Question 15

What is the most specific marker for RA?

Answer 15

Anti-CCP is more specific than RF

Question 16

What will be seen on X-ray with RA?

Answer 16

Erosions/Periarticular Osteopenia
– Due to pannus formation which erodes bone

Question 17

1st and 2nd line drugs to treat RA?

Answer 17

1. Methotrexate
2. Leflunomide

Question 18

1st and 2nd line drugs to treat RA?

Answer 18

1. Methotrexate
2. Leflunomide

Question 19

3 common side effects of Methotrexate?

Answer 19

1. Liver toxicity
2. Oral ulcers
3. Macrocytic anemia

Question 20

How do you offset Methotrexate adverse effects?

Answer 20

Give folic acid

Question 21

What antibody is usually positive with Limited Scleroderma?

Answer 21

Anti-Centromere

Question 22

Pneumonic for Scleroderma symptoms?

Answer 22

CREST

Question 23

What are some symptoms seen with Limited Scleroderma?

Answer 23

CREST
- Calcinosis
- Raynaud’s
- Esophageal motility
- Sclerodactyly
- Telangiectasias

Question 24

How does Diffuse Scleroderma differ from Limited Scleroderma?

Answer 24

Diffuse = CREST + visceral involvement

Question 25

What antibody is often positive with Diffuse Scleroderma?

Answer 25

Anti- scl 70 Topoisomerase

Question 26

What is the treatment for Scleroderma?

Answer 26

Supportive

Question 27

What complication can occur with Scleroderma?

Answer 27

Pulmonary HTN

Question 28

What are 2 possible signs of Diffuse Scleroderma in addition to CREST?

Answer 28

ILD Constrictive Pericarditis

Question 29

What causes Sjogren's Syndrome?

Answer 29

Lymphoplasmacytic exocrine gland destruction

Question 30

3 signs of Sjogren's Syndrome?

Answer 30

Dry eyes Dry mouth Parotid swelling

Question 31

3 signs of Sjogren's Syndrome?

Answer 31

Dry eyes Dry mouth Parotid swelling

Question 32

What antibody will be positive with Sjogren's?

Answer 32

Anti-RO/LA

Question 33

Treatment for Sjogren's?

Answer 33

Artificial tears/saliva

Question 34

With the inflammatory myopathies (dermatomyositis/polymyositis//ibm), what are the signs?

Answer 34

Proximal muscle weakness Derm findings

Question 35

List 3 possible derm findings for the inflammatory myopathies (dermatomyositis/polymyositis/ibm)?

Answer 35

Heliotrope rash = purple around eyes Gottran's papules Shawl sign = skin exposed to sun gets rash

Question 36

What marker is often elevated with the inflammatory myopathies? What are 2 possible positive antibodies?

Answer 36

HIGH CK (+) Anti-mi and (+) Anti-Jo

Question 37

How will Pseudogout look on arthrocentesis?

Answer 37

Positively birefringent rhomboid crystals of calcium-phosphate

Question 38

How will Gout look on arthrocentesis?

Answer 38

Negatively birefringent needles of monosodium urate

Question 39

What is the treatment for Gout/Pseudogout flares?

Answer 39

Colchicine or NSAIDs

Question 40

2 treatment options for chronic gout?

Answer 40

Allopurinol Probenecid if under excreter

Question 41

How will Ankylosing Spondylitis present?

Answer 41

Low back pain that is worse in the morning = Sacroiliitis

Question 42

How will the spine look with Ankylosing Spondylitis?

Answer 42

"Bamboo spine"

Question 43

What can be seen with Psoriatic Arthritis?

Answer 43

- Arthritis - Psoriasis - Nail pitting

Question 44

What can be seen with Reactive Arthritis?

Answer 44

- Urethritis - Conjunctivitis - Arthritis

Question 45

What are 4 seronegative but HLA-B27 diseases?

Answer 45

1. Ankylosing Spondylitis 2. Psoriatic Arthritis 3. Reactive Arthritis 4. IBD-Related

Question 46

Describe how Complex Regional Pain Syndrome will present?

Answer 46

Trauma/injury --> Heals --> Burning pain, swelling, redness, loss of ROM

Question 47

Burning pain with swelling, erythema, etc. following trauma to a region is?

Answer 47

Complex Regional Pain Syndrome

Question 48

What can be seen on X-ray of the region affected with Complex Regional Pain Syndrome?

Answer 48

Demineralization/Osteopenia

Question 49

If you diagnose a patient with an inflammatory myopathy like Dermatomyositis, what should you do next?

Answer 49

Screen for malignancies!!

Question 50

What pathology in the cervical spine are patient's with RA at risk for?

Answer 50

AA subluxation

Question 51

What will you see with Polymyalgia Rheumatica?

Answer 51

Proximal muscle stiffness/pain + HIGH ESR/CRP

Question 52

If you see proximal muscle stiffness/pain with elevated inflammatory markers, what is the likely diagnosis?

Answer 52

Polymyalgia Rheumatica

Question 53

What is the treatment for Polymyalgia Rheumatica?

Answer 53

Steroids

Question 54

What is Polymyalgia Rheumatic often associated with?

Answer 54

Giant Cell Arteritis

Question 55

What is a possible adverse effect of SLE patients taking Hydroxychloroquine?

Answer 55

Retinopathy/vision loss