Rheumatology

Question 1

Differential for hot swollen joint?

Answer 1

Septic arthritis, gout, pseudogout, hemarthrosis

Question 2

How to work up hot and painful joint?

Answer 2

Tap it

Question 3

Appearance of normal joint fluid

Answer 3

Serous,

Question 4

Appearance of OA joint fluid

Answer 4

Normal! Serous

Question 5

Appearance of inflammatory joint fluid

Answer 5

Cloudy, between 5 and 50,000 WBC

Poly predominance

Question 6

Appearance of crystal arthropathy fluid?

Answer 6

Cloudy, between 5 and 50,000 WBC

Poly predominance. Intracellular crystals

Question 7

Appearance of septic joint fluid

Answer 7

> 50,000 WBC, Opaque, 90% polys. + gram stain (except for GC)

Question 8

Sexually active female with hot swollen joint?

Answer 8

Think gonococcal arthritis. Careful because it doesn’t gram stain well

Question 9

ANA

Answer 9

Lupus

Question 10

Anti-CCP

Answer 10

RA

Question 11

RF

Answer 11

RA

Question 12

Anti-histone

Answer 12

Drug induced lupus, procainamide, isoniazid, hydralazine

Question 13

Anti ds DNA

Answer 13

Lupus, correlates with renal disease

Question 14

Centromere

Answer 14

CREST

Question 15

Anti topoisomerase

Answer 15

Scleroderma (systemic)

Question 16

Anti smooth muscle

Answer 16

Autoimmune hepatitis

Question 17

Ro+lA

Answer 17

Sjogrens

Question 18

Antimitochondrial

Answer 18

PBC

Question 19

Anti Jo

Answer 19

Myositis

Question 20

Lupus

Answer 20

Autoimmune complex formation and deposition

Question 21

Symptoms of LUPUS

Answer 21

MD SOAP BRAIN

Malar Rash
Discoid rash
Serositis
oral ulcers
arthritis
photosensitivity
blood (decreased ph and decresed hgb)
Renal failure
ana
immunologic complex
neuro (cerebritis, transverse myelitis)

Liebman sach’s endocarditis

Question 22

How to diagnose lupus

Answer 22

Need 4 sxs with ANA and DSDNA
U/A with biopsy for nephritis
Get complement levels (will be decreased) during a flare
ESR and CRP to track progress

Question 23

How to treat Lupus?

Answer 23

Treat arthritis and serositis with NSAIDS (or hydroxychloroquine)
Treat flare with steroids
Treat severe disease with cyclophosphamide

Question 24

RA

Answer 24

Autoimmune, affects women>men >40 years old. Pannus formation with joint destruction. Periarticular osteopenia.

Question 25

Symptoms of RA

Answer 25

Symmetric joint involvement that spares dips. Morning stiffness, nodules filled with cholesterol, C1 and C2 spinal involvement

Question 26

Diagnosis of RA

Answer 26

Anti CCP and RF

Question 27

How to treat RA?

Answer 27

NSAIDs for symptomatic relief DMARDS for everybody --MTX If severe, then biologics like infliximab. Steroids during a flare

Question 28

Felty syndrome

Answer 28

RA + neutropenia + splenomegaly

Question 29

Scleroderma

Answer 29

Collagen deposition that replaces smooth muscle | CREST and systemic

Question 30

CREST syndrome

Answer 30

Calcinosis, raynauds, esophageal dysmotility, sclerodactyly, telangiectasias

Question 31

Systemic sclerosis

Answer 31

Interstitial lung disease and scleroderma renal crisis (malignant hypertension with renal failure, hemolytic anemia and thrombocytopenia)

Question 32

Pulmonary hypertension in scleroderma

Answer 32

Happens in both crest syndrome and systemic sclerosis

Question 33

How to treat scleroderma

Answer 33

Can't do anything, can, however, treat interstitial lung disease with cyclophosphamide.

Question 34

How to treat scleroderma renal crisis?

Answer 34

ACE inhibitors

Question 35

Sjogren's Disease

Answer 35

Lymphocytic infiltration of exocrine glands, dry eyes, dry mouth, parotid swelling. Shermer test Treat with artificial tears and saliva.

Question 36

Inclusion body myositis vs polymyositis vs dermatomyositis pathogenesis

Answer 36

Inclusion - t cell mediated polymyositis - t cell mediated dermatomyositis - immune complex deposition

Question 37

How do patients with myositis present

Answer 37

Proximal muscle weakness with painful muscles. Grotton's papules, heliotrope rash, shawl sign

Question 38

How to diagnose myositis

Answer 38

EMG, muscle biopsy, anti jo

Question 39

How to treat myositis

Answer 39

Steroids or find the cancer.