Rheumatology

Question 1

gt 50,000 white cells on arthrocentesis, dx?

Answer 1

Septic arthritis

Question 2

Anti-CCP antibody positive, dx?

Answer 2

Rheumatoid arthritis

Question 3

Anti-centromere antibodies, dx?

Answer 3

Scleroderma CREST (isolated type of scleroderma)

Question 4

Positive ANA, most correlated with?

Answer 4

lupus

Question 5

Anti-histone antibodies, dx?

Answer 5

Drug induced lupus

Question 6

Topoisomerase antibodies, dx?

Answer 6

Scleroderma (systemic form - they likely won’t show it as Scl-70 on the test)

Question 7

10,000 white cells on arthrocentesis, dx?

Answer 7

Inflammatory arthritis (yellow, white in color, gt 50% polys)

Question 8

What’s the max number of WBCs you will see in arthrocentesis of osteoarthritis? And percent polys?

Answer 8

less than 2000, less than 25%

Question 9

Acute joint pain, name 4 causes?

Answer 9

septic (infxn), trauma, crystal, reactive

Question 10

Chronic joint pain, name two categories?

Answer 10

Degenerative (osteoarthritis) vs Inflammatory (everything else)

Question 11

Anti-Ro+La antibodies? Anti-Jo

Answer 11

Sjogren’s; polymyositis

Question 12

Anti-smooth muscle antibodies?

Answer 12

autoimmune hepatitis

Question 13

What is the most specific antibody for lupus and lupus nephritis?

Answer 13

Anti-dsDNA

Question 14

What is the antibody seen in primary biliary cirrhosis?

Answer 14

Anti-mitochondrial

Question 15

If gt 50,000 WBCs on tap but negative gram stain/cx, what should you think?

Answer 15

Gonorrhea! Can do NAAT or grow on chocolate agar

Question 16

Pt has lupus and is in renal failure, what do you do next?

Answer 16

get a biopsy (lupus nephritis)

Question 17

Name 5 drugs that can cause drug-induced lupus

Answer 17

SHIPP

Sulfonamides, hydralazine, isoniazid, phenytoin, procainamide (also alpha methyl dopa)

Question 18

How do you diagnose antiphospholipid syndrome? What happens in mixing study? What happens to coag study?

Answer 18

Russel viper venom test; mixing study fails to correct; PTT increases, normal INR

Question 19

Anti-histone antibodies, dx? Tx?

Answer 19

Drug-induced lupus; remove drug

Question 20

Picture of a face with a rash that spares nasolabial folds, dx?

Answer 20

Malar rash = lupus

Question 21

How do you treat lupus nephritis?

Answer 21

Cyclophosphamide IV (can switch to po mycophenolate mofetil)

Question 22

Vegetation on BOTH sides of a valve, dx?

Answer 22

libman sacks endocarditis (LSE for SLE)

Question 23

How do you treat lupus? Lupus flare?

Answer 23

hydroxychloroquine; prednisone

use NSAIDs to control symptoms; cyclophosphamide for severe or lupus nephritis

Question 24

Name 5 of 11 symptoms of Lupus

Answer 24

MD SOAP BRAIN
Malar rash, Discoid rash, Serositis (pleuritic chest pain), Oral ulcers, Arthritis (joint pain), Photosensitivity, Blood (anemia and thrombocytopenia), Renal failure, ANA+, Immunologic (other serologic markers), Neurology (cerebritis causes psychosis or AMS)
also see libman sacks endocarditis

Question 25

Refractory RA treatment (3)?

Answer 25

Biologics = etanercept, infliximab, or rituximab

Question 26

RA and the spine, where is it located?

Answer 26

C1 and C2

Question 27

XR shows erosions in joints, diagnosis?

Answer 27

rheumatoid arthritis

Question 28

Name the 3 conditions of felty syndrome?

Answer 28

1) RA; 2) neutropenia; 3) splenomegaly

Question 29

What antibodies should you order for RA? Which is sensitive and which is specific?

Answer 29

``` RF = sensitive CCP = specific ```

Question 30

Before you start a biologic, what do you do?

Answer 30

Screen for TB and fungus

Question 31

How do you tx rheumatoid arthritis?

Answer 31

NSAIDs (Sxs) + Methotrexate (DMARD for everyone!); if severe can use biologic, and steroids for flare

Question 32

What joint does RA spare?

Answer 32

DIP joints

Question 33

XR shows periarticular osteopenia, dx?

Answer 33

Rheumatoid arthritis (buzzword)

Question 34

Name the 7 characterisitcs of RA with the mnemonic

Answer 34

Nobody Should Have Rheumatoid Symptoms 3 X Nodules (bx shows cholesterol); Symmetric; Hands (and feet); RF (or ccp); Stiffness; 3 or more joints spares DIP; Xray shows erosions

Question 35

Anti-topoisomerase antibody, dx?

Answer 35

Systemic sclerosis (also see anti-Scl-70)

Question 36

Dry eyes and dry mouth, dx? Tx?

Answer 36

Sjogren's; artificial tears, artificial saliva

Question 37

How do you diagnose a myositis?

Answer 37

biopsy the muscle (will also see increased CK, and possibly anti-Mi or anti-Jo antibodies)

Question 38

How do you treat scleroderma GERD?

Answer 38

PPI

Question 39

Scleroderma renal crisis, tx?

Answer 39

Ace-inhibitor (not steroid!!!)

Question 40

Anti-centromere antibody, dx?

Answer 40

CREST

Question 41

What does CREST stand for and how do they present?

Answer 41

calcinosis (can cause HTN), raynauds, esophageal dysmotility (causes unrelenting GERD), Sclerodactyly (tense fingers), Telangiectasia (GI bleeds/Fe deficiency anemia)

Question 42

Name 3 skin presentations of dermatomyositis

Answer 42

1) heliotrope rash (purple eyelids); 2) Gottron's papules (scaly rash on extensors of joints); 3) Shawl sign (neck shoulders) (causes proximal muscle weakness)

Question 43

What is the underlying pathology in inclusion body myositis, polymyositis, and dermatomyositis? Which one is associated with cancer?

Answer 43

IBM and Polymyositis: T-cell dermatomyositis: Complex deposition Dermatomyositis (in 25% of cases - ovary, lung, GI, lymphoma)

Question 44

What tests can you order when considering myositis (5)?

Answer 44

Antibodies (anti-Mi and Jo), increased CK, increased aldolase, EMG, biopsy of muscle

Question 45

How do you treat tumor lysis after it happens?

Answer 45

Rasburicase

Question 46

How do you tx gout?

Answer 46

NSAIDs (can't if have CKD - then use steroids)

Question 47

How do you tx gout chronically?

Answer 47

allopurinol (febuxostat also okay)

Question 48

Rhomboid shaped crystals, diagnosis?

Answer 48

pseudogout

Question 49

Septic joint and cultures are positive for gram positive cocci, diagnosis and next step?

Answer 49

Staph spetic joint; Tx with nafcillin (vanco if pt is toxic or MRSA is confirmed)

Question 50

What type of crystals do you see with gout?

Answer 50

needle shaped negatively birefringent

Question 51

Inflamed big toe, diagnosis?

Answer 51

Podagra, gout

Question 52

Septic joint but no cultures are positive, dx and next step?

Answer 52

Gonorrhea, send for pcr (NAAT)

Question 53

Positively birefringent crystals, dx?

Answer 53

pseudogout (rhomboid shaped)

Question 54

Nail pitting and arthritis: diagosis?

Answer 54

psoriatic arthritis

Question 55

How do you handle enteropathic arthritis?

Answer 55

Treat the inflammatory bowel disease (UC and Crohns) - Mild: 5-ASA; Mod: Azathioprine or 6-MP; Severe: UC = resection, Crohn's = Anti-TNF

Question 56

Ulcerative colitis and arthritis, dx?

Answer 56

Enteropathic arthritis

Question 57

How do you treat reactive arthritis?

Answer 57

IM ceftriaxone and doxycycline

Question 58

Sexually active, cervicitis, joint pain, dx? Next step?

Answer 58

Reactive arthritis; find the STD to diagnose (swab everything)

Question 59

Vascultitis commonly associated with Hep B?

Answer 59

Polyarteritis nodosa (no lung involvement is what differentiates it from wegeners!)

Question 60

Which small vessel vasculitide is associated with palpable purpura and hepatitis C?

Answer 60

Cryoglobulinemia

Question 61

Giant cell arteritis: classic sxs (3) and first step?

Answer 61

``` age gt 50, unilateral temporal headache, tender swollen temporal artery Give steroids (then confirm) ```

Question 62

Which vasculitis is associated with a strawberry-like tongue?

Answer 62

Kawasaki disease

Question 63

Absent pulses in large vessels of a systemically inflamed female less than 40 yo?

Answer 63

Takayasu arteritis

Question 64

Polymyalgia rheumatica is commonly associataed with which vasculitis?

Answer 64

Giant cell arterities (large vessel)

Question 65

Vasculitis that's usually c-ANCA positive?

Answer 65

Wegner's