Rheumatology

Question 1

> 50 yoa, Unilateral temporal HA, swollen tender temp. artery, Jaw Claudication, fever, elevated ESR, weight loss. dx? tx? assoc?

Answer 1

Giant cell temporal arteritis via biopsy

assoc: polymyalgia rheumatica
tx: steroids

Question 2

<40fever, elevated ESR, weight loss, w/absent pulses. how to dx? tx?

Answer 2

takayasu arteritis, dx w/angiongram.

tx: prednisone

Question 3

What is polymyalgia rheumatica? whats it assoc w/?

Answer 3

Giant Cell Temporal arteritis. inflammatory disorder that causes muscle pain and stiffness, especially in the shoulders. worse in the morning. normal CK but elevated ESR.

Question 4

Asian child, strawberry red tongue, truncal rash, palmer erythema, MI in kid. dx? tx?

Answer 4

Kawasaki

Tx: IVIG, ASA

Question 5

Renal failure, mesenteric ischemia, purpura, painful nodules + Mononeuritis Multiplex. dx? tx? assoc?

Answer 5

PAN, assoc w/HEP B.

dx: angiogram
tx: steroids + cyclophos bc dz is so severe.

Mononeuritis Multiplex: motor +sensory deficits at periphery that come and go, painful + asymmetric

Question 6

Pt w/hematuria, hemotysis + nasal problems. dx? assoc? tx?

Answer 6

Wegners = C-ANCA

dx: biopsy shows necrotizing granulomas
tx: steroids + cyclophos

Question 7

Cryoglobinemia

Answer 7

assoc w/HEPC = palpable purpura + RF, elevated ESR + cryoglobins in serum along with decreased compliment

tx: steroids + Cyclophosphamide

Question 8

Eosinophilic Polyangitis

dx? tx?

Answer 8

looks just like wegners w/PANCA & eosinophils on biopsy

tx: steroids + cyclo

Question 9

Association ab dz: smith

Answer 9

lupus

Question 10

Association ab dz: RF

Answer 10

RA

Question 11

Association ab dz: CCP

Answer 11

RA

Question 12

Association ab dz: Histone

Answer 12

drug induced lupus

Question 13

Association ab dz: ds-DNA

Answer 13

lupus + renal

Question 14

Association ab dz: mitochondrial

Answer 14

PBC

Question 15

Association ab dz: JO

Answer 15

polymyositis

Question 16

Association ab dz: Ro + La

Answer 16

Sjogren

Question 17

Association ab dz: Topo(SCL70)

Answer 17

Systemic Scleroderma

Question 18

Association ab dz: centromere

Answer 18

Scleroderma CREST

Question 19

Association ab dz: smooth muscle

Answer 19

AI hepatitis

Question 20

sx of lupus?

Answer 20

cerebritis(psycosis, ams), alopecia, malar/discoid rash, oral ulcers, libman-sacks endocarditis, arthralgias, renal failure, serositis(chest pain from lungs), 2nd trimester losses(hypercoagubility due to antiphospholipid syndrome)

Question 21

Ab assoc w/ lupus nephritis?

Answer 21

ds-DNA ab

Question 22

everyone with lupus gets….alternate?

Answer 22

Hydroxychloroquine > methotrexate

Question 23

tx of lupus flares/mild?

Answer 23

steroids

Question 24

tx of life threatening lupus nephritis or cerebritis?

Answer 24

IV cyclophosphamide then transition to Mycophenolate Mofetil PO

Question 25

Role of NSAIDs w/lupus?

Answer 25

tx arthralgias

Question 26

Pt with neck pain in the morning that last for about 2 hrs along with knee, wrist and general joint pain. Dx? Tx?

Answer 26

Rheumatoid arthritis Tx: NSAIDs(supplemental) + DMARDs(methotrexate > leflunomide, hydroxychlorquine if prego) +biological(anti-TNF if severe) + steroids(flares)

Question 27

Tx of severe RA?

Answer 27

NSAIDs(supplemental) + DMARDs(methotrexate > leflunomide, hydroxychlorquine if prego) +biological(anti-TNF if severe) + steroids(flares)

Question 28

Tx of RA flare?

Answer 28

NSAIDs(supplemental) + DMARDs(methotrexate > leflunomide, hydroxychlorquine if prego) +biological(anti-TNF if severe) + steroids(flares)

Question 29

How to dx RA?

Answer 29

1. Anti-RF(sensitive) & CCP(specific) 2. Symmetric arthritis that involves three joints and spares the DIPs 3. X-ray shows Periarticular osteopenia and marginal bony erosions 4. Rheumatoid nodule biopsy shows cholesterol deposits

Question 30

What is the pathology of RA?

Answer 30

Auto immune disease resulting in pannus formation at the joint which leads to a erosion and bony destruction

Question 31

What would you see if you biopsied a rheumatoid nodule?

Answer 31

Cholesterol deposits

Question 32

What is the classic presentation of RA?

Answer 32

How long morning stiffness affecting many small joints that is symmetric. Morning stiffness last longer than 60 minutes and if it doesn't go off the back will only affect the cervical spine. (Lower back=ankylosing spondylitis)

Question 33

Ai dx resulting in collagen replacing smooth muscle?

Answer 33

Scleroderma

Question 34

CREST scleroderma?

Answer 34

Calcinosis, Reynards, esophageal dysmotility, sclerodactyly, telangiectasias. Assoc w/anti centromere an.

Question 35

Systemic scleroderma dx?

Answer 35

CREST + heart + renal Assoc w/anti scl70

Question 36

How do you treat scleroderma?

Answer 36

Treat symptoms! Use calcium channel blocker's for Reynards. Penicillamine for skin changes. Ace inhibitors for hypertension. And steroids for acute flare's

Question 37

Pathology of Sjögren's syndrome

Answer 37

Inflammation of. Exocrine glands do to lymphoplasmacytic infiltrate

Question 38

Symptoms of Sjogren's

Answer 38

Dry eyes, dry mouth, bilateral parotid gland enlargement. Associated with ro and la antibodies

Question 39

How do you treat Sjogren's syndrome

Answer 39

Symptom control with artificial tears and saliva

Question 40

Symptoms of polymyositis, dermatomyositis, inclusion body myositis

Answer 40

Painful proximal muscle weakness, heliotropic rash, photosensitivity, Groton's papules

Question 41

How do you test for myositis?

Answer 41

You do EMG=electromyography to differentiate it from peripheral neuropathy

Question 42

Treatment of myositis and associated antibodies

Answer 42

Steroids!!! Jo and Mi

Question 43

Pt w/ 1 swollen joint. <50 wbcs and no gram stain on tap. Dx?

Answer 43

Crystal dz

Question 44

+birefringent crystals, rhomboid shape w/ calcium pyrophosphate. Dx? Tx?

Answer 44

NSAIDs or Colchine

Question 45

-birefringent crystals, needle shaped, mono sodium irate, podagra. Dx? To?

Answer 45

Gout! If due to: 1. Tumor lysis syndrome: PPx: IVF + probenecid + allopurinol Tx: rasburicase 2. Decrease excretion(diuretics,age,etoh,ckd) Tx: NSAIDS or Colchicine if no change add steroids +dirt &if refract allopurinol

Question 46

Hot tender, swollen join w/ >50 WBCs and somthing on gram stain dx?

Answer 46

Septic joint!

Question 47

Pt w/ >50 WBCs one joint tap w/ gram+cocci in clusters. Dx? Tx?

Answer 47

Staph! Usually due to trauma, IVDA or endocarditis To: vanc vs nafcillin

Question 48

Pt w/ >50 WBCs one joint tap w/ gram-cocci in chains, urethritis, cerivicitis, tenosynovial rash. Dx? Tx?

Answer 48

Gonorrhea! To: ceftriax and doxy(chlam)

Question 49

HLA B27 associated spondyoarthropathies

Answer 49

PAIR = Psoriatic Arthritis, Ankylosing Spondylitis, IBD-Assoc Arthritis, Reactive Arthritis

Question 50

pt w/urethrits who now has asymmetric bilateral arthritis of the lower back and hands and conjunctivits. dx? tx?

Answer 50

Reactive Arthritis = usually do to chalymidia tx: cause! = doxy + NSAIDs

Question 51

27 yo dude w/lower back pain + morning stiffness that improves w/use. +stiffness in his right ankle. dx? assoc? tx?

Answer 51

Ankylosing Spondylitis = men 20-30 w/calcifications of joints + tendons(achilies mc) = bamboo spine on xray. * associated w/UC * inflammation at ligamentous insertions tx: NSAIDs > Methotrexate > Etanercept(TNF inhib)

Question 52

Pt w/IBD and now has arthritis in his back. You treat the patient for his IBD and arthritis goes away. dx?

Answer 52

IBD-associated arthritis/Enteropathic *may also involve other joints!

Question 53

Pt w/IBD and now has arthritis in his back. You treat the patient for his IBD and arthritis doesnt goes away. dx?

Answer 53

Ankylosing Spondylitis! the person prob has UC!