Rheumatology

Question 1

Lupus serology

Answer 1

ANA
Ds DNA (antismith) Nephritis
Anti-histone drug Induced

Question 2

RA Serology

Answer 2

RF

Anti-ccp

Question 3

Scleroderma, CREST antibody

Answer 3

Anti-centromere

Question 4

Scleroderma, Systemic Antibody

Answer 4

Topoisomerase, Scl70

Question 5

SLE Presentation

Answer 5

4 of 11 for the diagnosis 
Malar rash 
Discoid rash 
Serositis 
Oral Ulcers 
Arthritis 
Photosensitivity 
blood 
Renal Failure 
ANA pos 
Immunologic 
Neuro

Question 6

SLE Dx Tests

Answer 6

Serology-
ds-DNA (anti-smith) nephritis 
Anti-histone-Drug induced 
U/A-ESR, CRP
C3,C4

Question 7

SLE Tx

Answer 7

Everyone-Hydroxychloroquine
Steroids (flare)

Nephritis-
IV cyclophosphamide
Oral Mycophenolate

Question 8

drugs that induce lupus

Answer 8

Hydralazine
Isoniazid
Procainimide
methlydopa

Question 9

Rheumatoid Arthritis Presentation

Answer 9

Morning Stiffness >60 min

Hands/feet affected symmetrical >3 joints spares DIP

Question 10

RA Treatment

Answer 10

NSAIDs for Sx Control
EVERYONE-Methotrexate
Severe (TNF-a Inhibitors)
Steroids for flares

Question 11

CREST Scleroderma presentation, Dx

Answer 11

Calcinosis 
Raynauds
Esophageal dysmotility 
Sclerodactyly 
Telangiectasias 
Dx: Anti-centromere 
Pulmonary Artery HTN

Question 12

Diffuse Scleroderma Presentation, Dx

Answer 12

CREST + Visceral Involvement 
Lung=Interstitial lung disease 
Heart=constrictive pericarditis 
Kidney=renal scleroderma (ACEi)
Dx: ANTI-SCL-70 (topoisomerase)

Question 13

Scleroderma Treatment

Answer 13

Sclerodactyly=Penacillamine
Esophageal=PPI
Raynauds/Calcinosis=CCB

Question 14

Sjogrens Presentation, Dx, Tx

Answer 14

Dry eyes, Dry Mouth, Parotid Swelling 
Dx: ANA, RF serology 
RO and La
Schirmer test 
Tx: Artifical tears, saliva

Question 15

Idiopathic Inflammatory Myopathy Presentation, Dx, Tx

Answer 15

Proximal muscle weakness, Painless, Subacute, malignancy 
heliotrope rash 
Grottens papules-symmetrical 
Shawl Sign 
Dx: Increased CK 
EMG 
Anti Mu, Jo
Tx: Steroids

Question 16

Arthrocentesis
>50 K WBCs
+ Organism
- Crystal

Answer 16

Infection 
Gonorrhea 
Hematogenous, STD 
Cervicitis, Urethritis 
Dx: Gram stain (-) 
NAAT 
Tx: Ceftriaxone 
7-14 days IV 
Doxycycline or azithromycin

Question 17

Non-gonorrhea monoarticular arthropathy

Dx, Tx

Answer 17

Dx: Gram stain (+)
Tx: Nafcillin

Question 18

Arthrocentesis

Shows Crystals

Answer 18

Gout or pseudo gout

Question 19

Gout Presentation

Answer 19

Crystals Negatively Bifringent
Patient history=CKD, EtOH, Thiazide use
presents with podogra

Question 20

Tumor Lysis syndrome Causes, ppx, tx

Answer 20

Chemo, leukemia, Renal Failure
ppx: IVF
Allopurinol
Tx: Rasburicase

Question 21

Gout Acute Flare Tx

Answer 21

Colchicine
NSAIDs
Steroids

Question 22

Gout Tx >2 attacks/year

Answer 22

Lifestyle modifications-alcohol, red meat, fructose
>2 attacks/year - Allopurinol
Febuxostat

Question 23

gout PPX

Answer 23

colchicine

Question 24

Repeated Gout Attacks Dx, Tx

Answer 24

Uric Acid level, >6
goal <6 
Tx: Lifestyle
Allopurinol 
Febuxostat

Question 25

Gout PPx

Answer 25

Colchicine

Question 26

What are the seronegative Arthritides PAIR

Answer 26

``` Psoriatic Ankylosing IBD related Reactive all are HLA-B27 positive ```

Question 27

Ankylosing Spondylitis Presentation, Dx, Tx

Answer 27

``` Sacroilieitis - low back pain better with use Dx: X-ray=Bamboo Spine Tx: NSAIDs Localized Steroids Anti-TNFa F/u back pain-CT ```

Question 28

Psoriatic Arthritis Presentation, Dx, Tx

Answer 28

``` Psoriasis and arthritis Nail pitting Dx: Clx Tx: NSAIDs Local steroids DMARDs ANTI-TNFa ```

Question 29

IBD Related (Enteropathic) Presentation, Dx, Tx

Answer 29

IBD and arthritis Dx: Clx Tx-Treat the IBD No NSAIDs/steroids

Question 30

Reactive Arthritis Presentation, Dx, Tx

Answer 30

``` Urethritis and arthritis (conjunctivitis->Reiters) Dx: Arthrocentesis negative Find Infxn Tx: Arthritis=NSAIDs + time treat GC/NG ```

Question 31

Giant Cell Arthritis Presentation, Dx, Tx (Large)

Answer 31

Jaw Claudication, Vision Changes, Temporal Tenderness Dx: Bx Tx: Steroids

Question 32

Takeyasu Presentation Dx, Tx (Large)

Answer 32

<40 Aorta and branches Pulselessness Dx: Angiogram Tx: Steroids

Question 33

Wegners Granulomatosis Presentation, Dx, Tx | small vessel

Answer 33

Hemoptysis, Hematuria, something with the nose Dx: C-ANCA Bx ( BEST) Tx: Steroids and cyclophosphamide

Question 34

Polyarteritis Nodosum Presentation, Dx, Tx

Answer 34

``` Associated with Hep B Gut, Renal, Skin Mesenteric Ischemia Renal Failure Purpura Mono neuritis Multiplex Dx: angiogram Tx: Steroids and cyclophosphamide ```

Question 35

Cryoglobulinemia Presentation, Dx, Tx

Answer 35

``` associated with HepC Palpable Purpura + HepC Tx: Severe-Plasmapheresis Underlying Dz Steroids and cyclophosphamide ```

Question 36

Henoch Scholnein Purpura Presentation, Dx, Tx

Answer 36

Palpable Purpura GI Sx- Pain of bleeding Dx: Bx-IgA immunofluorescence Tx: Steroids