Question | Answer |
What are three causes of migratory arthropathy? | 1. rheumatic fever
2. disseminated gonococcal infection
3. lyme disease |
What are the 4 questions in evaluating a patient with joint swelling? | 1. Distribution
2. Acute or chronic
3. Systemic symptoms
4. Inflammation (morning stiffness, ↑ ESR) |
Which disease is inflammatory in nature: rheumatoid arthritis or osteoarthritis? | rheumatoid |
What are the 3 basic tests in rheumatologic diseases? | 3C's to run on synovial fluid aspirate
1. WBC cell count
2. crystals
3. cultures |
1. negative birefringent crystals
2. positive birefringent crystals | 1. gout
2. pseudogout |
1. antihistone antibodies
2. anti ds-DNA
3. anti-centromere
4. anti-RO
5. c-ANCA
6. p-ANCA | 1. drug-induced lupus
2. SLE
3. CREST
4. Sjogren syndrome
5. Wegener's
6. polyarteritis nodosa, Churg-Strauss |
What is rheumatoid factor? | an autoantibody against the FC portion of IgG |
What joints of the hand are involved in rheumatoid arthritis? | 1. MCPs
2. PIPs
never DIP |
1. RA + splenomagaly
2. RA + pneumoconiosis | 1. Felty syndrome
2. Caplan syndrome |
1. boutonniere deformity
2. swan-neck deformity | 1. PIP flexed, DIP extended
2. PIP extended, DIP flexed |
What causes
1. boutonniere deformity
2. rheumatoid nodules | 1. damage to ligaments and tendons
2. focal vasculitis |
What routine screening test are necessary for rheumatoid arthritis patients on the following drugs:
1. hydroxychloroquine
2. methotrexate | 1. regular eye exams
2. CBC and liver enzymes |
What are the 3 TNF-α inhibitors? | 1. infliximab
2. abdilimumab
3. etanercept |
1. Antibodies may form against which biological agent used to Rx rheumatic diseases.
2. What is known to reduce this complication? | 1. infliximab is not an entirely human antibody and therefor anti-infliximab antibodies may form
2. co-treatment with methotrexate |
Patient with RA complaining of occipital headaches and upper extremity tingling/numbness. | atlantoaxial subluxation |
Patient with RA presenting with swollen painful calf. | ruptured Baker cyst |
What meds are used to treat severe complications of SLE? | azathioprine, cyclophosphamide |
Treatment for anti-phospholipid antibodies in pregnancy? | LMWH |
Which drugs cause drug-induced lupus? | See first aid for step 1 |
What causes Raynauds phenomenon is patients with scleroderma? | vascular dmage from accumulation of connective tissue diminishes blood flow to the extremities |
Medication that prevents scleroderma renal crisis induced by malignant hypertension. | ACE inhbitors |
Acronym of CREST syndrome | 1. Calcinosis
2. Raynaud
3. Esophageal dysfunction
4. Sclerodactyly
5. Telangiectasias |
Medications used in scleroderma for:
1. skin manifestations
2. severe Raynaud phenomenon
3. hypertension | 1. D-penicillamine
2. calcium-channel blockers
3. ACE inhibitors |
What 2 infectious disease cause symmetrical polyarthropathy? | 1. parvovirus B19
2. hepatitis B |
Young male with lower back stiffness that is worse in the morning and improves with exercise.
1. diagnosis
2. treatment | 1. clinical and x-ray findings
2. TNF blockers |
What are the 3 extraarticular manifestations of ankylosing spondylitis? | 1. anterior uveitis
2. aortic insufficiency
3. third-degree heart block |
What is the infectious cause:
1. Reiter syndrome
2. Septic arthritis
3. What is the difference in presentation of these two diseases? | 1. chlamydia (back stiffness, urethritis)
2. gonorrhea, S. aureus (fever, erythemia) |
Enteropathic arthropathy occurs in which diseases? | 1. ulcerative colitis
2. Crohn disease |
1. Most common joint affected by osteoarthritis
2. Second most common | 1. knee
2. base of thumb |
First drug used for pain in osteoarthritis | acetaminophen |
Treatment of:
1. acute gout
2. chronic gout | 1. indomethacin, prednisone, colchicine
2. probenecid, allopurinol, or febuxostat |
What are the four H's to investigate in individuals with pseudogout? | 1. hyperparathyroidism
2. hemochromatosis
3. hypophosphatemia
4. hypomagnesemia |
Rx for septic arthritis | Depends on likely etiology
1. ceftriaxone if suspect gonorrhea
2. nafcillin or vancomycin if suspect S. aureus (elderly) |
1. What organs are commonly involved in Wegener's granulomatosis?
2. How do you confirm diagnosis?
3. Treatment | 1. lungs, kidney's,joints
2. biopsy of involved organ
3. prednisone + cyclophosphamide |
1. First test done in suspected temporal arteritis
2. If this test is positive, what is the management? | 1. ESR
2. start corticosteroids immediately and then perform temporal artery biopsy |
40 year old individual with proximal muscle weakness and rash. What are the first labs to order? | 1. creatine kinase
2. aldolase |
Polyarticular symmetric arthritis (3) | 1. rheumatoid arthritis
2. SLE
3. viruses (hepatitis B, parvovirus B19) |
Mainstay of treatment in rheumatoid arthritis. | methotrexate |
Predominant infiltrating cell in rheumatoid arthritis. | T lymphocyte |
Patient with long-term rheumatoid arthritis has anemia. What are your two differentials and workup? | 1. anemia of chronic disease or PUD from glucocorticoid use leading to bleeding
2. check iron and ferritin levels |
Screening tests for patients taking methotrexate | CBC and liver enzymes (side effects of hepatitis/hepatic fibrosis) |
If a lupus patient becomes pregnant, what is the proper screening test to protect the fetus? | screen for anti-Ro (SSA) and anti-La (SSB) antibodies because these cross the placenta and can cause neonatal lupus |
Symptoms of drug induced lupus | 1. fever, fatigue and arthritis
2. No systemic manifestations |
1. Arthritis following diarrhea
2. Arthritis following urethritis | 1. reactive arthritis from Campylobacter, Shigella or Salmonella
2. reactive arthritis from Chlamydia |
1. First line drug in acute gouty arthritis of an otherwise healthy adult.
2. Drug used in acute gouty arthritis if patient has renal failure
3. 2nd line for acute gout | 1. indomethacin
2. steroids
3. colchicine |
After confirming that a patient has pseudogout, what is the next step? | 1. determine if systemic symptoms are present
2. four H's: hyperparathyroidism, hemochromatosis, hypophosphatemia, hypomagnesemia |
What is chondrocalcinosis? | deposits in joint menisci or articular cartilage seen with pseudogout |
What vasculitis syndrome is associated with hepatitis B? | polyarteritis nodosa |
First step in possible temporal arteritis? | erythrocyte sedimentation rate |
Proximal muscle weakness and ocular symptoms? | myasthenia gravis or Eaton-Lambert |
1. What is the most common rash on the face?
2. How do you distinguish the butterfly rash of SLE? | 1. seborrheic dermatitis
2. the SLE rash does not involve the nasolabial folds |
Which lab is elevated in antiphospholipid antibody syndrome? | 1. PTT is falsely elevated
2. false positive RPR and VDRL |