Rheumatology Subsection of Step 3 Questions
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| Diagnosis of Lupus - PE, CBC, etc | Skin changes (malar rash, solar rash, oral ulcers, discoid);
Arhtralgia - 90% of SLE patients;
Serositis- Pericarditis, pleuritic chest pain, pul HTN, PNA, myocarditis
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| Change in complement levels during SLE flare | Complements drop
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| SLE and pregnancy with Anti-Ro. Most Likely fetal problem? | Heart Block
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| Treatment of SLE - Acute flare | Prednisone (steroids)
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| SLE flare that re-flares after stopping steroids? | Give blimumab, Azathioprine, cyclophosphamide
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| CCS: Patient comes in with SLE. What do you order? | Complement Levels, ANA, Anti-DSdna; Always.
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| Lupus Nephritis Treatment | Steroids + Mycophenolate
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| Drugs a/w Drug-induced Lupus | Hydralazine, Procainamide, INH.
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| Diagnose drug-induced lupus: pertinent positives and negatives | Antihistone Ab, Or Positive ANA.
NEVER has Renal or CNS.
Always has normal complements and normal DSdna.
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| Early Loss of teeth or lots of cavities | Sjogren's Syndrome (poor saliva)
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| Diagnose Sjogren | Lip Biopsy
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| Serology of Sjogren's - 4 types | Anti-Ro (SSA)
Anti- La (SSB)
Ro and La are highly specific but not so sensitive
ANA is 90% sensitive
RF is also present (70% sensitive)
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| Sjogren's - Presentation | "Sicca Syndrome"
Dry mouth, dry eyes, "sand under the eyelid"
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| Anti SSA, Anti SSB | AKA Anti Ro, Anti La. Specific for Sjogren.
Also can be seen in ANA-negative lupus
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| Scleroderma - Clinical Presentation | Woman, Tight Skin, Raynaud, Joint Pain
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| Lung Manifestations of diffuse scleroderma | Pulmonary Fibrosis, Pulmonary HTN (leading cause of death for scleroderma)
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| GI Manifestations of diffuse scleroderma | Barrett's, diverticulosis, primary biliary cirrhosis
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| Cardiac Manifestations of diffuse scleroderma | Restrictive cardiomyopathy
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| Treating renal involvement and HTN of scleroderma | ACE inhibitors
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| Treating pulmonary HTN a/w scleroderma | bosentan (endothelin antagonist)
Prostacyclin analogs
sildenafil
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| Preventing Raynaud's | calcium channel blocker
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| Treating lung fibrosis a/w scleroderma | cyclophosphamide
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| CREST Syndrome: Findings (positives and negatives) | Calcinosis of the fingers
Raynaud's
Esophageal dysmotility
Sclerodactyly
Telangectasia
Pertinent negatives:
No joint pain
No heart involvement
No lung involvement
No kidney involvement
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| Serology a/w CREST | + anti-centromere Ab
Never has Anti-Scl70
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| Raynaud's Phenomenon | White -> blue -> red (+/- digital ulceration as a sequela)
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| Diagnosis of Lupus: Serological | ANA, Anti DSdna
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| Diagnosis of Lupus: CBC Findings | Low WBC, PLT, or hemolysis
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| Eosinophillic Fasciitis | thick skin, orange peel appearance, eosinophillia. does not have raynaud's, heart, lung, or kidney involvement.
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| Polymyositis: presentation | Patient that can't get up from seated position. Muscle pain and tenderness.
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| Polymyositis/Dermatomyositis common physical exam findings | Prox muscle weakness
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| Labs a/w polymyositis | Muscle inflammation: Elevated CPK, Aldolase
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| Difference b/w polymyositis and dermatomyositis | Skin Rashes: Grotton's papules (over MCP jt), Heliotrope rash (purple, over periorbital), Shawl Sign (shoulder and neck erythema).
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| Definitive diagnosis of polymyositis or dermatomyositis | Need a biopsy
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| Anti-Jo in polymyositis | Risk of interstitial lung disease
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| Most common serious complication of dermatomyositis | High association with cancer
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| Treatment options for fibromyalgia | Milnacipran (SNRI), Duloxetine (SNRI), pregabalin
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| Polymyalgia Rheumatica | age 50+, Proximal muscle pain and AM stiffness, elevated ESR. Has normal CPK, EMG, Alsolase, muscle biopsy, no muscle atrophy.
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