DIT(4-6)

Question 1

Patient presents with joint space narrowing, eburnation on Xray, and pain which is worse at night.

Answer 1

Osteoarthritis– “wear and tear” damage to joints, destruction of articular cartilage–joint space narrowing.

Question 2

Osteoarthritis and RA differ how in joint involvemnet?

Answer 2

RA–spares DIP, MCP and PIP
OA–spares MCP, DIP (heberden) and PIP(bouchard)
Systemic symptoms in RA (fever, fatigue..etc)

Question 3

Rheumatoid Arthritis

Answer 3

Autoimmune destruction of synovial joints.
Worse in the morning, better with use.
Type 3 and 4 hypersensitivity

Question 4

What blood tests is RA associated with?

Answer 4

RF +, anti cyclic citrullinated peptide antibody.

Also HLA-DR4

Question 5

RA also is seen with Boutonniere and Swan neck deformations. What are these?

Answer 5

Boutonniere– flex at PIP, extend at DIP

Swan Neck– extend at PIP, flex at DIP

Question 6

Xerophthalmia, Xerostomia are present in 50 year old female. What blood test would confirm the diagnosis.
and what other finding can be found with this condition?

Answer 6

Sjogren’s syndrome–autoimmune destruction of exocrine glands (salivary, lacrimation)
Anti-Ro (SSA)
Anti-La (SSB)
Bilateral parotid enlargement is also seen.

Question 7

Podagra. monosodium urate cyrstals. What is seen under parallel light?
why does doing to bar dog make this disease worse?

Answer 7

Gout–neg birefringence (yellow under polar light)

Alcohol competes with uric acid for renal excretion, thus less uric acid is excreted.

Question 8

Positive Birefringence, seen in large joints such as the knee. What kind of crystals are seen

Answer 8

Pseudogout– Calcium pyrophosphate crystals
these are pos. birefringence thus are blue on parallel light.
Crystals are rhomboid and basophilic.

Question 9

Patient presents with red swollen knee one week, after resolution, presents with red, swollen, painful shoulder.

Answer 9

migratory arthritis seen in Neisseria gonorrhea infection.
Sepsis Arthritis (infectious arthritis)
S. aureus, Strep, N. Gonorrhea.

Question 10

Psoriasis, and dactylitis (sausage fingers) are seen in a patient, what other typical finding on Xray may be seen?

Answer 10

Psoriatic Arthritis- ( a seronegative spondylarthropathy)

Pencil in cup deformity on Xray

Question 11

RF is what kind of antibody?

Answer 11

IgG

Question 12

Ankylosing Spondylitis patients present with a stiff back because of fusion of joints what other common symptoms can be seen?

Answer 12

Uveitis, aortic regurgitation.

Also these patients typically improve with exercise.

Question 13

IBD

Answer 13

crohns and UC associated with ankylosing spndylitis or peripheral arthritis

Question 14

Classic Triad of Conjunctivitis, urethritis, Arthritis is seen with what?

Answer 14

Cant see, cant pee, ,cant bend a knee
Reiter’s syndrome (reactive arthritis)
Chlamydia
Post GI (salmonella, shigella, yersina, campylobacter)

Question 15

A 28 year old african american woman is found to have Libman Sack’s endocarditis. What serious related condition should she be closely monitored for in the future?

Answer 15

Lupus--autoimmune presents with malar rash, fever, joint pain, in young AA women.
RASH OR PAIN
Lupus nephritis ( a type III hypersensitivity reaction)

Question 16

Nephritic syndrome associated with Lupus?

Answer 16

Diffuse proliferative glomerulonephritis

Question 17

Nephrotic Syndrome associated with Lupus?

Answer 17

Membranous Glomerulonephritis

Question 18

tests for lupus?

Answer 18

ANA, Anti-dsdna, Anti-Smith, Anti-histone (drug induced), Anti-cardiolipin.

Question 19

skin thickening in face and fingers only, seen with raynauds, esophageal dysmotility, and scelerodactylly. What antibody is this condition associated with?

Answer 19

CREST syndrome (limited scleroderma)–Anti Centromere antibody. crest is more benign than Diffuse Scleroderma (Anti-Scl-70)