IM Arthropathies

Question 1

Non articular/ Articular:

Deep/diffuse pain or limited ROM during passive and active movement
• Swelling, crepitation, instability, deformity
• Examples: see algorithms

Answer 1

Articular

Question 2

Non articular/ Articular:

Painful on active (but not passive) ROM
• Seldom with swelling, crepitus, instability
• Examples: trauma/fracture, fibromyalgia,
polymyalgia rheumatica, bursitis, tendinitis

Answer 2

Non articular

Question 3

Commonly affected joints: Cervical and lumbosacral spine, Hip,
Knee, first MTP joint, hand joints (DIP, PIP)

Answer 3

OA

Question 4

Joint space loss or narrowing is a typical radiographic finding

Answer 4

OA

Question 5

Manifests as DIP and PIP pain with bony hypertrophy sufficient to produce Heberden’s and Bouchard’s nodes; pain +/-swelling involving base of thumb (1st carpometacarpal joint)

Answer 5

OA

Question 6

Cause symmetric, polyarticular involvement of PIP, MCP, intercarpal, and carpometacarpal joints (wrist) with pain

Answer 6

RA

Question 7

Single most accurate test for RA

Answer 7

Anti CCP Ab

Question 8

• Flexor tenosynovitis (frequent hallmark)
• “Swan-neck deformity”
• “Boutonniere deformity”
• “Z-line deformity

Answer 8

RA

Question 9

• Ulnar deviation from subluxation of the MCP joints
• Ulnar deviation from subluxation of the MCP joints
• Piano-keymovementofulnarstyloid

Answer 9

RA

Question 10

Pathologic hallmarks of RA
oSynovial inflammation
oFocal bone erosions
oThinning of articular cartilage

Answer 10

RA

Question 11

RA: most common pulmonary manifestation.

Answer 11

Pleuritis

Question 12

Most common Valvulopathy in RA

Answer 12

Mitral Regurgitation

Question 13

Nodular RA
Splenomegaly
Neutropenia.

Answer 13

Felty’s syndrome

Question 14

Initial radiographic Finding in RA

Answer 14

Periarticular osteopenia

Question 15

Male, sudden, knee & big toe, comorbids, presence of inflammation

Answer 15

Gout

Question 16

Needle shaped monosodium urate crystals

negative birefringence

Answer 16

Gout

Question 17

Rhomboid shaped Calcium pyrophosphate dehydrate crystals

Answer 17

Pseudogout

Question 18

How much 24 hr urine Uric Acid to be
Overproducer?
Underexcreter?

Answer 18

> 800

<800

Question 19

Conditions positive with RF:

S
S
s
H

Answer 19

SLe
Sjogren’s
Subactue bacterial endocarditis
Hepatitis B and C

Question 20

You have a patient with RA who suddenly has dry cough, progressive shortness of breath, you are to think of ???``

Answer 20

ILD

Question 21

Best initial DMARD for RA

Answer 21

Methotrexate

Question 22

Most common early clinical manifestation of gout

Answer 22

Acute Arthritis

Question 23

Classic inital presentation of gout

Answer 23

Podagra

Question 24

Commonly affected joints in OA

Answer 24

Cervical, lumbosacral spine, hip , knee, 1st MTP

Question 25

Most frequently involved joints in RA

Answer 25

wrist, mcp, PIP

Question 26

Hallmark of RA and leads to decreased ROM

Answer 26

Flexon tendon tenosinuvitis

Question 27

sicca, xerostomia + RA What do you have?

Answer 27

Sjogren's

Question 28

During acute attack of gout give uric acid lowering agents. | True or fals

Answer 28

False. Avoid in acute attacks. just give nsaids, the short acting ones, ibuprofen, indomethacin

Question 29

Offers greatest sensitivity for detecting synovitis & joint effusions; and early bone/bone marrow changes

Answer 29

MRI

Question 30

Characteristic radiographic features oDIP involvement or Pencil-in-cup deformity o Marginal erosions with adjacent bony proliferation (“whiskering”) oSmall joint ankylosis o Osteolysis of phalangeal and metacarpal bone, with telescoping of digits oPeriostitis and proliferative new bone at sites of enthesitis oCharacteristics of axial PsA: asymmetric sacroiliitis

Answer 30

Psoriatic Arthritis

Question 31

Young adult, fever, chills, rash and articular symptoms =

Answer 31

Think of disseminated gonococcal arthritis

Question 32

In Lupus Nephritis start using Steroids in what stage

Answer 32

Lupus II

Question 33

In Lupus Nephritis start using Cyclophosphomide in what stage

Answer 33

Lupus III

Question 34

best screening For SLE

Answer 34

ANA

Question 35

specific and correlate with disease activity for SLE

Answer 35

Anti DSDNA

Question 36

LE: specific

Answer 36

Anti Sm

Question 37

Increased in SLE with overlap features of other CTD’s Sicca syndrome, subacute cutaneous lupus, neonatal lupus with CHB both are associated with DECREASED risk for nephritis) drug induced lupus (MC: hydralazine, procainamide, quinidine, INH, minocycline) Antiphospholipid: clotting useful in distinguishing lupus cerebritis and steroid-induced psychosis

Answer 37

Anti RNP Anti RO SSA Anti La SSB Anti Histone Antiphospholipid Anti neuronal and Anti Ribosomal P

Question 38

Drugs in associated with Drug induced Lupus

Answer 38

``` procainamide, hydralazine, propylthiouracil, lithium, phenytoin, isoniazid, nitrofurantoin, sulfasalazine, statin ```

Question 39

Marginal erosions with adjacent bony proliferation

Answer 39

Ps A

Question 40

1. Joint space loss or narrowing _______2. Periarticular osteopenia as the initial radiographic finding _______3. Cystic changes with well-defined erosions and overhanging sclerotic margins and soft tissue masses _______4. DIP involvement or Pencil-in-cup deformity

Answer 40

OA RA Gout PsA

Question 41

1. A 60-year old woman with left hip pain during walking stairs and bony enlargement of the first DIP. _______2. A 22-year-old woman cervical discharge, rashes on forearms and elbow swelling and tenderness. _______3. A 40-year-old man with swollen and painful 1st MTP joint after a binge drinking. _______4. A 40-year-old woman with morning joint stiffness and bilateral ulnar deviation. _______5. A 30-year-old woman with joint pain, photosensitive erythematous rash on the face and anemia.

Answer 41

OA Gonococchal Arthritis Gout RA SLE