Inpatient- Ortho

Question 1

middle age white lady, morning stiffness of proximal joints, (-) RF and CCP

Answer 1

polymyalgia rhuematica

Question 2

constitutional sx, myalgias, bowel/renal infarcts (maybe rbc cast), skin ulcers

Answer 2

polyarteritis nodosa

Question 3

trouble climbing stairs/brushing hair (proximal weakness), maybe trouble speaking. no pain. +ANA

Answer 3

polymyosistitis

Question 4

difference in pathophysio for PAN vs PMR

Answer 4

PAN: medium vessel, ischemic injury to vessels>necrosis

PMR: large vessel, idiopathic inflam>narrowing>necrosis

Question 5

what vasculitis is a/w Hep B

Answer 5

PAN

Question 6

tx for PMR

Answer 6

CCS, then MTX long term

Question 7

tx for PAN

Answer 7

CCS, + cyclophos if refrac, & plasmapheresis if Hep B

Question 8

grossly high CPK and aldolase

Answer 8

polymyositits, dermatomyositis

Question 9

SRP

Answer 9

PM

Question 10

Mi2

Answer 10

DM

Question 11

dx for :
PMR
PAN
DM/PM

Answer 11

PMR: clinical
PAN: bx or renal/GI angiography
DM/PM: MRI guided muscle bx

Question 12

tx: DM/PM

Answer 12

high CCS

+/- MTX, azithioprine, IVIG

Question 13

Sjoren Syndrome increases risk of what Ca

Answer 13

NHL

Question 14

pilocarpine tx for what

Answer 14

sjogren

Question 15

tx fibromyalgia

Answer 15

TCA< duloxetine, pregabalin

Question 16

infection, then asymmetrical joint pains of LE

Answer 16

Reactive arthritis

Question 17

reactive arthritis tx

Answer 17

nsaid, mtx, ssalazine

Question 18

cbc w/ reactive arthritis

Answer 18

normocytic normochromic anemia, high WBC, high ESR

Question 19

whats the most lie threatening complication of SLE

Answer 19

glomerulopethritis, renal failure

Question 20

what kind of anemia a/w SLE

Answer 20

hemolytic (due to Ab, Coombs +)

Question 21

most specific Ab for SLE

Answer 21

anti ds DNA (a/w renal)

anti smiwth

Question 22

is SLE ANA + or -

Answer 22

usually +

Question 23

best way to test ANA

- ELISA v multiplex assay v immunofluoresnce

Answer 23

immunoflu

ELISA in particular has high false +

Question 24

SLE tx

Answer 24

NSAID, sunscreen
CCS if refrac
MTX/cyclophos if GN
antimalrial if rash/arthritis

Question 25

would you expect complement to be low or high with lupus

Answer 25

LOW

Question 26

what are the HIPPS a/w lupus

Answer 26

hydralazine, INH, procainamide/phenytoin, sulfonamine

Question 27

whats the ab a/w drug indiced lupus

Answer 27

anti-histone

Question 28

MC scleroderma death and how to treat it

Answer 28

ILD, tx =cyclophosphamide

pulm HTN, tx=sildenafil, iltoprost

Question 29

PFT with pulm HTN from scleroderma

Answer 29

preserved FVC

reduced DLCO

Question 30

how is diffuse scleroderma worse than limited

Answer 30

widespread skin “above theknees diffuse dz”

ILD
Renal crisis leading to HTN/sz/sight probs (tx w ACEI)

Question 31

what’s CCREST syndrome

Answer 31

a/w limited scleroderma

• centromere ab
• calcinosis
• raynaud
• eso dysmot
• scleradactyly
• teleangetasia

Question 32

would you expect + or - ANA with scleroderma

Answer 32

+

Question 33

constitutional sx, morning stiffness, nodules on the joints

Answer 33

RA

Question 34

whats the most specific lab for RA

Answer 34

ACPA

A CPA with RA

Question 35

XR for RA vs OA

Answer 35

RA: symmetric narrowing, osteopenia

OA: assymetric narrowing, osteosclerosis

Question 36

tx for RA

Answer 36

NSAID/CCS for symptom relief
- need Ca/D supps

DMARD (preservation)
- MTX, SSalazine, plaquenil, -mabs

Question 37

RA DMARDS CI in pg

Answer 37

MTX, ssalazine, leflunomide

Question 38

Safe DMARD in pg

Answer 38

Plaquenil if Pregnant

Question 39

tx of gout v psuedogout

Answer 39

gout: NSAID 1st line, then colchine, for chronic allopurinol
psuedogout: CCS/NSAID lst line, then colchine

Question 40

HLA-DR3

Answer 40

MG
Celiac
SLE

dz of young women, like DRE

Question 41

HLAB27

Answer 41

RA

to B 27 again

Question 42

what is ccp marker a/w

Answer 42

RA