Medicine- Rheumatology

Question 1

What are the longterm complications of diabetic neuropathy

Answer 1

Ulceration, Joint subluxation and charcot arthropathy (bone and soft tissue destruction and deformity)

Question 2

Methotrexate adverse effects?

Answer 2

1. hepatotoxicity
2. stomatitis
3. cytopenias

Question 3

What type of lung disease is associated with systemic sclerosis?

Answer 3

Interstitial lung disease

Question 4

Indications/red flags for imaging of lower back

Answer 4

1. Sudden onset of pain ass with midline spine tenderness
2. Hx of Cancer
3. constitutional sx (fever, weight loss)
4. trauma
5. significant or progressive neurological deficits (acute bowel or bladder incontinence, lower extremity weakness)

Question 5

Patient with SLE who is on prednisone and comes in with hip pain .. most likely diagnosis?

Answer 5

Osteonecrosis of the femoral head

Question 6

Patient with fatigue, palpable purpura, althralgias, hematuria, HTN, proteinura and peripheral neuropathy with positive rheumatoid factor, elevated transaminases and low C4

Answer 6

Mixed (type II & III) Cryoglobulinemia

Question 7

Most appropriate treatment in a patient with confirmed anti-GBM antibodies?

Answer 7

Immunosuppressive treatment with prednisone and cyclophosphamide, is commonly performed in combination with plasmapheresis to reduce new antibody formation for Goodpastures

Question 8

Arthritis that involves ≤ 4 joints within 6 months of disease onset, in combination with an elevated ESR and positive ANA titers in a 3-year-old girl

Answer 8

Oligoarticular juvenile idiopathic arthritis

Question 9

What screening is recommended in patients with Oligoarticular juvenile idiopathic arthritis

Answer 9

Regular ophthalmologic screening is recommended in patients with JIA to identify and treat asymptomatic anterior uveitis

Question 10

Treatment of choice for rheumatic fever in patients with hypersensitivity to beta-lactam antibiotics?

Answer 10

Clarithromycin

Question 11

recommendation for preventing thrombosis and pregnancy-related complications in pregnant women with antiphospholipid syndrome

Answer 11

A regimen of low-dose aspirin and low molecular weight heparin (e.g., such as enoxaparin)

Question 12

In the presence of proteinuria in the setting of SLE what is the next best step

Answer 12

Renal biopsy is indicated

Question 13

In a patient with kawasaki disease what is the next best step before starting treatment

Answer 13

Echocardiography should be performed at the time of diagnosis to evaluate for coronary artery aneurysms. Follow-up echocardiograms at 2 weeks and 6–8 weeks

Question 14

What would be seen on pulmonary function testing in a patient with long standing Ankylosing spondylitis

Answer 14

classical features of restrictive lung disease (i.e., normal/decreased FEV1 and decreased FVC) because of impaired mobility of the spine and thoracic cage however

In contrast to most forms of restrictive lung diseases, lung involvement in ankylosing spondylitis manifests with a normal FRC and a normal/increased RV because the lung parenchyma remains unaffected and lung compliance is not decreased

Question 15

Patient’s presentation of atypical pneumonia (dry cough, low-grade fever, malaise) in combination with positive polysaccharide antigen tests (best initial tests) (travelled to mississipi)

Answer 15

Histoplasma capsulatum

Question 16

Patients with Giant cell arteritis are at increased risk of which vascular complication?

Answer 16

Approximately 10–20% of patients with giant cell arteritis (GCA) will have involvement of the thoracic aorta, which significantly increases the risk of thoracic aortic aneurysms and dissections

Question 17

Meltzer’s triad (purpura, arthralgia, and fatigue) with increased serum concentration of polyclonal IgG and IgM is highly suggestive of which disease

Answer 17

mixed cryoglobulinemia

Question 18

What is the difference in tests between mixed cryoglobulinemia and type 1 cryoglobulinemia

Answer 18

Unlike type 1 cryoglobulinemia, in which a cryoglobin precipitation test becomes positive within 24 hours, the cryoprecipitation test becomes positive only after a minimum period of 72 hours in the case of mixed cryoglobulinemia.

Question 19

X-ray findings for Rheumatoid Arthritis

Answer 19

1. periarticular osteopenia

2. erosions

Question 20

Other than oral ulcers what else can you see in Behcet disease

Answer 20

1. ocular disease (uveitis, optic neuritis) –> blindness
2. skin lesions which occur due to hyperactive needle sticks –> skin abscess
3. CNS disease

Question 21

Treatment of Behcet disease

Answer 21

Prednisone and colchicine