MK Rheum

Question 1

Risk factors for prosthetic joint infection

Answer 1

Malignancy

Immunosuppression

Question 2

Giant Cell Arteritis. AKA, associated with

Answer 2

• GCA aka Temporal Arteritis (HA, jaw pain, visual)

- Ass with Polymyalgia Rheumatica (flu-like sxs, joint and muscle pain)

Question 3

Large vessel vasculitis (age)

Answer 3

> 50: GCA

<50: Takayasu (young asian female). visual, neuro sxs with weak/absent UE pulse), hits aortic arch branch pt

Question 4

young adult w/HTN (renal a)
Abdominal Pain (melena)
Neuro change
Rash

Answer 4

Polyarteritis Nodosa. medium vessel vasculitis.

Question 5

Tx for polyarteritis nodosa

Answer 5

Steroids + Cyclophosphamide

Question 6

Middle age male, sinusitis, hemoptysis, hematuria (RPGN)

Answer 6

Granulomatosis with polyangitis. cyclophosphamide + steroids

Question 7

Severe recurrent/tophaceous gout resistant to standard therapy

Answer 7

Pegloticase, discontinue other urate-lower meds. start prophylaxis: colchicine, prednisone, or nsaids

Question 8

Time frame for reactive arthritis

Answer 8

3-6 weeks after infection, up to 6 months

Question 9

Inflammatory back pain (better with exercise), reduced ROM, fusion of sacroiliac joints

Answer 9

Ankylosing Spondylitis. don’t need to test of hla-b27 unless xray w/o sacroilitis

Question 10

Dx of SIBO

Answer 10

Glucose hydrogen breath testing or jejunal aspirate culture

Question 11

Chronic diarrhea and malabsorption secondary to gastric dysmotility

Answer 11

SIBO

Question 12

Felty syndrome associations

Answer 12

serious infections
LE ulcers
lymphoma
vasculitis

Question 13

times to avoid nsaids

Answer 13

ckd
cad
blood thinners, asa
steroids

Question 14

Inclusion Body Myositis: epidemiology and presentation

Answer 14

male >50 yo, most common muscle dz
can have both proximal and distal mm weakness, can be symmetric. CK will be elevated. insidious onset. no LMN signs i.e. fasciculations (ALS), no rash (polymyositis = younger female with v high CK). Poor response to tx.

Question 15

polyarthralgia
dermatitis
tenosynovitis

Answer 15

Disseminated Gonococcal arthritis. usually a painless pustular lesion

Question 16

Takayasu arteritis vs GCA

Answer 16

Both large vessels, like aorta.

Takayasu: YOUNG patients, young woman starting age 15-25 years. Think takayasu is in teenagers with tits.

GCA: usually head and neck vessels, can also affect aorta (i..e aortic regurg, heart failure). Ass with PMR (shoulder/hip girdle pain + stiffness). Tx Pred 60mg/d

Question 17

Primary Angitis

Answer 17

Of the CSF. Rare vascular dz with HA, strokes, cognitive impairment, neuro changes. Normal labs including esr, crp, anca. 90% have CSF with increased lymphocytes and protein. Bx granulomatous inflammation. Tx high dose steroids + cyclophosphamide (vasculitis).

Question 18

favorite RA antibody

Answer 18

anti-CCP

Question 19

Adult Still Dz

Answer 19

Systemic inflammatory dz of several organs. fevers, salmon rash, fever, arthritis, lymphadenopathy, wbc count. very high ferritin.

Question 20

Labs for lupus flare

Answer 20

Increased ESR
Increased anti-dsDNA
Decreased C3, C4

Question 21

how do you decrease fracture risk in patients at risk on chronic streoids?

Answer 21

Bisphosphonate (

i.e. alendronate, risedronate, or zoledronic acid)