Money makers 2

Question 1

What is infliximab? When is it used?

Answer 1

Anti-TNF drug

Can be used for RA

Question 2

Antihistone antibodies are seen with drug-induced lupus. What drugs cause this?

Answer 2

Hydralazine
Procainamide
Isoniazid
Methyldopa
Quinidine
Chlorpromazine

Question 3

A patient comes in with malar and discoid rashes, serositis (pleuritic, pneumonitis, pericarditis), oral ulcers, arthritis, photosensitivity, CNS symptoms, cardiac symptoms, and renal symptoms. What does this person have?

Answer 3

SLE

Question 4

A patient has all of the symptoms of lupus, and because of some risky sexual behavior, STDs were checked. What might come back falsely positive?

Answer 4

Syphilis

Question 5

What can all be used to treat SLE?

Answer 5

NSAIDs
Hydroxychloroquine
Corticosteroids
Sun avoidance

Question 6

Who typically gets polymyositis/dermatomyositis? What can be seen?

Answer 6

Old black women

Proximal muscle weakness (legs first)
Red heliotropic rash on face, upper extremities, chest or back
Violet discoloration of eyelids
Scaly patches over hand joints

Question 7

A patient has muscle pain/weakness and some rashes. What labs might be increased?

Answer 7

Cr
Aldolase
CK
AST
ALT
LDH

Question 8

A biopsy is taken for someone expected of either myositis or dermatomyositis. How can the two be told apart on biopsy?

Answer 8

Myo: inflammatory cells WITHIN the muscles

Dermatomyo: inflammatory cells SURROUNDING the muscles

Question 9

When are anti-Jo-1 antibodies positive with myositis/dermatomyositis?

Answer 9

When there is also interstitial lung disease

Question 10

An old lady has multiple sites of joint pain, headaches, and jaw pain. What could be going on? What should be done?

Answer 10

Temporal arteritis and polymyalgia rheumatica (often associated with temporal arteritis)

Start on corticosteroids (treats both…often resolves PMR w/in 1 day)…then get a temporal biopsy

Question 11

Is the patient usually weak with polymyalgia rheumatica?

Answer 11

No…limited motion due to pain, not weakness

Question 12

A 30yo white guy has hip and low back pain that is worse in the morning and following activity, but improves as the day goes on. The pain is also relieved by leaning forward (pain from kyphosis). What could be going on? what could be seen on x-ray? Treatment?

Answer 12

This could be ankylosing spondylitis (20-40yo white guys most common)

Bamboo spine (multiple vertebral fusions)

PT, NSAIDs…immunsuppression or surgery if necessary

Question 13

A patient with a history of a scaly rash has asymmetric joint pain that is worse in the morning and most noticeable at that DIP and PIP joints. What is going on?

Answer 13

This is Psoriatic arthritis…different from RA in that it is asymmetric, includes DIP joint, and is RF and ANA negative

Question 14

A patient has arthralgias, myalgias, hand swelling, Raynaud phenomenon, skin thickening, esophageal dysmotility, intestinal hypo motility, dyspnea, and heart issues. What could be going on? What lab could be positive? What is a syndrome that this is part of?

Answer 14

Scleroderma

Anti-scl-70 ANA

CREST syndrome (Calcinosis, Raynaud’s, Esophageal dysmotility, Sclerodactyly, and Telangiectasias

Question 15

A patient comes in and seems to have aspects of SLE, scleroderma, and polymyositis…but doesn’t fit the criteria for any of them individually. What is likely going on? What usually isn’t seen with this diagnosis?

Answer 15

This is mixed connective tissue disease

Renal and neurological symptoms are usually absent

Question 16

A patient comes in with dry eyes and dry mouth. On exam, the parotid gland is enlarged, there is purport on the legs, and peripheral neuropathy. What is likely going on? What else is likely going on? What is it called if nothing else is going on?

Answer 16

Sjogren syndrome

Often associated with RA, SLE, or PBC

If no secondary autoimmune association, it is called sick syndrome

Question 17

What is the most common adult bone cancer?

Answer 17

Metastatic…breast, kidney, prostate, lung, thyroid, lymphoma

Question 18

An adolescent boy comes in with pain in his right leg just above the knee. If it were a primary malignancy, what would it most likely be? What are risk factors?

Answer 18

Osteosarcoma is the most common primary malignant bone tumor

Paget disease of bone, p53 genetic mutations, familial retinoblastoma, radiation, and bone infarcts

Question 19

An adolescent boy comes in with pain in his right leg just above the knee. What would be seen on x-ray that would make you think “osteosarcoma”? What should be ordered?

Answer 19

Sunburst pattern and Codman triangle (periosteal new one formation at the diaphysral end of the lesion)

MRI or PET to determine extent of lesion
Chest CT to look for metastases

Question 20

A child (5-15yo) comes in with severe thigh pain after bumping into a table. The x-ray shows a femur fracture and an “onion-skin” bone lesion. What is the likely diagnosis?

Answer 20

Ewing sarcoma…highly malignant cartilage tumor occurring in diaphysis of long bones

Question 21

A male patient who is less than 25yo comes in with a hard bump a little above/below a joint with muscle pain over the top of it. What is likely going on?

Answer 21

Osteochondroma…most common benign bone tumor in metaphysics of long bones

Question 22

An x-ray shows a bony growth on a long bone that sits on top of cortical bone and is NOT continuous with the normal cancellous bone. What is the concern?

Answer 22

Malignant lesion