MTB Rheuma

Question 0

Felty syndrome:

Caplan syndrome:

Answer 0

• RA • Splenomegaly • Neutropenia

* RA • Pneumoconiosis • Lung nodules

Question 1

The most common risk factors of CPPD are

Answer 1

hemochromatosis and hyperparathyroidism.

Question 2

JRA

Answer 2

Fever in young
Features of JRA rash:
• Often only with fever spikes • “Salmon” colored • On chest and abdomen
Other features of JRA:
• Splenomegaly • Pericardial effusion • Mild joint symptoms

Question 3

SLE presentation

Answer 3

Skin: Four of the manifestations of SLE are of the skin:
1. Malar rash 2. Discoid rash 3. Photosensitivity 4. Oral ulcers
Joint: Arthritis is present in 90% of those with SLE and is often the first symp-tom that brings patients to seek medical attention. SLE gives joint pain without deformation or erosion. That is why the x-ray is normal.
Serositis: Inflammation of the pleura and pericardium gives chest pain poten-tially with both pericardia! and pleural effusion.
Renal: Any degree of abnormality can occur, from mild proteinuria to end-stage renal disease requiring dialysis. The most common glomerulonephritis is membranous. Red cell casts and hematuria occur.
Neurologic: Symptoms include psychosis, seizures, or stroke from vasculitis.
Hematologic: Hemolytic anemia is part of the diagnostic criteria, but the ane-mia of chronic disease is more commonly found. Lymphopenia, leukopenia, and thromobocytopenia are also seen.
Immunologic (laboratory) abnormalities: Criteria include positive ANA, or any one of the following:
• Anti-double-stranded DNA • Anti-Sm • False positive test for syphilis • Positive LE cell preparation

Additional findings:
• Mesenteric vasculitis • Raynaud phenomenon • Antlphosphollpld syndromes

Question 4

SLE diagnostic lab

Answer 4

ANA
anti DS DNA
anti sm
Decreased complements
Anti SSA/SSB

Question 5

In an acute lupus flare,

Answer 5

complement levels drop and anti-DS DNA levels rise.

Question 6

APL Dx

Answer 6

Mixing test
the aPTT will remain elevated.
Russell viper venom test (RVVT).
The RVVT is prolonged with APL antibodies and does not cor-rect on mixing with normal plasma.

Question 7

Scleroderma CREST syndrome

Answer 7

CREST syndrome (Calcinosis, Raynaud, Esophageal dysmotility, Sclerodactyly, Telangiectasia).

Question 8

Scleroderma presentation

Answer 8

Presentation
Raynaud syndrome: increased vascular reactivity of the fingers beginning with pain and pallor (white) or cyanosis (blue) followed by reactive hyperemia (red). Raynaud is precipitated by cold and emotional stress. Some cases lead to ulceration and gangrene.

Skin manifestations: fibrosis of the hands, face, neck, and extremities; telan-giectasia and abnormalities of pigmentation occur

Gastrointestinal: esophageal dysmotility with GERD, large-mouthed diver-ticuli of small and large bowel

Renal: sudden hypertensive crisis

Lung: fibrosis leading to restrictive lung disease and pulmonary hypertension

Cardiac: myocardial fibrosis, pericarditis, and heart block; lung disease gives right ventricular hypertrophy

Question 9

Scleroderma diagnosis

Answer 9

Diagnostic Tests

ANA: positive in 85% to 90%, but nonspecific

ESR: usually normal

SCL-70: the most specific test is the SCL-70 (anti-topoisomerase), but present in only 30% of those with diffuse disease and 20% of those with limited disease

Anticentromere: present in half of those with CREST syndrome

Question 10

Scleroderma treatment

Answer 10

Treatment

Methotrexate slows the underlying disease process of limited scleroderma. Penicillamine is not effective.

Renal crisis: ACE inhibitors (use even if the creatinine is elevated)

Esophageal dysmotility: PPis for GERD

Raynaud: calcium channel blockers

Pulmonary fibrosis: Cyclophosphamide improves dyspnea and PFTs.

Pulmonary hypertension: • Bosentan ambrisentan (endothelin antagonist) • Sildenafil • Prostacyclin analogs: iloprost, treprostinil, epoprostenol

Question 11

Dermatomyositis presents with:

Answer 11

Proximal muscle weakness
They do not affect facial or ocular muscles as occurs in myasthenia gravis

• Malar involvement • Shawl sign: erythema of the face, neck, shoulders, upper chest, and back • Heliotrope rash: edema and purplish discoloration of the eyelids • Gottron papules: scaly patches over the back of the hands, particularly the PIP and MCP joints

Question 12

Shawl sign:
Heliotrope rash:
Gottron papules:

Answer 12

erythema of the face, neck, shoulders, upper chest, and back

edema and purplish discoloration of the eyelid

scaly patches over the back of the hands, particularly the PIP and MCP joints

Question 13

Sjogren s Dx

Answer 13

Schirmer test

Biopsy

Question 14

All vasculitides (e.g., polyarteritis nodosa, Wegener granulomatosis, Churg-Strauss, giant cell) give:

Answer 14

• Fever • Malaise/fatigue • Weight loss • Arthralgia/myalgia

Question 15

Sjögren’s syndrome Evaluate for ???, which occurs in·up to 10% of patients.

Answer 15

lymphoma

Question 16

Wegener Granulomatosis

“What Is the Most Likely Diagnosis?”

Answer 16

Look for a combination of upper and lower respiratory tract findings in asso-ciation with renal insufficiency.
The clue to answering the “most likely diagnosis” question is unresolving pneumonia not better with antibiotics. You will not first think of Wegener when presented with the case.

Question 17

Churg-Strauss Syndrome

Answer 17

A pulmonary-renal syndrome, Churg-Strauss also has: • Asthma • Eosinophilia
Pulmonary-renal syndrome is a rare medical syndrome involving bleeding in the lungs and kidney damage (glomerulonephritis).

Question 19

Henoch-Schonlein Purpura

When the case describes xxx vasculitis on biopsy, the answer is Henoch-Schonlein purpura.

Answer 19

A vasculitis more frequently seen in children

leukocytoclastic

Question 20

Osteoarthritis Laboratory tests are normal:

X-rays show:

Answer 20

• Erythrocyte sedimentation rate (ESR)
• Complete blood count (CBC)
• Antinuclear antibody (ANA)
• Rheumatoid factor
• Joint space narrowing • Osteophytes
• Dense subchondral bone
• Bone cysts

Question 21

CPPD It differs from DJD in that

Answer 21

the DIP and PIP are not affected.

Question 22

Cause of Back pain not to miss

Answer 22

Cord compression
Epidural abscess
Cauda equina
Ankylosing Spondylitis
Sciatica

Question 23

Fibromyalgia The best initial therapy is

Answer 23

amitriptyline.

Question 24

Tumor Necrosis Factor Inhibitors

Answer 24

{infliximab, adalimumab, etanercept)

Question 25

Sausagedigitsfromenthesopathy • Nailpitting

Answer 25

Psoriatic arthritis

Question 26

Septic arthritis treatment

Answer 26

Ceftriaxone and vancomycin