Ortho/Rheum 7

Question 1

What disease should you suspect if your patient presents with anterior uveitis (blurred vision, eye pain, erythema around limbus, constricted sluggish pupils)… + constitutional symptoms, cough/dyspnea, arthritis, and hilar lymphadenopathy?

Answer 1

Sarcoidosis

Question 2

Sarcoid presents with granulomas…when you bx the lesion you will see what classic finding.

Stain will be negative for what two types of organisms?

Answer 2

NON-Caseating Granuloma

negative acid fast stain and negative fungal stain

Question 3

What Ab is classically associated with Drug induced lupus?

Answer 3

Anti-Histone Ab

Question 4

Henoch-Schonlein Purpura presents with what 4 classic symptoms?

Answer 4

1. Palpable Purport of buttox and LE.
2. Joint pain
3. Renal disease (looks like IgA nephropathy)
4. Abdominal pain.

Question 5

What is the pathophysiology of Henoch-Schonlein Purpura?

What is often the pathology behind abdominal pain in HSP?

Answer 5

Systemic IgA deposition.

Abd pain 2/2 intussusception (edema/hemorrhage in sm bowel acts as pathologic lead points.

Question 6

Duchennes and Becker’s muscular dystrophy are due to disruption of what gene? What is the specific gene disruption in each?

What is the inheritance pattern?

Answer 6

Duchennes = Deletion of Dystrophin gene

Becker’s = Mutation of Dystrophin gene

X- linked recessive

Question 7

What is the classic presentation of Duchennes Muscular Dystrophy:

Age of onset?
PE exam findings?
Any maneuver signs?

Answer 7

Age of onset –> 2-3 yo

Physical Exam –> Progressive muscle weakness, calf pseudohypertrophe, cardiomegaly, scoliosis.

Signs –> Gower sign = use hands to walk up from squat.

Question 8

What is the Classic presentation of Becker’s Muscular Dystrophy:

Age of onset?
PE findings?

Answer 8

Age on onset 5-15 yo

Physical exam –> Variable weakness, less severe, cardiomyopathy.

Question 9

If you suspect Duchenne’s of Beckers what is the first test you want to order?

What test is confirmatory?

Answer 9

First step = CPK (usually 10-20X normal)

Confirm with –> Genetic testing for Dystrophin gene deletion (Duchennes) vs mutation (Beckers).

Question 10

What is the first line trx option of HTN for someone with comorbid GOUT?

What antihypertensive agents should you avoid?

Answer 10

ARB (has a mild uricosuric effect)

Avoid diuretics bc can cause increase in uric acid.