rheum Flashcards
What is spondylolysis?
Spondylolysis refers to a stress fracture in the pars interarticularis of the lumbar spine.
What is the most likely diagnosis for a young woman with anterior knee pain during activity?
The most likely diagnosis is patellofemoral pain syndrome.
What is Crest syndrome?
Crest syndrome is an autoimmune disorder manifesting with calcinosis, Raynaud’s phenomenon, esophageal dysmotility, sclerodactyly, and telangiectasias.
Can septic arthritis cause release of calcium pyrophosphate (CPP) crystals?
Yes, septic arthritis can cause the release of calcium pyrophosphate (CPP) crystals from cartilage.
What characterizes sarcoidosis?
Sarcoidosis is characterized by the accumulation of epithelioid granulomas in various organs, including the lungs, skin, eyes, and heart.
What spinal movement exacerbates spondylosis?
Spondylosis is predominantly exacerbated by extension.
What is the grind test associated with?
The grind test describes the trochlear groove and is common in patellofemoral pain syndrome (PFPS).
What is the fever pattern in patients with adult onset Still’s disease?
The fever in patients with adult onset Still’s disease is typically high and occurs daily with complete normalization of temperatures between episodes.
What is the typical fever pattern in patients with adult onset Still disease?
The fever is typically high and occurs daily with complete normalization of temperatures between episodes.
What is Type III cryoglobulinemic vasculitis associated with?
It is associated with rheumatoid factor activity carried by polyclonal immunoglobulins.
What infections can cause Type III cryoglobulinemic vasculitis?
It is often due to HCV but can also be secondary to diseases such as Sjögren syndrome, systemic lupus erythematosus, and rheumatoid arthritis.
What is the key to early diagnosis of Complex Regional Pain Syndrome?
The identification of autonomic changes such as edema, skin mottling, sweating, or temperature change of the affected area.
What must a patient be capable of to make a decision regarding their treatment?
The patient must be capable of understanding the information provided, the relevance of the information to their specific situation, making a decision, and communicating that decision.
What should a clinician suspect in an older patient with vision disturbance and headache?
The clinician should have a high suspicion for giant-cell arteritis.
What happens to patients receiving at least 10 mg of prednisone for more than one month?
They develop progressive atrophy of the adrenal cortex.
What percentage of healthy women test positive for antinuclear antibodies at a titer of 1:80?
As many as 10% of healthy women test positive for antinuclear antibodies at a titer of 1:80.
What symptom of giant-cell arteritis has the highest diagnostic specificity?
Jaw claudication is associated with a fourfold increase in the likelihood of a diagnosis.
What does PAN spare in renal involvement?
PAN spares the capillaries, which means it does not lead to glomerulonephritis but causes renal infarcts and renovascular hypertension.
What characterizes Type I Cryoglobulinemic vasculitis?
It is associated with self-aggregating monoclonal immunoglobulins and is usually secondary to B-cell or plasma-cell malignancies.
What is the rash in AOSD like?
The rash is a salmon-colored maculopapular eruption involving the trunk and extremities, which is evanescent and may resolve with the resolution of the fever.
What skin lesions may be present in reactive arthritis?
Acute pustular skin lesions known as keratoderma blennorrhagica may be present.
What skin lesions may be present in reactive arthritis?
Keratoderma blennorrhagica may be present in reactive arthritis.
When does PAN typically occur in relation to hepatitis B virus infection?
PAN typically occurs within the first 6 months of the infection.
What pulmonary process frequently leads to dyspnea in patients with diffuse systemic sclerosis?
Interstitial lung disease is the pulmonary process that frequently leads to dyspnea.
What is hydroxyapatite crystal deposition disease of the shoulder characterized by?
It is characterized by a large shoulder effusion with associated destructive arthritis of the glenohumeral joint and often with calcification of periarticular tissue.
What is Type I Cryoglobulinemic vasculitis associated with?
It is associated with self-aggregating monoclonal immunoglobulins and is usually secondary to B-cell or plasma-cell malignancies.
What is reactive arthritis formerly known as?
Reactive arthritis was formerly known as Reiter syndrome.
What are the classic manifestations of reactive arthritis?
The classic manifestations are arthritis, urethritis, and conjunctivitis.
What does the presence of the HLA-B*5801 allele increase the risk of?
It substantially increases the risk of serious allergic reactions with allopurinol.
What can patients with relapsing polychondritis experience?
They can experience abnormalities of cardiac conduction leading to life-threatening arrhythmias.
Does colchicine lower uric acid levels?
No, colchicine does not lower uric acid levels.
Are recurrent episodes of gouty arthritis more likely to be polyarticular or monoarticular?
Recurrent episodes of gouty arthritis are more likely to be polyarticular.
What autoimmune disease is diagnosed using a pathergy skin test?
The pathergy skin test is often used to aid in the diagnosis of Behcet’s disease.
In relapsing polychondritis, which part of the ear is most often affected?
The ears are affected most often, sparing the lobule which does not contain cartilage.
What joints are frequently affected in relapsing polychondritis?
The nose, trachea, bronchi, and joints are also frequently affected.
RA rarely affects which joints?
RA rarely affects the distal interphalangeal joints.
What helps to distinguish RA from osteoarthritis?
The fact that RA rarely affects the distal interphalangeal joints helps to distinguish it from osteoarthritis.
What are initial attacks of gouty arthritis usually characterized by?
Initial attacks of gouty arthritis are usually monoarticular and involve the lower extremities.
What is the typical presentation of initial attacks of gouty arthritis?
Initial attacks of gouty arthritis are usually monoarticular and involve the lower extremities.
How can arthritis in AOSD present?
Arthritis in AOSD can be transient and/or migratory or it can be a fixed symmetric polyarthritis.
What findings suggest acute compartment syndrome?
The findings of pain out of proportion to the injury, pain with passive muscle stretching, swelling, and compartment tightness in a patient who sustained trauma to the lower extremity suggest acute compartment syndrome.
In a patient with suspected fibromyalgia, what should be done if initial tests are unrevealing?
No additional testing is needed if a thorough history, examination, and basic laboratory testing including inflammatory markers and thyroid studies are unrevealing.
What are MPA and EGPA associated with?
MPA and EGPA are associated with MPO-ANCA antibodies and a p-ANCA pattern.
What tests are recommended for a new diagnosis of sarcoidosis?
Recommended tests include an electrocardiogram, pulmonary function testing, complete blood count, serum levels of creatinine, calcium, alkaline phosphatase, and an ophthalmologic examination.
What is the likely diagnosis for a red, posterior swollen elbow with fluid collection and no history of trauma?
The likely diagnosis is hemorrhagic olecranon bursitis from overuse.
What is Type II Cryoglobulinemic vasculitis associated with?
Type II Cryoglobulinemic vasculitis is associated with a mixture of polyclonal and monoclonal immunoglobulins, rheumatoid factor activity, hepatitis C virus infection, and connective tissue diseases or lymphoma.
What is Immunoglobulin A (IgA) vasculitis?
IgA vasculitis is a small-vessel vasculitis affecting the skin, gastrointestinal tract, and kidneys.
What is polyarteritis nodosa?
A vasculitis of medium- to small-sized arteries that is associated with hepatitis B virus infection.
What combination of symptoms suggests a diagnosis of systemic lupus erythematosus?
The combination of arthritis, photosensitivity, glomerulonephritis, and mucocutaneous ulceration.
What is a common cause of distal lower-extremity pain in runners?
Medial tibial stress syndrome (shin splints).
What does Takayasu arteritis involve?
The aorta and its major branches.
What are typical findings in patients with iliotibial band syndrome (ITBS)?
Point tenderness at the lateral femoral condyle and reproducible pain with the Noble test.
What is the initial approach to knee osteoarthritis?
Includes analgesia and strategies to stabilize the knee, including physical therapy.
What is iliotibial band syndrome a common cause of?
Lateral hip and knee symptoms.
What is the purpose of aspiration of bursal fluid in hemorrhagic olecranon bursitis?
It may be diagnostic and therapeutic.
What glucocorticoid should be administered before major surgery in a patient on high doses?
Hydrocortisone is a stress dose.
What is the most appropriate evaluation for a patient with suspected infection in a prosthetic joint after total-knee replacement?
Arthrocentesis.
How does rheumatoid arthritis (RA) affect the distal interphalangeal joints?
RA rarely affects the distal interphalangeal joints, which helps to distinguish it from osteoarthritis.
What condition helps to distinguish psoriatic arthritis from osteoarthritis?
Psoriatic arthritis and gout should be considered when the DIP is affected.
Which ethnic groups have higher rates of Behçet disease?
Ethnic groups of Mediterranean or East Asian descent.
What is the most likely diagnosis in a patient presenting with asthma, palpable purpura, peripheral neuropathy, and eosinophilia?
Eosinophilic granulomatosis with polyangiitis.
What is the most likely diagnosis in a patient with limited passive and active range of motion in abduction, internal rotation, and external rotation of the shoulder?
Adhesive capsulitis.
What should prompt evaluation for Pancoast tumor in a patient with shoulder pain and wasting of the small muscles of the hand?
A long history of cigarette smoking.
What is the most likely cause of acute knee pain after lateral contact injury with a positive Lachman test and a positive anterior drawer test?
A tear of the anterior cruciate ligament.
What should Class IV lupus nephritis prompt treatment with?
Glucocorticoids and one of these two first-line immunosuppressive medications: mycophenolate mofetil or cyclophosphamide.
What type of joint inflammation can occur in inflammatory bowel disease (IBD)?
Joint inflammation in IBD can involve the sacroiliac joint and axial skeleton, similar to ankylosing spondylitis.
What are the types of arthritis associated with axial skeleton?
It can be similar to ankylosing spondylitis or it can be a peripheral arthritis.
What is dactylitis?
Dactylitis is a type of peripheral arthritis.
What is tenosynovitis?
Tenosynovitis is another type of peripheral arthritis.
What are typical findings in patients with ITBS?
Point tenderness at the lateral femoral condyle and reproducible pain with the Noble test.
What does the Noble test involve?
Flexing the knee from 0 to 60 degrees while keeping pressure on the lateral femoral condyle.
What does absence of plantar flexion upon compression of the gastrocnemius muscle indicate?
It indicates a potential issue with the Achilles tendon.
What is the Thompson test?
The Thompson test has high sensitivity and specificity for detecting a clinically significant tear of the Achilles tendon.
What is the most likely diagnosis for an athlete with a twisted knee and stable ligament examination?
The most likely diagnosis is patellar dislocation.
What symptoms are associated with patellar dislocation?
A large effusion, a positive apprehension test, and a normal knee radiograph.
What is fibromyalgia characterized by?
Widespread pain for at least 3 months in the absence of any inflammatory or metabolic cause.
It remains a clinical diagnosis of exclusion.
What pathogens are causative of reactive arthritis?
Chlamydia trachomatis and enteric bacteria such as Salmonella, Shigella, Yersinia, Campylobacter, and Clostridioides difficile.
What is greater trochanteric pain syndrome formerly referred to as?
Trochanteric bursitis.
What exacerbates greater trochanteric pain syndrome?
Pressure over the trochanteric bursa over the lateral or medial hip.
What combination of symptoms is suggestive of calcium pyrophosphate deposition disease?
An acute arthritis of the wrist and a radiographic finding of chondrocalcinosis.
What are the most common sites for acute compartment syndrome?
The anterior and deep posterior compartments of the leg.
What syndrome has been associated with inhaled levamisole in cocaine?
A syndrome of cutaneous vasculitis, arthralgias, and systemic symptoms.
What can trigger attacks of gout?
Sudden discontinuation or recent initiation of allopurinol can cause abrupt increases or decreases in serum uric acid.
What does spondylolysis refer to?
A stress fracture in the pars interarticularis of the lumbar spine.
What is the key to early diagnosis of complex regional pain syndrome?
The identification of autonomic changes such as edema, skin mottling, sweating, or temperature change of the affected area.
What are common manifestations of dermatomyositis?
Common manifestations include rash, muscle weakness, and interstitial lung disease.
What is systemic lupus erythematosus associated with?
It is associated with an increased incidence of osteonecrosis (avascular necrosis of bone); patients treated long-term with glucocorticoids are at especially high risk.
What is Immunoglobulin A (IgA) vasculitis?
IgA vasculitis is a small-vessel vasculitis affecting the skin, gastrointestinal tract, and kidneys.
What characterizes sarcoidosis?
Sarcoidosis is characterized by the accumulation of epithelioid granulomas in various organs, including the lungs, skin, eyes, and heart.
What do radiographs of patients with acute calcium pyrophosphate crystal arthritis typically show?
They typically show chondrocalcinosis, i.e., calcification of cartilage in the affected joints.
How does Neisseria gonorrhoeae cause arthritis?
It causes arthritis in two ways; in the second, the pathogen causes true joint infection that manifests as a monoarticular or oligoarticular purulent arthritis, often without other symptoms or findings.
What is the most appropriate treatment for acute olecranon bursitis with significant erythema and swelling?
The most appropriate treatment is antibiotic therapy that covers Staphylococcus aureus infection.
What is the most appropriate long-term treatment for psoriatic arthritis that is refractory to nonsteroidal antiinflammatory drug therapy?
The treatment is continued methotrexate therapy plus a biologic agent.
What is the treatment for rheumatoid arthritis (RA)?
Therapy plus a biologic agent.
What complication can rheumatoid arthritis cause?
Cervical subluxation, most often in the atlantoaxial joint.
What induces subluxation in rheumatoid arthritis?
Laxity of the transverse ligament induced by proliferative synovial tissue at C1–C2 or from erosions or fracture of the odontoid process.
What pathogens cause reactive arthritis?
Chlamydia trachomatis and enteric bacteria such as Salmonella, Shigella, Yersinia, Campylobacter, and Clostridioides difficile.
What is the characteristic pain of patellofemoral pain syndrome?
Pain located behind the kneecap that worsens with squatting, sitting for prolonged periods, and ascending or descending stairs.
What types of cryoglobulinemia cause small-vessel vasculitis?
Types II and III cryoglobulinemia.
What are the symptoms of small-vessel vasculitis caused by cryoglobulinemia?
Characterized by arthralgias, myalgias, and purpuric skin lesions without a clear association with cold exposure.
What is sarcoidosis characterized by?
The accumulation of epithelioid granulomas in various organs including the lungs, skin, eyes, and heart.
What does a positive talar tilt test suggest?
Injury to the calcaneofibular ligament.
What is the treatment for Class IV lupus nephritis?
Treatment with glucocorticoids and one of two first-line immunosuppressive medications: mycophenolate mofetil or cyclophosphamide.
What is the initial management for a lateral ankle sprain?
RICE (Rest, Ice, Compression, Elevation).
What is RICE?
RICE stands for Rest, Ice, Compression, and Elevation.
What is the recommended treatment for lateral epicondylitis that persists despite conservative measures?
Referral to physical therapy and initiation of eccentric exercises to the wrist extensors.
What does an ulcerating skin rash without palpable nodules or papules suggest?
It is more suggestive of an occlusive vasculopathy (such as APS) than vasculitis.
What does absent or diminished peripheral pulses in a young woman with arm claudication and elevated inflammatory markers suggest?
It is suggestive of Takayasu arteritis.
What are violaceous patches on the nose a characteristic manifestation of?
They are a characteristic cutaneous manifestation of sarcoidosis called ‘lupus pernio.’
What is the typical joint involvement in reactive arthritis?
Typically oligoarticular and asymmetric, often affecting the lower extremities and may involve the spine.
What is required to confirm the diagnosis of GPA?
A positive ANCA test in the appropriate clinical setting or a tissue biopsy consistent with GPA.
What should physical therapy for a meniscus tear aim to strengthen?
It should aim to strengthen the quadriceps and hamstring muscles to provide support to the joint.
Where is septic arthritis more common?
It is more common in prosthetic knees than in prosthetic hips or shoulders, especially in the first 2 years after surgery.
What finding on examination of the shoulders is consistent with shoulder osteoarthritis?
The finding of crepitus on examination.
What does the presence of the HLA-B*5801 allele increase the risk of?
It substantially increases the risk of serious allergic reactions with allopurinol.
What is the typical presentation of meralgia paresthetica?
Pain and loss of sensation in the anterolateral thigh.
What is included in the treatment for APS in pregnancy?
Unfractionated heparin or low-molecular-weight heparin injected subcutaneously at full doses.
What is drug-induced lupus typically associated with?
It is typically associated with skin manifestations.
What is the typical manifestation of catastrophic antiphospholipid syndrome?
Typically skin limited or systemic, although it rarely affects the kidneys.
What is the mainstay of therapy for catastrophic antiphospholipid syndrome?
Anticoagulation in combination with glucocorticoids and either intravenous immune globulin or plasmapheresis.
What is the likely diagnosis for wrist pain exacerbated by hand movements?
De Quervain tenosynovitis.
Can be caused by repetitive strain of the thumb and wrist.
What is the characteristic finding in De Quervain tenosynovitis?
Myxoid degeneration (rather than inflammation) within the tendon sheaths.
What are the manifestations of Crest syndrome?
Autoimmune disorder manifesting with calcinosis, Raynaud’s phenomenon, esophageal dysmotility, sclerodactyly, and telangiectasias.
What is Granulomatosis with polyangiitis (GPA)?
A small-vessel vasculitis that often causes a pulmonary–renal syndrome.
Where is the pain located in patellofemoral pain syndrome?
Located behind the kneecap and worsens with squatting, sitting for prolonged periods, and ascending or descending stairs.
What is the rash characteristic of AOSD?
A salmon-colored maculopapular eruption involving the trunk and extremities, which is evanescent and may resolve with the resolution of fever.
What is common in acute gout?
Low-grade fever.
What effect does cyclosporine have on colchicine?
It reduces hepatic metabolism of colchicine, making managing gout particularly challenging in this situation.
Which CMP values are typically elevated in sarcoid?
Creatinine, calcium, and alkaline phosphatase for renal sarcoid.
What laboratory results are typical in patients with AOSD?
Leukocytosis and a markedly elevated serum ferritin level.
What should a pregnant woman with systemic lupus erythematosus and positive anti-Ro antibodies undergo?
Fetal cardiac ultrasound due to the risk for complete heart block.
What is the most likely diagnosis in a patient with purpura, renal insufficiency, active urine sediment, and chronic hepatitis C infection?
Cryoglobulinemic vasculitis.
What may gout be the result of?
Increased serum uric acid caused by commonly used medications such as thiazide and loop diuretics.
What are loop diuretics?
Loop diuretics are a class of medications used to treat conditions like heart failure and edema by promoting the excretion of water and electrolytes.
What is the risk for a pregnant woman with systemic lupus erythematosus (SLE) and anti-Ro antibodies?
A pregnant woman with SLE and anti-Ro antibodies has a 1% to 2% risk for delivering a baby with complete heart block.
What is relapsing polychondritis?
Relapsing polychondritis is an inflammatory disease characterized by recurrent inflammation in cartilaginous tissues.
What is Type II Cryoglobulinemic vasculitis associated with?
Type II Cryoglobulinemic vasculitis is associated with a mixture of polyclonal and monoclonal immunoglobulins, often linked to hepatitis C virus infection and connective tissue diseases.
What causes iliopectineal bursitis?
Iliopectineal bursitis causes anterior and posterior hip pain and tenderness.
What are the characteristics of initial attacks of gouty arthritis?
Initial attacks of gouty arthritis are usually monoarticular and involve the lower extremities.
What does the American College of Rheumatology recommend before initiating allopurinol?
The American College of Rheumatology recommends screening for HLA-B*5801 before initiating allopurinol in patients of Southeast Asian descent and those who identify as Black.
What should Class IV lupus nephritis prompt?
Class IV lupus nephritis should prompt treatment with glucocorticoids and one of two first-line immunosuppressive medications: mycophenolate mofetil or cyclophosphamide.
How does new-onset rheumatoid arthritis typically present?
A patient with new-onset rheumatoid arthritis is most likely to present with synovitis at the wrists, proximal interphalangeal joints, metacarpophalangeal joints, and flexor tendons.
How many compartments does the lower leg have?
The lower leg has four compartments: anterior, deep posterior, lateral, and superficial posterior.
What are the compartments of the lower leg?
The compartments are: anterior, deep posterior, lateral, and superficial posterior.
Where can granulomas be found?
Granulomas can be found in the lung and the skin.
What do granulomas in the lung and skin suggest?
The presence of sarcoidosis.
What percentage of patients with inflammatory bowel disease have concurrent axial spondyloarthritis?
Approximately 10% to 15%.
How does axial spondyloarthritis manifest?
As inflammatory back pain due to sacroiliitis.
What are common signs and symptoms in Adult-Onset Still’s Disease (AOSD)?
Pharyngitis, lymphadenopathy, and splenomegaly.
What is detectable on imaging in many patients with Giant Cell Arteritis (GCA)?
Large-vessel vasculitis.
Which arteries are typically involved in GCA?
The aorta and the subclavian artery.
What is the preferred medication to prevent pneumocystis pneumonia in an immunosuppressed patient?
Trimethoprim-sulfamethoxazole.
What is the dosage for trimethoprim-sulfamethoxazole to prevent pneumocystis pneumonia?
One double-strength tablet (160 mg/800 mg) three times weekly or one single-strength tablet (80/400 mg) daily.
What leukocyte count is considered consistent with septic bursitis?
> 2000 per mm3.
What is the most likely diagnosis for a young woman with abdominal pain, palpable purpura, and arthritis?
Immunoglobulin A vasculitis.
What are the symptoms of polymyalgia rheumatica?
Pain and morning stiffness in the shoulders, neck, and hip girdle.
What percentage of patients with GCA experience symptoms of polymyalgia rheumatica?
About 40%.
What is reactive arthritis formerly known as?
Reiter syndrome.
What does reactive arthritis classically manifest as?
Arthritis, urethritis, and conjunctivitis.
Does a negative c-ANCA rule out GPA?
No, it does not.
What is the sensitivity of ANCA testing in patients with systemic disease?
95% in patients with severe disease such as pulmonary–renal syndromes, but only about 70% overall.
What is the sensitivity of testing in patients with systemic disease?
Testing is 95% sensitive in patients with systemic disease (i.e. those that have more severe disease such as pulmonary–renal syndromes).
What is the sensitivity of testing in patients with limited disease?
It is only about 70% sensitive in patients with more limited disease.
What characterizes greater trochanteric pain syndrome?
It is characterized by pain and tenderness at the lateral hip overlying the greater trochanteric bursa.
Where is the characteristic pain of patellofemoral pain syndrome located?
The characteristic pain is located behind the kneecap and worsens with squatting, sitting for prolonged periods, and ascending or descending stairs.
What are the vascular manifestations of Behçet disease?
They include variable-size vasculitis and venous thrombosis.
What is Type II Cryoglobulinemic vasculitis associated with?
It is associated with a mixture of polyclonal and monoclonal immunoglobulins, with rheumatoid factor activity.
What infections are associated with Type II Cryoglobulinemic vasculitis?
It is associated with hepatitis C virus infection in the majority of cases and with connective tissue diseases or lymphoma in most other cases.
What happens to symptoms of spinal stenosis when the patient sits or flexes forward?
Symptoms tend to resolve.
What do patients report after a lateral patellar dislocation?
They frequently report that they have dislocated their knee but have been able to correct it themselves.
What is the risk associated with the use of tumor necrosis factor inhibitors in rheumatoid arthritis patients?
They increase the chance of developing a serious infection, particularly a severe respiratory or skin infection.
What is Granulomatosis with polyangiitis (GPA)?
It is a small-vessel vasculitis that often causes a pulmonary–renal syndrome.
What may patients with late disseminated Lyme disease present with?
They may present with inflammatory monoarthritis.
What does spondylolysis refer to?
It refers to a stress fracture in the pars interarticularis of the lumbar spine.
What is the most likely diagnosis in a patient with abdominal pain, joint pain, and palpable purpura?
It is immunoglobulin A vasculitis.
What does a skin biopsy usually reveal in immunoglobulin A vasculitis?
It usually reveals leukocytoclastic vasculitis.
What does a skin biopsy usually reveal in cases of vasculitis?
A skin biopsy usually reveals leukocytoclastic vasculitis.
What can a subset of patients develop in relation to glomerulonephritis?
A subset of patients can develop a proliferative glomerulonephritis.
What does the proliferative glomerulonephritis stain positive for?
It stains positive for IgA deposition on immunofluorescence.
Who is more likely to develop chronic renal disease as a result of IgA vasculitis?
Adults are more likely to develop chronic renal disease.
What is the typical outcome for most children with IgA vasculitis?
Most children recover completely.
How many compartments does the lower leg have?
The lower leg has four compartments: anterior, deep posterior, lateral, and superficial posterior.
What type of vasculitis is associated with a mixture of polyclonal and monoclonal immunoglobulins?
Type II Cryoglobulinemic vasculitis.
What is the association of rheumatoid factor activity in Type II Cryoglobulinemic vasculitis?
Rheumatoid factor activity is associated with hepatitis C virus infection in the majority of cases.
What is the most likely cause of substantial chronic gastrointestinal blood loss in patients with scleroderma?
It is most likely attributable to gastric antral vascular ectasia.
What can gastric antral vascular ectasia lead to?
GAVE can lead to occult blood loss severe enough to require transfusions.
What is radiculopathy that results in discomfort at the medial thigh likely to originate from?
It is most likely to originate from lumbar level L2.
What is detectable on imaging in many patients with GCA?
Large-vessel vasculitis is detectable on imaging in many patients.
What arteries are typically involved in GCA?
The aorta and the subclavian artery are typically involved.
What are common signs and symptoms in AOSD?
Common signs include pharyngitis, lymphadenopathy, and splenomegaly.
What is the most severe manifestation of PAN?
Gastrointestinal involvement is the most severe manifestation of PAN.
What can gastrointestinal involvement in PAN lead to?
It can lead to bowel perforation.
What is the most likely diagnosis in a patient with purpura and renal insufficiency?
The most likely diagnosis is cryoglobulinemic vasculitis.
What is an active urine sediment associated with?
Chronic hepatitis C infection.
What condition is associated with cryoglobulinemic vasculitis?
Chronic hepatitis C infection.
What does synovial fluid analysis of septic bursitis often reveal?
Lower leukocyte counts than are found in cases of septic arthritis.
What may the Gram stain show in cases of septic bursitis?
It may be negative.
What is the preferred treatment for chlamydia in a nonpregnant patient?
Doxycycline.
What is the preferred treatment for chlamydia during pregnancy?
Azithromycin.
What is Crest syndrome?
An autoimmune disorder manifesting with calcinosis, Raynaud’s phenomenon, esophageal dysmotility, sclerodactyly, and telangiectasias.
What does ischiogluteal bursitis typically radiate down?
The posterior hip.
What is the characteristic rash in AOSD?
A salmon-colored maculopapular eruption involving the trunk and extremities.
What exacerbates pain in prepatellar bursitis?
Passive flexion of the knee.
What is the most likely diagnosis for a runner with lateral knee pain and tenderness at the lateral femoral epicondyle?
Iliotibial band syndrome.
How can arthritis in AOSD present?
It can be transient and/or migratory or it can be a fixed symmetric polyarthritis.
What joint is most infected with late disseminated Lyme disease?
The knee.
What tests are recommended for a new diagnosis of sarcoidosis?
Electrocardiogram, pulmonary function testing, complete blood count, and serum levels of creatinine.
What are serum levels of creatinine associated with?
Serum levels of creatinine are associated with kidney function.
What can increased serum uric acid lead to?
Increased serum uric acid may lead to gout.
What medications can cause increased serum uric acid?
Common medications include thiazide and loop diuretics, low-dose aspirin, and niacin.
What are the characteristic symptoms of relapsing polychondritis?
Symptoms include recurrent episodes of inflammation involving the ears, nose, respiratory tract, ocular inflammation, polyarthritis, and audiovestibular involvement.
Which part of the body is most often affected in relapsing polychondritis?
The ears are most often affected, sparing the lobule.
What is GPA characterized by?
GPA is characterized by the presence of antineutrophil cytoplasmic antibody directed against PR3-ANCA.
Where are the second most common locations for acute gout?
The midfoot joints are the second most common location for acute gout after the first metatarsal-phalangeal joint.
What is Felty syndrome associated with?
Felty syndrome has a polyclonal expansion of lymphocytes.
What is more consistent with a diagnosis of RA than systemic lupus erythematosus?
A history of erosive arthritis is more consistent with a diagnosis of RA.
What is the triad characteristic of Felty syndrome?
The triad includes neutropenia, splenomegaly, and rheumatoid arthritis.
What are extraarticular manifestations of Felty syndrome?
Extraarticular manifestations can include vasculitis, mononeuritis multiplex, necrotizing skin lesions, pleuritis, pericarditis, and rheumatoid nodules.
What are rheumatoid nodules?
Rheumatoid nodules are firm lumps that develop under the skin in people with rheumatoid arthritis.
What is lymphadenopathy?
Lymphadenopathy refers to the swelling of lymph nodes, often due to infection or disease.
What is episcleritis?
Episcleritis is inflammation of the episclera, a thin layer of tissue covering the white part of the eye.
What does bone marrow often show in certain conditions?
Bone marrow often shows an arrest of maturation of granulocytes as seen in certain patients.
How can a labral tear manifest in an athletic patient?
A labral tear can manifest as subacute anterior groin pain in an otherwise healthy athletic patient.
What is common in relapsing polychondritis?
Episcleritis is common in relapsing polychondritis, but patients should be evaluated for scleritis.
What can scleritis lead to?
Scleritis can be vision threatening.
What is the initial treatment for recent-onset rotator cuff tendinitis?
The initial treatment is physical therapy.
What joints may be involved in hand osteoarthritis?
Hand osteoarthritis may involve the distal interphalangeal joint (Heberden nodes), the proximal interphalangeal joint (Bouchard’s nodes), or the first carpometacarpal joint.
How does TMJ arthritis typically manifest?
TMJ arthritis typically manifests with pain and crepitus.
What is a potential result of TMJ arthritis damage?
TMJ arthritis can lead to micrognathia as a result of damage to the mandibular growth plate during childhood.
What is a likely diagnosis in a patient with inflammatory arthritis and gastrointestinal symptoms?
The most likely underlying diagnosis is inflammatory bowel disease.
How is immunoglobulin A vasculitis best confirmed?
Immunoglobulin A vasculitis is best confirmed by immunofluorescence examination of a skin biopsy specimen.
What is a common knee syndrome in athletes?
A common knee syndrome in athletes complaining of lateral knee pain is iliotibial band syndrome.
What are common manifestations of dermatomyositis?
Common manifestations of dermatomyositis include muscle weakness and skin rash.
What are common manifestations of dermatomyositis?
Common manifestations include rash, muscle weakness, and interstitial lung disease.
What does osteoarthritis of the hip cause?
Osteoarthritis of the hip causes anterior hip and groin pain that can be reproduced by internal rotation of the hip.
How does systemic lupus erythematosus typically manifest?
Systemic lupus erythematosus typically manifests with cytopenias, a symmetric arthritis, and fixed rather than evanescent skin findings.
What is Takayasu arteritis?
Takayasu arteritis is a rare vasculitis of the large arteries that typically affects young women.
What is the first-line pharmacologic treatment for Raynaud phenomenon in systemic sclerosis?
The first-line pharmacologic treatment for Raynaud phenomenon in systemic sclerosis is a calcium-channel blocker.
What are the four compartments of the lower leg?
The lower leg has four compartments: anterior, deep posterior, lateral, and superficial posterior.
What can rheumatoid arthritis cause in the cervical spine?
Rheumatoid arthritis can cause cervical subluxation, most often in the atlantoaxial joint.
What induces subluxation?
Subluxation results from laxity of the transverse ligament induced by proliferative synovial tissue at C1–C2 or from erosions or fracture.
Where is the characteristic pain of patellofemoral pain syndrome located?
The characteristic pain of patellofemoral pain syndrome is located behind the kneecap and worsens with squatting, sitting for prolonged periods, and ascending or descending stairs.
What is complex regional pain syndrome characterized by?
Complex regional pain syndrome is characterized by a regional pain disorder frequently preceded by a noxious event and characterized by neuropathic features and signs of local autonomic dysfunction.
What are the features of hypertrophic osteoarthropathy?
Hypertrophic osteoarthropathy is characterized by finger clubbing, widening of the fingertips, arthritis, and periostitis with periosteal thickening at long bones.
What tests are recommended for a new diagnosis of sarcoidosis?
Recommended tests include an electrocardiogram, pulmonary function testing, complete blood count, serum levels of creatinine, calcium, alkaline phosphatase, and an ophthalmologic examination.
What is consistent with a diagnosis of antiphospholipid syndrome?
The combination of a vasculopathic skin rash with microthrombi, acute kidney injury, and a history of multiple miscarriages is consistent with a diagnosis of antiphospholipid syndrome.
What does reproduction of pain by the empty can test indicate?
Reproduction of pain by the empty can test is a sign of supraspinatus muscle/tendon injury, indicating rotator cuff tendinopathy.
What conditions are associated with MPO-ANCA antibodies?
MPA and EGPA are associated with MPO-ANCA antibodies and a p-ANCA pattern.
What is indicated to confirm the diagnosis of acute CPP crystal arthritis?
Arthrocentesis is indicated to confirm the diagnosis of acute CPP crystal arthritis.
What can cause prepatellar bursitis?
Repetitively being on one’s knees can cause prepatellar bursitis.
What defines oligoarticular JIA?
Oligoarticular JIA is defined as synovitis of up to four large joints, typically the knees and ankles, but sometimes the wrists and elbows.
What antibodies are present in Drug-induced lupus?
Antihistone antibodies are present in more than 90% of cases of Drug-induced lupus.
What are antihistone antibodies?
Antihistone antibodies are present in more than 90% of cases.
When is high-resolution CT of the chest appropriate?
High-resolution CT of the chest is appropriate for patients with diffuse systemic sclerosis at the time of scleroderma diagnosis, especially with pulmonary symptoms.
What is the characteristic triad of Löfgren syndrome?
The triad of arthritis, erythema nodosum, and hilar adenopathy is characteristic of Löfgren syndrome, an acute form of sarcoidosis.
What are patients with diffuse systemic sclerosis at high risk for?
Patients with diffuse systemic sclerosis are at high risk for interstitial lung disease, particularly those with anti–Scl-70 antibodies.
What vaccinations should a patient over 50 with systemic lupus erythematosus receive?
A patient over 50 years of age with systemic lupus erythematosus should receive influenza and pneumococcal vaccination as well as the recombinant zoster vaccine.
What is radiculopathy that results in discomfort at the medial thigh most likely to originate from?
Radiculopathy that results in discomfort at the medial thigh and adductor muscle weakness is most likely to originate from lumbar level L2.
What combination of findings is suggestive of calcium pyrophosphate deposition disease?
A combination of acute arthritis of the wrist and a radiographic finding of chondrocalcinosis is most suggestive of an underlying diagnosis of calcium pyrophosphate deposition disease.
What is Polyarteritis nodosa (PAN)?
Polyarteritis nodosa (PAN) is a necrotizing vasculitis of small to medium-sized arteries that causes microaneurysms and stenoses leading to ischemia and infarction.
What are common features of Polyarteritis nodosa?
Common features of PAN include weight loss, myalgia, peripheral neuropathy, skin lesions, and other symptoms and findings of tissue ischemia or infarction in a wide range of organs.
What organs can be involved in hypertension?
A wide range of organs including the testicles, uterus, or ovaries.
What cardiovascular manifestations are associated with ankylosing spondylitis?
Aortic root dilatation and coronary artery disease.
What is the diagnosis for bilateral lower-extremity pain most prominent over the distal two-thirds of the posteromedial tibial surfaces?
Medial tibial stress syndrome.
What are some proposed risk factors for medial tibial stress syndrome?
Female sex, pes planus, excessive pronation, and recent increases in training intensity.
What is Type II Cryoglobulinemic vasculitis associated with?
A mixture of polyclonal and monoclonal immunoglobulins with rheumatoid factor activity, often linked to hepatitis C virus infection.
What are common areas affected by relapsing polychondritis?
Ears, nose, trachea, bronchi, and joints.
How can calcific tendinitis of the rotator cuff be distinguished radiographically?
By plain film radiographs showing the presence of calcifications in the soft tissues surrounding the affected tendon.
What is detectable on imaging in patients with GCA?
Large-vessel vasculitis, typically involving the aorta and the subclavian artery.
What crystals can be visualized by electron microscopy in certain conditions?
Calcium hydroxyapatite crystals.
When should an MRI be indicated for a meniscus tear?
For severe symptoms or symptoms lasting longer than 2 weeks.
What indicates the need for an MRI in case of a meniscus tear?
Severe symptoms or symptoms lasting longer than 2 weeks, particularly inability to walk or bear weight after injury.
What are the cardiovascular manifestations of ankylosing spondylitis?
Aortic root dilatation and coronary artery disease.
What is most likely to be diagnosed in a patient with severe respiratory compromise, renal impairment, and sinusitis?
ANCA-associated vasculitis, particularly granulomatosis with polyangiitis.
What is the definitive procedure to diagnose crystal arthropathy?
Arthrocentesis.
What is hypertrophic osteoarthropathy often associated with?
Chronic hypoxia.
How does new-onset rheumatoid arthritis typically present?
With synovitis at the wrists, proximal interphalangeal joints, metacarpophalangeal joints, and flexor tendons.
What does the Finkelstein test diagnose?
De Quervain tenosynovitis.
What are the manifestations of Crest syndrome?
Calcinosis, Raynaud’s phenomenon, esophageal dysmotility, sclerodactyly, and telangiectasias.
What is the typical joint involvement in reactive arthritis?
Oligoarticular and asymmetric, often affecting the lower extremities and may involve the spine.
What criteria are used to diagnose APS?
Pregnancy morbidity and/or an arterial, venous, or small-vessel thrombosis, with positive tests for specific antibodies on two occasions 12 weeks apart.
What does a positive McMurray test suggest?
A meniscal tear.
What is hyperuricemia frequently associated with among solid organ transplant recipients?
The use of cyclosporine.
How can a labral tear manifest in an otherwise healthy athletic patient?
As subacute anterior/lateral groin pain.
What is the manifestation of types II and III cryoglobulinemia?
Not specified in the provided text.
What are the types of cryoglobulinemia?
Types II and III cryoglobulinemia involve immune complexes that are polyclonal, either with (type II) or without (type III) a monoclonal component.
What is the average disease duration for reactive arthritis?
The average disease duration for reactive arthritis is 3 to 6 months.
What is pulmonary hypertension more commonly a complication of?
Pulmonary hypertension is more commonly a complication of limited rather than diffuse systemic sclerosis.
Is it true that pulmonary hypertension is more commonly a complication of limited rather than diffuse systemic sclerosis?
True.
What type of drug is methotrexate?
Methotrexate is a folate antimetabolite that inhibits dihydrofolate reductase and is a first-line disease-modifying drug.
What is the preferred imaging technique for identifying labral pathologic findings?
Magnetic resonance arthrography is the preferred imaging technique.
What is the mainstay of therapy for catastrophic antiphospholipid syndrome?
The mainstay of therapy is anticoagulation in combination with glucocorticoids and either intravenous immune globulin or plasmapheresis.
What joints may be involved in hand osteoarthritis?
Hand osteoarthritis may involve the distal interphalangeal joint (Heberden nodes), the proximal interphalangeal joint (Bouchard’s nodes), or the first carpometacarpal joint.
What is the most likely diagnosis in a patient with active Crohn disease presenting with back pain and morning stiffness?
The most likely diagnosis is inflammatory bowel disease-associated arthritis.
What are the common sites for acute compartment syndrome in the leg?
The anterior and deep posterior compartments of the leg are the most common sites for acute compartment syndrome.
What pathogens are causative of reactive arthritis?
Causative pathogens include Chlamydia trachomatis and enteric bacteria such as Salmonella, Shigella, Yersinia, Campylobacter, and Clostridioides difficile.
What is the most appropriate initial treatment for remission induction in active severe granulomatosis with polyangiitis?
The most appropriate initial treatment is intravenous glucocorticoids.
How many compartments does the lower leg have?
The lower leg has four compartments: anterior, deep posterior, lateral, and superficial posterior.
What are the types of posterior structures mentioned?
Deep posterior, lateral, and superficial posterior.
What condition should be suspected in a patient with COPD or significant finger clubbing?
Lung cancer.
What is Type I cryoglobulinemia caused by?
Monoclonal cryoglobulins, usually in the setting of a lymphoproliferative disorder.
What typically causes anterior dislocation of the shoulder?
Trauma to the arm while the arm is abducted and externally rotated.
What triad is characteristic of Löfgren syndrome?
Arthritis, erythema nodosum, and hilar adenopathy.
What can patients with relapsing polychondritis experience?
Abnormalities of cardiac conduction leading to life-threatening arrhythmias.
What should a clinician suspect in an older patient with vision disturbance and headache?
Giant-cell arteritis.
What condition may develop in a patient with rheumatoid arthritis treated with a TNF inhibitor?
TNF-inhibitor–induced lupus.
What is the initial treatment for idiopathic cutaneous small-vessel vasculitis?
Symptomatic management.
What characterizes sarcoidosis?
The accumulation of epithelioid granulomas in various organs including the lungs, skin, eyes, and heart.
What is the preferred treatment for chlamydia?
Doxycycline.
What is the preferred treatment for chlamydia in a nonpregnant patient?
Doxycycline
What is the preferred treatment for chlamydia during pregnancy?
Azithromycin
What does a combination of acute arthritis of the wrist and chondrocalcinosis suggest?
An underlying diagnosis of calcium pyrophosphate deposition disease
What condition is caused by the entrapment of the lateral femoral cutaneous nerve?
Meralgia paresthetica
What should indicate an MRI for further diagnosis of a meniscus tear?
Severe symptoms or symptoms lasting longer than 2 weeks
Severe meaning inability to walk (inability to bear weight after injury)
What is the second most common location for acute gout?
The midfoot joints
What is the mainstay of therapy for catastrophic antiphospholipid syndrome?
Anticoagulation in combination with glucocorticoids
What should be suspected in patients with persistent fever, arthralgia, rash, and leukocytosis?
Adult-onset Still disease
What should patients with a childhood history of oligoarticular juvenile idiopathic arthritis be screened for?
Temporomandibular joint arthritis
What do Types II and III cryoglobulinemia cause?
A primarily small-vessel vasculitis
What is characterized by arthralgias, myalgias, and purpuric skin lesions without a clear association with cold exposure?
Giant-cell arteritis (GCA)
The most common systemic vasculitis in adults occurs almost exclusively in patients older than age 50.
What medication has been shown to have uricosuric effects and may be preferred for treating hypertension in patients with gout?
Losartan
It is effective in managing blood pressure while also reducing uric acid levels.
What is the mainstay of therapy for catastrophic antiphospholipid syndrome?
Anticoagulation in combination with glucocorticoids and either intravenous immune globulin or plasmapheresis.
What condition is characterized by widespread pain for at least 3 months in the absence of any inflammatory or metabolic cause?
Fibromyalgia
It remains a clinical diagnosis of exclusion.
What type of joint fluid from patients with Milwaukee shoulder is often not inflammatory but shows evidence of chronic hemarthrosis?
Joint fluid with rusty-brown synovial fluid.
What should an athlete with low back pain exacerbated by extension be evaluated for?
Spondylolysis.
What syndrome is characterized by pain and tenderness at the lateral hip overlying the greater trochanteric bursa?
Greater trochanteric pain syndrome.
What allele substantially increases the risk of serious allergic reactions with allopurinol?
HLA-B*5801 allele.
What is defined as synovitis of up to four large joints, typically the knees and ankles?
Oligoarticular JIA.
What is the most likely cause of substantial chronic gastrointestinal blood loss in patients with scleroderma?
Gastric antral vascular ectasia.
What does synovial fluid analysis typically show in septic arthritis?
An elevated leukocyte count.
What does synovial fluid analysis typically show?
An elevated leukocyte count of 50,000 to 100,000 cells per mm3 and at least 75% neutrophils.
What are the causative pathogens of reactive arthritis?
Chlamydia trachomatis and enteric bacteria such as Salmonella, Shigella, Yersinia, Campylobacter, and Clostridioides difficile.
How do symptoms of spinal stenosis change with movement?
Symptoms tend to resolve when the patient sits or flexes forward while walking.
What is reactive arthritis formerly known as?
Reiter syndrome.
What are the classic manifestations of reactive arthritis?
Arthritis, urethritis, and conjunctivitis.
In which age group do PMR and GCA typically occur?
In older patients, often >60 years old and almost exclusively >50 years old.
What is the racial demographic of patients with GCA?
The vast majority of patients with GCA are white.
What condition is associated with limited systemic sclerosis and a positive anticentromere antibody?
Patients are more likely to develop PAH than ILD.
How is fever characterized in patients with adult onset still disease?
Typically high and occurs once or twice daily with complete normalization of temperatures between episodes.
What triad is characteristic of Löfgren syndrome?
Arthritis, erythema nodosum, and hilar adenopathy.
What is sarcoidosis characterized by?
The accumulation of epithelioid granulomas in various organs including the lungs, skin, eyes, and heart.
What condition compresses the median nerve?
Carpal tunnel syndrome.
Which type of JIA affects girls more frequently than boys?
Oligoarticular JIA.
What is the peak incidence age for oligoarticular JIA?
2 to 4 years of age.
What syndrome is associated with inhaled levamisole in cocaine?
A syndrome of cutaneous vasculitis, arthralgias, and systemic symptoms, often associated with high titers of ANCA.
How is the rash in AOSD described?
A salmon-colored maculopapular eruption involving the trunk and extremities, evanescent and may resolve with the resolution of fever.
What is commonly used to cut cocaine in the United States?
Levamisole, a veterinary anthelmintic drug.
What are the characteristic symptoms of adult-onset Still disease (AOSD)?
Fever, rash, and arthritis.
AOSD has a bimodal age distribution with peaks between 15 to 25 and 35 to 45 years of age.
Which part of the body is most often affected in relapsing polychondritis?
The ears are affected most often, sparing the lobule.
What other areas can be affected in relapsing polychondritis?
The nose, trachea, bronchi, and joints are also frequently affected.
What condition should be considered in patients with systemic sclerosis experiencing gastrointestinal blood loss?
Gastric antral vascular ectasia (GAVE).
What is complex regional pain syndrome?
A regional pain disorder frequently preceded by a noxious event, characterized by neuropathic features and signs of local autonomic dysfunction.
What is a common cause of anterior knee pain in young active adult females?
Patellofemoral pain syndrome, often secondary to overuse.
What is required for the diagnosis of antiphospholipid syndrome (APS)?
A patient must have pregnancy morbidity and/or an arterial, venous, or small-vessel thrombosis, and test positive for specific antibodies on two occasions 12 weeks apart.
What are the antibodies associated with antiphospholipid syndrome (APS)?
Anti–beta2-glycoprotein antibody, high-titer anticardiolipin antibody, or lupus anticoagulant.
When is prophylaxis against PCP recommended?
For patients expected to be treated with prednisone 20 mg or greater for at least 3 weeks.
What distinguishes Felty syndrome from LGL leukemia?
Felty syndrome has a polyclonal expansion of lymphocytes, while LGL leukemia has a monoclonal expansion.
What symptoms should raise concern for giant-cell arteritis in patients over 50?
A combination of new-onset arm claudication, transient vision loss, and elevated levels of inflammatory markers.
What should be avoided in treating chronic lateral epicondylitis?
Glucocorticoid injections.
Should glucocorticoid injections be avoided in treating chronic lateral epicondylitis?
True
What type of fluid is typically found in joint effusions related to osteoarthritis?
Noninflammatory fluid with leukocyte counts in the range of 200 to 2000 cells per mm3
What are common signs and symptoms in Adult-Onset Still’s Disease (AOSD)?
Pharyngitis, lymphadenopathy, and splenomegaly
What should prompt evaluation for a Pancoast tumor?
Shoulder pain and wasting of the small muscles of the hand in a patient with a long history of cigarette smoking
How is Antiphospholipid Syndrome (APS) diagnosed?
When a patient has had pregnancy morbidity and/or an arterial, venous, or small-vessel thrombosis, and tests positive for at least one of the following on two occasions 12 weeks apart: anti–beta2-glycoprotein antibody, high-titer anticardiolipin antibody, or lupus anticoagulant
Does sarcoidosis frequently affect the eyes?
True
Patients should have an ophthalmologic exam upon diagnosis.
What is the second most common location for acute gout?
The midfoot joints, after the first metatarsal-phalangeal joint
What is key to the early diagnosis of Complex Regional Pain Syndrome?
The identification of autonomic changes such as edema, skin mottling, sweating, or temperature change of the affected area
What is a risk associated with the use of tumor necrosis factor inhibitors in patients with rheumatoid arthritis?
Increased chance of developing a serious infection, particularly a severe respiratory or skin infection
What is Type III cryoglobulinemic vasculitis associated with?
Rheumatoid factor activity carried by polyclonal immunoglobulins and often due to HCV, but can also be secondary to diseases such as Sjögren syndrome, systemic lupus erythematosus, and rheumatoid arthritis
Which ethnic groups have higher rates of Behçet disease?
Those of Mediterranean or East Asian descent
What is a slowly progressive skeletal disease characterized by increased bone turnover?
Paget’s disease
Causes normal lamellar bone to be replaced by weak woven bone.
What condition typically manifests with cytopenias rather than leukocytosis?
Systemic lupus erythematosus
Important consideration in a patient with this presentation.
What type of arthritis is characterized by symmetric arthritis and fixed rather than evanescent skin findings?
Systemic lupus erythematosus
Recurrent or refractory calcific tendinitis is treated with US guided lavage.
When is the best time to evaluate the fetal heart?
Between 18 and 22 weeks’ gestation.
What is the most common systemic vasculitis in adults?
Giant-cell arteritis (GCA)
Occurs almost exclusively in patients older than age 50, with the highest risk among patients aged 75 to 85.
How is calcific tendinitis treated?
Conservatively with rest and NSAIDs
Or steroid injections if conservative treatment does not work.
What is an appropriate next step in therapy for a patient with rheumatoid arthritis that is flaring despite maximum-dose methotrexate therapy?
Add a DMARD.
What are some examples of biologic DMARDs?
Anti–interleukin-6 receptor monoclonal antibodies (tocilizumab, sarilumab)
Anti–CD20 monoclonal antibody (rituximab).
What type of protein is abatacept?
Anti–cytotoxic T-lymphocyte antigen-4 fusion protein.
What are tumor necrosis factor (TNF) inhibitors used for?
They are used in the treatment of rheumatoid arthritis.
Examples include etanercept, infliximab, adalimumab, certolizumab pegol, and golimumab.
What is most consistent with a small-vessel vasculitis of the skin?
Palpable purpura extending over the shins and tops of the feet.
What conditions should be considered when the DIP joint of the hand is affected?
Psoriatic arthritis, tophaceous gout, and osteoarthritis.
What does a warm, swollen, and erythematous foot in an afebrile patient with type 2 diabetes indicate?
Peripheral neuropathy.
What is peripheral neuropathy most consistent with?
A diagnosis of diabetic neuropathic arthropathy.
What may gout be the result of?
Increased serum uric acid caused by commonly used medications such as thiazide and loop diuretics.
What is the most common ocular manifestation in sarcoidosis?
Anterior uveitis.
What would tenderness on palpation at the medial proximal tibia be consistent with?
Anserine bursitis.
What is a hallmark for the diagnosis of plantar fasciitis?
Local tenderness in the distal aspect of the heel-pad overlying the medial calcaneal tubercle.
What does an ulcerating skin rash without palpable nodules or papules suggest?
An occlusive vasculopathy (such as APS) rather than vasculitis.
What is key to early diagnosis of Complex regional pain syndrome?
Identification of autonomic changes such as edema, skin mottling, sweating, or temperature change of the affected area.
What characterizes the rash in AOSD?
A salmon-colored maculopapular eruption involving the trunk and extremities that is evanescent and may resolve with the resolution of fever.
How is oligoarticular JIA defined?
Synovitis of up to four large joints, typically the knees and ankles, but sometimes the wrists and elbows.
What is Immunoglobulin A (IgA) vasculitis?
It is a small-vessel vasculitis affecting the skin, gastrointestinal tract, and kidneys.
What ocular problem is common in relapsing polychondritis?
Scleritis, which can be vision threatening.
What part of the cerebral circulation is most often associated with stroke in patients with giant-cell arteritis?
The vertebrobasilar circulation.
What is Takayasu arteritis?
A rare vasculitis of the large arteries that typically affects young women.
What are recurrent oral and genital lesions in a patient with a history of ocular inflammatory disease suggestive of?
Behçet disease.
What is the appropriate treatment for a trauma-induced minor meniscal tear?
Analgesia such as NSAIDs.
What does a positive anterior drawer test of the ankle suggest?
Injury to the anterior talofibular ligament.
What is Type II cryoglobulinemia most commonly associated with?
Hepatitis C virus infection.
What is the first-line therapy for symptomatic Paget disease of bone?
A high-potency intravenous bisphosphonate, such as zolendronic acid.
What pathogens are causative of reactive arthritis?
Chlamydia trachomatis and enteric bacteria such as Salmonella, Shigella, Yersinia, Campylobacter, and Clostridioides difficile.
What conditions should be considered when the DIP is affected?
Psoriatic arthritis, tophaceous gout, and osteoarthritis.
What is the significance of Raynaud phenomenon in a young healthy woman?
It may indicate an underlying connective tissue disorder.
What is the likely diagnosis for a young healthy woman with Raynaud phenomenon and normal inflammatory markers?
Primary Raynaud phenomenon.
What is required to confirm the diagnosis of GPA?
A positive ANCA test in the appropriate clinical setting or a tissue biopsy consistent with GPA.
What vaccinations should a patient over 50 years of age with systemic lupus erythematosus receive?
Influenza, pneumococcal vaccination, and the recombinant zoster vaccine.
What symptom in a patient with giant-cell arteritis is most likely to portend permanent vision loss?
Amaurosis fugax.
What is the most appropriate management for post-traumatic and recurrent anterior instability of the shoulder that has not responded to physical therapy?
Surgical stabilization.
Which CMP values are typically elevated in sarcoidosis?
Creatinine, calcium, and alkaline phosphatase.
What is Type I cryoglobulinemia usually caused by?
Monoclonal cryoglobulins, typically in the setting of a lymphoproliferative disorder.
What effect does Losartan have and in which patients is it preferred?
Losartan has uricosuric effects and may be preferred for treating hypertension in patients with gout.
What does the American College of Rheumatology recommend before initiating allopurinol?
Screening for HLA-B*5801 in patients of Southeast Asian descent and those who identify as Black.
What is the most appropriate treatment for preventing recurrence of mild-to-moderate mucocutaneous Behçet disease?
Colchicine.
What do multiple renal and/or mesenteric microaneurysms on angiography suggest?
A diagnosis of polyarteritis nodosa.
What do current guidelines recommend measuring as a first step in evaluating for possible prosthetic joint infection?
C-reactive protein level and erythrocyte sedimentation rate.
What should be done if the C-reactive protein level is significantly elevated?
Joint aspiration is recommended to assess for prosthetic joint infection.
What is relapsing polychondritis characterized by?
Recurrent inflammation in cartilaginous tissues.
What combination of symptoms should raise suspicion for drug-induced lupus?
Malar rash, serositis, and arthralgia in a patient recently taking chlorpromazine.
What are other drugs commonly associated with drug-induced lupus?
Procainamide, hydralazine, minocycline, methyldopa, and tumor necrosis factor (TNF) inhibitors.
What is the diagnosis for a young woman who develops exertional symptoms in her arms, loses weight, and has diminished forearm pulses and elevated inflammatory markers?
Takayasu arteritis.
What are common symptoms of Takayasu arteritis?
Constitutional symptoms such as fever and weight loss, along with localizing symptoms corresponding to the arteries involved, such as claudication in the upper or lower extremities, headache, and symptoms of severe hypertension due to renal-artery stenosis.
What is Immunoglobulin A (IgA) vasculitis?
A small-vessel vasculitis formerly referred to as Henoch–Schönlein purpura, which occurs most often in children but can also occur in adults, often following an upper respiratory tract infection.
What is the characteristic joint fluid in patients with Milwaukee shoulder?
Joint fluid is not necessarily inflammatory but often has evidence of chronic hemarthrosis with rusty-brown colored synovial fluid.
What is the treatment for primary Raynaud phenomenon with no acute complications?
Observation.
What do current guidelines recommend for evaluating possible prosthetic joint infection?
Measuring the C-reactive protein level and erythrocyte sedimentation rate as a first step.
What is recommended if the C-reactive protein level is significantly elevated?
Joint aspiration is recommended to assess for prosthetic joint infection.
What are the most commonly affected areas in relapsing polychondritis?
The ears, which are affected most often (sparing the lobule, which does not contain cartilage), as well as the nose, trachea, and bronchi.
What are bronchi and joints frequently affected by?
They are frequently affected by various conditions.
What must a patient be capable of to make a decision?
The patient must be capable of understanding the information provided and its relevance, as well as making and communicating a decision.
What is the most likely diagnosis for a young woman with abdominal pain, palpable purpura, and arthritis?
The most likely diagnosis is immunoglobulin A vasculitis.
Where is the characteristic pain of patellofemoral pain syndrome located?
The pain is located behind the kneecap and worsens with squatting, sitting for prolonged periods, and ascending or descending stairs.
What is hydroxyapatite crystal deposition disease of the shoulder characterized by?
It is characterized by a large shoulder effusion with associated destructive arthritis of the glenohumeral joint and often with calcification of periarticular tissue.
What vaccinations should a patient over 50 years of age with systemic lupus erythematosus receive?
The patient should receive influenza and pneumococcal vaccinations, as well as the recombinant zoster vaccine.
How can arthritis in AOSD present?
Arthritis in AOSD can be transient and/or migratory, or it can be a fixed symmetric polyarthritis.
What is polyarteritis nodosa associated with?
It is a vasculitis of medium- to small-sized arteries associated with hepatitis B virus infection.
What uricosuric effects does Losartan have?
Losartan has been shown to have uricosuric effects and may be a preferred agent for treating hypertension.
What causes arthritis in patients with gout?
Gout is caused by the deposition of uric acid crystals in joints.
How does Neisseria gonorrhoeae cause arthritis?
It causes arthritis through disseminated gonococcal infection, spreading through the bloodstream.
What are the symptoms of disseminated gonococcal infection?
Symptoms include pustular or vesiculopustular skin lesions, constitutional symptoms, and tenosynovitis or arthritis.
What is a common knee syndrome in athletes with lateral knee pain?
Iliotibial band syndrome.
How can calcium hydroxyapatite crystals be visualized?
They can be visualized by electron microscopy or by alizarin red staining.
What is the association of lupus induced by TNF inhibitors?
It is associated with a higher incidence of cutaneous manifestations and a higher frequency of positive anti-double-stranded DNA antibodies.
What is the preferred treatment for osteoarthritis in patients with chronic kidney disease?
Topical NSAIDs are preferred over oral NSAIDs.
What defines oligoarticular JIA?
Oligoarticular JIA is defined as synovitis of up to four large joints, typically the knees and ankles.
How does systemic lupus erythematosus typically manifest?
It typically manifests with cytopenias, symmetric arthritis, and fixed skin findings.
What characterizes drug-induced lupus?
It is typically skin limited or systemic, although it rarely affects the kidneys.
What is the initial management for patellofemoral pain syndrome?
The initial management is quadriceps strengthening.
What type of joint inflammation can occur in IBD?
Joint inflammation in IBD can involve the sacroiliac joint.
What type of joint involvement can occur in IBD?
Inflammation can involve the sacroiliac joint and axial skeleton, similar to ankylosing spondylitis.
What are the types of arthritis that can occur in IBD?
It can be peripheral arthritis, dactylitis, or tenosynovitis.
What does synovial fluid analysis show in septic arthritis?
Typically shows an elevated leukocyte count of 50,000 to 100,000 cells per mm³ and at least 75% neutrophils.
Which CMP values are typically elevated in sarcoidosis?
Creatinine, calcium, and alkaline phosphatase.
What is the first choice of therapy for arthritis in reactive arthritis?
NSAID therapy.
What combination of symptoms is most consistent with a diagnosis of sarcoidosis?
The combination of uveitis and junctional bradycardia.
What is the appropriate initial management for a lateral ankle sprain?
RICE and an air-stirrup or lace-up brace.
What is the typical joint involvement in reactive arthritis?
Typically oligoarticular and asymmetric, often affecting the lower extremities and may involve the spine.
What is the initial treatment for suspected nonradiographic axial spondyloarthritis?
Consists of nonsteroidal antiinflammatory drug therapy and physical therapy.
What triad of symptoms is characteristic of Löfgren syndrome?
Arthritis, erythema nodosum, and hilar adenopathy.
What is the rash in AOSD like?
A salmon-colored maculopapular eruption involving the trunk and extremities, evanescent and may resolve with fever.
What should a pregnant woman with systemic lupus erythematosus and positive anti-Ro antibodies undergo?
Fetal cardiac ultrasound due to the risk for complete heart block.
What does radiculopathy that results in discomfort at the medial thigh indicate?
Most likely to originate from lumbar level L2.
What do current guidelines recommend measuring for evaluating possible prosthetic joint infection?
C-reactive protein level and erythrocyte sedimentation rate.
What is the first step in evaluating for possible prosthetic joint infection?
Joint aspiration is recommended to assess for prosthetic joint infection.
What does a negative antinuclear antibody test indicate?
A negative antinuclear antibody test almost always rules out lupus.
What should the goal of physical therapy be for a meniscus tear?
The goal should be strengthening the quadriceps and hamstring muscles to provide support to the joint.
What is Type I Cryoglobulinemic vasculitis associated with?
It is associated with self-aggregating monoclonal immunoglobulins and is usually secondary to B-cell or plasma-cell malignancies.
In which age group do PMR and GCA tend to occur?
They tend to occur in older patients, often >60 years old and almost exclusively >50 years old.
What is characteristic of Löfgren syndrome?
The triad of arthritis, erythema nodosum, and hilar adenopathy is characteristic of Löfgren syndrome.
What are patients with systemic sclerosis at increased risk for?
They are at increased risk for pulmonary complications of interstitial lung disease and pulmonary arterial hypertension.
What should be considered if high-dose calcium-channel blockers are ineffective in pulmonary arterial hypertension?
Alternative treatments such as prostacyclin pathway agonists, endothelin receptor antagonists, or phosphodiesterase type 5 inhibitors can be considered.
What effect does allopurinol have on azathioprine metabolism?
Azathioprine metabolism is impaired by the use of allopurinol, a xanthine oxidase inhibitor.
What characterizes hydroxyapatite crystal deposition disease of the shoulder?
It is characterized by a large shoulder effusion with associated destructive arthritis of the glenohumeral joint.
Who should receive prophylaxis against PCP?
Prophylaxis is recommended for patients who are expected to be treated with prednisone 20 mg or greater for at least 3 weeks.
What is the initial treatment for suspected nonradiographic axial spondyloarthritis?
The initial treatment consists of nonsteroidal antiinflammatory drug therapy and physical therapy.
What is involved in the induction of remission in patients with active severe GPA?
Induction of remission involves glucocorticoids in combination with further immunosuppressive therapy, preferably rituximab.
What type of joint inflammation can occur in IBD?
Joint inflammation in IBD can involve the sacroiliac joint and axial skeleton, similar to ankylosing spondylitis, or it can be a peripheral arthritis, dactylitis, or tenosynovitis.
What are the capacity requirements for a patient in decision-making?
The patient must be capable of understanding the information provided, the relevance of the information to their specific situation, and must have the ability to make and communicate a decision.
What characterizes types II and III cryoglobulinemia?
In types II and III cryoglobulinemia, the immune complexes are polyclonal, either with (type II) or without (type III) a monoclonal component with rheumatoid factor activity.
What are common adverse effects of methotrexate therapy?
Oral ulceration and gastrointestinal symptoms are common adverse effects of methotrexate therapy and should be managed with supplementation with folic acid.
How can calcium hydroxyapatite crystals be visualized?
Calcium hydroxyapatite crystals can be visualized by electron microscopy or by alizarin red staining with visualization of eosinophilic clumps of amorphous material.
What can prolonged sitting lead to?
Prolonged sitting can lead to irritation of the bursa overlying the ischial prominence, resulting in the clinical syndrome of ischiogluteal bursitis.
What does an apprehension test involve?
An apprehension test involves applying pressure on the medial side of the patella while the knee is flexed. The test is positive if the patient has pain or tightens their muscles in anticipation of pain or because of a feeling of instability.
What conditions should be considered when the DIP is affected?
Psoriatic arthritis, tophaceous gout, and osteoarthritis should be considered when the DIP is affected.
What are key findings of Paget disease of bone?
Key findings of Paget disease of bone include elevated serum level of alkaline phosphatase, radiographic evidence of cortical thickening, coarsening of the trabeculae, lytic lesions, and increased uptake on bone scintigraphy.
What is a vasculitis?
A vasculitis is an inflammation of medium- to small-sized arteries.
What is polyarteritis nodosa?
A vasculitis of medium- to small-sized arteries that is associated with hepatitis B virus infection.
What is methotrexate?
A folate antimetabolite that inhibits dihydrofolate reductase and is a first-line disease-modifying agent.
How can calcium hydroxyapatite crystals be visualized?
They can be visualized by electron microscopy or by alizarin red staining with visualization of eosinophilic clumps of amorphous material.
What may gout result from?
Increased serum uric acid caused by commonly used medications such as thiazide and loop diuretics, low-dose aspirin, and niacin.
What are common manifestations of dermatomyositis?
Rash, muscle weakness, and interstitial lung disease.
Does the healthcare surrogate decision maker have power over the power of attorney?
True.
What is the most likely cause of chronic pain and squaring at the base of the thumb in an older patient?
Osteoarthritis of the first carpometacarpal joint.
What is key to early diagnosis of Complex Regional Pain Syndrome?
Identification of autonomic changes such as edema, skin mottling, sweating, or temperature change of the affected area.
What does polyarteritis nodosa (PAN) spare?
It spares the capillaries, which means it does not lead to glomerulonephritis but causes renal infarcts and renovascular hypertension.
What is the most likely diagnosis for a young woman with abdominal pain, palpable purpura, and arthritis?
Immunoglobulin A vasculitis.
What is lupus induced by TNF inhibitors associated with?
A higher incidence of cutaneous manifestations.
What is associated with a higher incidence of cutaneous manifestations?
Lupus induced by TNF inhibitors
Higher frequency of positive anti-double-stranded DNA antibodies and a lower frequency of antihistone antibodies.
What maneuver is used to diagnose de Quervain tenosynovitis?
The Finkelstein test
No back content.
What is the most sensitive diagnostic test for early inflammatory sacroiliitis?
The most sensitive diagnostic test for early inflammatory sacroiliitis is not specified in the provided text.
No back content.
What imaging is used for a patient with Crohn disease?
MRI of the sacroiliac joints
What is the most common cause of symptomatic cardiac disease in systemic lupus erythematosus?
Pericardial involvement
What percentage of patients with oligoarticular JIA develop temporomandibular joint arthritis?
Approximately 75%
What is the mainstay of treatment for fibromyalgia?
Lifestyle modifications
What condition is suggested by absent or diminished peripheral pulses in a young woman with arm claudication and elevated inflammatory markers?
Takayasu arteritis
What is the likely diagnosis for pain localized to the base of either thumb that radiates up the forearm with movement?
de Quervain tenosynovitis
Does musculoskeletal hip pain usually radiate below the knee?
No, it does not usually radiate below the knee
What do granulomas in the lung and skin suggest in the absence of other explanations?
Sarcoidosis
How does Neisseria gonorrhoeae cause arthritis?
It causes true joint infection that manifests as monoarticular or oligoarticular purulent arthritis
What type of pain does osteoarthritis of the hip cause?
Anterior hip and groin pain that can be reproduced by internal rotation of the hip
What laboratory results are typical in patients with AOSD?
Leukocytosis and a markedly elevated serum ferritin level
What is the most likely injury resulting from a twisting injury to the knee that causes catching and locking?
Injury to the meniscus
What tests are recommended for a patient with a new diagnosis of sarcoidosis?
An electrocardiogram
What tests are included for a patient with a new diagnosis of sarcoidosis?
Tests include an electrocardiogram, pulmonary function testing, complete blood count, serum levels of creatinine, calcium, alkaline phosphatase, and an ophthalmologic examination.
What must a patient be capable of regarding their medical information?
The patient must be capable of understanding the information provided and its relevance to their specific situation, as well as have the ability to make and communicate a decision.
What is the risk for a pregnant woman with systemic lupus erythematosus (SLE) and anti-Ro antibodies delivering a baby with complete heart block?
There is a 1% to 2% risk for delivering a baby with complete heart block.
How can arthritis in AOSD present?
Arthritis in AOSD can be transient and/or migratory or it can be a fixed symmetric polyarthritis.
How is calcific tendinitis treated?
Calcific tendinitis is treated conservatively with rest and NSAIDs, or steroid injections if conservative treatment does not work.
What does synovial fluid analysis in septic arthritis typically show?
It typically shows an elevated leukocyte count of 50,000 to 100,000 cells per mm3 and at least 75% neutrophils.
What is the appropriate initial management for a lateral ankle sprain?
The appropriate initial management is RICE and an air-stirrup or lace-up brace.
What joints can inflammation in IBD involve?
Joint inflammation in IBD can involve the sacroiliac joint and axial skeleton, similar to ankylosing spondylitis, or it can be a peripheral arthritis, dactylitis, or tenosynovitis.
What symptoms does Type I cryoglobulinemia caused by monoclonal cryoglobulins manifest?
It manifests with symptoms of hyperviscosity, particularly in body areas exposed to cold.
What does spondylolysis refer to?
Spondylolysis refers to a stress fracture in the pars interarticularis of the lumbar spine.
What is the most likely diagnosis in a patient with a history of cigarette smoking and occlusive arteriopathy leading to digital ischemia?
The most likely diagnosis is thromboangiitis obliterans.
What is the preferred treatment for acute calcium pyrophosphate crystal arthritis (pseudogout) involving a single joint?
The preferred treatment is intra-articular glucocorticoids.
What is a common treatment involving a single joint?
Intra-articular glucocorticoid injection.
Which patients are more likely to develop pulmonary arterial hypertension (PAH)?
Patients with limited systemic sclerosis and a positive anticentromere antibody result.
What is a hallmark for the diagnosis of plantar fasciitis?
Local tenderness in the distal aspect of the heel-pad overlying the medial calcaneal tubercle.
What are patients with systemic sclerosis at increased risk for?
Pulmonary complications of interstitial lung disease and pulmonary arterial hypertension.
What is the most likely diagnosis for a young woman with abdominal pain, palpable purpura, and arthritis?
Immunoglobulin A vasculitis.
What percentage of patients with inflammatory bowel disease have concurrent axial spondyloarthritis?
Approximately 10% to 15%.
How does a labral tear manifest in an otherwise healthy athletic patient?
As subacute anterior groin pain.
How can calcific tendinitis of the rotator cuff be distinguished radiographically?
By plain film radiographs showing the presence of calcifications in the soft tissues surrounding the affected tendon.
What is the best treatment for lateral epicondylitis that persists despite conservative measures?
Referral to physical therapy and initiation of eccentric exercises to the wrist extensors.
What are the vascular manifestations of Behçet disease?
Variable-size vasculitis and venous thrombosis.
What does the lateral femoral cutaneous nerve innervate?
The skin on the anterolateral hip to midthigh.
What is the joint most affected in gonococcal arthritis?
The knee.
What does osteoarthritis of the hip cause?
Anterior hip and groin pain that can be reproduced by internal rotation of the hip.
What is indicated by patchy sclerosis and areas of demineralization in the femoral head of a patient being treated long-term with glucocorticoids?
It is most consistent with a diagnosis of osteonecrosis of the femoral head.
What condition is associated with an increased incidence of osteonecrosis?
Systemic lupus erythematosus.
What is another term for osteonecrosis?
Avascular necrosis of bone.
Who is at especially high risk for developing osteonecrosis?
Patients treated long-term with glucocorticoids.
