Rheum

Question 1

HLA-DR3

Answer 1

a/w DM-1, systemic lupus erythematosus and Graves’ disease.

Question 2

HLA-B27

Answer 2

a/w ankylosing spondylitis, Reiter’s syndrome (arthritis, urethritis, and conjunctivitis).

Question 3

HLA-B51

Answer 3

a/w Behçet’s syndrome.

Question 4

HLA-D11

Answer 4

a/w Hashimoto’s disease

Question 5

HLA-DR2

Answer 5

a/w Goodpasture’s syndrome and multiple sclerosis.

Question 6

Pancreatic tumors, hyperparathyroidism, and pituitary tumors (prolactinoma/ ACTH/GH-secreting adenomas)

Answer 6

Type I multiple endocrine neoplasia (MEN-I), AD

Question 7

Recurrent peptic ulcers due to excessive gastrin secretion by a gastrinoma, either in the pancreas or elsewhere in the gastrointestinal tract

Answer 7

Zollinger-Ellison syndrome causes

Question 8

Hypercalcemia, hypophosphatemia, and elevated levels of serum parathyroid hormone

Answer 8

Hyperparathyroidism

Question 9

Medullary thyroid cancer, pheochromocytoma, and hyperparathyroidism

Answer 9

MEN 2A: type IIA multiple endocrine neoplasia

Question 10

Medullary thyroid cancer, pheochromocytoma, and mucosal neuromas

Answer 10

MEN 2B: type IIB multiple endocrine neoplasia

Question 11

Depressed mental status and hypothermia, and can also involve bradycardia, hypotension, hypoglycemia, and hyponatremia

Answer 11

Myxedema coma: hypothyroid emergency

Question 12

CREST Sx? Rx?

Answer 12

Calcinosis (IVF), Raynaud’s (CCB), Esophageal dysmotility (PPI), Sclerodactyly, and Telangiectasias

Question 13

AL Amyloidosis a/w?

Answer 13

Multiple Myeloma, Waldenstroms Macroglobullinemia

Question 14

AA Amyloidosis a/w?

Answer 14

Chronic infl dz/inf- Rheumatoid arthritis, IBD, TB, Osteomyelitis

Question 15

Antimitochondrial

Answer 15

1° biliary cirrhosis

Question 16

Anti-smooth muscle

Answer 16

Autoimmune hepatitis

Question 17

Anti-U1 RNP (ribonucleoprotein)

Answer 17

Mixed connective tissue disease

Question 18

CREST syndrome sx? Elevated ab?

Answer 18

Calcinosis, Raynaud’s phenomenon, Esophageal dysmotility, Sclerodactyly, Telangiectasias. Elevated anti-centromere and/or anti-nucleolar autoantibodies.

Question 19

Cytoplasmic Anti-Neutrophil cytoplasmic autoantibody

Answer 19

Wegener’s granulomatosis, sinusitis, lungs and kidneys

Question 20

anti-Scl-70 antibody (anti-DNA topoisomerase I)

Answer 20

diffuse cutaneous systemic sclerosis (DCSS); widespread skin involvement, rapid progression, early visceral involvemen; death from pulmonary fibrosis

Question 21

AntiCentromere antibody

Answer 21

Limited scleroderma—limited skin involvement confined to fingers and face. Also with CREST involvement

Question 22

Anti-Smith autoantibodies, anti–double-stranded DNA autoantibodies, ANA

Answer 22

Systemic lupus erythematosus (SLE)

Question 23

Anti-SSA, anti-SSB (anti-Ro, anti-La)

Answer 23

Sjögren’s sx w dry eyes, dry mouth, and enlarged salivary glands

Question 24

p-ANCA (MPO-ANCA)

Answer 24

Microscopic polyangiitis, Churg-Strauss syndrome

Question 25

Antimicrosomal, antithyroglobulin

Answer 25

Hashimoto thyroiditis

Question 26

Anti-glutamate decarboxylase

Answer 26

Type 1 diabetes mellitus

Question 27

Antihistone

Answer 27

Drug-induced lupus

Question 28

Anti-Jo-1, anti-SRP, anti-Mi-2, +ANA

Answer 28

Polymyositis, dermatomyositis

Question 29

Anti-desmoglein

Answer 29

Pemphigus vulgaris

Question 30

Anti-hemidesmosome

Answer 30

Bullous pemphigoid

Question 31

Anti-cardiolipin, lupus anticoagulant

Answer 31

SLE, antiphospholipid syndrome

Question 32

Anti-dsDNA, anti-Smith, ANA (not specific)

Answer 32

SLE

Question 33

Rheumatoid factor (antibody, most commonly IgM, specific to IgG Fc region), anti-CCP (anti- cyclic citrullinated peptide)

Answer 33

Rheumatoid Arthritis; sx>6months, morning joint stiffness >1hr, joint swelling, involes PIP/MCP, spares DIP

Question 34

Daycare/school teacher p/w 10days of b/l arthalgia/arthritis of PIP/MCP/wrists/knee/ankle, fatigue, intermittent diarrhea, mild itchy skin patches; dx?

Answer 34

Parvovirus B19 (B19 IgM), self resolves in 2-3 weeks

Question 35

Drugs that cause lupus-like sx w/ malar rash, fevers, arthritis, positive ANA

Answer 35

Procainamide, hydralazine, isoniazid, minocycline, propylthiouracil, lithium, carbamazepine, and phenytoin.

Question 36

2 wks Post BM transplant maculopapular rash on hands, feet, face, bloody diarrhea, elevated ALT/AST; rx?

Answer 36

GVHD Graft vs Host Dz w/ donor T-cell activation

Question 37

Rhabdomyolysis labs?

Answer 37

Elevated K, Cr, BUN (BUN:Cr

Question 38

F >50yo p/w Pain and stiffness in shoulders hips w morning stiffness, mild fever, malaise, and wt loss, fatigue; elevated ESR, CRP, normal CK.

Answer 38

Polymyalgia rheumatica (PMR) a/w temporal (giant cell) arteritis; Rapid response to low-dose corticosteroids (prednisone 10-20mg).

Question 39

F 20–50 YO. Chronic, widespread msk pain a/w stiffness (improves w use), paresthesias, poor sleep, and fatigue.

Answer 39

Fibromyalgia; rx regular exercise, antidepressants (TCAs, SNRIs), and anticonvulsants. (amitriptyline 1st, fluoxetine, chlorpromazine, cyclobenzaprine.)

Question 40

F p/w progressive symmetric proximal muscle weakness, "can't comb hair" (involves shoulders), Elevated CK; dx? ab? Rx?

Answer 40

Polymyositis, characterized by endomysial inflammation with CD8+ T cells,􏰆 positive ANA, anti-Jo-1, anti-SRP, anti-Mi-2 antibodies; rx steroids

Question 41

Pt p/w uveitis, urethritis, and arthritis; penile ulcer, Dx? a/w?

Answer 41

Reactive arthritis (Reiter's, seronegative spondyloarthropathy); Post-GI (Shigella, Salmonella, Yersinia, Campylobacter) or Chlamydia; a/w HLA-B27, RF/ANA negative

Question 42

Pt. p/w exertional dyspnea cxr b/l basilar reticulonodular infiltrates, elevated antitopoisomerase or anti-Scl-70 and ANA, normal anti-centromere ab

Answer 42

interstitial pulmonary fibrosis from diffuse cutaneous systemic sclerosis (DCSS)

Question 43

45yof p/w fatigue, myalgia, proximal muscle weakness, sluggish ankle reflex, normal ESR, elevated CK, dx?

Answer 43

Hypothyroid myalgia, check TSH

Question 44

10 yof p/w wk of high-spiking fevers, arthritis, salmon-colored macular rash lymphadenopathy, HSM; dx?

Answer 44

Systemic-onset juvenile rheumatoid arthritis (JRA)

Question 45

Enlarged DIP (Heberden’s) and PIP (Bouchard’s) joints, w joint space narrowing, subchondral sclerosis, osteophytes, and subchondral cysts.

Answer 45

Osteoarthritis

Question 46

Smoker p/w lower lobe lesion, wt loss, symmetric proximal muscle weakness, erythematous rash on dorsum of fingers and upper eyelids; dx?

Answer 46

Dermatomyositis, paraneoplastic (a/w malignancies); inflammatory damage of muscle fibers w/ elevated CK, (Gottron's fingers)

Question 47

Pt. w celiac dz p/w pruritic herpetiform rash of small erythematous vesicular papules; dx/rx?

Answer 47

Dermatitis Herpetiformis; rx Dapsone and gluten free

Question 48

Recurrent nasal discharge, post nasal drip, anosomia, asthma hx, NSAID use; dx?

Answer 48

Aspirin associated nasal drip with Nasal Polyps

Question 49

sinusitis, hemoptysis, hematuria, red cell casts; CXR: large nodular densities.

Answer 49

Granulomatosis with polyangiitis (Wegener); focal necrotizing vasculitis, n. granulomas in the lung, n. glomerulonephritis; rx cyclophosphamide, corticosteroids.

Question 50

Necrotizing vasculitis involving lung, kidneys, skin with pauci-immune glomerulonephritis and palpable purpura, mononeuritis multiplex

Answer 50

Microscopic polyangiitis, rx cyclophosphamide and corticosteroids.

Question 51

Asthmatic p/w sinusitis, palpable purpura, peripheral neuropathy (wrist/foot drop), eosinophilia, pulmonary infiltrates; dx, rx?

Answer 51

Churg-Strauss syndrome; p-ANCA, IgE; Can also involve heart, GI, kidneys (pauci-immune glomerulonephritis)

Question 52

Recurrent oral aphthous and genital ulcers, eye lesions, skin lesions, and a positive pathergy test (a pinprick that turns into a pustule)

Answer 52

Behçet’s dz, systemic vasculitis that affects arteries and veins of all sizes

Question 53

25yoF p/w absent or decreased brachial artery pulse, subclavian bruit, pain along the vessels, unequal pulses, claudications

Answer 53

Takayasu’s arteritis, also known as “pulseless disease

Question 54

44yoF p/w headaches, fever, anemia, tender temporal regions, elevated ESR, alkPhos, IgG, complement, normochromic anemia

Answer 54

Temporal arteritis, also known as giant cell arteritis; high dose steroids

Question 55

wart-like vegetations on both sides of valve.

Answer 55

Libman-Sacks endocarditis - SLE

Question 56

Pt. p/w RHF, GERD, HTN, thick skinned swollen fingers, elevated antitopoisomerase or anti-Scl-70 and ANA, normal anti-centromere ab

Answer 56

Systemic sclerosis (DCSS) (widespread Scleroderma), fibrosis of pulmonary (RHF), esophagus (GERD), kidneys (HTN)

Question 57

Minutes post transfusion hypotension, respiratory distress and shock; dx/rx?

Answer 57

IgA deficiency anaphylactic reaction; rx intramuscular epinephrine w/ respiratory support

Question 58

Within an hour post blood transfusion p/w fever, chills, flank pain, hemoglobinuria; dx?

Answer 58

ABO mismatch hemolytic transfusion reaction, may progress to DIC

Question 59

SE for Cyclosporine and Tacrilimus (Calcineurin inhibitors)

Answer 59

Nephrotoxic, HypERkalemia, HTN, tremor; Hirsutism and gum hyperplasia unique ot Cyclosporine

Question 60

SE for Mycophenolate (IMDPH purine synthesis inhibitor)?

Answer 60

Bone Marrow suppression

Question 61

SE for Azathioprine (purine analogue)?

Answer 61

Dose related leukopenia, diarrhea, hepatotoxicity