Rheum

Question 1

Raynauds phenomenom that does not respond to nifedipine and with joint pains should get what kind of workup?

Answer 1

Ana, rF, c3/4

Question 2

IG deficiency has what?

Answer 2

Ie. IGG def causes recurrent sinopulm inf and GI infections

Remember incr risk of malign

Question 3

Symmetric polyarthritis involving MCP and PIP joints with morning stuffness for more than 6 wks more than 1 hr

Answer 3

Diagnose clinically RF. can check rf factor and anti CCP

Tx w NSAIDS. If severe and xray shows erosive joint dz then give sulfasalazine, methotrex

Also if aspirate see NO crystals

Could also be parvovirus BUT only lasts weeks

Question 4

Polyarthritis with morning stiffness lasting LESS than 30 min with other constitutional prk lens like dm2, weak, decr libido, hepatomeg. Xray shows subchondral cysts, sclerosis, osteopenia. Aspiration shows pos bifringent crystals line CPPD (calcium) which is PSEUDOGOUT,

Answer 4

Hemochromatosis

Question 5

OA spares which joints in hands?

Answer 5

MCP

Question 6

Reactive arthritis affects which joints?

Answer 6

DIP. Assoc with urethritis or conjunctivitis

Question 7

Hemochromatosis labs include:

Answer 7

Iron, transferrin, ferritin levels

transferrin >50% with high ferritin and iron

Dx with liver biopsy

Question 8

RA tx

Answer 8

To slow progression of joiny dz, control synovitis

Tx w dmards like methotrexate and steroids first. If doesnt work then switch to
Anticytokine drug like infliximab and etanercept but must check ppd before

Question 9

Classical presentation of sarcodosis is

Answer 9

B/l hilar adenopathy in 90% pts with or wo lung involvement

Hypercalcemia only happens in 20% of pts

Question 10

Best test for lupus and for lupus activity after the ANA is done?

Answer 10

Anti ds dna can follow course of disease and assoc w development of lupus nephritis

Question 11

Lupus tx- esp if have arthalgias and cutaneous symptoms

Answer 11

Steroids tor short term relief
Hydroxychloroquine long term to prevent kidney and cns involvement

If severe organ damage then methotrexate

Question 12

20s yr old guy w back pain and morning stiffness impr with exercise, decr chest expansion has what?
What is test to diagnose

Answer 12

Ankylosing spondylitis

Plain xray of sacroiliac joint to eval for sacroiliitis

Assoc with uveitis

Question 13

To monitor disease activity in ankylosing spondylitis- what to do?

Answer 13

Xray after 3 month

Can also check EST

Question 14

Life expectancy of ankylosing spondylitis incr, decr, or same?

Does smoking have effect?

Answer 14

Same

Smoking worsens bc of restrictive lung dz

Question 15

Mono or oligoarthritis not due to trauma in 20s yr old usually due to

What is unique finding about the tendons?

Answer 15

Gonococcal arthritis- esp if sex active

Usually see wbc>50k but may be less

Dx w many cultures- joint, urethral/cervical/rectal/oral since joint cx may be neg in 50%

Have tenosynovitis- inflammed tendons or may even get a vesiculo-pustular rash

Question 16

Lupus pt in 30s who has cardiac arrest and dies. What is most likely cause of cardiac arrest?
Cad
Coronary vasculitis
Cardiac tamponade

Answer 16

Cad!! 50x incr. lupus accelerates atherosclerosis

Question 17

Sarcoidosis w bl hilar lad and erythema nodosum- need tx?

Answer 17

Nope!! Spontaneously remits and good prognosis!! Tx it hyperca etc w steroids!!

Question 18

37 yo aa woman w raynauds, gerd, now w severe htn, ha, aki, blurred vision has

Answer 18

Scleroderma crisis- esp when have gerd and raynaud

Not fibromusc dysplasia which is cause of renal artery stenosis

Question 19

Tx of scleroderma htn crisis

Answer 19

Ace inh like captopril to reverse some angiotensin induced vasoconstriction as well as nitropruss

Question 20

Tx of hyperca in sarcoidosis

Answer 20

Steroids!!!!