Rheum

Question 1

Drugs that cause Lupus- like syndrome***

Answer 1

Procainamide

Hydralazine

Question 2

Conditions associated with Anti-Ro

Answer 2

Sjogresn (also Anti-La but not as specific)

SLE

Question 3

Conditions associated with Anti-Sm

Answer 3

SLE… most specific to SLE is Anti-dsDNA

Question 4

Conditions with HLA-B27***

Answer 4

95% sensitivity with ankylosing spondylitis
Reactive arthritis (Reiters)
Psoriatic arthritis
Seen in Northern Scandinavian descent

Question 5

Conditions with Anti-centromere

Answer 5

Calcinosis
Raynauds
Esophogeal dysmotility
Sclerodactyly
Telangiectasia

See eosinophilia with CREST

Question 6

Osteoarthritis

Answer 6

Most common form of arthritis
Joint space narrowing with loss of articular cartilage
affects hands most commonly
Heberdens= DIP
Bouchards=PIP
Acetaminophen is initial treatment!

Question 7

Rheumatoid arthritis

Answer 7

RF may be negative!!!
RA forms a pannus=destructive granulation of vascular tissue
In hands with MP and DIP...PIP spared
ulnar deviation at MP
NSAIDS and MTX (fast acting DMARDS

Question 8

Diagnosis of gout

Answer 8

Birefringent crystals with monosodium irate crystals
Tx NSAIDs: Inomethacin 1st line
Colchicine

Question 9

Polyarteritis Nodosa

Answer 9

idiopathic but related to Hep B and C and Hairy cell Leukemia
thickened vessel walls and luminal narrowing (DOES NOT involve veins, so not cause of DVT)
s/s: skin lesions-Livedo Reticularis, renal insufficiency, abdominal pain, arthralgia, myalgia
Labs: ANCA NEGATIVE, increased ESR

Question 10

Kawasaki disease diagnostic criteria

Answer 10

fever for 5 days with… (4/5 to dx, fever of 38.5 C/ 101.3 F)
conjunctival injection
strawberry tongue/fissured lips/oral mucous membrane changes
erythema or edema of hands/feet
polymorphous rash
cervical lymphadenopathy

Question 11

Kawasaki Disease Treatment

Answer 11

IVIG infusion with HIGH dose ASA until fever resolves for 2 months to prevent MI/ coronary artery aneurism

Question 12

Wegners Granulomatosis

Answer 12

Small vessel vasculatide so ANCA positive
upper and lower respiratory tract symptoms, hemoptysis, renal insufficiency
PE: Saddle nose deformity***

Question 13

Henoch-Schonlein Purpura

Answer 13

small vessel vasculitis common in children
Palpable purpura
Renal biopsy: Crescent cells and mesangial changes similar to IGA nephropathy
Self limiting in 1 month

Question 14

Lupus physiology

Answer 14

Type III hypersensitivity with antigen/antibody deposits in the basement membrane of the kidneys

Question 15

***Bamboo spine on xRay is associated with…

Answer 15

Ankylosing Spondylitis: Insidious back pain that improves with exercise, worse in the morning, seen in males in 20’s

Question 16

Polymyalgia rheumatica

Answer 16

Females over 50 (peak 70-80), aching and stiffness in shoulder and pelvic girdle… RELATED to Giant cell arteritis!!
ESR will be elevated
Responds very well to steroids!

Question 17

Giant Cell arteritis

Answer 17

women 70-80
sx: headache, fever, malaise, jaw pain/claudication
PE: temporal artery tenderness and pulsations
ESR >50
Dx: with temporal artery biopsy
Tx: corticosteroids and ASA

Question 18

***Sjogren’s syndrome is associated with what condition

Answer 18

Non-hodgkins lymphoma develops in 2.5%

Question 19

Diagnostic test for Sjogrens

Answer 19

Schirmer test (test strip on eye)

Question 20

*** Physical exam for dermatomyositis

Answer 20

Grotton’s sign= rash over PIP and MCP joints
Purple Heliotrope rash around eyes
Shawl sign= erythema over upper chest/traps

associated with malignancy

Question 21

Drugs to obtain PPD prior to use

Answer 21

TNF Inhibitors:
Enbrel
Infliximab (Remicaide)
Humira 
BBW of reactivating latent TB
(also do not administer live vaccines... MMR, Varicella, Flu)