Rheum/MSK

Question 1

Disease associated with polymyalgia rheumatica

Answer 1

Giant cell / temporal arteritis

Question 2

Specific serologic markers of Sjogren syndrome

Answer 2

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

ANA and RF may also be positive but are not specific

Question 3

Specific serologic markers of polymyositis and dermatomyositis

Answer 3

anti-Jo-1 and anti-Mi-2

ANA may also be positive but is not specific

Question 4

Erythematous rash on dorsal fingers and upper eyelids with muscle weakness

Answer 4

Dermatomyositis

Question 5

First choice treatment in mild knee OA

Answer 5

Topical NSAIDs like diclofenac or ketoprofen

Question 6

Initial maintenance treatment in most RA patients

Answer 6

Methotrexate

Question 7

What can be done to reduces AEs associated with methotrexate?

Answer 7

Give with folate (to prevent macrocytic anemias, as it inhibits dihydrofolate reductase)

Question 8

Rare but serious effect of hydroxychloriquine that must be monitored for?

Answer 8

Retinopathy

Question 9

DMARDs that can trigger hemolysis in G6PDD (2)

Answer 9

Sulfasalazine and hydroxychloroquine

Question 10

Felty syndrome

Answer 10

Severe RA, neutropenia, and splenomegaly

Question 11

HLA associated with RA? Seronegative spondylarthropathies?

Answer 11

RA: DR4

Seronegative spondylarthropathies: B27

Question 12

Seronegative spondylarthropathies

Answer 12

PAID:

• Psoriatic arthritis
• Ankylosing spondylitis
• IBD-associated arthritis
• Reactive arthritis

Question 13

Most common extra-articular manifestation of ankylosing spondylitis

Answer 13

Anterior uveitis

Question 14

Triad of reactive arthritis?

Treatment?

Answer 14

Conjunctivitis, urethritis, and oligoarthritis

Treatment: NSAIDs are first-line

Question 15

Arthritis with high fevers and a salmon-colored bumpy rash

Answer 15

Adult-onset Still’s disease (usually RF and ANA negative)

Question 16

Crystals of gout? Pseudogout?

Answer 16

Gout: uric acid
Pseudogout: calcium pyrophosphate dihydrate

Question 17

Classic medication that triggers gout?

Answer 17

Thiazide and loop diuretics (via hyperuricemia)

Aspirine and cyclosporine can as well

Question 18

Joint pain with punched-out erosions on rim of cortical bone

Answer 18

Gout

Question 19

Joint pain with chondrocalcinosis

Answer 19

Pseudogout

Question 20

Classic disease that can lead to pseudogout

Answer 20

Hereditary hemochromatosis (iron deposition leads to chondrocalcinosis)

(Also associated with hyperparathyroid and thypothyroid)

Question 21

Acute, polyarticular symmetric arthritis with a rash?

Treatment?

Answer 21

Parvovirus B19

No specific treatment (self-limited, 2-3 weeks)

Question 22

Tenosynovitis, dermatitis, and asymmetric migratory polyarthralgias?

Treatment?

Answer 22

Disseminated gonococcal infection (can also cause a purulent monoarthritis)

Treatment: Drain any septic joint, IV ceftriaxone (+axithro or doxy for chlamydia)

Question 23

Specific markers of SLE

Answer 23

anti-dsDNA and anti-SM (a.k.a. anti-Smith)

ANA is more sensitive but less specific

Question 24

Specific marker of drug-induced SLE

Answer 24

Anti-histone

Question 25

Thrombosis and prolonged aPTT with positive VDRL

Answer 25

Anti-phospholipid syndrome

Question 26

Markers of antiphospholipid syndrome

Answer 26

Anticardiolipin, anti-beta2-glycoprotein-I, and lupus anticoagulant

Question 27

Treatment of antiphospholipid syndrome in pregnancy

Answer 27

LMWH (decreases risk of miscarriage) | Warfarin is CI in pregnancy

Question 28

Specific marker of limited cutaneous systemic sclerosis (e.g. CREST)

Answer 28

Anti-centromere (ANA positive but less specific) (Anti-topo I and RNA pol III are for diffuse scleroderma)

Question 29

Specific marker of diffuse cutaneous systemic sclerosis?

Answer 29

Anti-topoisomerase I (a.k.a. anti-Scl-70) and anti-RNA pol III (Anti-centromere is for limited scleroderma / CREST)

Question 30

CREST manifestations? | Another severe manifestation that is not part of the mnemonic?

Answer 30

``` Calcinosis cutis Raynaud phenomenon Esophageal dysmotility Sclerodactyly Talangiectasia ``` Pulmonary hypertension

Question 31

Three key manifestations of diffuse cutaneous systemic sclerosis?

Answer 31

1. Interstitial lung disease 2. Myocardial fibrosis and CHF 3. Scleroderma renal crisis (AKI + microangiopathic hemolysis and thrombocytopenia)

Question 32

Vasculitis of arorta and primary branches in young Asian women

Answer 32

Takayasu arteritis

Question 33

Emergency in giant cell arteritis? | Treatment?

Answer 33

Anterior ischemic optic neuropathy presenting with sudden monocular vision loss Treat with high-dose IV steroids

Question 34

Screening imaging in giant cell arteritis

Answer 34

CXR for aortic aneurysm

Question 35

What is associated with cANCA? pANCA?

Answer 35

cANCA: GPA/Wegener's pANCA: EGPA/Churg-Strauss and MPA

Question 36

Organ systems involved in GPA/Wegener's?

Answer 36

1. Upper respiratory (chronic rhinosinusitis/otitis) 2. Lower respiratory (tracheal narrowing, cavitary lung nodules) 3. Renal (GN, possibly RPGN) 4. Skin (livedo reticularis, non-healing ulcers)

Question 37

Recurrent oral and genital ulcers

Answer 37

Behcet's disease

Question 38

Urine hydroxyproline

Answer 38

Specific marker of bone turnover, elevated in e.g. Paget disease of bone

Question 39

Bone pain + hearing loss

Answer 39

Paget disease of bone

Question 40

Benign but locally agressive tumor of osteoclast-like giant cells? Appearance on MRI? Treatment?

Answer 40

Giant cell tumor of bone MRI: Expansive "soap bubble" lesion Treat with resection

Question 41

Frozen shoulder

Answer 41

Adhesive capsulitis

Question 42

Tendon inflammation from repeat abduction and extension of the thumb in a new mother?

Answer 42

De Quervain tenosynovitis

Question 43

First step in suspected epidural spinal compression

Answer 43

IV glucocorticoids

Question 44

Hemarthrosis with knee injury suggests...

Answer 44

ACL tear (rare in MCL and meniscus tears unless the ACL is also torn)

Question 45

Localized anterior medial tibial pain not aggrevated by valvus stress with normal x-rays

Answer 45

Pes anserinus pain syndrome (PAPS)

Question 46

Anterior knee pain elicited while extending the knee while compressing the patella

Answer 46

Patellofemoral pain syndrome (PFPS)

Question 47

Tenderness at the inferior patella

Answer 47

Patellar tendonitis ("jumper's knee")

Question 48

Arc of ecchymosis distal to the medial malleolus

Answer 48

Ruptured popliteal (Baker) cyst

Question 49

Focal pain in the plantar rearfoot that is worst when first get up and later in the day

Answer 49

Plantar fasciitis

Question 50

Numbness, aching, and burning in the distal forefoot from the metatarsal heads to the 3rd and 4th toes of a runner

Answer 50

Morton / interdigital neuroma (actually not a neuroma but mechanically-induced degeneration of interdigital nerves)

Question 51

Pain on weight bearing, hip abduction, and internal rotation with normal labs and x-rays

Answer 51

Avascular necrosis of the hip | Late x-ray shows crescent-sign, an area of subchondral lucency