Rheumatology

Question 1

What is the diagnosis associated with complete heart block in neonate?

Answer 1

Neonatal lupus erythematous

Question 2

What is the most likely diagnosis of patient with purpuric rash on buttocks, abdominal pain, arthralgia, hematuria and proteinuria?

Answer 2

IgA vasculitis (Henoch Schonlein Purpura)

Question 3

What is the most likely diagnosis for patient under 16 years old with daily self resolving fever, swelling of joints for more than 6 weeks and macular salmon pink rash on trunk and proximal extremities when febrile?

Answer 3

Systemic Juvenile Idiopathic Arthritis

Question 4

What is the most likely diagnosis of patient with arthritis of small joints especially of the DIP joint of finger for more than 6 weeks, abnormal nail findings, risk of anterior uveitis and periostitis (new bone formation despite no fracture) on Xray?

Answer 4

Psoriatic juvenile idiopathic arthritis

Question 5

What test is specific for systemic lupus erythematosus?

Answer 5

anti-double stranded DNA antibody

Question 6

What is the most likely diagnosis of patient with progressive proximal muscle weakness, elevated CK (creatine kinase), abnormal EMG, muscle biopsy changes, heliotrope sign and Gottren papules?

Answer 6

Juvenile Dermatomyositis
(tx: high dose steroids)

Question 7

… is swollen eyelids with distinctive reddish purple rash involving the upper eyelids and suggestive of Juvenile Dermatomyositis

Answer 7

Heliotrope Sign

Question 8

… are papular erythematous, papulosquamosus lesion on dorsal surface of knuckles and associated with Juvenile Dermatomyositis

Answer 8

Grotton papules

Question 9

A patient with monoarticular arthritis of lower extremities with associated pain and swelling at insertion of Achilles tendon and of plantar fascia on the calcaneus, dysuria/ urethritis, mucocutaneous lesions of mouth and genitals and conjunctivitis in setting of Chlamydia/ Campylobacter/ Shigella/ Salmonella infection most likely suffers from…

Answer 9

Reactive Arthritis

can’t see, can’t pee, can’t climb a tree

Question 10

What is the most likely diagnosis for patient age 6 months to 7 years who presents with fever, cervical lymphadenopathy, oral aphthous ulcers, and sore throat which resolves in 5 days but recurs every 4 weeks? What is treatment?

Answer 10

PFAPA (periodic fever with aphthous stomatitis, pharyngitis, and cervical adenitis)
(tx: steroids)

Question 11

What is the most likely diagnosis for patient presenting with sacroiliac joint tenderness, pain and swelling at Achilles insertion, positive HLA-B27, morning stiffness and family history?

Answer 11

Enthesitis- related arthropathy

Question 12

What is the treatment for reactive arthritis?

Answer 12

NSAIDs

obtain baseline labs

Question 13

What is the most likely diagnosis for patient with hip/ thigh pain with lower extremity held slightly externally rotated and internal rotation produces pain in setting of SLE/ chronic steroid use/ connective tissue disorder?

Answer 13

Avascular Necrosis of femoral head

Question 14

What is the most likely diagnosis for patient with chorea (neuro deficits), oral ulcers, serositis, renal disease, anemia, leukopenia, malar rash, discoid rash, photosensitivity and positive ANA?

Answer 14

Systemic Lupus Erythematosus (SLE)

Question 15

what is the most likely diagnosis for patient with history of systemic JIA presenting with persistent fever, hepatosplenomegaly, increased ferritin, cytopenia, liver dysfunction, coagulopathy, decreased fibrinogen, and hemophagocytosis by histiocytes on bone marrow?

Answer 15

Macrophage activation syndrome

Question 16

What is the most common cause of septic arthritis?

Answer 16

S. Aureus

Question 17

What two conditions are associated with worse prognosis for patient with SLE (lupus)?

Answer 17

1. nephritis

2. neuro abnormalities

Question 18

What is the most likely diagnosis for patient with fever for 3-7 days every 1-2 months, abdominal pain, diarrhea, nondestructive large joint arthritis, and macular rash with negative ANA?

Answer 18

Hyperimmunoglobuin D syndrome

dx: immunoglobulin D and E elevated

Question 19

What is the most likely diagnosis for patient with recurrent fevers, urticaria and joint pain who develops sensorineural hearing loss and renal failure as get older?

Answer 19

Muckle-Wells syndrome

tx: IL- 1 inhibitors like anakinra, rilonacept, canakinumab

Question 20

What is the most likely diagnosis for patient presenting with Raynaud’s phenomenon (finger pain with white, blue, red discoloration in cold), tortuous dilated vessels in nailbed and positive anti-U1 RNP antibody?

Answer 20

Mixed Connective Tissue Disease

risk of pulmonary HTN

Question 21

What is the most likely diagnosis for patient of Mediterranean decent presenting with recurrent episodes of fever, abdominal pain, testicular pain, and swelling of knee and ankles?

Answer 21

Familial Mediterranean Fever

Question 22

What is the treatment of choice for complex regional pain syndrome (exaggerated and prolonged pain without fracture after an injury)?

Answer 22

Physical therapy

Question 23

What GI manifestation is associated with IgA vasculitis (formerly known as Henoch Schonlein purpura)?

Answer 23

Intussusception