Rheumatology

Question 1

Give the classic tetrad of Henoch-Schonoein Purpura // IgA Vasculitis

Answer 1

Palpable purpura
Glomeruloneohritis
Arthralgia
Abdominal Pain

Question 2

Give the antibody associated with drug-induced lupus, and the medications associated with it.

Answer 2

Antihistone Antibody
Caused by: Procainamide, Hydralazine, Chlorpromazine, and Quinidine

Minocycline

Question 3

Give the antibodies associated with Lupus. Which are associated with disease activity?

Answer 3

ANA, nearly 100% sensitive but not specific

Anti-dsDNA, specific, correlates with disease activity

Anti-Smith, specific

Question 4

Give antibodies for RA

Answer 4

RF, sensitive

Anti CCP, specific

Question 5

Give antibodies for scleroderma (limited and diffuse)

Answer 5

Limited: Anti-centromere

Diffuse: Anti-Scl 70, anti-topoisomerase

Question 6

Give the antibody for polymyositis/dermatomyositis

Answer 6

Anti-Jo-1 (anti Aminoacyl-transfer RNA synthetase)

Question 7

Give autoantibody for granulomatosis with poyangiitis (Wegener)

Answer 7

c-ANCA and anti-proteinase 3 (PR3)

Question 8

Sjogrens is associated with increased risk of…

Answer 8

Lymphoma, non-Hodgkin
MALT lymphoma
Type 1 RTA

Question 9

SLE is associated with what chronic morbidity…

Answer 9

Accelerated atherosclerosis, CAD

Question 10

Give the classic symptoms of reactive arthritis and associated infections

Answer 10

Conjunctivitis, Urethritis, and Arthritis (Also keratoderma blennorrhagicum— pustular rash in soles of feet)

GI: Salmonella, Shigella, Campylobacter, Yersinia

GU: Chlamydia and Ureaplasma

Question 11

What blood pressure medications should you avoid and selectively choose for gout

Answer 11

Switch from thiazides to LOsartan to LOwer serum urate

Question 12

Give the key skin findings, CK lab, and any key associations for Dematomyositis

Answer 12

Proximal muscle weakness
Gottron Papules
Héliotrope rash

Elevated CK

Strong association with underlying malignancy

Question 13

Give the classic sings of antisynthetase syndrome

Answer 13

Subtype of dermatomyositis and polymyositis associated with poor prognosis

ILD, Raynaud phenomenon, arthritis, and anti-Jo-1

“Hair, Chair, Stair, Air (ILD), and Beer (Dysphagia)”

Question 14

Give the classic findings for Granulomatosis with Polyangiitis (Wegener Granulomatosis)

Answer 14

Nodules of the UPPER and LOWER respiratory tract + Glomerulonephritis

+c-ANCA and anti-proteinase 3

Bx shows vasculitis and necrotizing granulomatosis

Question 15

Give the classic triad for Eosinophilic Granulomatosis with Polyangiitis (Churg-Strauss)

Answer 15

Asthma, Eosinophilia, and p-ANCA

Question 16

Describe Adult-Onset Still Disease

Answer 16

Daily fevers,
Salmon colored rash
Erosive arthritis
Lymphadenopathy
Splenomegaly

Seronegative

Question 17

Give the two common causes of Pulmonary-Renal Syndrome and how to differentiate them

Answer 17

Anti-glomerular basement membrane antibody disease (GBM, or Goodpasture Syndrme)

OR

Granulomatosis with Polyangiitis (Wegener’s). Upper respiratory involvement, systemic symptoms (fever, weight loss, arthralgia, fatigue)

Question 18

Give the findings and autoantibody for mixed connective tissue disease

Answer 18

Anti-U1-RNP (Ribonucleoprotein)

Findings of multiple rheumatic conditions

Question 19

Give key findings for PMR

Answer 19

Women > 50

Proximal shoulder and pelvic pain WITHOUT weakness

Normal CK

Dramatic response to steroids. Look for giant cell arteritis

Question 20

Define CREST Syndrome and give the autoantibody, associated problem

Answer 20

Calcinosis: subcutaneous calcium nodules

Raynaud phenomenon

Esophageal dysmotility

Sclerodactyly

Telangiectasia

Associated with anticentromere antibodies and pulmonary hypertension

Question 21

Give clinical features, diagnosis, and treatment if Polyarteritis nodosa

Answer 21

Clinical Fx:
Fever, wt loss
Nodules, livedo reticularis,
Mesenteric ischemia
Myalgias, arthritis
Headache, seizures
Orchitis, MI, retinal ischemia

Dx: -ANCA, -ANA. Associated with hepatitis B and C. Micoraneurysms on arteriography. Tissue box nongranulomatous vasculitis

Txt: Prednisone and Cyclophosphamide. ACEi for htn