rheumatology

Question 1

henoch-schonlein purpura

Answer 1

IgA mediated vasculitis involving skin GI and kidneys
About age 5, males more common
Sx: viral syndrome precedes
- petechiae and palpable purpuric lesions on buttocks and lower extremities, edema of hands feet scrotum and scalp
- joint arthralgia or arthritis (knees and ankles(
- GI (colicky abdominal pain, GI bleeding, intussusception)
- renal issues
Tx: pain control and hydration

Question 2

kawasaki

Answer 2

acute febrile vasculitis of childhood, males more affected, asian children, 18-24 months
Sx: fever lasting > 5 days, bilateral conjunctivitis of bulbar, oropharygeal changes (strawberry tongue), cervical adenopathy unilateral, rash on trunk, edema of hands and feet (later peeling)
Complications: - coronary artery aneurysms
- urethritis
-aseptic meningitis
- hydrops of gallbladder
- arthritis
- anterior uveitis
Dx: increased ESR and CRP
Tx: IVIG and aspirin

Question 3

juvenile rheumatoid arthritis - pauciarticular

Answer 3

< four joints involved, 40% of cases
- early onset is females, ANA, chronic uveitis risk
- late onset is males, HLA B27, involvement of hips and SI joint
Tx: NSAIDS, steroids, OT/PT

Question 4

juvenile rheumatoid arthritis - polyarticular

Answer 4

> four joints, 40% cases
RF negative and positive disease (children over 8 and more severe arthritis), articular involvement
Tx: NSAIDS, steroids, OT/PT

Question 5

juvenile RA - systemic onset

Answer 5

still’s dx
- high fevers
- salmon colored rash trunk and extremities
- HSM
- LAD
- fatigue, anorexia, weight loss, failure to thrive, serositis, CNS involvement, myositis, tenosynovitis
Tx: NSAIDS, steroids, OT/PT

Question 6

SLE

Answer 6

females, after 10

SOAP BRAIN MD
- serositis, oral/ ulcerations, arthritis, photosens, blood cytopenia, renal diseasea, ana positive, immunoserology abnl, neuro sx malar rash, discoid lupus

Sx: fever, weight loss, malaise, CNS involvement (sz, psychosis), malar rash, photosensitivity, raynauds, arthralgias and arthritis rarely causes joint deformity or erosion

• HSM, splenic infarction
• pericarditis, libman sacks endocarditis, congenital heart block
• pleuritis, renal involvement

Tx: NSAIDS, glucocorticoids, cyclophosphamide

Question 7

dermatomyositis

Answer 7

progressive muscle weakness with skin findings, 5-14 y/o, females
Sx: fatigue, anorexia, malaise, fevers, weight loss, periorbital violaceous heliotrope rash, gottron’s papules (skin over MIP and PIP), proximal muscle weakness
- neck flexor muscle weakness, calcinosis, nail bed telangiectasias, constipation, dysphagia, cardiac involvement
Tx: steroids, vit D, calcicum
Complications: aspiration pneumo, intestinal perforation, osteopenia, no assoc with cancer

Question 8

rheumatic fever

Answer 8

from strep pyogenes pharyngitis
Sx: cardiac endocarditis and myocarditis, rarely pericarditis
- polyarthrtitis, sydenham’s chorea, erythema marginatum, subcutaneous nodules
Dx: ASO, anti DNAase and anti hyaluronidase
Tx: PCN with strep, NSAIDS and steroids

Question 9

reactive arthritis

Answer 9

inflammation of joints triggered by microorganism

Reiter’s - arthritis, urethrits, conjunctivitis

Question 10

psoriatic arthritis

Answer 10

small and large joints with psoriasis

Question 11

ankylosing spondylitis

Answer 11

male HLA-B27

Sx: enthesitis inflammation of tendinous insertions in bone and arthritis