Rheumatology

Question 1

Calcium Pyrophosphate Dihydrate
Prism shaped crystals
Positive birefringence

Hint : all have Ps.

Answer 1

Pseudogout

Pseudogout With a P.
Gout has no P. Has negative birefringence.

Question 2

Gout treatment

Pseudogout treatment

Answer 2

NSAIDs and colchicine
Dietary
Allopurinol

Pseudogout usually not painful so not treated

Question 3

Rheumatoid arthritis

Answer 3

20-40 yo F with sudden onset of morning stiffness for 2 hrs with symmetric joint swelling in wrist, MCP, and PIP. Ulnar deviation at MCP.
spares the PIP
Swan neck and Boutonnière deformity
Juxta-articular dimineralization

Question 4

Rheumatoid arthritis

What labs will indicate diagnosis?

Answer 4

80% positive RF

Positive CCP

Positive ANA

Question 5

Rheumatoid arthritis treatment

Answer 5

Methotrexate
Hydrochloroquine
Azothioprine

Question 6

Systemic Lupus Erythematosis

Answer 6

90% young female with family hx

Malar rash
Discoid rash 
Oral ulcers 
Renal disease 
Positive ANA
More-- see list

Question 7

Mainstay of treatment for lupus

Answer 7

Prednisone

Then hydroxychloroquin

Question 8

Hallmark of Sjogrens

Answer 8

Dry eyes and dry mouth

Question 9

CREST

Answer 9

Calsinosis 
Raynaud's phenomenon 
Esophageal dysmotility - GERD
Sclerodactyly 
Tangelectasias

Question 10

Bamboo spine

Answer 10

Ankylosing spondylitis

Question 11

Commonly presents in 20-40 yo M that has pain stiffness with *uveitis

Answer 11

Ankylosing spondylitis

Question 12

Psoriasis followed by arthritis

Answer 12

Psoriatic arthritis

Question 13

Positive HLA-B27

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

Answer 13

Reactive arthritis or reiters syndrome

Question 14

60 yo F with acute vision loss or diplopia and tender temple

May have history of polymyalgia rheumatica

Answer 14

Temporal arteritis

Question 15

Upper extremity clarification in young girl with absent pulses

Answer 15

Takayasu’s arteritis

Question 16

Abdominal pain and livedo reticularis

Answer 16

Polyarteritis Nodosa

Question 17

Kawasaki Disease

Question 18

Wegeners granulomatosis

Answer 18

40 yo M with shortness of breath, bloody urine, and necrotizing vasculitis

Question 19

Polymyalgia Rheumatica

Answer 19

70 yo F with Pain and stiffness in neck (doesn’t want to comb hair) with fever and fatigue, hx of temporal arteritis

High ESR and CRP

Question 20

Hypospadius

Answer 20

Urethral meatus is at the Ventral aspect of penis or scrotum or perineum

Question 21

Epispadius

Answer 21

Urethral meatus on dorsal aspect of penis –

Usually doesn’t connect all the way around

Question 22

Peyronie’s disease

Answer 22

curvature of penis that is painful when erect!!!

Question 23

Phimosis

Answer 23

Chronic infection where can’t retract foreskin

Typically uncircumcised

Question 24

Paraphimosis

Answer 24

Iatrogenic reason that Can’t retract foreskin – due to catheter placement

Question 25

Can’t use PDE-5 inhibitor with which drugs ?

Answer 25

Nitro -duh

Alpha blocker for BPH!!

Question 26

Baby with large testicle

Answer 26

Hydrocele – effusion of the scrotum

Transilluminate at the bedside

Watchful waiting, Refer

Question 27

African American Male with priapism should be evaluated for what condition?

Answer 27

Sickle cell disease

Question 28

Varicocele

Answer 28

Enlargement of internal spermatic veins  
Bag of worms 
If lay flat, should go away
Can lead to infertility 
Left side and slow - reassure
Right side, abrupt, doesn't go flat-RCC

Question 29

Bell clapper deformity

Answer 29

Testicular torsion

Question 30

Testicular pain that awakens or at night

Answer 30

Testicular torsion

Question 31

All infants / toddlers with abdominal pain should be evaluated for what?

Answer 31

Testicular torsion

Minimally symptomatic in kids

Question 32

Testicular torsion suspected. What next?

US or surgery?

Answer 32

Surgery .

Medical emergency. No time for US

Question 33

Urge Incontinence

Answer 33

Uninhibited bladder contractions

have to go. Already went before standing up to go.

Tx: anti-spasmodic. Oxybutinen

Question 34

Stress incontinence

Answer 34

Loss of small amounts with cough and sneezing etc

Tx: oxybutinen

Question 35

Overflow incontinence

Answer 35

Detrusor underactivity
Chronic urinary retention
Continual leaking

Tx:
Double void
Catheter

Question 36

BPH

Answer 36

Size of prostate does NOT equal symptoms

Symmetrical, large, rubbery

Surgery if: retention, recurrent UTI, hematuria, stones, renal insuff

Question 37

Acute cystitis

Answer 37

E.coli

Positive LE, blood, bacteruria, pyuria

Question 38

Cystitis treatment

Answer 38

Cephalexin 250-500 po QID 1-3 days
Nitrofurantoin 100mg PO bid 7days
Cipro 500 bid 1-3 days
TMP-SMX 160/800 x 2 tabs one dose

Question 39

Prostatitis

Answer 39

Less than 40: STD
Older than 40: e.coli, pseudomonas

NO parastatic massage

Question 40

73 yo M with Painless hematuria in a smoker

Answer 40

Bladder cancer

Should always be concerned if bloody urine in plavix pts – rule out cancer

Question 41

How diagnose bladder cancer?

Answer 41

UA
Urine cytology

Cystoscopy and biopsy is gold standard

Question 42

High alk phos or high calcium

Hx of prostate cancer

Answer 42

Think bony metastasis from prostate cancer

Question 43

Urethritis

Answer 43

Inflammation of urethra
Usually have STI

Note : recall that May have reactive arthritis if have this !

Tx: ceftriaxone 250mg iM x 1 + doxycycline 100mg po bid x 10 days

Question 44

Epididymitis

Answer 44

Painful enlargement of epididymis
Usually STI

Scrotal US

Tx: scrotal elevation
Treat STI : ceftriaxone + doxy

Question 45

Orchitis

Answer 45

Inflammation of

Question 46

Uric acid
Needle shaped crystal
Negative birefringence

Answer 46

Gout