Rheumatology

Question 1

What disease is the pneumonic SOAP BRAIN MD for and what does it mean

Answer 1

Lupus: serositis, oral ulcers, arthritis, photosensitivity, blood disorders, renal disease, ANA, immunologic phenomena, neurologic disorder, malar rash, discoid rash

Question 2

An IV drug user presents with buttock area pain. What is it?

Answer 2

Infectious sacroiliitis

Question 3

If a patient has polymyositis/dermatomyositis, what type of screening should be done?

Answer 3

cancer screening - look for underlying malignancy

Question 4

What type of kidney disease is seen with ankylosing spondylitis?

Answer 4

IgA nephropathy

Question 5

White middle-aged man with diarrhea, fat malabsorption/weight loss, CNS symptoms (memory loss due to progressive dementia, osculomasticatory myorhythmia, and recurring episodes of inflammatory arthritis. What is it?

Answer 5

Whipple disease - due to Tropheryma whipplei

Question 6

Chondrocalcinosis (calcification of cartilaginous tissue) is a hint to what underlying disease?

Answer 6

CPPD

Question 7

What joints are rarely affected by OA?

Answer 7

It’s non erosive; rarely affects ankle, wrist, and elbow or MCP’s or small bones of the feet

Question 8

What diagnoses should you consider if you see CPPD in a patient

Answer 8

primary hyperparathyroidism, hemochromatosis, hypothyroidism, hypomagnesemia, hypophosphatemia

Question 9

Of the three, RA, Lupus, OA, which is erosive and which is non erosive?

Answer 9

RA is erosive; Lupus is non erosive; OA is non erosive

Question 10

What areas are rarely affected by RA?

Answer 10

thoracic, lumbar, and sacral spine and the SI joints

Question 11

In diffuse and limited scleroderma, there are 2 auto-antibodies. What are they? What type of lung dz does each increase the risk of?

Answer 11

Diffuse - anti-Scl-70 or anti-RNA polymerase III - interstitial lung dz for first (also more likely to dvlp scleroderma renal crisis for 2nd AB)
Limited - anti-centromere - pulmonary HTN (they also have more severe digital ischemia)

Question 12

Sausage shaped digits (dactylics) are common in the spondyloarthropathies. Name 4 diseases in this category.

Answer 12

1. Ankylosing spondylitis 2. Reactive arthritis 3. Psoriatic arthritis 4. IBD-associated arthropathy

Question 13

What is the classic triad of reactive arthritis?

Answer 13

urethritis, conjunctivitis, and asymmetric arthritis

Question 14

What are common causes of erythema nodosum?

Answer 14

sarcoid
IBD
Infection - TB, strep, fungal
Drugs - OCP’s, sulfa, PCN

Question 15

If a young person presents with arthralgia, abdominal pain, renal disease, and palpable purpura, what should you think?

Answer 15

IgA vasculitis - formerly Henoch-Schonlein purpura

Question 16

In which disease do you see a scarlet tongue?

Answer 16

Scarlett fever

Question 17

Buzzwords for both RA and SLE: the arthritis is _____ and ________

Answer 17

1. symmetric

2. polyarticular

Question 18

In RA, which joints of the hand are affected and which are spared?

Answer 18

involves the mcp and pip

spares the dip

Question 19

Is RA and SLE joint involvement symmetric are asymmetric? What about joint involvement of hemochromatosis?

Answer 19

RA/SLE - symmetric

Hemochromatosis - asymmetric

Question 20

What is the most common single joint initially involved in RA? What is the site of the earliest radiographic changes?

Answer 20

the knee

radiographic changes - the forefoot

Question 21

What is felty syndrome?

Answer 21

RA, splenomegaly, neutropenia

Question 22

A RA patient on rituximab has new onset of CNS symptoms. What do they have?

Answer 22

PML -progressive multifocal leukencephalopathy

Question 23

What disease do you think when you see these 2 buzzwords: sausage-shaped digits (dactylitis) + pitted nails?

Answer 23

Psoriasis

Question 24

What 2 arthritis syndromes do you see sausage shaped digits?

Answer 24

reactive arthritis and psoriatic arthritis

Question 25

Describe OA changes in the hands

Answer 25

changes most often affect PIP's and DIP's and may have Bouchard nodes (PIP) and Heberden nodes (DIP)

Question 26

Allopurinol dosing must be decreased by 66-75% in patients taking what medications?

Answer 26

Azathioprine or mercaptopurine

Question 27

What joints does CPPD commonly affect?

Answer 27

Usually affects the knee; other joints include wrists, 2nd/3rd MCPs, shoulders, elbows, and ankles.

Question 28

What are some other diagnoses associated with CPPD?

Answer 28

hemochromatosis, hyperparathyroidism, hypothyroidism, hypomagnesemia, hypophosphatemia

Question 29

What diagnosis should you consider in an adolescent with knee pain?

Answer 29

gonococcal joint infection

Question 30

Young adult female works with school aged children presents with symmetric synovitis of the hands and a macular rash. What is it?

Answer 30

Viral arthritis from parvovirus B19; she may describe a slapped cheek rash in the kids

Question 31

What should you think about and further evaluate the patient for when you see polyarthritis, clubbing of the fingers and toes, and periostitis of the long bones?

Answer 31

Hypertrophic pulmonary osteoarthropathy and you should eval for lung cancer (usually adenocarcinoma)

Question 32

People with Sjogren syndrome are at increased risk for developing what other disease?

Answer 32

B cell lymphoma | Babies can also have congenital heart block and neonatal lupus if the mom has SSA/SSB antibodies

Question 33

What diagnosis might you want to consider in a young female who presents with acute malignant hypertension and renal failure?

Answer 33

diffuse scleroderma

Question 34

What skin findings do you see with dermatomyositis?

Answer 34

heliotrope rash - violaceous rash on the upper eyelids | gottron papules - redish to violet scaling papules on the knuckles

Question 35

Buzz word = weak handshake

Answer 35

inclusion body myositis - most common inflammatory myopathy in people > 50 - can also have dysphagia - requires a muscle biopsy

Question 36

Polyarteritis nodosa doesn't classically cause disease of what?

Answer 36

pulmonary arteries or glomerulonephritis (although it can involve the kidneys)

Question 37

olecranon bursitis is associated with which systemic dz?

Answer 37

RA

Question 38

If a patient has plantar fasciitis, what other disease must be considered?

Answer 38

spondyloarthropathy

Question 39

Which AB is associated with lupus nephritis?

Answer 39

anti-DS DNA

Question 40

What is the classic tetrad of hemochromatosis?

Answer 40

cirrhosis, diabetes, hyperpigmentation, cardiac issues

Question 41

Name examples of extra glandular involvement seen with Sjogrens

Answer 41

lymphocytic interstitial pneumonitis, non hodgkin lymphoma, peripheral neuropathy, RTA

Question 42

What antihypertensive medication increases uric acid levels and can cause gout? What are some other drugs that increase uric acid?

Answer 42

HCTZ | cyclosporine, niacin, ethambutol/pyrazinamide

Question 43

Men who present with fibromyalgia-like symptoms can have what?

Answer 43

Testosterone deficiency

Question 44

What is anti-Jo-1 autoantibody?

Answer 44

associated with pulmonary fibrosis in patients who have dermatomyositis or polymyositis

Question 45

Name an antibiotic used to treat MRSA that is contraindicated in patients on methotrexate

Answer 45

Bactrim