Rheumatology

Question 1

parvovirus B19 arthritis

Answer 1

Self limiting parvovirus RA

- acute symmetric arthralgia/ arthritis of hands wrist knee and feet ( may resemble RA)

Question 2

initial treatment for patellofemoral pain syndrome

Answer 2

1. activity modification
2. stretching and strengthening exercise - quadriceps strengthening exercise
3. NSAIDS

Knee arthroplasty - ONLY if patients have failed 6-12 months of conservative management

Question 3

first line treatment of reactive arthritis

Answer 3

NSAIDS

Question 4

back pain - exacerbated by walking and prolonged sitting but okay with bicycle

Answer 4

spinal stenosis

Question 5

recurrent oral and genital ulcers - skin and ocular involvement

Answer 5

think BEchets syndrome

Question 6

cause of reactive arthritis

Answer 6

follows acute GI ( salmonella, termini) or GU ( chlmaydia) infection and causes of subacute to chronic rather than episodic symptoms

Question 7

difference b/w reactive arthritis and bechets

Answer 7

bechets- usually recurrent oral and genital ulcers

Reactive arthritis - follows GI / GU infection - usually does not have subacute to chronic rather than episodic symptoms

Question 8

elevated ALP - normal rest of labs

Answer 8

pages disease

Question 9

if suspect gout but patients has elevated calcium

Answer 9

THINK PSEUDOGOUT

b/c hyperparathyroidism –> can cause rhomboid shaped calcium pyrophosphate crystals in synovial fluid

Question 10

complication of fiat cell arthritis

Answer 10

aortic aneurysm

Question 11

what do you do if you suspect acute low back pain constant with lumbar strain

Answer 11

treatment with NSAIDS

( don’t need to get x-rya

Question 12

monoartricular arthritis and chodrocalcinosis - dx?

Answer 12

pseudo gout

- usually age > 65

Question 13

first investigation when you suspect ankylosing spondylitis

Answer 13

do an x-ray of sacroiliac joints

• don’t need to get HLA B 27 - yes it supports AS but not specific for diagnosis

Question 14

right sided neck pain and numbness over the posterior surface of forearm - decrease pinprick in this area - what will you see on c-spine X-ray

Answer 14

you will see bony spurs - this patient most likely has cervical spondylosis - affects 10 % of people > 50

Question 15

chronic knee pain and bland synovial effusion ( no organism, EBC < 2000 ) - dx?

Answer 15

OA

Question 16

normal joint space with soft tissue swelling will show what?

Answer 16

septic arthritis

Synovial fluid - very high cell count with visible organisms on gram stain

Question 17

patient has sciatic - what is the first step in management

Answer 17

give trail of NSAIDS

• MRI can be done later -will not change initial management

Question 18

causes of compression fracture

Answer 18

trauma 
OSTEOPOROSIS , osteomalacia 
Infection ( osteomyelitis) 
Bone mets 
Metabolic ( hyperparathyroidism) 
Pagets disase

Question 19

treatment of GCA

Answer 19

high dose steroids

Question 20

osteonecrosis of femoral head - x-ray findings

Answer 20

x-ray finding will be normal initially

Question 21

x-ray knee shows chonedrocalcinosis with moderate effusions, hepatomegaly and DM

Answer 21

think heamachromotosis with pseudo gout