Rheumatology

Question 1

What is dx:

Fatigue, Weightloss, Arthralgia, New Onset Psychosis, swollen wrists bilaterally, mild LE edema, WBC 3800

Answer 1

SLE

-Arthralgia, LE edema, pericarditis, HTN, Raynaud, malar rash, Neuropsychiatric symptoms

Question 2

What are serum findings of Statin-induced myopathy?

Answer 2

Elevated CPK level

Normal ESR

Question 3

What are serum findings of Polymyalgia Rheumatica?

Answer 3

elevated ESR

normal CPK

Question 4

How is acute monoarticular gout managed in recent renal transplant patients?

Answer 4

Intraarticular glucocorticoids or increasing doage of systemic glucocorticoids

Question 5

What is dx? Lab findings?
35 yr old man with pain in R knee/ankle w swelling for 2 weeks. Bilateral eye pain, irritation, blurry vision. Burning urination, tenderness in lumbosacral area. developed diarrhea last month after eating at restaurant. Urinalysis is normal

Answer 5

Reactive arthritis - occurs after GU or GI infection.

Synovial fluid - elevated WBC, negative bacterial culture

-only 30-50% w ReA are HLA-B27 positive

Question 6

What additional intervention is most appropriate in a patient that is begun on methotrexate therapy for RA with normal hepatic aminotransferase levels

Answer 6

Folic acid supplementation

• MTX inhibits dihydrofolate reductase
• -side fx = hepatotoxicity, stomatitis, bone marrow suppression

Question 7

What is dx?
Dx modalities?
Lab findings?
Mgmt?
55 yr old woman w 2 mo hx of malaise, mild fever, difficulty climbing stairs, rising from chair. Weightloss, bilateral proximal upper and lower extremity weakness w normal reflexes. Violaceous papules and plaques on dorsum of both hands.

Answer 7

Dermatomyositis

• prox, symmetric muscle weakness
• Gottron’s papules, Heliotrope rash
• Interstitial lung dz, Dysphagia, Myocarditis

Dx: elevated CPK, aldolase, LDH

• -Anti-RNP, anti-Jo-1, anti Mi2
• —–if uncertain: EMG, skin/muscle biopsy

Tx: High-dose glucocorticoids PLUS glucocorticoid-sparing agent
–Screen for malignancy

Question 8

What is dx and tx?

Pt transfused w blood - 30 mins later, develops severe flank pain, febrile, tachycardia. Urine is dark

Answer 8

Acute hemolytic reaction
–dx made by Coombs test, pink plasma’

Stop transfusion and hydrate aggressively w IV NORMAL SALINE

Question 9

What are risk factors and a common comorbidity of Dupuytren Contracture?

Answer 9

Risk fx: smoking/alcohol

Comorbidity: Diabetes mellitus in up to 40%

Question 10

What is dx, tx?

70 yo w pain/stiffness of neck,shoulders,hips for last 3 months - worse in the morning, lasts 1-2 hours. General malaise, recent 7lb weight loss. No signs of giant cell arteritis
Elevated ESR, Normal CK

Answer 10

Polymyalgia rheumatica

-low dose prednisone