Rheumatology

Question 1

What is the most likely diagnosis for Mediterranean pt presenting with cyclic fever, abdominal pain, testicular pain, swelling of the knees and ankles, and erysipelas skin rash?

Answer 1

Mediterranena fever

familial recurrent polyserositis

Question 2

What is an orthopedic complication of chronic glucocorticosteroid use?

Answer 2

Avascular necrosis of bone

Question 3

What is the most likely diagnosis for pt presenting with GI discomfort, arthritis, purpuric rash (especially on legs and buttocks) with elevated ESR and leukocytosis?

Answer 3

Henoch-schonlein purpura (HSP, immunoglobulin A vasculitis)

tx: hydration and pain meds

Question 4

What is a possible GI complication associated with Henoch-schonlein purpura (immunoglobulin A vasculitis)?

Answer 4

Intussusception

Question 5

What is the most likely diagnosis for pt presenting with recurrent oral aphthous ulcerations, genital ulcers, uveitis (limbic conjunctivitis, pupillary constriction, photophobia, visual disturbance), large aneurysmal vasculitis, erythema nodosum and arthritis of medium/large joints?

Answer 5

Behcet disease

(pathergy test: papule greater than 2 mm developing within 48 hours after oblique insertion of 20-25 gauge needle in forearm)

Question 6

What is the most likely diagnosis for pt presenting with neuro disorder (chorea), oral ulcers, serositis (pleuritis), renal disorder, hematologic disorder, malar/ discoid rash and positive ANA test?

Answer 6

Systemic lupus erythematosus

Question 7

What is the most common cause of congenital heart block?

Answer 7

Neonatal lupus erythematosus

Question 8

What is the most likely diagnosis for pt presenting with chronic pain after minor trauma, hyperesthesia, allodynia (pain exaggerated by light touch), vasomotor disturbances (mottling, bluish discoloration, decreased peripheral pulses), diemineralization on Xray?

Answer 8

Complex regional pain syndrome (aka reflex sympathetic dystrophy)

(tx: physical therapy and counseling)

Question 9

What is the most common cause of long-term morbidity for patients with Henoch-Schonlein purpura (IgA vasculitis)?

Answer 9

chronic renal disease

Question 10

What is the most likely diagnosis for pt presenting with proximal muscle weakness, heliotrope sign (edematous, erythematous, blusish eyelids), Gottron papules (scaly erythematous slightly raised lesions on dorsal surface of knuckles), elevated CK, muscle biopsy showing perifascicular atropy, degeneration and regeneration of muscle fibes andperivascular mononuclear infiltrate, and EMG shows insertional irritability, positive sharp waves and bizarre high frequency repetitive discharges?

Answer 10

Dermatomyositis

tx: high dose steroids

Question 11

What types of vaccines are safe to give a pt on a biologic response modifier?

Answer 11

Inactivated vaccines

Question 12

What is the most likely diagnosis for pt presenting with recurrent oligoarthritis, enthesitis (pain over tendon/ ligamentous insertions), postiive HLA-B27, and loss of lumbosacral spine mobility causing morning stiffness?

Answer 12

Ankylosing spondylitis (type of JIA called enthesitis related arthropathy)

(Schober test- measures forward flexion of lumbar spine)

Question 13

What is the most likely diagnosis of pt presenting with periodic fever, aphthous stomatitis (aphthae on buccal mucosa), exudative pharyngitis, and cervical lymphadenopathy lasting 5 days and occuring every 4 weeks?

Answer 13

PFAPA syndrome

(periodic fever with aphthous stomatitis, pharygitis, and cervical adenitis)

(tx: prednisone)

Question 14

What is the most likely diagnosis for pt presenting with intermittent fever that improves daily, macular salmon pink to reddish rash on trunk and proximal extremities with fever or stroking of skin, arthralgia, arthritis, and visceral involvement?

Answer 14

systemic juvenile idiopathic arthritis (Still disease)

Koebner phenomenon: rash appears with stroking of skin

Question 15

What is the most likely diagnosis for pt presenting with musculoskeletal aches and pain with multiple tender points along with poor sleep, fatigue, cognitive complaints and anxiety?

Answer 15

Juvenile Fibromyaglia

Question 16

What is the most likely diagnosis for pt presenting with sudden arthritis with swelling, enthesitis (pain and swelling at the insertion of Achilles tendon and plantar fascia), dactylitis (sausage like digits), uveitis, urologic problems and found to have positive infection (Chlamydia, or GI infections)?

Answer 16

Reactive Arthritis
(Reiter syndrome)

(dx: joint aspiration, CBC, ESR, RF)

(can’t see, can’t pee, can’t climb a tree)

Question 17

What is the treatment for reactive arthritis?

Answer 17

NSAIDS

antibiotics only to treat active urethritis or cervicitis

Question 18

What orthopedic disorder is associated with systemic lupus erythematosus?

Answer 18

Avascular necrosis of femoral head

Question 19

What are the two most specific lab findings for systemic lupus erythematosus?

Answer 19

1. Anti- double stranded DNA

2. Anti- smith

Question 20

What is the most likely diagnosis for pt presenting with distal interphalangeal joint pain and swelling, pitting of nails, oil spotting (brownish tan discoloration) associated with thickened and friable nails, erythematous raised sharply circumscribed plaques with thickened silvery scales on elbows and knees, enthesitis, guttate psoriasis (post strep lesions), and arthritis/ spondylitis?

Answer 20

Psoriatic Juvenile Idiopathic Arthritis

Question 21

What is the cause of neonatal systemic lupus erythematosus?

Answer 21

maternal anti-Ro and anti-la antibodies passing via placenta to fetus

Question 22

What is the most likely diagnosis for pt presenting with fever (more than 4 days), tender cervical lymphadenopathy, edema, red dry cracking lips, red maculopapular rash in inguinal area, urine WBCs but no bacteria, elevated transaminases, and elevated CRP/ ESR?

Answer 22

Kawasaki Disease

(complication is coronary aneurysms so get ECHO)

(tx: IVIG and aspirin)

Question 23

What are the major determinants of prognosis for children with systemic lupus erythematosus?

Answer 23

1. Nephritis

2. neuro complications

Question 24

What is the most likely diagnosis for pt presenting with Raynaud’s phenomenon (fingers turn white, blue and red in cold weather), positive ANA, and dilated tortuous vessels on nailfold capillaroscopy?

Answer 24

Mixed connective tissue disorder

Dx: anti-U1RNP

Question 25

what is the most likely diagnosis for patient presenting with purpuric rash on buttocks and lower extremities, joint pain, proteinuria, abdominal pain, and blood in stool?

Answer 25

IgA vasculitis (Henoch Scholein Purpura)

Question 26

What is the most distinguishing factor for patients with chronic fatigue syndrome?

Answer 26

tenderness to palpation of multiple soft tissue sites

Question 27

What is the most common cause of septic arthritis?

Answer 27

Staph aureus