Rheumatology

Question 1

What constellation of symptoms is seen in giant cell arteritis?

Answer 1

• HA
• Jaw claudication
• Vision changes
• Polyneuropathy (which can make it look like stroke)

Question 2

A normal ___________ (serum test) does not rule out GCA.

Answer 2

ESR and CRP

Question 3

True or false: temporal biopsy has a high sensitivity for GCA.

Answer 3

False

There is a false negative rate of about 15%.

Question 4

Those with polymyositis are at risk of what cardiopulmonary complication?

Answer 4

Interstitial lung disease

Diagnose this with high-resolution CT and/or PFTs.

Question 5

True or false: PMR usually presents with mild signs of frank arthritis (e.g., erythema, swelling).

Answer 5

False

Question 6

Treat PMR with _____________.

Answer 6

low-dose prednisone

Question 7

Anti-centromere antibodies are seen in those with _____________.

Answer 7

CREST

Imagine toothpaste being squeezed onto a chromosal centromere.

Question 8

Anti-Smith antibodies are seen in those with ___________.

Answer 8

SLE

Smith antibodies are specific but not sensitive, so they should not be used to rule out SLE.

Question 9

____________ antibodies are most sensitive for Sjogren’s.

Answer 9

Anti-Ro/SSA

Imagine Dr. Ro with a dry mouth and dry eyes.

Question 10

Anti-mitochondrial antibodies are seen in those with which disorder?

Answer 10

Primary biliary cirrhosis

Question 11

Plaquenil is best at treating which aspects of SLE?

Answer 11

Serositis, arthralgia, and cutaneous findings

Question 12

Dermatomyositis is suggested by an insidious onset of proximal muscle weakness and ______________.

Answer 12

Gottron papules and a heliotrope rash

Question 13

True or false: most of those with dermatomyositis need muscle biopsy to confirm diagnosis.

Answer 13

False

A consistent clinical story and positive anti-Mi2 or anti-Jo antibodies are sufficient for diagnosis in most cases.

Question 14

Which autoimmune condition is most commonly a paraneoplastic syndrome and warrants cancer workup?

Answer 14

Dermatomyositis

Complete age-appropriate cancer screenings and ROS for cancer.

Question 15

Sjögren’s syndrome causes dramatic increase in the rates of which cancer?

Answer 15

B-cell lymphoma

Question 16

True or false: thrombocytopenia is often present in IgA vasculitis.

Answer 16

False

Question 17

What antibodies are positive in antiphospholipid antibody syndrome?

Answer 17

Anticardiolipin
Lupus anticoagulant
Beta-2 glycoprotein

Question 18

In addition to elevated ESR, ___________ is seen in about 50% of patients with giant cell arteritis.

Answer 18

transaminitis

Question 19

What is the pathophysiology of scleroderma renal crisis?

Answer 19

Sudden oliguric AKI causing HTN emergency

Question 20

What is the management of scleroderma renal crisis?

Answer 20

ACEi for blood pressure control

Question 21

How does the most serious complication of JIA present?

Answer 21

Bleeding, liver injury, shock, fever, pancytopenia

This describes the presentation of macrophage activation syndroome

Question 22

True or false: dermatomyositis is a disease almost exclusively of the middle aged.

Answer 22

False

There is a pediatric version.