Rheumatology

Question 1

Holster sign

Answer 1

Poikilodermic rash on the holster area seen with dermatomyositis

Question 2

Most specific antibody for SLE

Answer 2

Anti-Smith

Question 3

Antiribosomal P

Answer 3

Associated w/ CNS lupus and lupus hepatitis

Question 4

Antibody in drug-induced lupus

Answer 4

Antihistone antibodies

Question 5

Unusual RA findings

Answer 5

Hip- axial migration of femoral head into acetabulum

Knee-Tricompartmental joint-space narrowing

Ankle/mid-foot-Flat feet

Elbow joint- Difficulty w/ hand pronation/supination

Ulna-Loss of ulnar styloid

Question 6

Rheumatoid nodules

Answer 6

Typically seen on olecrenon; can be manifested by MTX or leflunomide; helped by plaquenil and colchicine

Question 7

Rheumatoid effusion

Answer 7

Characteristically has mononuclear WBCs unlike w/ infection

Question 8

Cricoarytenoid athritis

Answer 8

Hoarseness, sore throat, dysphagia, and stridor seen commonly w/ RA and can present problem w/ intubation

Question 9

Order of drugs to start for Fibromyalgia

Answer 9

1. Duloxetine
2. Pregabalin
3. Milnacipran

Question 10

Digital Pitting

Answer 10

Can be seen in patients w/ chronic Raynaud’s

Also more common in patients who have an underlying cause for their Raynauds (in contrast to idiopathic)

Question 11

Chronic cutaneous lupus erythematosis

Answer 11

“Discoid variant”

Slowly progressive infiltrative plaques, scaly papules, or atrophic red plaques on sun exposed surfaces

Can appear verrucous

Only 10% will develop SLE

Question 12

Subacute cutaneous lupus erythematosis

Answer 12

Papulosquamous, annular, or polycyclic rash that spares the face that can appear almost like psoriatic plaques

25% will develop SLE

Question 13

Acute cutaneous lupus erythematosis

Answer 13

Butterfly rash that is invariably associated w/ SLE

Question 14

Subcranial Giant Cell Arteritis

Answer 14

GCA affecting the large vessels of the chest (and sparing the temporal artery) causing UE claudication and aortitis

Can progress to HF, aortic root dilation, or aortic regurgitation if left untreated

**TO DIFFFERENTIATE FROM TAKAYUSU ARTERITIS, USE PATIENT AGE AS THIS DISEASE OCCURS EXCLUSIVELY IN PTS >50

Question 15

Tocilizumab ADRs

Answer 15

Bowel perforation w/ history of diverticulitis

Also transaminitis, HLD, pancytopenia

Question 16

Things to do prior to starting DMARD therapy

Answer 16

Update vaccinations

Screen for hepatitis, HIV, TB

Question 17

Immune Mediated Necrotizing Myopathy (IMNM)

Answer 17

Prominent myonecrosis on bipap with RAPID onset of weakness; no dermatological manifestations

Anti-HMG coA reductase antibodies typically present or anti SRP

Question 18

Inclusion body myositis

Answer 18

Cricopharyngeal weakness =» aspiration risk and dysphagia

Patients also typically have asymmetrical involvement of muscle weakness

Question 19

Level to check when highly suspicious of inflammatory myopathy but CK is normal

Answer 19

Aldolase

Question 20

Other cause common in USA for gout

Answer 20

High fructose corn syrup (sodas)

Question 21

Specific US sign for gout

Answer 21

” Double Contour Sign”

Question 22

Antihypertensive with mild uruicosuric effects

Answer 22

Losartan

Question 23

Length of time for NSAID/colchicine prophylaxis for patients starting urate-lowering therapy

Answer 23

3 months after target serum levels are reached

Question 24

Hypersensitivity Vasculitis

Answer 24

Palpable purpura that appear approximately 7 days after the offending antigen

Biopsy w/ immunofluorescence shows leukocytoclastic vasculitis w/o IgA deposits (unlike in IgA vasculitis)

Tx: Remove antigen =» resolves in 1 month