Rheumatology

Question 1

Recurrent episodes of periodic fevers every 3-5 days, serositis (peritonitis, less commonly pleuritis/pericarditis), joint pains, and erysipelas-like rash; family history of disorder. What is the patient’s likely ethnicity? Most likely complication of disorder?

Answer 1

Familial Mediterranean Fever
Mediterranean
Amyloidosis due to increase Acute Phase reactants during attacks.

Question 2

True or false. Complex regional pain syndrome can be preceded by a traumatic trigger and lead to somatic changes in involved extremity (mottling, cool to touch, demineralization of bone).

Answer 2

True, requires multidisciplinary approach (PT/OT).

Question 3

True or false. Kingella kingae is the most common cause of septic arthritis in kids <4 years of age.

Answer 3

False. Staph aureus is the most common cause in ANY age group of septic arthritis. K. kingae is more commonly seen in <4 years old, would add CTX to Vanc/clinda if suspect that.

Question 4

Antibody(ies) most specific for SLE?

Answer 4

Anti-Smith, Anti-dsDNA

Question 5

Antibodies for neonatal lupus?

Answer 5

Anti-Ro (SS-A) and Anti-La (SS-B) antibodies

Question 6

Drug induced lupus antibodies?

Answer 6

Anti-histone antibodies

Question 7

Most frequent cause of congenital heart block?

Answer 7

Neonatal Lupus, may also have associated cardiac structural anomalies (transposition and septal defects)

Question 8

Lab abnormalities for SLE?

Answer 8

Anemia, thrombocytopenia, leukopenia, elevated transaminases

Question 9

Factors that indicate worse prognosis in SLE?

Answer 9

Renal and neurological manifestations

Question 10

Mixed Connective Tissue Disease antibody?

Answer 10

anti-U1 RNP

Question 11

Calcium deposits in the muscle/skin can be seen in which rheumatologic condition?

Answer 11

Dermatomyositis

Question 12

Anti-citrullinated protein antibodies are useful in the diagnosis of which condition?

Answer 12

Rheumatoid arthritis

Question 13

Systemic JIA

Answer 13

Recurrent daily fevers, joint swelling, evanescent and salmon colored blanchable rash on trunk and proximal extremities that comes on with a fever and resolves on its own, may have serositis

Question 14

Koebner phenomenon is related to which disorder? What is another name for this disease?

Answer 14

Cutaneous hypersensitivity following superficial trauma seen in sJIA aka Still’s disease.

Question 15

Oligoarticular vs polyarticular JIA?

Answer 15

4 or less vs 5 or more joint involvement; need to check vision regularly with slit-lamp exam for oligo due to chronic uveitis (esp. if ANA+)

Question 16

What is Hyperimmunoglobulin D syndrome? What lab finding is usually associated with this?

Answer 16

Starts in infancy, monthly episodes of fevers, non-erosive arthritis, abd pain, diarrhea, HSM, LAD, oral ulcers, macular rash that common occurs especially after vaccines; deficiency of MVK enzyme causing an increased production of IL-1;
elevated IgD

Question 17

Psoriatic arthritis physical exam findings?

Answer 17

Dactylitis (swollen digits) and nail bed pitting, psoriatic scales on extensor surfaces, asymmetric oligoarticular or symmetrical polyarticular arthritis, enthesitis (Achilles tendonitis)

Question 18

Infectious triggers for reactive arthritis?

Answer 18

Preceding GI (Salmonella, Shigella, E coli) or GU illnesses (gonorrhea/chlamydia)

Question 19

Enthesitis of the Achilles tendon, dactylitis and arthritis can be a clinical presentation of which two rheumatologic conditions?

Answer 19

Reactive arthritis and psoriatric arthritis

Question 20

What can help differentiate reactive arthritis and psoriatic arthritis?

Answer 20

Reactive arthritis– urethritis (UA +leukocytes), conjunctivitis
Psoriatic arthritis– pitting of nail beds

Question 21

Onset in infancy of cyclic fevers, oral ulcers, neutropenia as low as ANC <200, may have family history of similar symptoms?

Answer 21

Cyclic neutropenic fever

Question 22

Severe complication of sJIA? How does it present?

Answer 22

Macrophage Activation Syndrome, juxta-articular osteoporosis caused by hemophagocytosis by histiocytes

Question 23

Painful sloughing ulceration commonly seen in children/adolescents with IBD?

Answer 23

Pyoderma gangrenosum

Question 24

Enthesitis-related arthropathy is also known as?

Answer 24

Arthropathy seen with ankylosing spondylitis

Question 25

HLA B-27 is positive in?

Answer 25

Ankylosing spondylitis and psoriatic sJIA