Rhuem

Question 1

Negatively birefrigent crystals

Answer 1

Gout

Question 2

Positively birefrigent crystals

Answer 2

Pseudogout (calcium pyrophosphate crystals)

Question 3

Treatment of primary angiitis of the CNS

Answer 3

High dose steroids and cyclophosphamide

Question 4

Triad bilateral hilar lymphadenopathy, arthritis and erythema nodosum

Answer 4

Lofgren syndrome - diagnostic of sarcoidosis, no further testing needed

Question 5

IgA Vasculitis diagnosis

Answer 5

Biopsy most accessible organ - usually skin. Will demonstrate leukocytoclastic vasculitis with heavy deposits of IgA and complement on immunofluorescent staining

Question 6

Allopurinol hypersensitivity risk factors

Answer 6

CKD, diuretic use, Thai, Han Chinese and Korean descent

Question 7

Testing for allopurinol sensitivity

Answer 7

HLA-B*5801 allele

Question 8

Treatment of Ankylosing spondylitis

Answer 8

NSAIDs first line. TNF inhibitors second line, then sulfasalazine

Question 9

Erythematous, macular patchy eruption sometimes with desquamation. Malar rash

Answer 9

Acute cutaneous lupus erythematosus

Question 10

Photosensitivity rash on arms, neck and face. Annular/polycyclic or patchy papulosquamous

Answer 10

Subacute cutaneous lupus erythematosus

Question 11

Hypo or hyper pigmented patches or plaques with erythema during active disease. Skin can become atrophic or hyperkeratotic with scarring

Answer 11

Discoid lupus erythematosus

Question 12

Hypertensive emergency, rising Cr, microangiopathic hemolytic anemia and proteinuria in a patient with scleroderma

Answer 12

Scleroderma Renal Crisis

Question 13

Treatment for scleroderma renal crisis

Answer 13

ACEi - titrate to blood pressure goal. Continue even in setting of rising Cr

Question 14

Fever, erythema/warmth in superficial bursae with high WBC (>3000 with >50% PMNs) from bursal fluid +/- positive gram stain

Answer 14

Acute septic bursitis

Question 15

Characteristic finding with HSP

Answer 15

leukocytoclastic vasculitis caused by IgA immune complexes within affected organs.

Question 16

Does RF have to be positive to diagnose rheumatoid arthritis?

Answer 16

No! RA diganosis is based on clinical features consistent with symmetric polyarticular joint pain/stiffness and evidence of systemic inflammation. At diagnosis about 50% of patietns have an elevated RF, and 75-80% will develop a positive at some point in their course of disease.

Question 17

Clinical tests in diagnosing akylosing spondylitis

Answer 17

Chest expansion test - normal is ability to expand the chest wall > or = 5 cm after maximum forced expiration. Expansion < 2.5cm is considered abnormal.
Limitation of lumbar spine motion in frontal and sagittal planes.

Question 18

Atypical degenerative joint disease (involving 2/3/4 MCP joints), liver function abnormalities, diabetes

Answer 18

Suggestion of hemochromatosis as a cause

Question 19

Ottawa ankle rules for malleolar zone

Answer 19

Xray ankle if pain at malleolar zone AND tender at posterior medial malleolus or posterior lateral malleolus or unable to bear weight 4 steps

Question 20

Ottawa ankle rules for midfoot zone

Answer 20

Xray foot if pain at midfoot zone AND tender at navicular or tender at base of 5th metatarsal or unable to bear weight 4 steps

Question 21

DIP arthritis and arthritis mutilans (deforming and destructive arthritis) with pencil in cup formation on XRAY

Answer 21

Psoriatic arthritis. Up to 30% of patietns can present with arhtritis PRIOR to psoriasis rash

Question 22

Positive serologies for systemic sclerosis

Answer 22

ANA, anti-topoisomerase 1 (ant-SCL-70) antibody, anticentromere antibody

Question 23

What should you screen for in a younger patient presenting with pseudogout?

Answer 23

Hemochromatosis

Question 24

Plain radiographs demonstrating lytic/sclerotic lesions (often in skull, throacic/lumbar spine and pelvis) with elevated alk phosphatase

Answer 24

Paget Disease

Question 25

Next step after diagnosis of Paget Disease

Answer 25

Should bone scan to determine extent and distribution of disease. Then if asymptomatic can treat with bisphosphonates

Question 26

Groin pain on weight bearing, limited internal rotation, steroid use, normal vital signs/infalmmatory markers

Answer 26

Avascular necrosis

Question 27

Prognostic factors that are predictive of more severe erosive disease in RA

Answer 27

positive anti CCP Ab with higher titers, involvement of higher number of joints, positive RF and anti CCP Ab elevated ESR and CRP, persistent joint inflammation > 12 weeks

Question 28

Stroke or VTE in a young patient without obvious risk factors and a prolonged PTT and thrombocytopenia

Answer 28

Suspicious for antiphospholipid syndrome

Question 29

Antibodies to DNA histone complex

Answer 29

Drug induced lupus

Question 30

Antibodies to dsDNA and Sm

Answer 30

SLE

Question 31

Antibodies to RNA polymerase II/III and scl-70/anti-topoisomerase I

Answer 31

Systemic Sclerosis

Question 32

Antibodies to RNP

Answer 32

MCTD

Question 33

Antibodies to Sjogren’s syndrome

Answer 33

SS-A/Ro, SS-B/La

Question 34

Antibodies to centromere

Answer 34

LImited scleroderma

Question 35

Antibodies to aminoacyl-tRNA synthetases (Jo-1)

Answer 35

polymyositis, dermatomyositis

Question 36

Antibodies to myeloperoxidase

Answer 36

microscopic polyangitis

Question 37

Antibodies to proteinase 3

Answer 37

granulomatosis with polyangittis

Question 38

Proximal muscle weakness, myalgia and neuropathy in CKD patients with gout with elevated CK and cytoplasmic vacuolization on muscle biopsy.

Answer 38

Colchicine neuromyopathy

Question 39

Test to determine between primary and secondary raynaud’s

Answer 39

nailfold capillary examination - put oil on naifold and look at with an ophthalmoscope

Question 40

Rheumatoid arthritis, neutropenia and splenomegaly

Answer 40

Felty syndrome

Question 41

PAtients with dermatomyositis and polymyositis are at a fivefold increased risk of what?

Answer 41

Malignancy - they should have age approrpiate cancer screening, but also CT chest, abd, pelvis, UA for hematuria, serum CA125 and CA19-9, PSA, and EGD

Question 42

Palpable purple, arthralgias, membranoproliferative glomerulonephritis, low serum complement, cutaneous vasculitis and neuropathy. False positive ANA and RF

Answer 42

Mixed (type 2) cryoglobulinemia due to Hep C

Question 43

Things to consider in a patient presenting with clubbing of the fingers (even with underlying lung disease) AND synovitis of knees, ankles and fingers

Answer 43

Hypertrophic osteoarthropathy - abnormal proliferation of skin and osseous tissues usually due to an intrathoracic process frequently non-small cell lung cancer

Question 44

Patient with long standing RA presenting with neck pain radiating to occipital region, slowly prgoressive spastic quadriparesis, painless sensory deficits in hands/feet, respiratory dysufnction

Answer 44

Consider RA cervical myelopathy - occurs due to atlanto-axial subluxation (C1-C2)

Question 45

Methotrexate toxicities

Answer 45

Fever and GI distubrances with days of MTX dose. Macular rash. Stomatitis and megaloblastic anemia (these two are due to folic acid inhibition and can be treated with supplementation)

Question 46

Subacute shoulder arthropathy with hemorrhagic effusion. Xrays show periarticular calcification and destructive arthritis

Answer 46

Basic calcium phosphate deposition (milwaukee shoulder)