Rosh Review Rheumatology

Question 1

Biopsy findings in a patient with positive p-ANCA show necrotizing inflammation and small-vessel vasculitis in the respiratory tract and necrotizing glomerulonephritis in the kidneys.

Diagnosis?

Answer 1

Granulomatosis with polyangiitis (Wegener granulomatosis)

Question 2

What is the treatment of scleroderma renal crisis?

Answer 2

• Captopril
• Nitroprusside

Question 3

When is nitroprusside added to captopril for the treatment of scleroderma renal crisis?

Answer 3

Nitroprusside is initially added for acute blood pressure management in patients with central nervous system effects such as retinal changes, papilledema, or encephalopathy.

Question 4

Is captopril plus nitroprusside superior to captopril alone in the treatment of scleroderma renal crisis?

Answer 4

Yes

Question 5

High-dose glucocorticoids increase the risk of developing which complication of diffuse cutaneous systemic sclerosis?

Answer 5

Scleroderma renal crisis.

Question 6

What does colchicine toxicity typically present as?

Answer 6

Vomiting and diarrhea

Question 7

What do calcium pyrophosphate dihydrate crystals look like under polarized light?

Answer 7

Positively birefringent rhomboid-shaped crystals.

Question 8

What imaging modality should be ordered on all patients presenting with pulmonary involvement and suspected granulomatosis with polyangiitis?

Answer 8

CT scan

Question 9

What is prophylactic therapy for patients at high risk of tumor lysis syndrome?

Answer 9

Rasburicase

Question 10

When can allopurinol be used as prophylactic therapy for tumor lysis syndrome?

Answer 10

When patients have intermediate risk

Question 11

Which prophylactic agent is preferred in patients at high risk for tumor lysis syndrome… allopurinol or rasburicase?

Answer 11

Rasburicase

Question 12

When is febuxostat used as prophylactic therapy for tumor lysis syndrome?

Answer 12

When both allopurinol and rasburicase cannot be used

Question 13

What is the treatment for established tumor lysis syndrome?

Answer 13

Management of electrolyte abnormalities, cardiac monitoring, rasburicase, intravenous fluids, loop diuretics, and, if needed, renal replacement therapy.

Question 14

What disease has joint space narrowing?

Answer 14

Osteoarthritis

Question 15

What disease has bone erosions with new bone formation?

Answer 15

Psoriatic arthritis

Question 16

Which medication that was previously used for pain control in osteoarthritis of the hip and knee is no longer part of the first-line recommended treatment guidelines?

Answer 16

Acetaminophen because of a lack of efficacy and its potential side effects.