TBL Rheumatology

Question 1

Nerves for foot inversion

Answer 1

L3-L4

Question 2

Nerves for big toe dorsiflexion

Answer 2

L4-L5

Question 3

Nerves for foot eversion

Answer 3

L5-S1

Question 4

sensory changes around medial mallaelous

Answer 4

L4

Question 5

sensory changes around 3rd metatarsal (foot)

Answer 5

L5

Question 6

sensory changes around lateral heel

Answer 6

S1

Question 7

decreased patellar DTR

Answer 7

L3-L4

Question 8

decreased medial hamstring DTR

Answer 8

L5-S1

Question 9

decreased Achilles DTR

Answer 9

S1-S2

Question 10

decrased anal wink DTR

Answer 10

S2-S4

Question 11

indications for arthrocentesis

Answer 11

i. Unexplained arthritis with synovial effusion
ii. Suspicion of septic arthritis
iii. Suspected crystal-induced arthritis
iv. Evaluation of therapeutic response in septic arthritis

Question 12

what do you order on initial evaluation of suspected knee OA?

Answer 12

CBC
ESR (neg increases specificity of OA)
X-Ray

Question 13

Image findings on OA:

Answer 13

1. Narrowing of joint space
2. Sclerosis appearing as productive bone of increased density on both sides of the involved joint
3. Osteophyte
4. Small cysts in bone near joint resulting from fractures of joint cartilage and penetration of joint fluid into juxtaarticualr bone

Question 14

Image findings on RA:

Answer 14

1. Soft tissue swelling
2. Osteoporosis
3. Narrowing of joint space
4. Marginal erosions

Question 15

Image findings on Gout:

Answer 15

1. Scattered erosions of bone, often with sclerotic, overhanging, hook-like margins where soft tissue nodules (tophi) adjoin the erosions.
2. Distribution of joint involvement random
3. Tophi may or may not calcify

Question 16

Dermatomyositis: clinical and lab findings

Answer 16

i. Can present with photosensitive rash and arthritis, however proximal muscle weakness is almost always present.
ii. Useful lab is creatine kinase, which is typically elevated

Question 17

Risk factors for RA

Answer 17

i. Peak onset 4th or 5th decade for women; 6th to 8th decade for men
ii. women > men
iii. Inheritance of HLA DRB1 alleles encoding 5-amino acid sequence called the “shared epitope” is best genetic risk factor

Question 18

Risk factors for SLE

Answer 18

i. 85% pts are women
ii. sex hormones play a role (most cases develop after menarche and before menopause)
iii. Race (Blacks > whites)
iv. Familial component (HLA DR2 and DR3)

Question 19

Diagnosis criteria from SLE

Answer 19

Need 4/11

1. Malar rash
2. Discoid rash
3. Photosensitivity
4. Oral ulcers
5. Arthritis
6. Serositis
7. Kidney disease
   a. >0.5g/d proteinuria OR
   b. >3+ dipstick proteinuria OR
   c. cellular casts
8. neurologic disease (sz or psychosis)
9. hematologic disorders
   a. hemolytic anemia OR
   b. leukopenia (<100000)
10. immunologic abnormalities
    a. positive LE cell prep oR
    b. antibody to native DNA OR
    c. antibody to Sm OR
    d. false-positive test for syphilis
11. Positive ANA