rheumatoid

Question 1

if you are thinking about starting DMARDs (hydroxychloroquine or azathrioprine (imuran) on a pt w/ RA, what exam must be done first?

Answer 1

Eye

both can cause retinitis

Question 2

Is reactive arthritis an HLA-B27 disorder or associated with a post GI/GU infection?

Answer 2

Both

Question 3

treatment of reactive HLA-B27?

Answer 3

NSAIDS

Question 4

are HLA-B27 disorders RF positive or negative?

Answer 4

negative

Question 5

factors of psoriatic arthritis?

Answer 5

pitting nails, psoriasis, uvetitis/conjunctivitis, arthritis (SI and DIP)

Question 6

tx of psoriatic arthritis?

Answer 6

NSAIDS or sulfasalazine

Question 7

what lab is 99% positive in lupus?

Answer 7

ANA, double stranded DNA is also highly positive

Question 8

Name the rash associated with lupus

Answer 8

discoid/butterfly/malar

Question 9

Is ANA + or - in raynauds?

Answer 9

negative

Question 10

Is ESR high or low in raynauds?

Answer 10

normal

Question 11

explain scleroderma?

Answer 11

multi-system autoimmune, deposition of collagen

Question 12

What syndrome describes the characteristics of scleroderma?

Answer 12

CREST, calcinosis, raynauds, esophageal dysmotility , sclerodactyly-chronic contractures & Telangiectasis

Question 13

what lab is 95% positive is scleroderma?

Answer 13

ANA

Question 14

age group & gender affected by scleroderma?

Answer 14

female 30-50

Question 15

tx for scleroderma

Answer 15

symptomatic

Question 16

sjogren’s pt are 40x higher risk of what medical condition?

Answer 16

lymphoma

Question 17

ok

Answer 17

ok

Question 18

characteristics of scleroderma?

Answer 18

dry eyes, dry mouth, and enlarged saliva glands

Question 19

describe polymyositis

Answer 19

inflammatory muscle disease associated with proximal muscle weakness

Question 20

patient is having difficulty raising from chair and brushing her hair, you are concerned about polymyositis, what test can be done?

Answer 20

do a striated muscle biopsy. muscle enzymes may be elevated

Question 21

rash associated with polymyositis?

Answer 21

heliotrope

Question 22

stiffness after rest and proximal muscle weakness….think?

Answer 22

polymyositis

Question 23

20 year old male complains of 3 days hx of joint pain that moves around & experiencing redness & swelling over tendon and knee joint. He also has necrotic pustules over fingers.. he has?

Answer 23

gonococcal septic arthritis

Question 24

how do gonococcal and septic arthritis present differently?

Answer 24

gonococcal migrates from joint to joint, septic affects one joint

Question 25

septic arthritis is dx with IV drug user, gram - e.coli, what do you use?

Answer 25

Cipro or TMP-SMX

Question 26

besides the spine, what other joints does ankyolsing spondylitis affect?

Answer 26

hips & shoulder

Question 27

best tx for ankylosing spondylitis?

Answer 27

NSAIDS and activity

Question 28

Name the spondyloarthropathies?

Answer 28

Ankylosing spondylitis, reactive arthritis, psoriatic arthritis, arthritis associated with IBS

Question 29

all spondyloarthropathies are RF and ANA negative but ___positive?

Answer 29

HLA-B27

Question 30

pt has pain with urination, pink eye, painful joints and ulcers in his mouth. most likely dx?

Answer 30

reactive arthritis (reiter’s syndrome)

Question 31

how many triggers point do you need to dx fibromyalgia

Answer 31

11 of 18

Question 32

tx for fibromyalgia?

Answer 32

tricyclic antidepressant

Question 33

most common etiology of gout?

Answer 33

95% do not excrete ca+ well enough. only 5% are overproducers

Question 34

X-ray shows chrondrocalcinosis (linear calcification in articular carriage ) is a _____finding?

Answer 34

pseudogout

Question 35

HB will have OA?

Lisa Schwantas will have?

Answer 35

herberden’s (DIP) & Bouchard’s (PIP) = OA. Swan’s neck=OA

Question 36

ulnar deviation & subluxation of the MCP joint

Answer 36

RA

Question 37

other organs involved in RA?

Answer 37

sicca (dry eyes, pericarditis, CAD, pleural nodules, effusions, carpel tunnel, anemia and vasculitis

Question 38

i have arthritis in my DIP joint, what type of arthritis is most likely?

Answer 38

OA

Question 39

AM stiffness

Answer 39

RA

Question 40

What test is 95% positive in patient with primary biliary cirrhosis?

Answer 40

AMA levels (Anti-mitochondrial antibody)

Question 41

gold standard to dx addison’s disease

Answer 41

A rise in serum cortisol levels to 20 mcg/dL or more after administration of the synthetic ACTH indicates a normal functioning adrenal cortex. A suboptimal response to the Cosyntropin test confirms the presence of primary Addison’s disease.

Question 42

A 27 year old African American female presents to your office complaining of persistent aching in her joints for a couple of weeks. She has also had fatigue, and a fever that has lasted for the last 5 days. On physical exam you find range of motion and stability intact in the affected joints, which are also non-tender to palpation. You also note an erythematous rash covering the cheeks and bridge of the nose. Which of the following lab tests is most specific in diagnosing this patient’s condition?

Answer 42

This patient is presenting with symptoms common in systemic lupus erythematosus such as polyarthralgias and a malar (discoid) rash. Anti-DS DNA is the most specific test in detecting the presence of SLE; ANA is the most sensitive test (meaning that most cases of SLE will have a positive ANA test, but that it is not exclusive to this condition)