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Clin Med - Rheumatology P2

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26 Questions

A 50 year old woman presents with c/o dryness in her mouth and eyes. She has been struggling with eating dry foods and some with speech. On PE, you notice that her parotid gland is enlarged. You tell this patient that you suspect an autoimmune condition that causes the dysfunction of the lacrimal and salivary glands called:

Sjögren Syndrome

What labs are specific to Sjögren Syndrome?

anti-SS-A (Ro) + and SS-B (La) +

A patient presents to the ER post marathon with c/o muscle pain and weakness with dark red urine. You order a UA and find large amounts of heme. The patient has markedly elevated CK levels. What is the likely pathology?

breakdown and necrosis of skeletal muscle

What large vessel vasculitits leads to blindness, headache, and jaw claudication in women greater than 50 years of age?

Giant Cell (Temporal) Arteritis (TA)

A patient presents with fever, malaise, weight loss and muscle stiffness/pain in the shoulders and pelvis specifically. The patient reports struggling to complete every day activities such as combing hair and rising from a seat. The patient's labs come back with a elevated ESR >100 and elevate CRP. What is the likely condition?

Polymyalgia Rheumatica (PMR)

79 year old man presents with headache, scalp pain, jaw claudication and double vision. The patient is febrile. On PE, there is slight enlargement of the temporal artery. The labs are elevated but not specific towards any condition. What condition could this be?

Giant Cell (Temporal) Arteritis (TA)

A patient presents with an insidious onset of fever, malaise, weight loss and is in extreme pain. This patient has a + foot drop. You notice rashes and ulcers on his skin. Labs come back with positive Hep B, leukocytosis, and elevated ESR/CRP. What condition are you concerned about?

Polyarteritis Nodosa (PAN)

A patient in their 40s presents to their PCP due to concerns of weight loss and recurrent respiratory infections. This starts to look like lung malignancy due to nodules and masses in the chest XR. You decided to order c-ANCE, which was positive. You then order a tissue biopsy for confirmation of the diagnosis of

Granulomatosis with Polyangiitis (GWP)

What lab is positive in microscopic polyangitis? (C/P)-ANCA

P

A patient presents with recurrent palpable purpura with peripheral neuropathy and glomerulonephritis. .Serum labs are positive for Hep C. What is the likely diagnosis?

Cryoglobulinemia

A pediatric aged patient presents with c/o abd pain, hematuria, and joint pain. On PE, you find skin lesions and palpable purpura. What is this condition?

Henoch-Schonlein Purpura (HSP)

A patient presents with c/o painful ulcers in her mouth and genitals. The ulcers are tender and red. The patient is positive for pathergy, which is a skin condition in which a minor trauma such as a bump or bruise leads to the development of skin pustules. What condition is linked with these ulcers?

Behcet Syndrome

A patient with headaches, encephalopathy, and multifocal strokes has a angiograms that appears like a "string of beads" with alternation between arterial narrowing and dilation. What is this condition?

CNS Vasculitis

Mottled, purplish skin discoloration in reticulated pattern, with pale central core (“fishnet” pattern) due to spams and/or obstruction of arterioles is called:

Livedo Reticularis

A 30 year old Asian female presents with pulseless upper extremities and fever, malaise/fatigue, wt. loss, night sweats, and arthralgia. What condition is this?

Takayasu Arteritis

A 30 year male patient with a 20 pack per year history of smoking presents with ulceration and gangrene of his fingertips. This will need amputation. What is this called?

Buerger’s Disease (Thromboangiitis Obliterans)

A 27 year old male patient presents with inflammation of the tendons and ligaments of his large peripheral joints. He also has signs of uveitis. Labs show a positive HLA-B27 with negative autoantibodies. What is likely?

Seronegative Spondyloarthropathies

A 25 year old male patient presents with c/o gradual onset of back pain (radicular) and stiffness (worse in a.m.) that can last for hours, but does improve with exercise. On x-ray of his spine, there are findings of "fusion of vertebral bodies." Labs: elevated ESR, mild anemia, negative RF, and positive HLA-B27. What is likely?

Ankylosing Spondylitis

A male patient with a history of psorasis presents with concerns about his fingers. He noticed that his fingers are larger (like sauages) and has swelling in the joints with splitting nails. Imaging: bony erosions and joint destruction in the R hand digits. There is a patch of rash on one of his fingers. What is likely?

Psoriatic Arthritis

You recently treated a male patient 4 weeks ago for a GI infection. The patient returns with a PE that consists of "asymmetric oligoarthritis, urethritis, conjunctivitis, uveitis, mucous membrane lesions." Labs show a positive HLA-B27 and synovial fluid is sterile. What likely caused this condition post GI/GU infection?

Reactive Arthritis

1 out of 5 patients with IBD have arthritis. Whipple Disease has a stronger link!

True

A patient presented with an acute onset of pain, swelling and warmth in the left knee that rapidly progressed over hours with fever/chills. Labs showed synovial fluid with WBC usu. >50,000. You know this is likely Acute Bacterial (Septic) Arthritis. What is the most common causative agent?

S. aureus

A 35 year old pregnancy woman presents with c/o several days of migratory polyarthralgia of wrist, knee, ankle, elbow that then progresses to tenosynovitis of wrists, fingers, ankles, toes. On PE, you find a few small, necrotic pustules over extensor surfaces of the palms and soles. The patient's labs show an elevated WBC 30-60K. What is likely?

Gonococcal Arthritis

Rheumatic Manifestations of Cancer has a strong association with ovarian cancer

True

Viral Arthritis can be due to Parvovirus, Hep B/C, or HIV.

True

Arthritis in Sarcoidosis is typically polyarticular and symmetric and presents with erythema nodosum. Where is the most common to occur?

Knees and ankles

Study Notes

Sjögren Syndrome

  • Presents with dryness in mouth and eyes, difficulty eating dry foods and speaking
  • Parotid gland is enlarged
  • Autoimmune condition affecting lacrimal and salivary glands

Rhabdomyolysis

  • Patient presents with muscle pain and weakness, dark red urine, and elevated CK levels
  • Likely caused by intense exercise or marathon running

Giant Cell Arteritis

  • Leads to blindness, headache, and jaw claudication in women over 50 years old
  • Characterized by inflammation of large vessels

Polymyalgia Rheumatica

  • Presents with fever, malaise, weight loss, and muscle stiffness/pain in shoulders and pelvis
  • Elevated ESR and CRP levels
  • Difficulty performing daily activities

Giant Cell Arteritis (Temporal Arteritis)

  • Presents with headache, scalp pain, jaw claudication, and double vision
  • Enlargement of temporal artery
  • Elevated lab results, but not specific to any condition

Polyarteritis Nodosa

  • Presents with fever, malaise, weight loss, and extreme pain
    • foot drop, rashes, and ulcers on skin
  • Positive Hep B, leukocytosis, and elevated ESR/CRP levels

Castleman Disease

  • Presents with weight loss, recurrent respiratory infections, and lung nodules/masses
  • Positive c-ANCE and tissue biopsy confirmation

Microscopic Polyangitis

  • Positive c-ANCA
  • Presents with recurrent palpable purpura, peripheral neuropathy, and glomerulonephritis
  • Positive Hep C

Henoch-Schönlein Purpura

  • Presents with abdominal pain, hematuria, and joint pain
  • Skin lesions and palpable purpura

Behçet's Disease

  • Presents with painful ulcers in mouth and genitals
  • Positive pathergy test
  • Skin pustules due to minor trauma

Vasculitis

  • Presents with headaches, encephalopathy, and multifocal strokes
  • Angiogram shows "string of beads" pattern with arterial narrowing and dilation

Livedo Reticularis

  • Presents with mottled, purplish skin discoloration in reticulated pattern
  • Due to spams and/or obstruction of arterioles

Takayasu's Arteritis

  • Presents with pulseless upper extremities, fever, malaise, weight loss, and night sweats
  • Affects large vessels

Buerger's Disease

  • Presents with ulceration and gangrene of fingertips
  • Requires amputation
  • Associated with smoking

Ankylosing Spondylitis

  • Presents with inflammation of tendons and ligaments of large peripheral joints
  • Uveitis and positive HLA-B27

Psoriatic Arthritis

  • Presents with gradual onset of back pain and stiffness
  • Inflammation of tendons and ligaments of large peripheral joints
  • X-ray shows fusion of vertebral bodies
  • Elevated ESR and positive HLA-B27

Psoriatic Arthritis

  • Presents with finger swelling, bony erosions, and joint destruction
  • Positive HLA-B27 and patch of rash on finger

Reactive Arthritis

  • Presents with asymmetric oligoarthritis, urethritis, conjunctivitis, uveitis, and mucous membrane lesions
  • Positive HLA-B27 and sterile synovial fluid
  • Follows GI or GU infection

Arthritis in IBD

  • 1 out of 5 patients with IBD have arthritis
  • Stronger link with Whipple Disease

Acute Bacterial (Septic) Arthritis

  • Presents with acute onset of pain, swelling, and warmth in joints
  • Synovial fluid with WBC >50,000
  • Most common causative agent is Staphylococcus aureus

Still's Disease

  • Presents with migratory polyarthralgia, tenosynovitis, and necrotic pustules
  • Elevated WBC count

Rheumatic Manifestations of Cancer

  • Strong association with ovarian cancer
  • Viral Arthritis can be due to Parvovirus, Hep B/C, or HIV
  • Arthritis in Sarcoidosis typically polyarticular and symmetric, presents with erythema nodosum
  • Most common in ankles

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