Clin Med - Rheumatology P1

When examining joint fluid, it is safe to pass a needle through area of cellulitis or plaque

What is the most common joint disease, known as "the disease of aging"?

What is NOT a risk factor for the development of osteoarthritis?

A patient presents with cartilage degeneration and increase of bone density/mass at a previous injury site. What is likely?

A patient presents with complaints of gradual onset of stiffness, pain and restricted movement of their finger joints (PIP and DIP). The patient otherwise has a normal ROS and PE. What comment would make you think this is osteoarthritis?

A patient complains of stiffness for the last 3-4 months. You decide to get imaging (xray), and find "joint space narrowing, osteophytes, thickened subchondral bone, cysts." What could this be?

For osteoarthritis, what what labs are likely?

What are treatment recommendations for osteoarthritis?

A male patient (MC) has labs that show the overproduction (or underexcretion) of uric acid. He reports that his mother had this condition as well. What is being described?

A patient presents with complaints of intermittent, acute joint pain in their great toe (MTP joint) that is much worse at night. The patient reports mild fevers, chills and fatigue. The recent episode occurred after a large purine-rich meal. On physical exam, you find the patient's great toe to be red, warm, and swollen. The patient is very tender to palpation. What is likely?

Gout is commonly associated with what chronic disease?

What is the initial diagnosis test that should be ordered for a patient with possible gout?

You are not sure if your patient has pseudogout or gout. Their joint fluid analysis shows uric acid crystals (needle- like, - birefringent urate crystals). What did you decide?

Your patient has a diagnosis of ______. You are monitoring their condition with x-ray at today's visit. The patient is later the course of ______ and the x-ray shows "punched-out erosions with overhanging bone."

Asymptomatic hyperuricemia does need treatment, it is gout!!

What cannot be used for the treatment of GOUT?

A patient with hemochromatosis presents with sudden severe joint pain. PE shows a red, warm joint with limited range of motion. You decided to order radiographs which shows linear calcifications of the cartilage. What is likely?

A 26 year old woman presents to your office with complains of greater than 3 months of widespread MSK pain and stiffness. The patient reports feeling extremely fatigue and does not sleep well at night. On PE, you find nothing remarkable other than point tenderness at the patient's trapezius, knees, and elbows (see image). What is likely?

This is a correct scenario: A patient with fibromyalgia asks for opiates to help with their chronic pain. They reports bad sleep and many trigger points. You prescribe it for them.

A woman in her 40s presents with insidious onset of pain and stiffness in multiple joints bilaterally. On PE, you notice hot, swollen, tender, red joints bilaterally in the hands, knee and ankle (but spares the DIP in the hand). The patient reports that the pain is worse in the morning, but improves throughout the day with activity. What is the likely autoimmune disease?

Chronic systemic inflammatory disease that presents as synovitis/arthritis of multiple joints.

What systemic finding may presents with Rheumatoid Arthritis (RA)?

You have a high index of Rheumatoid Arthritis (RA) due to a patient presents with multi-system complaints and symmetric joint swelling. What is the best initial test?

What finding in the synovial joint fluid is likely for Rheumatoid Arthritis (RA)?

You diagnosis your patient with ____________. At first, the patient had a normal x-ray (first 6 mo), then you repeat to monitor the condition and find "joint space narrowing and erosions, C1-2 subluxation." What is likely?

Chronic deformities such as ulnar deviation, boutonniere and swan- neck deformities of PIP and DIP joints, can be seen in what pathology?

A 26 year old AA female presents to your office and reports feeling "terrible." She c/o fatigue, fever, weight loss, joint pain, facial rash, and hair loss. What is a likely cause?

What antibody is VERY sensitive for lupus?

What are the worst cause of symptoms in Systemic Lupus Erythematosus (SLE)?

What specific, but not sensitive labs are used to diagnosis Systemic Lupus Erythematosus (SLE)?

Using the diagnostic criteria in the picture, a patient has at least 4 out of 11 findings and is then diagnosed with:

A female patient with a history of 4 spontaneous abortions and 1 premature birth presents to discuss fertility. On PE, you notice a mottled violaceous rash (called livedo reticularis). What are you concerned of?

A patient with suspected Antiphospholipid Antibody Syndrome (APLA) had labs drawn, all of the following answer choices were positive. What test is most likely falsely positive due to a antibody associated with false positive tests?

A young woman presents to your office due to concern about her fingers. She reports that her finger tips get very white and cold whenever she is stressed or cold. What is this likely condition?

SH initially presented with Raynaud's phenomenon, experiencing episodes of fingers turning white and numb in response to cold temperatures or stress. She also noticed a progressive tightening and thickening of the skin on her fingers, hands, and face, which has been gradually spreading to other parts of her body. This tightening has led to difficulty with finger dexterity, making it challenging for her to perform tasks that once came easily. Her labs: + ANA, anemia, anticentromere ab. What is likely the cause of this disorder?

JH is a 60 year old black female that presents with c/o muscle weakness. She reports that it has been gradual and progressively worsening and is now hard to rise from her chair or get up the stairs. She denies any facial or ocular pain. On PE, you notice a rash that is red and present on the face, neck, shoulders, and upper chest (helitrope rash eyelids, poikiloderma chest). You also notice gottron papules on the fingers. What is the likely cause of this muscle weakness?

There is a risk of malignancy with dermatomyositis, but not polymyositis.