Rheumatology Quiz on Symptoms and Tests

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Questions and Answers

What is the primary symptom indicating a possible case of rheumatoid arthritis in the patient presented?

Hair loss

Severe fever

Progressively increasing pain and stiffness in small joints (correct)

Numbness in fingers

Which clinical finding might suggest carpal tunnel syndrome in the presented case?

Effusions in the knees

Normal range of motion in the spine

Positive squeezing of the metatarsophalangeal joints

Numbness in the thumb and fingers (correct)

Which of the following tests would most likely confirm the presence of carpal tunnel syndrome?

Tinel’s test (correct)

MRI of the spine

X-ray imaging

Blood test for rheumatoid factor

What is a notable symptom of Raynaud's disease?

Numbness and coldness in fingers and toes (D) Signup and view all the answers

What does a positive Tinel's sign typically indicate?

Carpal tunnel syndrome (C) Signup and view all the answers

In the context of the provided case, which symptom is most commonly associated with rheumatoid arthritis?

Limited joint range of motion (B) Signup and view all the answers

Which of the following conditions is characterized by inflammation of the pleura?

Pleurisy (D) Signup and view all the answers

What mechanism primarily causes symptoms in carpal tunnel syndrome?

Compression of the median nerve (D) Signup and view all the answers

What is a common physical manifestation of rheumatoid arthritis (RA)?

Swan neck deformity (C) Signup and view all the answers

Which autoantibody has the highest specificity for rheumatoid arthritis?

Anti-CCP antibodies (A) Signup and view all the answers

What environmental factor is associated with an increased risk of developing RA?

Low level of formal education (D) Signup and view all the answers

Which hormone-related factor is noted to have a favorable effect on rheumatoid arthritis?

Breast-feeding after the first pregnancy (B) Signup and view all the answers

What is the primary goal of using Disease Modifying Antirheumatic Drugs (DMARDs) in the treatment of RA?

To prevent joint damage (B) Signup and view all the answers

Which of the following is NOT considered an extra-articular manifestation of rheumatoid arthritis?

Joint swelling (D) Signup and view all the answers

What is the sensitivity of rheumatoid factor (RF) in diagnosing rheumatoid arthritis?

70% (D) Signup and view all the answers

Which genetic marker is most important in the risk factor profile for rheumatoid arthritis?

HLA–DR4 (A) Signup and view all the answers

What type of anemia is indicated by normal MCV and low hemoglobin levels?

Normocytic anemia (C) Signup and view all the answers

What percentage of patients with rheumatoid arthritis is expected to test positive for HLA–DR4?

60-70% (B) Signup and view all the answers

What is the typical peak age of onset for rheumatoid arthritis?

4th-5th decade (A) Signup and view all the answers

Which of the following symptoms is most characteristic of rheumatoid arthritis?

Morning stiffness (B) Signup and view all the answers

What is the incidence rate of rheumatoid arthritis in females, based on the provided data?

0.4/1000 (D) Signup and view all the answers

Which laboratory marker is strongly positive in patients with rheumatoid arthritis?

Rheumatoid factor (A) Signup and view all the answers

What does an elevated erythrocyte sedimentation rate (ESR) in this context suggest?

Chronic disease process (C) Signup and view all the answers

How much more common is rheumatoid arthritis in women compared to men?

2-3 times (D) Signup and view all the answers

Which treatment is specifically indicated for increasing salivary secretion in Sjögren syndrome?

Pilocarpine (A) Signup and view all the answers

What is the peak incidence age range for Systemic Lupus Erythematosus?

20 - 40 years (B) Signup and view all the answers

Which of the following symptoms is NOT typically associated with Systemic Lupus Erythematosus?

Dry mouth (B) Signup and view all the answers

What is the reported female to male ratio for Systemic Lupus Erythematosus?

8:1 (D) Signup and view all the answers

Which of the following is NOT a recommended practice for managing symptoms of Sjögren syndrome?

Using drugs with anticholinergic side effects (D) Signup and view all the answers

Which class of medications is categorized as conventional DMARDs?

methotrexate (MTX) (C) Signup and view all the answers

What is the primary effect of Sjögren syndrome on the body?

Decreased exocrine secretions (C) Signup and view all the answers

Which of the following is an example of a biological DMARD that inhibits TNF?

infliximab (C) Signup and view all the answers

What percentage of patients with rheumatoid arthritis experience TMJ involvement?

25% (C) Signup and view all the answers

Which autoantibodies are characteristic of Sjögren syndrome?

anti-SS-A and anti-SS-B (B), anti-Ro and anti-La (D) Signup and view all the answers

What is a major oral manifestation commonly seen in patients with Sjögren syndrome?

Xerostomia (C) Signup and view all the answers

Which condition can manifest as part of the extraglandular symptoms of Sjögren syndrome?

Keratoconjunctivitis sicca (A), Glomerulonephritis (B) Signup and view all the answers

What is a significant dental concern for patients with rheumatoid arthritis?

Malocclusion due to TMJ issues (D) Signup and view all the answers

What factors contribute to the etiology of systemic lupus erythematosus (SLE)?

Both host and environmental factors play a role. (D) Signup and view all the answers

Which of the following clinical manifestations occurs in the highest frequency in systemic lupus erythematosus?

Cutaneous manifestations (C) Signup and view all the answers

What is the characteristic appearance of the malar rash in systemic lupus erythematosus?

Butterfly-shaped and non-scarring (B) Signup and view all the answers

What distinguishes jaccoud arthropathy from arthritis in systemic lupus erythematosus?

Joint laxity without erosions in jaccoud arthropathy (B) Signup and view all the answers

Which of the following conditions can occur in patients with systemic lupus erythematosus affecting the cardiovascular system?

Raynaud's phenomenon and increased coronary artery disease risk (B) Signup and view all the answers

What type of anemia is commonly observed in systemic lupus erythematosus?

Normocytic or microcytic anemia, depending on the cause (D) Signup and view all the answers

In systemic lupus erythematosus, which feature is characteristic of lupus nephritis?

Classified into four histological types determined by biopsy (A) Signup and view all the answers

Which of the following statements applies to recurrent oral ulcers in patients with systemic lupus erythematosus?

They must occur at least three times in 12 months to be significant. (C) Signup and view all the answers

What immunologic abnormality is often associated with systemic lupus erythematosus?

Loss of immunologic tolerance to nuclear autoantigens (C) Signup and view all the answers

Which of the following is a common dermatological manifestation in systemic lupus erythematosus?

Chronic discoid lesions with scarring (B) Signup and view all the answers

Study Notes

Internal Medicine Notes

Increased blood cholesterol is a symptom to be considered.
History of heart problems, hernia, or conditions affecting the stomach are noted in patient history.
Assessing if the patient has asthma is also important.
Patient's age, general condition (e.g., fair or good), and the number of siblings and sisters are also observed.

Rheumatic Disorders

Rheumatism encompasses various diseases, one of which is rheumatoid arthritis.
A 42-year-old woman experienced increasing pain and swelling in her hands, feet, elbows, and knees.
She reported no fever, hair loss, dry eyes, dry mouth, mouth ulcers, rash, Raynaud's phenomenon or pleurisy.
The patient experienced tingling sensations in her right thumb, index, and middle fingers.

Raynaud's Phenomenon

Raynaud's disease affects areas such as fingers and toes, causing numbness and coldness in response to cold temperatures or stress.
Smaller blood vessels narrow, reducing blood flow to the affected extremities/areas.
This phenomenon is also called vasospasm.

Pleurisy

Pleurisy (also called pleuritis) is a condition where the pleura, lining the lungs and chest wall, becomes inflamed.
Pleurisy causes sharp chest pain, worsens with breathing.

Examination Findings

Antalgic gait (walking with pain) and limping were present.
Limited shoulder abduction and internal rotation.
Elbow flexion limited to 85 degrees.
Swelling, warmth, tenderness, and limited range of motion in the wrists were found.
Positive Tinel's and Phalen signs.
Swelling, warmth, tenderness in the metacarpophalangeal (MCP) joints of the hands.
Swelling and warmth in the proximal interphalangeal (PIP) joints of the hands were also found.
Effusions (fluid build-up) in the knees.
Positive findings in the metatarsophalangeal (MTP) joints of the feet.
Normal range of motion and normal sacroiliac (SI) joints in the spine.

Carpal Tunnel Syndrome

Carpal Tunnel Syndrome (CTS) is a common hand condition.
Pressure on the median nerve, in the carpal tunnel of the wrist, causes numbness, tingling, and weakness in the thumb and fingers.
Narrow passageway within the wrist, enclosed by bones and ligaments.

Investigations (Blood Tests)

Hemoglobin levels (normal range is 11.6-15g/dl, 13.2-16.6g/dl).
Mean Corpuscular Volume (MCV) (normal range 80-100 fl).
Platelets (normal range 150-450 x 10^3/µL)
Erythrocyte Sedimentation Rate (ESR) (85)
C-Reactive Protein (CRP) (50)
Rheumatoid factor (RF) strongly positive.
Anti-nuclear antibodies (ANA) negative.

X-Ray and MRI Findings

Erosion at the level of the second metacarpophalangeal joint.
Erosion in the 4th and 5th metacarpal bones.
Erosion on the level of the wrist of the joint.
Erosion of the metatarsal bones of the feet.

Diagnosis

Rheumatoid Arthritis (RA) was suspected given the patient's symptoms and test results.
RA is a chronic disease where small joints in the body become inflamed.
Common symptoms include morning stiffness, small-joint inflammation, and swelling in joints.
Increased inflammatory markers and a positive rheumatoid factor are common indicators for diagnosis.

Rheumatoid Arthritis (RA)

Chronic inflammatory autoimmune disease.
Incidence varies depending on sex and age: Male (0.2/1000), or Female (0.4/1000).
0.5%-1% prevalence globally. 2-3 times more common in women than men.
Family history of RA increases risk of developing the disease.
Onset is typically in the 4th-5th decade.
HLA-DR4 is present in 60-70% of RA patients and 20-25% in the general population.
HLA genes play a role but account for only 37% of genetic factors involved in RA.
Symptoms typically develop over weeks-months, but in 15% of cases, the onset is acute (in days).
Symptoms often begin as symmetrical polyarthritis of small joints.
Approximately one-Third of people initially have single-joint disease before RA spreads.
Severe, untreated arthritis can result in joint deformities like swan-neck deformity with per-extension of the PIP joints, and flexion of the DIP joints.
Current treatments are effective and prevent major deformities.

Risk Factors for RA

Environmental: Smoking (particularly in CCP-positive patients), low level of formal education, and urban environments can influence risk.
Hormonal: Estrogen, breast-feeding after the first pregnancy, and pregnancy show a favorable effect.
Genetic: HLA-DR4, DR1 are the most influential genes. PTPN22 and STAT4 are also related.

Autoantibodies (RF & CCP)

RF and CCP sensitivities are similar (around 70%).
CCP has greater specificity (95%) compared to RF (85%).
Most patients with anti-CCP antibodies also have positive RF results.

Disease Course

Different course patterns are identified depending on the patient: Progressive (10% of cases), Monocyclic (20% of cases), Polycyclic (70% of cases).
The duration of time from the initial onset of the disease until the diagnosis varies.

Extra-Articular Manifestations

Systemic diseases can affect all body parts.
Common manifestations in RA include skin, ocular, hematologic, pulmonary, cardiac, neurologic, and renal problems.

Systemic Lupus Erythematosus (SLE)

Chronic multi-system autoimmune disease.
Characterized by a variety of symptoms and highly variable course.
Frequent relapses and remissions are observed.
Peak incidence is between ages 20-40. Ratio of occurrence is 8:1 for women to men.
Prevalence worldwide is around 50-150 per 100,000.
Twins concordance rates: 25%-50% (monozygotic) and 5% (dizygotic).

Etiology of SLE

Host factors (environmental influences like sex, hormonal changes, infections, and exposure to substances like race and UV radiation).
Genetic factors (HLA-A1, B8, DR2, and DR3).
Drug-related causes (medicines and chemicals like procainamide, hydralazine, and quinidine).
Immunological (loss of tolerance to nuclear autoantigens, B-cell hyperactivity, and dysregulation of T-cells).

SLE Classification Criteria

4/11 criteria for clinical symptoms and lab results must be met.
Criteria include indicators like acute cutaneous lupus; chronic cutaneous lupus; oral and nasal ulcers; non-scarring alopecia; arthritis; serositis; renal involvement; neurologic involvement; hemolytic anemia; thrombocytopenia and leukopenia.
Immunological criteria include ANA; anti-DNA antibodies; anti-Sm antibodies; antiphospholipid antibodies; low complement levels, or a positive direct Coombs test.

Clinical Manifestations of SLE

Most frequent findings include skin manifestations (88%), arthritis (76%), neuropsychiatric symptoms (66%), pleuritis/pericarditis (63%), and anemia (57%).
Other manifestations include Raynaud's (44%), vasculitis (43%), atherosclerosis (37%), nephritis (31%), thrombocytopenia (30%), neuropathy (28%), and cardiac valve disease (18%), pulmonary involvement(12%), pancreatitis and mysitis (10 & 5% respectively).

Dermatological Manifestations of SLE

Classifed into acute, subacute, and chronic forms.

Acute SLE

Malar rash (butterfly rash) is a common manifestation.
Other findings include non-scarring alopecia, oral ulcers, and annular rash

Subacute SLE

Annular/Ring-shaped lesions can be found over the trunk/extremities.

Chronic SLE

Discoid lupus can occur, leading to hyperpigmented lesions and scarring in skin.
Hair loss from alopecia can also occur, and is typically irreversible

Musculoskeletal System in SLE

Jaccoud's arthropathy is a characteristic finding, involving joint laxity.
Joints may be affected but erosion is not present.

Pulmonary Manifestations in SLE

Pleural effusion can cause obliteration of the costophrenic angle on CT scan.
Infiltrations of the lung can be present, resulting in possible bleeding or fibrotic damage.

Cardiovascular Manifestations in SLE

Patients may experience pallor in their hands due to the Raynaud's phenomenon.
Potential cardiac involvement, such as coronary artery disease (CAD).

Renal Manifestations in SLE

4 classes of Lupus nephritis are found via biopsy.
Histological observations guide diagnosis and treatment.

Neuropsychiatric Manifestations in SLE

These involve a variety of symptoms, such as aseptic meningitis, cerebrovascular disease, demyelinating syndromes, headaches, movement disorders, myelopathy, seizures, acute confusion, anxiety disorders, cognitive problems, mood disturbances, and psychosis..

Hematologic Manifestations in SLE

Common findings include normocytic or microcytic anemia, thrombocytopenia, leukopenia, and lymphopenia.

Oral Ulcers

Recurrent oral ulcers, painless, and non-HSV related (must occur at least 3 times within a 12-month period) may be a sign of SLE.

Behçet's Disease

Recurrent oral ulcers are common.
Patients may also have recurrent genital ulcers, eye lesions, skin lesions, and pathergy (a skin-hypersensitivity reaction).
Oral ulcers are painful in Behçet's disease, in contrast to SLE.

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Description

Test your knowledge on the symptoms and diagnostic tests associated with rheumatoid arthritis and carpal tunnel syndrome. This quiz covers key clinical findings, specific autoantibodies, and related conditions. Perfect for medical students and professionals looking to refresh their understanding of rheumatological issues.