Pharm/therapy
These are the current various treatment options for fibromyalgia. (Must name 3)
What is amitriptyline, duloxetine, pregabalin, gabapentin, milnacipran, tramadol, CBT, tai chi, physical therapy, aquatic therapy, transcutaneous electrical nerve stimulation.
(Will NOT accept other opiates, marijuana, anti-inflammatories)
This should be tested for in a patient who presents with chronic low back pain, morning stiffness, dactylitis, uveitis, and Achilles tendinitis.
What is HLA-B27 antigen testing?
This is the most specific antibody for RA
What is anti-Citrullinated Paptide (Anti-CCP)?
Other than a T-score of -2.5, osteoporosis diagnosis can also be made with this finding/criteria.
What is fragility fracture?
This is the number of classes of lupus nephritis.
What is 6?
These two gout medications are non-purine direct xanthine oxidase inhibitors. (Must name at least one)
What are febuxostat/topiroxostat
This should be tested for in a patient with ankylosing spondylitis who develops diarrhea with diffuse non-specific abdominal pain.
What is IBD?
This antibody is very specific for diffuse systemic sclerosis.
What is anti-scl-70 antibody (or anti-topoisomerase 1)?
Note: Anti-RNA polymerase III is also strongly associated with diffuse disease
This disease often involves patients age >50, neck/shoulder/hip pain, morning stiffness lasting longer than 45 min, low grade fever, weight loss, fatigue, elevated ESR and CRP but normal CK, and negative RF/anti-CCP.
What is polymyalgia rheumatica?
This is the next best step when a 24 year old female patient presents with new onset hypertension, malar rash, bilateral arthralgias, creatinine 1.7, positive anti-dsDNA antibodies, low C3 and C4, and UA with 4+ protein and 2+ blood.
What is Kidney Biopsy?
This medication helps prevent complement binding to vascular endothelium in patients with antiphospholipid antibody syndrome.
What is hydroxychloroquine?
In PAN, this organ system is most likely to be spared.
What are the lungs.
This antibody can be positive in a patient who is completely healthy but smokes.
What is ANA?
This diagnosis should be suspected in a patient who presents with dry eyes, bilateral parotid enlargement, and dry mouth in addition to night sweats, intermittent fevers, and weight loss.
What is non-Hodgkin lymphoma?
This class of medication is first line for treating a 31 year old female who presents with bilateral Reynauds in both hands and feet, thickened skin over the hands, feet, and trunk, nuchal rigidity, seizures, BP 240/120, Cr 2.4 (baseline 0.8), and UA with 2+ protein but no blood or casts.
What are ACE inhibitors?
This medication is a good alternative for patients with Beçhet disease who cannot take long term steroids and who either fail or do not tolerate colchicine.
What is apremilast?
This is the pathophysiology that leads to the constellation of symptoms that you see in the disease of a 35 year old Japanese Female patient who presents with a year of intermittent fevers, myalgias, chronic fatigue, acute right eye vision loss. Right arm BP 160/100, left arm BP 130/80, absent left radial pulse, left subclavian bruit, elevated ESR/CRP, and MRA chest/abdomen showing large vessel narrowing of the ascending aorta, left subclavian, SMA, and right renal arteries.
What is large vessel vasculitis leading to widespread stenosis?
(Takayasu Arteritis)
This antibody can be seen in patients with the disease characterized by palpable purpura with lesions at the same stage of development, hematuria, hemoptysis, and biopsy results showing small vessel pauci-immune vasculitis with fibrinoid necrosis.
What is anti-MPO antibody (p-ANCA)?
(Microscopic Polyangiitis)
This disease is characterized by recurrent oral ulcers (2-3x per year) and 2 of the following:
- genital ulcers
- ocular lesions
- skin lesions
- positive pathergy test
This is also in context with labs negative for HSV, no recent infections, normal CT chest, negative ANCA panel, negative HIV, negative VDRL/RPR, and a normal colonoscopy.
What is Behçet’s disease?
This is the characteristic finding on kidney biopsy for a patient who presents with malaise, fatigue, sinusitis, dry cough, eye redness, rash, hematuria, proteinuria, and granulomatous lung disease.
What is pauci-immune crescentic necrotizing glomerulonephritis
This medication belongs to a class of osteoporosis medications that inhibit sclerostin, thus signaling the WNT pathway to upregulate blast cells and promote bone formation. It is the only currently FDA approved medication in this class.
What is romosozumab (Evenity)?
This gene is the main mutation in the disease characterized by systemic inflammation leading to episodic fevers, abdominal pain, rash, and arthritis. Episodes last several days then remit, recurring many times each year. The disease is found in Jewish, Arab, and Turkish populations and is autosomal recessive.
What is the MEFV gene?
(Leads to overproduction of interleukin -1Beta. Tx is lifelong ppx colchicine)
This antibody is highly associated with malignancy in patients with dermatomyositis.
What is Anti-TIF-1gamma antibody?
This disease should be tested for in a 21 year old patient who presents with disseminated shingles, arthritis of multiple joints, and severe lymphopenia of <500 without elevation of any other cell lines.
What is Lupus?
Of all the small and medium vessel vasculitis diseases, this one most commonly affects the kidneys more often than the others.
What is Microscopic Polyangiitis?