Intraarticular
22 yo male presents with three day history of right knee pain and swelling.
List three things on your differential.
What are septic arthritis (gonococcal, non-gonococcal), crystalline arthritis, trauma, and hemarthrosis
The two organs most severely affected by Granulomatosis with polyangitis.
What are:
Lungs
Kidneys
Four signs of Osteoarthritis on X-ray
What is
1. Subchondral sclerosis
2. Osteophytes
3. Joint Space Narrowing
3. Subchondral cysts
Non-pharmacologic therapies for fibromyalgia. Name 2.
What are
Exercise (esp water aerobics, tai chi, yoga)
Stress Reduction/CBT
Support back and neck
Hand joint typically involved in OA. List 3.
DIPs
PIPs
first CMC
35 year old woman 4 months post-partum presents with hand and foot pain/swelling which has been worsening over the past two months. She has stiffness and sharp pain throughout her hands and the balls of her feet. The stiffness seems to improve after about 90 minutes and movement, heat and acetaminophen help the pain. She is struggling to hold her baby. Apart from her recent delivery, she has no other past medical history.
Given the most likely diagnosis, what would your initial work up include? List 3.
RF, CRP, X-rays, etc.
Organ systems affected by SLE. List 4.
Cutaneous (alopecia, photosensitivity rash, discoid rash)
Renal (nephrotic syndrome, proteinuria)
MSK (arthritis, myalgia/myositis)
Cardiorespiratory (pericarditis, myocarditis, endocarditis, pleurisy, pneumonitis)
Neurological (seizures, chorea, transverse myelitis)
Hematological (hemolytic anemia, leukopenia, lymphopenia, thrombocytopenia)
Other than rheumatoid factor, list labs part of initial work up for Rheumatoid Arthritis. List two.
What are Anti-CCP, CRP
Treatment option for RA that is safe in pregnancy.
What is Sulfasalazine
Classic physical exam findings associated with advanced Rheumatoid Arthritis. List 3.
What are
Ulnar deviation at MCPs
Radial deviation at wrists (Z deformity)
Volar subluxation at wrists and MCPs
Boutonneire deformity of the thumb
Swan neck deformity of the fingers
37 yo M presenting to clinic for follow up for a recent ED visit. He had a fall and X-ray of his hand and wrist. There was no fracture but it did show multiple joint erosions. He has a history of PUD and IBS and is taking a PPI.
What would you prescribe for acute pain managment.
Glucocorticoid
Common findings associated with psoriatic arthritis. List two.
What is nail pitting, dactylitis, arthritis mutilans, rash.
Investigation that can help differentiate gout from a septic joint.
What is a Joint aspirate
Typical initial regimen for treatment of Rheumatoid Arthritis.
What areL
NSAIDs or Glucocorticoids
DMARD
Indications for urate lowering therapy
What are
>=1 tophi
radiographic disease from gout
>=2 flares/year
first flare and CKD stage >=3, SU >535 umol/L, or urolithiasis
45 yo man presents to clinic with persistent right shoulder pain. It began 2 days ago and is progressing. It is a deep ache that is worsened with activity and radiates down his right arm and occasionally into his chest and back. There is no history of injury or trauma.
What condition must be ruled out? If negative, what is the best test to evaluate his shoulder pain?
ACS
US Rt shoulder
29 yo M complaining of progressive lower back pain for the past 3 months. The pain is worst in the morning and improves with activity. It typically takes him about an hour to get everything “loosened up”. Which extraarticular manifestation is most common with this condition?
What is acute anterior uveitis
Classic finding on X-ray for Ankylosing Spondylitis.
What is squaring of the vertebral bodies?
First line treatment for psoriatic arthritis.
What is Methotrexate?
Risk factors for developing Rheumatoid Arthritis.
What are
1. Family history
2. Age 30-60
3. female
4. smoking
New York Criteria for diagnosing gout.
>= 2 attack of painful joint swelling with complete resolution in 2 weeks
unilateral first MTP joint attack
Response to colchicine
Tophi
Need >=2
Complications of untreated Rheumatoid Arthritis. List 2.
Scleritis
Deformities of the hands
Pericarditis
Tests that are part of the immunological work up for SLE. List 3.
What are:
1. ANA
2. Anti-dsDNA
3. Anti-Sm
4. Antiphospholipid antibody
5. C3, C4
6. Direct Coombs test
Empiric antibiotics for septic arthritis.
Cloxacillin 2g IV q4h x 2-4 weeks
Lifestyle factors that contribute to development of gout.
high purine diet (red meat, organ meat, seafood, excessive alcohol esp. beer)
obesity
dehydration