IM - rheum

20's y.o. female w/ a hx of other autoimmune dzs presents w/ numbness in tips of fingers when it's cold out. Photo shows ¾ of the finger distally as white and the rest of the hand being pink/red. Dx? if you were to medically tx, what could you use?
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20's y.o. female w/ a hx of other autoimmune dzs presents w/ numbness in tips of fingers when it's cold out. Photo shows ¾ of the finger distally as white and the rest of the hand being pink/red. Dx? if you were to medically tx, what could you use?
Raynaud's. tx w/ calcium channel blockers (amlodipine)
Elderly pt comes in complaining of chronic knee pain. There is no morning stiffness. X-ray shows narrowed joint space and osteophytes.
Osteoarthritis
Older pt presents w/ foreign-body sensation and grittiness feeling in her eyes for a number of months. Eye exam is fairly benign. On the rest of the exam you note cracking lips and dry oral mucosa. Dx?
Sjogren's
45 y.o. F presents w/ progressive proximal muscle weakness (walking up stairs or lifting things above head) w/o pain. May also have some dysphagia and choking episodes. No skin findings. Labs reveal elevated ESR and CK. Dx? what test is needed to definitively dx? tx?
Polymyositis. Need muscle biopsy for definitive dx. Tx w/ steroids initially
50's y.o. F presents w/ stiffness, pain, and decreased ROM in hips and shoulders. Also some fatigue and low grade fevers. On exam, there is 5/5 strength throughout. ESR is elevated but CK is normal. Dx? tx?
Polymyalgia rheumatica. Tx w/ steroids
Important autoantibodies:
-- match to dx
- anticardiolipin - antinuclear (ANA) - anti-dsDNA - anti-smith - anti-Ro - anti-La - anti-topoisomerase1 - anti-Jo - anti-cyclic citrullinated peptide - anti-U1 ribonucleoprotein - anti-neutrophil cytoplasmic antibodies
Anticardiolipin = antiphospholipid. ANA = nonspecific screening. Anti-dsDNA and anti-smith = SLE. Anti-Ro and anti-La = sjogren's. Anti-topoisomerase1 = scleroderma. Anti-Jo = polymyositis. Anti-cyclic citrullinated peptide = rheumatoid arthritis. Anti-U1RNP = mixed CT dz. Anti-neutrophil cytoplasmic antibodies (ANCA) = Wegner's, etc.
Middle aged F presents w/ a feeling of food getting stuck in her chest. Overall found to have hypomotility and incompetence of the LES. On ROS she is positive for arthralgias and fatigue. Dx? cause?
Systemic sclerosis. Caused by smooth muscle atrophy and fibrosis
20's y.o. M pt presents w/ chronic low back pain despite being a regular gym-goer. Back pain is better w/ exercise. X-rays show "bamboo" spine, and he has an elevated ESR. Dx? 1st and 2nd line tx?
Ankylosing spondylitis. First tx w/ NSAIDs, then TNF-alpha inhibitors
30's y.o. M presents w/ 2nd and 3rd MCP swelling and tenderness bilaterally for months. Xray w/ joint space narrowing, chondrocalcinosis, and hook-shaped osteophytes. He also has elevated transaminases. Dx? tx?
Hereditary hemochromatosis. Phlebotomy
30's y.o. F presents w/ aching pain and stiffness in her whole body to the point where she is having difficulty in her day-to-day life. Tenderness to palpation over neck, shoulders, back, and hips. Labs including ESR and CRP are all normal. Dx? tx? What are specific drug classes that are good for this pt?Fibromyalgia. Tx is really just regular aerobic exercise and good sleep hygiene. Drugs can include TCAs or SNRIsOlder F presents w/ pain in her fingers that is worse w/ activity. Pain in mainly located in DIPs w/ bony enlargement at the joints.Osteoarthritis50's y.o. pt presents w/ morning stiffness in fingers and fatigue. MCP and PIP have some boggy swelling w/ tenderness. ESR is elevated. Dx? what other lab tests should you run x3 (hint: antibody things)Rheumatoid arthritis. Check rheumatoid factor, ANA, and anti-CCPCREST syndrome is associated with what underlying dz? What are the components of CREST?CREST associated w/ systemic sclerosis. CREST = calcinosis, Raynaud, esophageal dysmotility, sclerodactyly, telangiectasiasPt w/ markedly painful and swollen R great toe. Joint fluid is positive for crystals. Dx? acute flare tx? Long term prevention tx?Gout. 1st line tx now is NSAIDs. 1st line prevention is allopurinolPt w/ chronic HCV presents w/ rash, joint pain, and fatigue. Exam shows palpable purpura and hepatomegaly. Reflexes are decreased. UA is consistent with glomerulonephritis. Other labs include: + RF, low complement, negative ANCA.Mixed cryoglobulinemia syndromePt w/ joint pain for awhile. On exam, DIPs are mainly involved with sausage fingers it looks like. Maybe some red and silver scaley patches.Psoriatic arthritis30's y.o. Black female presents w/ DOE. She has a hx of Raynauds and severe GERD. On exam w/ an RV heave. No other signs of CHF. Overall dx? whats the new cards/pulm dx?Systemic sclerosis (CREST). This presentation is PAH70 y.o. F presents w/ 1 week of a unilateral HA and malaise. Neuro and eye exams are normal. ESR is elevated. Dx? next step and diagnostic test? What are we worried about in this pt?Giant cell (temporal) arteritis. Start prednisone FIRST then get a temporal artery biopsy. Trying to prevent permanent blindnessPt w/ chronic inflammatory disorders presents w/ sxs of nephrotic syndrome (facial and BLE edema, proteinuria, etc.) and on exam has palpable kidneys. Also found to have other organ findings like hepatomegaly and an S4.Amyloidosis (secondary to inflammatory disorder). - (kidney is most commonly involved organ here)Mixed CT disorder is a combo of sxs of which 3 rheum disorders?SLE, systemic sclerosis, polymyositisAn older pt whose been on dialysis for many years for ESRD presents w/ bilateral shoulder pain and tingling in her hands for months. Exam reveals shoulder hypertrophy with decreased ROM, and signs of carpal tunnel. X-ray w/ bone cysts in shoulders. US w/ rotator cuff thickness with Ca deposits. Dx?Dialysis-related amyloidosis20's y.o. F presents w/ intermittent hand stiffness and joint pain. She's also had some sharp chest pains. Exam reveals bilateral hand joint swelling and tenderness, and mild BLE edema. Labs show decreased hgb, platelets, leukocytes. UA w/ 2+ protein. Dx? Dz-modifying drug?SLE. Dz-modifying drug is hydroxychloroquinePt who is home with her young kids all day presents with a few weeks of symmetric polyarticular joint pain that spontaneously resolved a few days ago. When the joint pain started, she also had fever and chills but that resolved after a few days. Joint looks normal on exam today. Dx? cause?Viral arthritis from parvoBaby is born with congenital heart block. What did the mother have?LupusF w/ multiple miscarriages and hx of DVT/PE. Elevated PT and PTT. Dx? what will the mixing study show?Antiphospholipid syndrome. Mixing study of pt's plasma and normal plasma fails to correct the abnormality.Gout vs. calcium pyrophosphate pseudogout. What are the crystals like in each?Gout = negatively birefringent, needle-shaped. Ca-pyrophosphate = positively birefringent, rhomboid-shapedPolymyalgia rheumatica is often associated with which other rheum-ish condition?Giant cell (temporal) arteritis5 y.o. w/ >5 days of fever, injected sclera, red tongue, cracked lips, macular rash on trunk + extremities, cervical lymphadenopathy, increased platelets. Dx? Tx? Whats the concern in these pts?Kawasaki dz. Give IVIG and aspirin. Concern for coronary artery aneurysmsYoung F w/ a hx of years of joint pain presents w/ LUQ pain for a few days. Vitals are normal. On exam, she has a holosystolic murmur heard best at the apex. Abd exam w/ tenderness but no rebound or guarding. CBC w/ low platelets. LFTs normal. CT shows splenic infarct. Underlying cause of everything? Whats the heart condition called?SLE. Likely w/ Libman-Sacks endocarditis (seen in SLE) which could have caused the thrombus resulting in the splenic infarct50's y.o. M w/ months of joint pain and weight loss. Fever and HTN on exam. CT angio shows bilateral renal infarcts and abd arteries w/ microaneurysms.Polyarteritis nodosa