Self-Assessment in Rheumatology: 2nd Edition – Chapters 1–12 Q&A Study Guide

Self Assessment in Rheumatology:
2nd Edition Chapter 1 - 12
An Essential Q & A Study
Guide




STUDY GUIDE

,Contents




1 Questions 1–10 .................................................................................. 1
References ...................................................................................... 13
2 Questions 11–20............................................................................... 15
References ...................................................................................... 27
3 Questions 21–30............................................................................... 29
References ...................................................................................... 42
4 Questions 31–40............................................................................... 43
References ...................................................................................... 56
5 Questions 41–50............................................................................... 57
References ...................................................................................... 70
6 Questions 51–60............................................................................... 71
References ...................................................................................... 84
7 Questions 61–70............................................................................... 85
References ...................................................................................... 98
8 Questions 71–80............................................................................... 99
References .................................................................................... 112
9 Questions 81–90............................................................................. 113
References .................................................................................... 126
10 Questions 91–100 .......................................................................... 129
References .................................................................................... 142
11 Questions 101–110 ........................................................................ 143
References .................................................................................... 156
12 Questions 111–120 ........................................................................ 157
Index .................................................................................................... 171


vii

,Chapter 1
Questions 1–10

2 1 Questions 1–10


Question 1
You are asked to assess this 68-year old male patient for vasculitis. He has a
history of congestive heart failure, type 2 diabetes and osteoarthritis. Lab
tests for viral, infectious causes are negative. He has no antibodies to
neutrophil cytoplasmic anti- gens or nuclear antigens and the Erythrocyte
Sedimentation Rate (ESR) is mildly elevated at 57 mm/h.
What is the most likely diagnosis and how would you treat the patient?

,1 Questions 1–10 3


Question 2
A 23-year-old male is referred for evaluation of a three-month history of ankle
pain, alternating buttock pain and morning stiffness. He has difficulty
ambulating and on exam has enthesopathy of his left Achilles tendon. He
has been evaluated by a prior physician due to an elevated ESR of 72 mm/h.
What procedure has been performed?
What is the most likely result of this procedure?

,4 1 Questions 1–10


Question 3
A 28-year-old Pakistani female presents with acutely swollen hands. She is a
teacher who has difficulty with daily activities, morning stiffness and hand
pain for the past eight weeks. She has tender metacarpophalangeal and
proximal interphalangeal joints. Her labs reveal a positive anti-cyclic
citrullinated antibody (CCP) and rheu- matoid factor (RF) but no erosions on
radiographs. How would you treat this patient
acutely?

,1 Questions 1–10 5


Question 4
This 40-year old female has a history of chronic renal failure and has just
completed an MRI with gadolinium to evaluate a breast mass. The MRI
result was normal but she has developed skin tightening and chest
discomfort. The skin is indurated and has a p’eau d’orange appearance.
What complication has occurred?

,6 1 Questions 1–10


Question 5
This 25-year-old female presents with painful shin lesions. How would you evaluate
her and what are the commoner causes?

,1 Questions 1–10 7


Question 6
This patient has primary Sclerosing Cholangitis (PSC) and chronic diarrhea. What
complication has occurred? Discuss management of the skin lesions.

,8 1 Questions 1–10


Question 7
This patient has Raynaud’s phenomenon and a ten-year history of
Dermatomyositis. What findings are noted in the hands? What is the
best way to examine this area more closely and what is the differential
diagnosis of this finding?

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