Self Assessment in Rheumatology by Yousaf Ali

Self Assessment in Rheumatology by Yousaf Ali

Author:Yousaf Ali
Language: eng
Format: epub
ISBN: 9783319893938
Publisher: Springer International Publishing


© Springer International Publishing AG, part of Springer Nature 2018

Yousaf AliSelf Assessment in Rheumatologyhttps://doi.org/10.1007/978-3-319-89393-8_7

7. Questions 61–70

Yousaf Ali1

(1)Mount Sinai Hospital, New York, NY, USA

Keywords

Assessment of rheumatic diseasesComplex rheumatology casesRare rheumatic diseasesRheumatology board exam preparationRheumatology case studiesStudy guide for rheumatology

Question 61

A 66-year-old male was seen with a history of recurrent oral ulceration. He has no other symptoms. PMH includes posterior uveitis and aseptic meningitis. On examination he has painful eythematous lesions on the anterior shins. Labs reveal a mild normocytic anemia .

What is the most likely diagnosis?

Question 62

A 19-year-old female with Systemic Lupus Erythematous (SLE ) consults you for contraceptive advice. She is sexually active and has a history of serositis, leucopenia, and arthritis. Current medications include azathioprine 100 mg/daily and naprosyn 500 mg twice daily. Labs: WBC = 2.4 × 109, Hb = 10.5g/dL, platelets = 125 × 109/L, lupus anticoagulant present, PTT = 55 s, and anticardiolipin (ACA) antibody IgM/IgG strongly positive.

What advice would you give her regarding contraception?

Question 63

A 23-year-old female has new onset edema following a course of high-dose steroids for poison ivy. On examination BP = 166/110, loud S2, and clear lungs without jugular distension. She has abnormal nail fold capillary examination with dilated loops and dropout. There is no sclerodactly, malar rash, synovitis, or weakness. Urinalysis shows nephritic range proteinuria with no cellular casts. ANA is 1:10,250, normal complements, negative centromere/Scl-70/ANCA antibodies. Platelets 75 × 109/L, +schistocytes on peripheral smear.

What is the most likely diagnosis?

Question 64

A 19-year-old previously healthy student is evaluated for new onset fever, joint pain, and rash. She is sexually active but denies diarrhea, urethral discharge, or sore throat. Her symptoms occurred 1 week following her menses. There was no history of travel, tick bite, or prior joint symptoms. Physical examination reveals a febrile patient with pustular lesions over the arms and tenosynovitis of the wrist. Her immunologic and hematologic studies and renal parameters are normal. The laboratory calls to inform you of gram negative diplococci growing in the blood cultures.

What is the diagnosis and how would you treat her?

Question 65

A 77-year-old male is referred to you for the treatment of intercritical gout . His serum Uric Acid (UA ) is 12.5 mg/dl and he has mild renal insufficiency with a serum creatinine of 1.6 mg/dl. Allopurinol and once daily colchicine are prescribed.

He calls your answering service 1 week later with new onset of fatigue and ecchymosis.

What complication has occurred?

Question 66

A 35-year-old female is seen for follow-up of Sjogrens syndrome due to persistent arthritis and parotitis. You consider starting azathioprine . She informs you that her sister took this medicine and had a “bad reaction with her blood.”

What tests should be ordered prior to commencing this drug?

How common is this abnormality?

Question 67

A 56-year old male is seen for a second opinion. He describes several years of intermittent joint pain affecting the ankles and knees with warmth and swelling. He describes chronic weight loss and diarrhea with a prior negative colonoscopy and upper GI endoscopy. He is referred for a small bowel biopsy which



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