MKSAP STUDY QUESTIONS AND ANSWERS
ANA, centromere pattern - Answers -CREST syndrome
ANA, nucleolar pattern - Answers -Sjogren syndrome
ANA, peripheral pattern - Answers -Systemic lupus erythematosus
ANA, speckled and diffuse patterns - Answers -Nonspecific
Anti-CCP antibody - Answers -Rheumatoid arthritis
Anti-dsDNA antibody - Answers -Systemic lupus erythematosus
Antihistone antibody - Answers -Drug-induced lupus erythematosus
Anti-Jo-1 antibody - Answers -Polymyositis/dermatomyositis
Anti-La (SSB) antibody - Answers -Sjogren syndrome
Anti-U1-RNP antibody - Answers -Mixed connective tissue disease
Anti-Ro (SSA) antibody - Answers -Sjogren syndrome
Anti-Scl-70 (anti-topoisomerase I) antibody - Answers -Systemic sclerosis (scleroderma)
Anti-Sm antibody - Answers -Systemic lupus erythematosus
Anti-ssDNA antibody - Answers -Nonspecific
Rheumatoid factor - Answers -Rheumatoid arthritis
Joint Fluid Categories - Answers -Normal
Clear, Transparent, Leukocyte <200
PMNs <25%
Noninflammatory
>3.5mL, straw, leukocytes 200-2000, PMNs <25%
Inflammatory
Leukocytes 2000-100,000
PMNs >50%
Culture Negative
Septic
Pus, Leukocytes >50,000
,PMNs >75%
Culture usually positive
Articular vs Nonarticular Pain - Answers -Articular:
internal/deep joint pain
worse with active & passive motion, reduced ROM
Joint effusion, synovial thickening, joint deformity, instability, crepitations, click, pop,
lock
Periarticular:
Greater pain with active vs passive motion
ROM usually preserved
Tenderness & inflammation not associated with joint
Plain radiographs of the hands and feet should be performed at the time of diagnosis in
patients with rheumatoid arthritis to detect erosions and joint-space narrowing.
Viral arthritis - Answers -usually is self-limited except when associated with hepatitis B
and C virus infection.
Parvovirus B19 infection in adults may induce an acute rheumatoid factor-positive oligo-
or polyarthritis.
dx via circulating IgM antibodies against parvovirus B19.
DMARDs for RA - Answers -start within 3 months
methotrexate (hepatotoxic), hydroxychloroquine, entanercept, NSAIDs
Psoriatic Arthritis - Answers -Untreated HIV infection is associated with the occurrence
of explosive-onset, widely distributed psoriasis and 20% to 40% of patients with
psoriasis may go on to develop psoriatic arthritis.
No confirmatory laboratory tests for psoriatic arthritis are available
Diseases associated with anterior uveitis - Answers -Reactive arthritis, ankylosing
spondylitis, and sarcoidosis
Ankylosing Spondylitis - Answers -Onset in teens or early 20s
persistent pain and morning stiffness
MRI w/ contrast used to detect sacroilitis = diagnosis
Specific lab test for SLE - Answers -anti-double-stranded DNA
Also measure C3, C4, and total hemolytic complement (CH50)
, Side effect of anti-TNF drugs - Answers -drug induced lupus
Leading cause of death in dermatomyositis and polymyositis - Answers -Interstitial lung
disease with progressive pulmonary fibrosis and secondary pulmonary arterial HTN
Leading cause of death in RA - Answers -CAD
Rocky Mountain Spotted Fever - Answers -nonspecific febrile fever within 3 weeks of
potential tick exposure and blanching erythematous macules located around the wrists
and ankles
treat with doxycycline
Factitious Fever - Answers -usually is diagnosed in young women; generally shows
unusual fever patterns such as very high or brief spikes, absent diurnal variation, and
rapid defervescence without chills; and diaphoresis.
Normal labs and physical exam
Fluid resuscitation in sepsis - Answers -placement of a central venous line and
aggressive fluid resuscitation will have the greatest impact on improving this patient's
chances of survival. Sepsis is known to result in tissue hypoperfusion
Additive vs migratory vs intermittent joint involvement - Answers -Additive: OA, RA
Migratory: gonococcal
Intermittent: gout, pseudogout, SLE
Inflammatory vs Non-inflammatory Arthritis - Answers -Inflammatory:
synovitis (swelling, tenderness, warmth, effusion)
stiffness > 1h & gelling
Non-inflammatory:
less morning stiffness <30-60min
no systemic symptoms
Leukocytes count <2000 & PMN <50%
Systemic signs with rheumatologic diseases - Answers -RA: nodules, pulmonary
(pleuritis, interstitial, nodules), cardiac (pericarditis, carditis), and ocular (scleritis,
episcleritis)
SLE: renal, hematologic, neurologic, serosal
Spondyloarthropathy: UC & Crohns
Lateral Epicondylitis of the Elbow - Answers -Tennis elbow
most common cause of elbow pain
ANA, centromere pattern - Answers -CREST syndrome
ANA, nucleolar pattern - Answers -Sjogren syndrome
ANA, peripheral pattern - Answers -Systemic lupus erythematosus
ANA, speckled and diffuse patterns - Answers -Nonspecific
Anti-CCP antibody - Answers -Rheumatoid arthritis
Anti-dsDNA antibody - Answers -Systemic lupus erythematosus
Antihistone antibody - Answers -Drug-induced lupus erythematosus
Anti-Jo-1 antibody - Answers -Polymyositis/dermatomyositis
Anti-La (SSB) antibody - Answers -Sjogren syndrome
Anti-U1-RNP antibody - Answers -Mixed connective tissue disease
Anti-Ro (SSA) antibody - Answers -Sjogren syndrome
Anti-Scl-70 (anti-topoisomerase I) antibody - Answers -Systemic sclerosis (scleroderma)
Anti-Sm antibody - Answers -Systemic lupus erythematosus
Anti-ssDNA antibody - Answers -Nonspecific
Rheumatoid factor - Answers -Rheumatoid arthritis
Joint Fluid Categories - Answers -Normal
Clear, Transparent, Leukocyte <200
PMNs <25%
Noninflammatory
>3.5mL, straw, leukocytes 200-2000, PMNs <25%
Inflammatory
Leukocytes 2000-100,000
PMNs >50%
Culture Negative
Septic
Pus, Leukocytes >50,000
,PMNs >75%
Culture usually positive
Articular vs Nonarticular Pain - Answers -Articular:
internal/deep joint pain
worse with active & passive motion, reduced ROM
Joint effusion, synovial thickening, joint deformity, instability, crepitations, click, pop,
lock
Periarticular:
Greater pain with active vs passive motion
ROM usually preserved
Tenderness & inflammation not associated with joint
Plain radiographs of the hands and feet should be performed at the time of diagnosis in
patients with rheumatoid arthritis to detect erosions and joint-space narrowing.
Viral arthritis - Answers -usually is self-limited except when associated with hepatitis B
and C virus infection.
Parvovirus B19 infection in adults may induce an acute rheumatoid factor-positive oligo-
or polyarthritis.
dx via circulating IgM antibodies against parvovirus B19.
DMARDs for RA - Answers -start within 3 months
methotrexate (hepatotoxic), hydroxychloroquine, entanercept, NSAIDs
Psoriatic Arthritis - Answers -Untreated HIV infection is associated with the occurrence
of explosive-onset, widely distributed psoriasis and 20% to 40% of patients with
psoriasis may go on to develop psoriatic arthritis.
No confirmatory laboratory tests for psoriatic arthritis are available
Diseases associated with anterior uveitis - Answers -Reactive arthritis, ankylosing
spondylitis, and sarcoidosis
Ankylosing Spondylitis - Answers -Onset in teens or early 20s
persistent pain and morning stiffness
MRI w/ contrast used to detect sacroilitis = diagnosis
Specific lab test for SLE - Answers -anti-double-stranded DNA
Also measure C3, C4, and total hemolytic complement (CH50)
, Side effect of anti-TNF drugs - Answers -drug induced lupus
Leading cause of death in dermatomyositis and polymyositis - Answers -Interstitial lung
disease with progressive pulmonary fibrosis and secondary pulmonary arterial HTN
Leading cause of death in RA - Answers -CAD
Rocky Mountain Spotted Fever - Answers -nonspecific febrile fever within 3 weeks of
potential tick exposure and blanching erythematous macules located around the wrists
and ankles
treat with doxycycline
Factitious Fever - Answers -usually is diagnosed in young women; generally shows
unusual fever patterns such as very high or brief spikes, absent diurnal variation, and
rapid defervescence without chills; and diaphoresis.
Normal labs and physical exam
Fluid resuscitation in sepsis - Answers -placement of a central venous line and
aggressive fluid resuscitation will have the greatest impact on improving this patient's
chances of survival. Sepsis is known to result in tissue hypoperfusion
Additive vs migratory vs intermittent joint involvement - Answers -Additive: OA, RA
Migratory: gonococcal
Intermittent: gout, pseudogout, SLE
Inflammatory vs Non-inflammatory Arthritis - Answers -Inflammatory:
synovitis (swelling, tenderness, warmth, effusion)
stiffness > 1h & gelling
Non-inflammatory:
less morning stiffness <30-60min
no systemic symptoms
Leukocytes count <2000 & PMN <50%
Systemic signs with rheumatologic diseases - Answers -RA: nodules, pulmonary
(pleuritis, interstitial, nodules), cardiac (pericarditis, carditis), and ocular (scleritis,
episcleritis)
SLE: renal, hematologic, neurologic, serosal
Spondyloarthropathy: UC & Crohns
Lateral Epicondylitis of the Elbow - Answers -Tennis elbow
most common cause of elbow pain
