The following cases and commentary, which focus on inpatient rheumatology, are excerpted from ACP’s Medical Knowledge Self-Assessment Program ( MKSAP. 17 Aug Title: MKSAP 17 – Rheumatology, Author: American College of Physicians, Name : MKSAP 17 – Rheumatology, Length: 9 pages, Page: 1. MKSAP (R) 17 Rheumatology [Michael H. Pillinger] on *FREE* shipping on qualifying offers. The 17th edition of Medical Knowledge.

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MKSAP Quiz: joint pain and plaque psoriasis | ACP Internist

Return to the next case Case 2 Correct answer: Training Fellowship training in rheumatology is two rheuatology following completion of a rhsumatology year basic internal medicine residency. He has a year history of rheumatoid arthritis, which is well controlled with methotrexate and etanercept; his last flare was 1 year ago. Monoarticular arthritis of the lower extremities may occur in patients with reactive arthritis, but fever and abdominal pain are uncommon.

Current laboratory studies show hemoglobin During the past year, he has had 3 similar episodes, each lasting 2 to 3 days. Although polyarteritis nodosa can result in arterial aneurysms, it typically affects medium-sized mesenteric and renal arteries rather than pulmonary arteries and commonly results in intestinal ischemia and renovascular hypertension.

MKSAP quiz on rheumatology

Key Points In patients with psoriatic arthritis, methotrexate helps to control cutaneous and musculoskeletal manifestations, slows the progression of joint destruction, and is considered first-line therapy for this condition.

SRC is characterized by acute onset of hypertension, acute kidney injury, and microangiopathic hemolytic anemia; however, some patients with evolving SRC may be normotensive. A year-old man is hospitalized for acute kidney injury and hypertension.

Patients with granulomatosis with polyangiitis often have a history of reumatology airway disease such as sinusitis or epistaxis and often have glomerulonephritis, none of which is present in this patient. A year-old male adolescent is evaluated in rgeumatology emergency department for a 2-day history of persistent fever, abdominal pain, and right knee pain.



Furthermore, hydroxychloroquine has been associated with severe flares of psoriasis and should be avoided in patients with this condition. He has new-onset fever, arthralgia, myalgia, nonblanching purpuric rash, pleuritis, pancytopenia, and proteinuria with active urine sediment, all of which are suggestive of a clinical diagnosis of systemic lupus erythematosus SLE.

He was given an intravenous dose of labetalol, and hemodialysis was initiated acutely to facilitate fluid and potassium management. Please upgrade your browser to allow continued use of ACP websites. CT of the chest demonstrates an aneurysm of the right pulmonary artery. On physical examination following dialysis, temperature is Laboratory studies show hemoglobin 9. Rheumatoid factor and anti-cyclic citrullinated peptide antibody assay.

MKSAP Quiz: 2-year history of rheumatoid arthritis | ACP Internist Weekly | ACP Internist

Although these findings might also be compatible with an infection, he has no focal symptoms or findings to suggest sepsis and has been appropriately tested with blood and urine cultures. Fellowship training in rheumatology is two years following completion of a three year basic internal medicine residency. After discussing medication options, the patient refuses to begin therapy with tumor necrosis factor a inhibitors because of concern about possible side effects. Sildenafil View correct answer for Case 1 Case 2: On physical examination, vital signs are normal.

Treatment with an ACE inhibitor such as lisinopril is indicated for this patient with scleroderma renal crisis SRC in the setting of diffuse cutaneous systemic sclerosis dcSSc.

Antinuclear antibody and anti-double-stranded DNA antibody assay B. Following completion of a rheumatology fellowship, board certification rbeumatology available through the American Board of Internal Medicine.


Cutaneous examination reveals sclerodactyly of both hands as well as skin induration of the forearms and anterior chest; there are no digital ulcers or acrocyanosis. A peripheral blood smear reveals several schistocytes. Acute kidney injury and sclerodactyly A year-old man is hospitalized for acute kidney injury and hypertension.

Sarcoidosis can manifest as arthritis and uveitis, and rarely can be associated with a large-vessel vasculitis. Diagnosis requires synovial fluid aspiration or open debridement, along with Gram stain and cultures.

On physical examination, vital signs are normal. Chest radiograph usually demonstrates hilar lymphadenopathy with or without parenchymal lung disease. Pulmonary artery aneurysms are not typical. A slit lamp examination reveals findings consistent with anterior and posterior uveitis; retinal vasculitis is also present. This patient has a prosthetic knee joint infection caused by methicillin-sensitive Staphylococcus aureus and requires surgical removal of the prosthesis.

Which of the following is the most likely diagnosis? The correct answer is C: Patients with Crohn disease typically have progressive fatigue, prolonged diarrhea with abdominal pain, weight loss, and fever; rheumatologu manifestations may include arthritis and skin rash erythema nodosum or pyoderma gangrenosum. Which of the following is the most appropriate diagnostic test to perform next?

This constellation of symptoms raises strong suspicion for psoriatic arthritis. Furthermore, in this patient with known seropositive erosive disease, therapy rheumayology disease-modifying agents is required, and prednisone does not halt bony destruction. He also has a year history of plaque psoriasis.