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WorksheetsCDM case 8
Total questions: 15
Worksheet time: 15mins
A 65 yo female presents to your clinic with weight gain, fatigue, mild arthralgia, cold intolerance, and dry skin. What would be in your management plan for this patient?
Propranolol until disease is resolved
Levothyroxine consistently
Methotrexate for 3 mo
Corticosteroid tapered
You have a 55 year old female you suspect to have RA, (she has morning stiffness in her wrists and PIP joints as well as a subcutaneous nodule on the ulnar side of her forearm) What is the most specific blood test you can run?
Rheumatoid Factor
ESR & CRP
CBC with iron studies
Anti-CCP antibody
A 48 year old female with carpel tunnel as well as stiffness in her knees, dryness of mouth and eyes, as well as some tissue nodules presents to your clinic? What is the suspected disease and how do you treat
Rheumatoid Arthritis- Methotrexate
Rheumatoid Arthritis- Prednisone bridged to Methotrexate
Lupus- Prednisone
Lupus- Hydroxychloroquine
Joint pain, Fever, malar rash are the triad for what disease?
Lupus
Rheumatoid arthritis
Scleroderma
Psoriatic Arthritis
What are the CREST symptoms and what disease do they represent?
Calcinosis, Raynauds phenomenon, Esophageal dysmotility, Sclerodactyly, Telangiectasia- Limited scleroderma
Calcinosis, Raynauds phenomenon, Esophageal dysmotility, Sclerodactyly, Telangiectasia- Diffuse scleroderma
Cutaneous nodules, Raynauds phenomenon, Esophageal perforation, scleroremia, telangiectasia- SLE
Cutaneous nodules, Raynauds phenomenon, Esophageal perforation, scleroremia, telangiectasia- Rheumatoid arthritis
Your patients presents with a chief complaint of white, fingers when they go outside in the cold and they are very painful when they warm up. You take a look at their nail fold capillaries. It shows capillary drop out and dilation of the remaining capillary loops. What is this indicative of?
Primary Raynauds phenomenon
Secondary raynauds due to scleroderma
Secondary raunauds due to Lupus
Primary raynauds due to scleroderma
You have a 23 year old female who presents with this rash on her lower leg. She also complains of occasional low grade fevers, burning easily in the sun, painful ulcers on her buccal mucosa. What does she most likely have?
SLE
Psoriasis
Psoriatic arthritis
Chrons Disease
What is the leading cause of mortality in scleroderma patients?
Fibrosis
Esophageal reflux
Pulmonary HTN
Heart failure
What is the treatment of choice for diffuse scleroderma?
Methotrexate
Hydroxychloroquine
Bosentan
Amlodipine
How do you treat limited scleroderma?
Treat based on symptoms present
No effective treatment is available
Corticosteroids can be helpful
NSAIDs as needed, DMARD if debilitating
What is a potential treatment for Raynauds?
Proton pump inhibitor
Alpha 1 inhibitor
Calcium channel blocker
Phosphodiesterase inhibitor
Endothelin receptor antagonists and phosphodiesterase inhibitors are crucial for the treatment of what life threatening manifestation of scleroderma?
Congestive heart failure
Pulmonary Hypertension
Esophageal hypomobility
Hepatic fibrosis
A scleroderma patient presents to your clinic with crackles in lung bases, decreased Forced Vital Capacity, decreased Diffusing Capacity of Lungs for CO. What would you be suspicious of?
Interstitial lung disease
Pulmonary hypertension
Pneumonia
Tuberculosis
What are relevant diagnostic tests for Scleroderma?
Anti- SCL70 (antibody against topoisomerase)
ARA (Anti reticulin antibody against collagen containing connective tissue)
ACA (antibody against centromeres)
ANA (antibody against nucleic acid)
Joint most commonly involved in Scleroderma?
Contractures of fingers
Wrists
elbows
ankles
