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CM - Rheum Skin

Total questions: 27

Worksheet time: 14mins

Name
Class
Date
1.

Chronic, autoimmune, systemic, inflammatory disorder of unknown cause characterized by slow progression of keratoconjunctivitis sicca and xerostomia. What is the diagnosis?

a)

Sjogren Syndrome

b)

Scleroderma

c)

Raynaud's

d)

Polymyositis

e)

Dermatomyositis

2.

What is NOT a lab that should be done to evaluate for Sjogren's Syndrome?

a)

Rheumatoid factor

b)

ANA: SS-A (R0), SS-B (La)

c)

Thyroid function tests

d)

Schirmer test

e)

SCL-70/ Anti-RNA polymerase III antibodies

3.

55 yo female pt presents with slow progression of burning, itching, photophobia, and foreign body sensation in the eyes. Pt also reports dysphagia, feeling of "cotton mouth," dental caries, loss of taste/smell. On PE you note parotid enlargement. What is NOT a possible treatment?

a)

Topical ocular 0.05% cyclosporine

b)

Hard candy/sugar free gum

c)

Phosphodiesterase inhibitors

d)

Pilocarpine/ Cevimeline

e)

Xylimelts

4.

What is NOT something that can impact prognosis of Sjogren's Syndrome patients?

a)

Pulmonary disease

b)

Lymphocytic vasculitis

c)

Painful peripheral neuropathy

d)

Lymphoma

5.

A syndrome of paroxysmal digital ischemia, most commonly caused by an exaggerated response of digital arterioles to cold or emotional stress. Intermittent arteriolar vasospasms. What is the diagnosis?

a)

Sjogren Syndrome

b)

Scleroderma

c)

Raynaud's

d)

Polymyositis

e)

Dermatomyositis

6.

25 yo female pt with no PMH presents with changes to all fingers symmetrically on each hand, but excluding the thumbs. Pt denies pain, ulcers, and hx of peripheral vascular disease. Labs show negative ANA. What diagnsis do you suspect?

a)

Primary Raynaud's

b)

CREST syndrome

c)

Polymyositis

d)

Secondary Raynaud's

e)

Dermatomyositis

7.

Pt with PMH of autoimmune disease presents with changes to fingers asymmetrically. Symptoms exclude the thumbs. Pt admits to pain and ulcers. What diagnsis do you suspect?

a)

Primary Raynaud's

b)

CREST syndrome

c)

Polymyositis

d)

Secondary Raynaud's

e)

Dermatomyositis

8.

Pt presents with rubor, throbbing/pain, paraesthesia, and slight swelling in the fingers down to the distal palm. Initially it only impacted 1 or 2 fingertips affected. The symptoms improve with warmth. What is NOT included in the treatment?

a)

Topical nitrates

b)

Phosphodiesterase inhibitors

c)

CCB

d)

Pilocarpine

e)

Lotion

9.

Pt presents with rubor, throbbing/pain, paraesthesia, and slight swelling in the fingers down to the distal palm. Initially it only impacted 1 or 2 fingertips affected. The symptoms improve with warmth. What is NOT included in the treatment?

a)

Avoid decongestants, diet pills, amphetamines

b)

SSRIs

c)

Endothelin-receptor inhibitors

d)

Cevimeline

e)

Stop smoking

10.

A chronic multisystem disease characterized by autoantibody production, collagen deposition, and vascular dysfunction. Fibrosis of skin and internal organs. Name meaning "hard skin." What is the diagnosis?

a)

Sjogren Syndrome

b)

Scleroderma

c)

Raynaud's

d)

Polymyositis

e)

Dermatomyositis

11.

What is NOT a lab that should be done to evaluate for Scleroderma?

a)

Esophageal manometry

b)

Urine microscopy

c)

ANA (anticentromere antibody)

d)

Schirmer test

e)

SCL-70/ Anti-RNA polymerase III antibodies

12.

What is NOT an imaging test that can be done to evaluate for Scleroderma?

a)

Parotid gland biopsy

b)

CXR

c)

Chest CT

d)

ECHO

e)

Barium swallow

13.

What is NOT part of CREST syndrome?

a)

Esophageal dysmotility

b)

Calcinosis

c)

Sclerodactyly

d)

Telangiectasias

e)

Polymyositis

14.

30 yo female pt presents with calcinosis, raynaud's phenomenon, esophageal dysmotility, sclerodactyly, telangiectasias, anticentromere antibody (CREST syndrome). PE reveals "salt and pepper" pigment change. What is NOT included in the treatment?

a)

Corticosteroids

b)

Quit smoking

c)

Phosphodiesterase inhibitors

d)

Surgery

e)

Immune modulators

15.

Idiopathic inflammatory myopathy. Autoimmune reaction to muscle tissue in genetically susceptible people. Consider underlying malignancy. Picornavirus-like structures have been found in muscle cells. Cellular damage and atrophy. What is the diagnosis?

a)

Sjogren Syndrome

b)

Scleroderma

c)

Raynaud's

d)

Polymyositis

e)

Dermatomyositis

16.

50 yo female pt presents with gradual and progressive symmetrical proximal muscle weakness (legs prior to arms). Pt admits to pain, tenderness, dysphagia, muscle atrophy, and contractures. What is the diagnosis?

a)

Sjogren Syndrome

b)

Scleroderma

c)

Raynaud's

d)

Polymyositis

e)

Dermatomyositis

17.

All of the following are diagnostic tests for Polymyositis, but what is the gold standard?

a)

Anti-SRP

b)

EMG

c)

Jo-1: interstitial lung disease

d)

Malignancy workup/cancer screening ≥ 60 yo

e)

Muscle biopsy

18.

A multisystem autoimmune connective tissue disease. Complement-mediated vasculopathy. Celluar damage and atrophy. Variable degrees of inflammation. Proximal muscle weakness. What is the diagnosis?

a)

Sjogren Syndrome

b)

Scleroderma

c)

Raynaud's

d)

Polymyositis

e)

Dermatomyositis

19.

50 yo female pt presents with proximal muscle weakness, fatigue, and rash. PE reveals visceral involvement. Erythematous rash that is slightly elevated and smooth/scaly, heliotrope rash, gottron papules, nail changes, desquamating dermatitis, secondary changes, rash on scalp (calcification in children). What is NOT a possible diagnostic test?

a)

ANA - Jo-1

b)

Anti-Mi-2

c)

Esophageal manometry

d)

Anti-155/140

e)

Malignancy workup

20.

All of the following are diagnostic criteria for dermatomyositis, but what is the definitive test?

a)

Proximal muscle weakness

b)

Characteristic rash

c)

Decreased serum muscle enzymes

d)

Characteristic EMG or MRI muscle abnormalities

e)

Muscle biopsy changes

21.

What is NOT a possible part of the treatment for polymyositis and dermatomyositis?

a)

Corticosteroids

b)

Azathioprine

c)

Methotrexate

d)

Surgery

e)

Mycophenolate mofetil

22.

What is NOT a possible part of the treatment for polymyositis and dermatomyositis?

a)

Rituximab

b)

Cyclosporine

c)

IVIG

d)

CCB

23.

What can occur at any age and does not involve the skin?

a)

Primary idiopathic polymyositis

b)

Scleroderma

c)

Primary Raynaud's

d)

Primary idiopathic dermatomyositis

e)

Secondary dermatomyositis

24.

What is similar to primary idiopathic polymyositis, but also involves the skin?

a)

Primary idiopathic polymyositis

b)

Scleroderma

c)

Primary Raynaud's

d)

Primary idiopathic dermatomyositis

e)

Secondary dermatomyositis

25.

In what disease is pulmonary disease the leading cause of mortality?

a)

Sjogren Syndrome

b)

Scleroderma

c)

Raynaud's

d)

Polymyositis

e)

Dermatomyositis

26.

What disease has "salt and pepper" pigment change and CREST syndrome?

a)

Sjogren Syndrome

b)

Scleroderma

c)

Raynaud's

d)

Polymyositis

e)

Dermatomyositis

27.

What disease has keratoconjunctivitis sicca, xerostomia, and parotid enlargement?

a)

Sjogren Syndrome

b)

Scleroderma

c)

Raynaud's

d)

Polymyositis

e)

Dermatomyositis