Deck 21: Rheumatologic Disorders

Question 1

A pediatric patient with rhizomelia, macroencephaly, normal IQ, a flat nasal bridge and frontal bossing is diagnosed with achondrodysplasia. At what age will this patient's height fall to <5^th percentile on the growth curve?

A) 4
B) 5
C) 6
D) 7

Answer 1

B
Explanation: "These children are on the growth curve at birth, but by 5 months of age, their length has fallen to < 5th percentile. Note that children with achondroplasia have normal intellect and cognition." (Genetics, Chapter 23- Rheumatologic Diseases, page 2, paragraph 4)

Question 2

What is NOT considered Type 1 collagen

A) Skin
B) Bone
C) Sclera
D) Cornea

Answer 2

D
Explanation: "Type I collagen, which is responsible for skin, tendon, ligament, bone and sclera formation." (Genetics, Chapter 23- Rheumatologic Diseases, page 3, paragraph 2. Type II collagen is abundantly present in cartilage and vitreous humor of the cornea (Bacino, 2016). Therefore answer D is the only choice not created by Type I collagen and is the correct answer choice for the question.

Question 3

An 8 year old Caucasian male presents to your office with complaints of bilateral upper arm pain x 1 month. The pain denies any recent trauma to the area. He states that the achy, localized pain is a 6/10 and is worse in the mornings. His mother has tried Ibuprofen to alleviate some symptoms but the pain often returns. There is no FHx of bone cancers. No signs of child neglect or abuse. Upon examination there is point tenderness along each humerus but no swelling or ecchymosis. The patient has full ROM and 4/5 strength bilaterally in his upper extremities. X-ray reveals opacity and multiple hairline fractures in the humerus. The patient is referred to a rheumatologist. If this patient is found to have a mutation in the LRP5 gene, what region of the humerus would you expect the hairline fractures to be located?

A) Epiphysis
B) Epiphyseal Plate
C) Metaphysis
D) Diaphysis

Answer 3

C
Explanation: Patients with juvenile primary osteoporosis typically see fractures along the long bones of the arms and legs, especially where the new bone forms, so you would expect hairline fractures to be located in the metaphysis.

Question 4

A 77 year old Black male presents to your office with hearing loss, headache, neck pain and bowing of the legs. He recalls that his late uncle had similar symptoms and was diagnosed with a bone disease late in his life but cannot recall the name. What is the most common cause of this patient's disease?

A) TNFRSF11A mutation
B) SQSTM1 mutation
C) Measles virus
D) TREX1 mutation

Question 5

In addition to the classic "salt and pepper" appearance on x-ray of the skull, what other lab value is needed to diagnose Paget's Disease of the Bone?

A) Elevated serum alkaline phosphatase
B) Low serum alkaline phosphatase
C) Elevated serum calcium
D) Low serum calcium

Question 6

What is an effective first line treatment for a patient just diagnosed with Paget's Disease of the Bone?

A) DMARDs
B) Vitamin D
C) Calcitonin
D) NSAIDs

Question 7

A 69-year-old Hispanic female presents to the orthopedic clinic with bilateral osteoarthritic knee pain x 2 months. The patient states that the pain is worse when she is walking upstairs or standing up from her couch. In the past she has tried Tylenol and Cortisone injections to alleviate the pain but now she cannot find any relief. Plain film x-rays show the proximal tibia to be denser and more ivory than the rest of the bones. What is the name of this finding?

A) Osteophytes
B) Eburnation
C) Subchondral cysts
D) Sclerosis

Question 8

A 41-year-old Caucasian female presents to the office with a recent 10-pound weight loss, fatigue, and dry mouth. Upon further examination, the provider discovers that the patient has a low-grade fever and redness along the MCP joints bilaterally. When asked about joint pain, the patient reports that her PIP, MCP, and shoulders hurt bilaterally for about 2 hours each morning. What lab test should the provider order on this patient to make the diagnosis of Rheumatoid Arthritis?

A) Antinuclear antibodies
B) anti-cyclic citrullinated peptide antibodies
C) rheumatoid factor antibodies
D) double stranded DNA antibodies

Question 9

How long must a patient under 16 years of age have persistent synovitis in 1 or more joints to be diagnoses with Juvenile Idiopathic Arthritis?

A) 4 weeks
B) 6 weeks
C) 6 months
D) 1 year

Question 10

What medication has been recognized to trigger Systemic Lupus Erythematous?

A) Methotrexate (Trexall)
B) Hydralazine (Apresoline)
C) Azathrioprine (Imuran)
D) Hydroxychloroquine (Plaquenil)