Missed Rheumatology Qs

1. Raloxifene is a SERM used in osteoporosis that may exacerbate hot flashes and vaginal dryness. It may cause blood clotting but does not have a significant affect on blood pressure
1. Raloxifene should be avoided in women with a past history of thrombosis.
2. Raloxifene does not increase the risk of endometrial cancer, unlike tamoxifen.
3. The risk of breast cancer decreases with raloxifene use.
4. There is no definitive data showing raloxifene modifies the risk of ovarian cancer.
5. Raloxifene is a mixed agonist/antagonist of estrogen receptors, acting as an antagonist in breast/vaginal tissues and an agonist in bone.
6. Raloxifene increases the risk of thromboembolism.
2. OA (Osteoarthritis)
1. Eroded cartilage with thickened underlying bone is typical of OA.
2. Initial management of osteoarthritis includes weight loss, physical activity as tolerated and acetaminophen for pain.
3. Symmetrical joint involvement is characteristic of RA and primary OA.
3. Pencil-in-cup deformity is characteristic of psoriatic arthritis
4. Bone erosion with joint deformity is more typical of advanced rheumatoid arthritis (RA)
5. Lytic lesions are typically associated with multiple myeloma and bone metastasis
6. Creatine kinase and aldolase levels are the most commonly elevated enzymes in patients with dermatomyositis.
7. Prednisone is safe to use in pregnant patients suffering from flare-ups of rheumatoid arthritis.
8. In a healthy female patient, screening for osteoporosis should begin at 65 years of age.
1. Overall, osteoporosis has a female-to-male ratio of 4:1. In addition to female sex and caucasian race/ethnicity, other risk factors for osteoporosis include smoking, alcohol intake, low body mass, and parental history of fractures, which warrant earlier screening.
9. A patient is said to have PAN if he/she has 3 of the 10 following signs:

1. Weight loss greater than/equal to 4 kg.

2. Livedo reticularis, which appears as a mottled, purple discoloration over the extremities or torso

3. Testicular pain in males (orchitis)

4. Myalgias or weakness

5. Elevated BUN and creatinine

6. Hepatitis-positive serology

7. Central or peripheral neuropathy

8. Diastolic blood pressure greater than 90 mm Hg

9. Arteriogram showing aneurysms in small or medium-sized vessels

10. Biopsy-positive tissue

1. All patients diagnosed with polyarteritis nodosa should also be worked up for hepatitis.
10. Whipple disease is a systemic gram-positive bacterial infection that commonly manifests as malabsorption, joint pain and CNS symptoms.
1. The combination of malabsorption with joint pain is most likely Whipple disease.
1. malabsorption syndrome (cramps, bloating, loose and foul-smelling stool)
2. This disease is caused by a gram-positive bacterium and can be diagnosed with a biopsy.
3. Oculomasticatory myorhythmia (OMM), which is pendular vergence oscillations of the eyes and synchronous contractions of the masticatory but not palatal muscles, is pathognomonic of Whipple disease.
11. Felty syndrome is characterized by the triad of rheumatoid arthritis, splenomegaly, and granulocytopenia.
1. Caplan syndrome is a combination of rheumatoid arthritis and pneumoconiosis that manifests as intrapulmonary nodules.