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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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However, tapering of corticosteroids in patients with psoriatic arthritis may be associated with dramatic flares in skin disease; these agents therefore should be used with caution in this population group. Morning home mjsap pressure strongly predicts coronary artery disease, stroke events, study finds Next. 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.

For patients with this complication, prompt and aggressive treatment with an ACE inhibitor is essential to restore kidney function and optimally manage hypertension, even for patients who require dialysis and for whom blood pressure has been lowered with other antihypertensive agents.

Laboratory test results are pending.

Abdominal pain is rare. Testing of rheumatoid factor and anti-cyclic citrullinated peptide CCP antibodies rheumatolovy not appropriate because the patient has had a clear diagnosis of rheumatoid arthritis, and, even if a flare were present, rheumatoid factor and anti-CCP antibodies would not necessarily increase. He reports no cough. There are large erythematous plaques with an overlying silvery scale on the elbows, knees, sacrum, and scalp.

A year-old man is evaluated for a 2-year history of joint pain in the wrists, hands, knees, ankles, and feet. After removal, an antibiotic spacer is inserted, and long-term weeks to months antibiotic therapy is initiated.

MKSAP quiz on rheumatology

Rheumatoid factor and anti-cyclic citrullinated peptide antibody assay. Return to the next case Case 5 Correct answer: Rheumatology is the subspecialty of internal medicine that focuses on the diagnosis and treatment of medical diseases of the joints, muscles, rheumahology connective tissues.

Methotrexate is the most appropriate treatment for this patient. On physical examination today, temperature is Pulmonary auscultation reveals bibasilar crackles. Screening laboratory tests, including metabolic profile, renal function, and liver rheumatologyy tests, are normal. He takes no medications.

In academic settings, rheumatologists provide consultative and ongoing care in ambulatory and inpatient settings, perform basic science and clinical research in rheumatological diseases, and teach medical students and residents.

A slit lamp examination reveals findings consistent with anterior and posterior uveitis; retinal vasculitis is also present. Monoarticular arthritis of the lower extremities may occur in patients with reactive arthritis, but fever and abdominal pain are uncommon. However, rheumatoid arthritis usually spares the distal interphalangeal joints and involves the proximal interphalangeal joints. Increasing prednisone may offer short-term relief of flares in patients with RA.

A repeat synovial fluid aspiration confirms the presence of methicillin-sensitive Staphylococcus aureus.


Which of the following is the most likely diagnosis? On physical examination, vital signs are normal. A peripheral blood smear reveals several schistocytes. The information included herein should never be used as a substitute for clinical judgment and does not represent an official position of ACP. Key Points Familial Mediterranean fever is characterized by recurrent to hour episodes of fever with serositis, synovitis, and erysipeloid rash.

Also from ACP, read new content every week from the most highly cited internal medicine journal. Diclofenac is a potentially useful therapy for joint pain but does not address the prosthetic joint infection. Which of the following is the most appropriate treatment? Oral ulcerations varying in size from 3 mm to 1 cm are noted on the inner cheek, palate, and tongue.

The knee is slightly warm, with pain rheumatolkgy passive range of motion. Key Points Treatment of delayed-onset prosthetic joint infection typically involves removal of the infected prosthesis.

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

Proteinuria revealed on urinalysis may represent kidney amyloidosis, which can develop in untreated persons. CT of the chest, abdomen, and pelvis D. Given the chronic nature of Dheumatology and need for long-term treatment, exposing patients to the numerous side effects associated with higher doses of glucocorticoids is not optimal.

During the past year, he has had 3 similar episodes, each lasting 2 to 3 days. He feels well between episodes. Chest radiograph reveals blunted costophrenic angles bilaterally without infiltrate.

On physical examination, vital signs are normal. Bosentan is an endothelin receptor antagonist used to treat pulmonary hypertension or recurring digital ulcers in patients with systemic sclerosis and is not rhsumatology therapy for SRC. Sildenafil, a phosphodiesterase inhibitor, is appropriate mskap patients with pulmonary hypertension or refractory Raynaud phenomenon symptoms but is not effective in the primary management of SRC.

More information is available online. This year-old male adolescent has familial Mediterranean fever FMFan autosomal rheumatooogy disorder characterized by recurrent to hour episodes of fever with serositis most rhheumatology abdominal or pleuralsynovitis most often monoarticular and affecting the lower extremities dheumatology, and erysipeloid rash.

Surgical removal of the prosthetic joint. Laboratory studies show hemoglobin 9. Shortness of breath and myalgia with rheumatoid arthritis A year-old man is evaluated in the emergency department for a 2-week history of progressive fever and malaise with gradual onset of shortness of breath, pleuritic chest pain, myalgia, arthralgia, and rash.

Furthermore, neither prednisone nor ibuprofen would slow the progression of this patient’s articular damage. The left knee and right ankle are swollen.

Sulfasalazine Answer and critique The correct answer is C: Pulmonary examination reveals a left pleural friction rub. 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. There is diffuse abdominal tenderness without rebound and no evidence of hepatosplenomegaly or lymphadenopathy.