Date
USC-LAC IM Core Curriculum Learning Session
Rheumatoid Arthritis: Early Diagnosis and Management
Team-Based Learning Strategy
MULTIPLE CHOICE QUESTIONS
1. Individually answer the items below.
2. Then in teams of 3-5 learners each, discuss the items, and come up with a group answer.
3. An IFAT form/Lottery-style answer sheet is provided. This form requires you to, rub off the overlying gold box of your team’s corresponding letter choice completely. A star would indicate that it is the correct answer. Please note that the star may be located in the middle or at the side of the gold box so the box has to be obliterated completely. If there is no star underneath your team’s choice, select the next best answer, rub off the gold box of the corresponding letter choice, until you arrive at the correct answer. Each rubbed-off blank box will correspond to a deduction of 1 point. The team with the least number of rubbed-off blank boxes is the winning team.
1. What are the radiologic features of Rheumatoid arthritis? A. Joint space narrowing, erosions (eg. PIP, MCP and wrist joints), deformities/subluxation B. Joint space narrowing, erosions (at DIP, PIP joints), osteophytes C. Joint space narrowing, erosions (eg. PIP, DIP joints), pencil-in-cup deformity, osteolysis D. Joint space narrowing, erosions with overhanging edge
2. A 20-year-old female walks into the student health clinic complaining of pain, swelling, morning stiffness lasting for 5 hours in her wrists and metacarpophalangeal joints for the past 4 months. She initially had relief with use of Naproxen 500mg TID but most recently she has not had relief of her symptoms. PE: diffuse tenderness and swelling of both wrists, elbows, and bilateral 2nd, 3rd, 4th MCP joints. Labs: ESR 70, CRP 25, Hgb 9.7, Platelets 650. RF 250, Anti-CCP >60. WBC, AST, ALT, Creatinine, UA are normal. CXR is normal. Tests for thyroid disease, hepatitis B & C are negative. Referral to a rheumatologist was made immediately. Which of the disease-modifying antirheumatic drugs (DMARD) is the mainstay of RA treatment? A. Hydroxychloroquine
B. Sulfasalazine
C. Methotrexate
D. Leflunomide
3. A 23-year-old male patient was diagnosed with rheumatoid arthritis recently. His rheumatologist recommends starting Methotrexate at 10mg weekly. What laboratory tests are needed to monitor for side effects due to Methotrexate? A. CBC, AST, ALT, Creatinine every 8-12 weeks, baseline Chest x-ray
B. PPD, CXR
C. CBC, AST, ALT every 8-12 weeks, G6PD level at baseline
D. Yearly eye exam
4. A 35-year-old female is scheduled to undergo surgery requiring general anesthesia. She has a history of rheumatoid arthritis. She complains of 1 week of numbness and weakness in his upper extremities. She has difficulty gripping things. She has been experiencing headaches with some stiffness mostly at the neck and occipital region of the neck for a month. What is the next step in diagnosing this potentially life-threatening complication of rheumatoid arthritis? A. Angiogram
B. Cspine x-rays with oblique and odontoid views
C. Lumbar puncture
D. Cspine x-rays with lateral flexion and extension views
5. A 35-year-old female with rheumatoid arthritis comes into your office complaining of right leg pain and swelling. Patient is noted to have diffuse swelling, tenderness, pitting edema of the right foreleg and ankle, with bruising around the ankle. What is the most likely diagnosis in this case? A. DVT
B. Ruptured Baker’s cyst
C. Compartment synd.
D. Ruptured popliteal aneurysm
6. What cytokine is the treatment target for methotrexate-non-responsive patients on Adalimumab, Etanercept and Infliximab? A. IL-1
B. IL6
C. TNF beta
D. TNF alpha
7. RA, when left untreated, can result in functional disability and job losses within how many years from onset of RA? A. 5 years
B. 10 years
C. 2 years
D. 20 years
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