Indian Journal of Rheumatology 2009 June

PG Forum
Volume 4, Number 2; p. 76

Rheumatology Quiz
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V Arya1, V Dhir2
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1. Which of the following features is uncommon in psoria- (b) watery diarrhoea

tic arthritis when seen in HIV positive patients? (c) eczematous dermatitis
(a) Dactylitis (d) polyneuropathy
(b) Axial skeletal involvement
(c) Enthesopathy 7. All the following are true for newer tests for latent
(d) Rapidly progressive joint destruction tuberculosis like QuantiFERON Gold, except
(a) detect interferon gamma production by stimulated
2. The word Podagra is derived from the name of T cells
(a) a Greek Goddess (b) can distinguish between M. tuberculosis infected
(b) a Roman emperor and BCG vaccinated individuals
(c) a Swedish rheumatologist (c) use CFP 10 and ESAT-6 antigens
(d) a French physician (d) QuantiFERON Gold performs better than
3. The US FDA approved maximum daily dose of allopu- T-SPOT.TB in immunocompromised patients
rinol in gout is
(a) 600 mg 8. The lowest risk for venous thromboembolism is seen in
(b) 800 mg patients with
(c) 1000 mg (a) Wegener’s granulomatosis
(d) 1200 mg (b) Churg Strauss syndrome
(c) Polyarteritis nodosa
4. Which of the following is not true of mycophenolate (d) Microscopic polyangiitis
mofetil?
(a) derived from the fungus Penicillium stoloniferum 9. Granulomatous angiitis of the CNS is characterized by
(b) acts by inhibiting inosine monophosphate dehydro- all except
genase (a) acute onset
(c) contraindicated in pregnancy (b) preponderance in males
(d) has a half life of 6 hours (c) absence of fever and weight loss
5. Which of the following is not true for “Treg”? (d) diffuse or focal involvement
(a) stands for regulatory T cells 10. Which of the following vitamins has been shown to
(b) require expression of FOXP3 during development lower the risk of developing gout?
(c) produce IL-2 (a) vitamin A
(d) high levels of CD25 expression (b) vitamin B1
6. Which of the following is not a feature of the IPEX (c) vitamin C
syndrome? (d) vitamin D
(a) onset in the first year of life For answers refer to page 79

1
Department of Medicine, JIPMER, Puduchery and 2Department of Immunology, Sanjay Gandhi Postgraduate Institute of Medical Sciences,
Lucknow, India.
Correspondence: Dr. V Arya, email: linuxphoenix@gmail.com
 What is your diagnosis?
of CRF patients with TB make it particularly difficult to
establish the diagnosis in this patient group. They highlighted
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that in order to avoid diagnostic delays, which may increase
the risk of complications and mortality, TB should be kept
in mind in any case of ongoing fever and infection that does
not respond to seemingly appropriate therapy. In addition,
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TB should always be suspected in endemic areas, even in
the absence of osseous involvement.
In contrast to previous reports, the present case was
unique in that no pulmonary source of infection was identified.
In the absence of obvious contagious source or haematoge-
nous spread, the cause could have been a traumatic inocula-
tion from a contaminated environment. Also, the diagnosis
was overlooked due to the history, prior procedure and inves-
tigations suggesting a pyogenic aetiology. The latter could
have been a superadded infection due to the initial response
though there were no supporting cultures. Soft-tissue swellings
in such circumstances should be examined with smears and
cultures for mycobacteria and should be repeated if initially
inconclusive.
This case highlights the need to maintain a high index of
suspicion for mycobacterial infection in immunosuppressed
patients with persistent fever and musculoskeletal symptoms,
ANSWERS TO THE RHEUMATOLOGY QUIZ
(page 76)
1b, 2a*, 3b, 4d**, 5c, 6d***, 7d†, 8c††, 9a†††, 10c
*Podagra is the daughter of Aphrodite and Dionysus, the
Greek God of wine
**Half life is 16 to 18 hours
***Immune dysregulation, Polyendocrinopathy, Enteropathy
X-linked; not polyneuropathy; overwhelming systemic
autoimmunity in the first year of life
IRA CME for medical students
September 6, 2009
LTMMG & Sion Hospital, Mumbai
Registration: Free (pre-registration required)
Contact: Dr Yojana Gokhale, Department of Medicine, LTMMG
Sion, Mumbai
PG Forum 79
despite the absence of disease elsewhere (including the lungs
and spine).
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†
Since T-SPOT.TB separates peripheral blood mononuclear
cells for assessing interferon gamma levels, it performs better
in these patients
††
Recent data from a retrospective study by the French
Vasculitis Study Group
†††
Insidious onset with a long prodromal period