Rheumatology Consult Rotation

Goals and Objectives of the Rotations - Depending on the length of your rotation during the Rheumatology consult month, you should develop skills during this rotation in the following:

1. Differential diagnosis and management of the acute mono/oligo-arthritis

2. Evaluation, differential diagnosis and management of patients with polyarticular signs and symptoms

3. Differentiation of spondyloarthropathies from rheumatoid arthritis

4. Evaluation, differential diagnosis and management of patients with connective tissue disease including systemic lupus erythematosus, systemic sclerosis, polymyositis/dermatomyositis, Sjögren’s syndrome, and vasculitides (polyarteritis nodosa, Wegener’s granulomatosis, giant cell arteritis).

5. Rational differential diagnosis and initial management of patients with diffuse pain syndromes

Available Learning Materials – Each resident assigned to the rheumatology consult rotation will be provided his/her copy of the Primer of Rheumatic Diseases. This handbook is compiled by the Arthritis Foundation and is an excellent quick reference source for developing basic knowledge for rheumatological illnesses. This book will be yours to keep.

You will in addition be loaned two CD-ROMs relevant to rheumatology. These must be signed out with the rheumatology secretary, Mihoko Kojima, and returned at the time you leave the rotation or replacement CD-ROMs will be purchased with money from your book account. These CD-ROMs are:

1. Rheumatology Self-assessment Program – This CD-ROM contains Up-To-Date for rheumatology; in addition it contains examination questions with which you can test yourself. The answers provide links to the appropriate Up-To-Date sections pertaining to the answer.

2. American College of Rheumatology Clinical Slide Collection – By clicking on the triangular ACR logo on this CD-ROM, you will activate the slide viewing program. This will present you with chapters on multiple rheumatologic subjects (e.g., rheumatoid arthritis, systemic lupus, crystal-induced arthropathies). The initial slides in each chapter tend to be tables listing, e.g., incidences, HLAB 27 associations, classification criteria, etc., with actual microscopic and gross photographs following the tables. In the case of the photographs, there is a narrative comment for each describing what features of the clinical photograph are important. By clicking on the slide, it is enlarged to allow better viewing, and the attached caption disappears. It is strongly recommend that you review the chapter on spondyloarthropathies, as this chapter contains many of the rashes, oral lesions, sausage digits etc., that can be seen in this group of diseases.

Weekly Rheumatology Grand Rounds - On Wednesday afternoons from 4:30-5:30 PM a conference is held. This may be a case presentation or formal lecture by guest speaker. This function generally is held in J524. Occasionally it will be in K519. Edith Fultz (3-4939) will Know its location each week, or you can check the Rheumatology Calendar.

Clinical Responsibilities while on the Rotation – You and any colleagues on the rotation with you will be responsible for receiving requests for in-patient rheumatology consultations. Attending coverage of the Consult Service is shown on the attached schedule. It is crucial that you page the consult attending as soon as a consultation request comes to arrange staffing of that consult. You should plan to round on all patients requiring concurrent care prior to attending rounds, which will occur Mon-Fri afternoons as arranged between you and your attending. Please note that we also do inpatient consults for the Children’s Hospital.

For the UKMC Rheumatology clinics please report to the front desk of Women’s Health and Rheumatology and they will help you locate the attending as some of our clinics will be held in the adjacent Physical Medicine and Rehab area.

You will be assigned to attending one or more of the following out-patient rheumatology clinic functions:

1. Arthritis Center of Lexington – A single resident will rotate through this experience Monday, Wednesday and Friday mornings of each week. No more than one resident will be in their offices at any given time. Preference will be given to those residents who have not previously attended this clinic or the most senior resident on service. Dr. Lightfoot will make this assignment each month. Drs. Cole, Egan, Goldfarb, Neal, Ahmed and Brown, are all excellent teachers. Dr. Egan will coordinate your experience in that practice. The Arthritis Center of Lexington is at 333 Waller Avenue, Suite 100, Phone: 257-0770 (If you are proceeding on Waller Avenue towards Harrodsburg Rd, the Arthritis Center is just over the railroad tracks on the right in a multiple-story gray building. Their offices are on the first floor.) You should arrive on the assigned dates by 8:30 in the morning and expect to work until 11:45am. You will be excused from morning report on the days of your assignments there.
    

2. Tuesday morning UKMC Rheumatology Clinic – Dr. Crofford and Dr. Temprano have clinics every Tuesday morning in the Women's Health & Rheumatology Clinic, 2nd floor of the Kentucky Clinic building (just above Starbuck's). You should come after Morning Report and you will be excused by noon to attend the teaching conference. If you are a rotating (non-Internal Medicine) resident and are not required to attend Morning Report, please plan to arrive at clinic by 8:00 AM.
    

3. Tuesday afternoon UKMC Rheumatology Clinic – Dr. Lohr has clinic from 12:00 PM – 4:00 PM but as residents are expected to attend noon conference they should arrive at 1:00 PM.
    

4. Wednesday morning UKMC Rheumatology Clinic – Dr. Lightfoot and Dr. Lohr have clinics Wednesday morning as above, and Dr. Temprano has Fellows clinic.
    

5. Thursday morning VAMC/UKMC Rheumatology Clinic – Dr. de Beer conducts rheumatology clinic Thursday mornings in the 2 North out-patient clinic areas at the VAMC. Check with the VA clinic desk to make sure there is a clinic any given Thursday. If not, Dr. Temprano has clinic Thursday mornings in Kentucky Clinic as above, which you should attend.
    

6. Thursday afternoon UKMC Rheumatology Clinic – Dr. Lohr has clinic from 1:00 PM – 5:00 PM.
    

7. Friday morning UKMC Rheumatology Clinic- Drs. Crofford and Temprano often see new patients in Kentucky Clinic on Friday mornings. Please check with them directly to see if they have patients.
    

8. Friday afternoon Fellows Clinic – Dr. Lohr has Fellows clinic from 1:00 PM – 5:00 PM.

You should check with the individual offices to make sure that clinics are held on each of your assigned days, as the individual attendings may arrange vacations which result in the specific clinic cancellations during the month you are on Rheumatology.

Relevant information for contacting the Rheumatology office, and picking up your learning materials are listed below. Mihoko Kojima will be your primary contact:

Rheumatology secretaries: