Rheumatology

Question 0

Define ankylosing spondylitis

Answer 0

Chronic inflammatory disease of the spine and sacroiliac joints

Question 1

Which arthritis spares DIP?

Answer 1

Rheumatoid arthritis

Question 2

When is joint pain and stiffness worse in RA?

Answer 2

Morning

Question 3

What is the CREST syndrome?

Answer 3

Calcinosis
Reynaud's phenomenon
Esophageal dysmotility
Sclerodactyly
Telangiectasia

Question 4

If a patient presents with calcinosis, Reynaud’s phenomenon, reflux and telangiectasia. What is the diagnosis?

Answer 4

Scleroderma

Question 5

Which disease is associated with the CREST syndrome?

Answer 5

Scleroderma

Question 6

What are the 4 characteristics of OA on x-ray?

Answer 6

LOSS
Loss of joint space
Osteophytes
Subchondral cysts
Subarticular sclerosis

Question 7

Which joints are most commonly affected in RA?

Answer 7

PIP, MCP, wrist and MTP

Question 8

Xray features of RA?

Answer 8

SOLED
Soft tissue swelling
Osteoporosis/osteopaenia
Loss of joint space
Erosions
Deformity

Question 9

what are the seronegative spondyloarthopathies

Answer 9

ankylosing spondyloarthritis
reiter syndrome
enteritis-associated arthritis
psoriatic arthritis

Question 10

what is Charcot joint

Answer 10

neuropathy leads to loss of protective mechanisms of the joint –> extreme traumatic damage

Question 11

Treatment of acute attack of gout

Answer 11

High dose NSAIDs (voltaren, indomethacin, piroxicam, ibuprofen) for 3-5 days. Then cut back to standard dose and cease after 6 weeks.
(colchicine or intra-articular steroids if NSAIDs contraindicated)

Question 12

Treatment of chronic gout

Answer 12

Once acute attack is controlled, start allopurinol at lowest possible dose with NSAID cover.
Increase dose slowly until you reach good control of serum urate (less than 0.3mmol/L)

Question 13

Dx of osteoporosis

Answer 13

DEXA scan T score -2.5 or lower

Question 14

Difference between T score and Z score in DEXA scans?

Answer 14

T score is with reference to a healthy 30 year old female matched to same age and ethnicity
Z score is with reference to same age, sex and ethnicity

Question 15

Dx of severe osteoporosis

Answer 15

DEXA scan T score -2.5 or lower
AND
1 or more fractures

Question 16

Dx of osteopaenia

Answer 16

DEXA T score between -1 to -2.4

Question 17

First line Rx of osteoporosis

Answer 17

Bisphosphonates

Question 18

What do bisphosphonate names start or end with?

Answer 18

End with -dronate

Question 19

What is the mechanism of action of bisphosphonates?

Answer 19

Cause osteoclast apoptosis

Question 20

What are the main concerns with long term bisphosphonate Rx?

Answer 20

Oesophageal cancer

Osteonecrosis of the jaw

Question 21

What is the Thomas test and what does it test for?

Answer 21

Pt lies supine. Place fist under lumbar lordosis. Lift Pt’s right leg and flex at knee. Left hip should stay on bed. If left hip raises off bed = right hip pathology.
Tests for fixed flexion hip deformity

Question 22

What is Schober’s test and what does it test for?

Answer 22

Mark point between PSIS (~L5) and 5cm above. Have Pt flex at hip and gap should increase to 10cm or more.
Tests for lumbar flexion

Question 23

What is Trendelenburg’s sign and what does it test for?

Answer 23

Have Pt stand on one foot. Positive = opposite side of hip drops
Tests for weakness of the hip abductors (gluteus medius and minimus)

Question 24

What is the straight leg raised test and what does it test for?

Answer 24

Have Pt lie supine. Passively raise leg to flex hip. Ask if causes pain esp shootiing down leg
Tests for ipsilateral sciatica esp from L5 disc herniation

Question 25

which joints of the hand are typically involved in OA?

Answer 25

PIP, DIP, MCP (especially base of thumb)

Question 26

which joints of the hand are typically involved in RA?

Answer 26

MCP, PIP, wrist

Symmetrical