4th Year Additions

Question 1

management pathway of OA

Answer 1

PO paracetamol and topical NSAIDs
oral NSAIDs (consider PPI)
topical capsaicin (chilli pepper)
intra-articular joint injections
joint replacement

Question 2

what is the action of drugs that end in -nib?

Answer 2

JAK inhibitors

Question 3

what is mixed connective tissue disease?

Answer 3

condition which features symptoms from other CTDs

Question 4

features of mixed connective tissue disease

Answer 4

Raynaud's
arthralgia/ arthritis
myositis
sclerodactyly
pulmonary hypertension
interstitial lung disease

Question 5

antibody in mixed connective tissue disease?

Answer 5

anti-RNP Ab

Question 6

what should be done annually in mixed connective tissue disease and systemic sclerosis

Answer 6

echo for pulmonary hypertension

PFTs for interstitial lung disease

Question 7

what is Libman-Sacks endocarditis?

Answer 7

growth on valves (commonly mitral) associated with APLS

Question 8

blood results in APLS

Answer 8

thrombocytopenia

prolonged APTT

Question 9

what is chondrocalcinosis?

Answer 9

calcium pyrophosphate deposits occur in cartilage and other soft tissues

Question 10

what does calcium pyrophosphate deposition disease encompass?

Answer 10

chondrocalcinosis
hyperparathyroidisim
hypothyroidism
renal osteodystrophy
haemochromatosis
Wilson's

Question 11

side effects of methotrexate

Answer 11

teratogenic

pulmonary fibrosis

Question 12

side effects of leflunomide

Answer 12

hypertension

peripheral neuropathy

Question 13

side effects of sulfasalazine

Answer 13

male infertility

Question 14

side effects of hydroxychloroquine

Answer 14

nightmares

reduced visual acuity

Question 15

side effects of anti-TNF

Answer 15

reactivation of TB or hep B

Question 16

side effects of rituximab

Answer 16

night sweats

thrombocytopenia

Question 17

what is polyarteritis nodosa?

Answer 17

medium vessel necrotising vasculitis

Question 18

what conditions is polyarteritis nodosa associated with?

Answer 18

HBV
HCV
CMV
HIV

Question 19

presentation of polyarteritis nodosa

Answer 19

weight loss
fever
malaise
myalgia
polyarthritis
hip BP
abdo pain
livedo recticularis
renal failure

Question 20

diagnosis of polyarteritis nodosa

Answer 20

arteriography shows multiple small aneurysms
urine
bloods

Question 21

management of polyarteritis nodosa

Answer 21

steroids

cytotoxic drugs

Question 22

which vessels does Takayasu affect?

Answer 22

aorta and pulmonary arteries

Question 23

what is Takayasu also called?

Answer 23

pulseless disease

Question 24

diagnosis fo Takayasu

Answer 24

doppler USS
CT
MR angiogrpahy

Question 25

who gets Takayasu?

Answer 25

young females 15-35

Question 26

management of Takayasu?

Answer 26

steroids +/- immunosuppressants, angioplasty/ surgical repair

Question 27

what is Bechet's disease?

Answer 27

complex inflammatory condition linked to HLA B51

Question 28

where is Bechet's more common?

Answer 28

turkey | iran

Question 29

major criteria for Bechet's

Answer 29

recurrent aphthous stomatitis sterile pustules at site of skin trauma (pathergy test) uveitis genital ulceration

Question 30

minor criteria for Bechet's

Answer 30

``` inflammatory large joint arthritis intestinal ulceration meningoencephalitis epididymitis thrombophlebitis ```

Question 31

what is the pathergy test?

Answer 31

sterile needle creates an abrasion in the forearm > weal progression of >5mm

Question 32

which conditions is pathergy test positive in?

Answer 32

bechets sweet's syndrome pyoderma gangrenosum

Question 33

management of bechets

Answer 33

steroids colchicine topical anaesthetic e.g. lidocaine immunosuppressants e.g. ciclosporin A and biologics

Question 34

what to do if patients have a raised plasma viscosity?

Answer 34

myeloma screen | IgG antibodies screen

Question 35

what is the FRAX tool?

Answer 35

assess risk of fragility fractures in OP over the next 10 years

Question 36

who should you perform the FRAX tool on?

Answer 36

men >75 and women >65

Question 37

what can be used as secondary prevention for OP in women?

Answer 37

raloxifene | HRT

Question 38

action of raloxifene?

Answer 38

selective oestrogen receptor modulator that stimulates oestrogen in bone but blocks them in uterus and breast

Question 39

what is the serum blood test for vitamin D?

Answer 39

25-hydroxyvitamin D

Question 40

monitoring in Paget's

Answer 40

ALP

Question 41

two complications of paget's

Answer 41

osteogenic sarcoma (osteosarcoma) spinal stenosis/ compression hearing loss

Question 42

first line for Paget's

Answer 42

pamidronate (can have flu-like reaction after first dose)

Question 43

L2 nerve root lesion

Answer 43

pain across upper thigh | weak flexion and adduction

Question 44

L3 nerve root lesion

Answer 44

pain across lower thigh weak hip adduciton weak knee extension

Question 45

L4 nerve root lesion

Answer 45

pain across knee to medial malleolus weak knee extension foot inversion dorsiflexion

Question 46

L5 nerve root lesion

Answer 46

lateral shin to dorsum of foot and great toe | weak hip extension, abduction, knee flexion, foot and great toe dorsiflexion (foot drop)

Question 47

S1 nerve root lesion

Answer 47

pain across posterior calf | weak knee flexion, foot plantar flexion and eversion

Question 48

minor SLE symptom management

Answer 48

NSAIDs hydroxychloroquine low dose steroids

Question 49

major SLE symptoms

Answer 49

steroids | immunosuppressants