Exam

Question 1

What is the main investigation in an acute attack of gout?

Answer 1

Aspiration and microscopy of synovial fluid- negatively birefringent needle-shaped crystals

Question 2

How is gout treated a) acutely and b) prophylactically?

Answer 2

a) NSAIDs, colchicine, intra-articular steroids

b) allopurinol (2-4 weeks after acute attack), feubuxostat

Question 3

What causes pseudogout?

Answer 3

Deposition of calcium pyrophosphate crystals

Question 4

Symptoms of osteoarthritis (3)

Answer 4

Pain on activity relieved by rest
Morning stiffness
Inactivity “gelling”

Question 5

Radiological signs of osteoarthritis (LOSS)

Answer 5

Loss of joint space
Osteophytes
Subchondral cysts
Subchondral sclerosis

Question 6

Conservative management of osteoarthritis

Answer 6

Analgesia, physio, OT, tricyclics

Question 7

Surgical management of osteo

Answer 7

Joint replacement, washout, osteophyte removal

Question 8

Symptoms of polymyalgia rheumatica (2)

Answer 8

Severe symmetrical pain across the neck and shoulder girdle and pelvis
morning stiffness

Question 9

Investigations in PMR (3)

Answer 9

Raised inflammatory markers
CK normal
Skip lesions on temporal artery biopsy

Question 10

Management of PMR (2)

Answer 10

Corticosteroids

High dose prednisolone if temporal arteritis

Question 11

Immunopathology of lupus

Answer 11

Immune complex deposition in small vessels

Question 12

Most sensitive lupus antibody

Answer 12

ANA

Question 13

Most specific lupus antibody

Answer 13

Anti-Sm

Question 14

Most clinically useful lupus antibody

Answer 14

Anti-dsDNA

Question 15

Monitoring of lupus (3)

Answer 15

C3/C4
ESR
dsDNA

Question 16

Management of lupus (3)

Answer 16

Steroids
Hydroxychloroquine
Immunosuppressants e.g. MTX, AZT

Question 17

Cause of Sjogren’s syndrome

Answer 17

Lymphocytic infiltration of exocrine glands

Question 18

Symptoms of Sjogren’s (6)

Answer 18

Dry eyes
Dry mouth
Dry cough
Dry vagina
Dysphagia
Raynaud's

Question 19

Tests for Sjogren’s (3)

Answer 19

Schirmer’s test
Gland biopsy
Autoantibodies- rheumatoid factor, ANA, Ro/lA

Question 20

Limited cutaneous scleroderma symptoms (CREST)

Answer 20

Calcinosis
Raynauds
Esophageal dysmotility
Sclerodoctyly
Telangiectasia

Question 21

Distinguishing features of diffuse cutaneous scleroderma

Answer 21

Rapid onset of skin symptoms following Raynaud’s;

early organ involvement

Question 22

Anti-centromere antibody

Answer 22

Limited scleroderma

Question 23

Treatment for Raynauds

Answer 23

Nifedipine

Question 24

Treatment of pulmonary hypertension (2)

Answer 24

Sildenafil, Bosentan

Question 25

Presentation of rheumatoid arthritis

Answer 25

Symmetrical stiff, swollen joints (MCP, PIP, wrist, feet) and non-specific symptoms

Question 26

Best antibodies for rheumatoid arthritis

Answer 26

Anti-ccp and rheumatoid factor

Question 27

Radiological signs in RA (5)

Answer 27

``` Osteopenia Erosions Loss of joint space Periarticular swelling Deformity ```

Question 28

Management of RA

Answer 28

Steroids for lag phase and flare-ups MTX + other DMARD Analgesia for symptomatic relief

Question 29

Main feature of polymyositis/dermatomyositis

Answer 29

Symmetrical proximal progressive muscle weakness

Question 30

Skin signs in dermatomyositis

Answer 30

Gottron's papules Shawl sign Heliotrope rash

Question 31

CK in polymyositis/dermatomyositis

Answer 31

Elevated

Question 32

Jo-1

Answer 32

Polymyositis

Question 33

Mi-2

Answer 33

Dermatomyositis

Question 34

Treatment of poly/dermatomyositis (3)

Answer 34

High dose prednisolone DMARDs Skin therapeutics

Question 35

Inclusion body myositis

Answer 35

More distal, more progressive, more often in men

Question 36

The four main seronegative arthritides

Answer 36

Ankylosing spondylitis Psoriatic arthritis Reactive arthritis Enteropathic arthritis

Question 37

HLA in the sernonegative arthritides

Answer 37

HLA-B27

Question 38

1-4 weeks after dysentery/urethritis

Answer 38

Reactive arthritis

Question 39

Reiter's syndrome

Answer 39

Conjunctivitis, urethritis, arthritis

Question 40

Skin lesions in reactive arthritis (3)

Answer 40

Keratoderma blenorrhagica Oral ulcers Hyperkeratotic nails