Medicine

Question 1

What complicates long-standing disease in LcSSc?

Answer 1

Pulmonary HTN

Pulmonary hypertension (HTN) is a significant complication in limited cutaneous systemic sclerosis (LcSSc).

Question 2

What is a common condition associated with dcSScl?

Answer 2

ILD

Interstitial lung disease (ILD) is common in diffuse cutaneous systemic sclerosis (dcSScl).

Question 3

Which antibodies are commonly found in patients with dcSScl?

Answer 3

Scl70

Antibodies to topoisomerase 1, also known as Scl70, are found in patients with diffuse cutaneous systemic sclerosis.

Question 4

What is one of the main causes of death in patients with renal involvement?

Answer 4

Hypertensive renal crisis

Hypertensive renal crisis is a significant cause of death in patients with renal involvement.

Question 5

What is the percentage of ANA positivity in investigations?

Answer 5

About 70%

Antinuclear antibodies (ANA) are positive in approximately 70% of patients.

Question 6

What tests are recommended if interstitial lung disease is suspected?

Answer 6

HRCT

High-resolution computed tomography (HRCT) is recommended for suspected interstitial lung disease.

Question 7

What is the mainstay of initial treatment for polymyositis (PM) and dermatomyositis (DM)?

Answer 7

Oral glucocorticoids

Oral glucocorticoids, such as prednisolone (1 mg/kg daily), are the initial treatment for PM and DM.

Question 8

What can indicate bacterial overgrowth in investigations?

Answer 8

Hydrogen breath test

A hydrogen breath test is used to indicate bacterial overgrowth.

Question 9

What skin lesions are associated with dermatomyositis?

Answer 9

Gottron’s papules and heliotrope rash

Gottron’s papules and a heliotrope rash are characteristic skin lesions in dermatomyositis.

Question 10

What are the common symptoms reported by patients with polymyositis?

Answer 10

Muscle weakness, pain, fever, weight loss, and fatigue

Patients often report difficulty with daily activities, muscle pain, and systemic symptoms.

Question 11

What is the age range for adults typically affected by polymyositis?

Answer 11

40 to 60 years

Polymyositis generally affects adults between the ages of 40 and 60.

Question 12

What is a common treatment for severe or progressive pulmonary hypertension?

Answer 12

Heart-lung transplant

In severe or progressive cases of pulmonary hypertension, a heart-lung transplant may be considered.

Question 13

What treatment should be considered for fulminant lung disease in Takayasu arteritis?

Answer 13

Plasmapheresis

Plasmapheresis is advisable for fulminant lung disease in Takayasu arteritis.

Question 14

What is the typical age of onset for Takayasu arteritis?

Answer 14

25–30 years

Takayasu arteritis typically presents in individuals aged 25 to 30 years.

Question 15

What type of vasculitis is characterized by granuloma formation?

Answer 15

Granulomatosis with polyangiitis

Granulomatosis with polyangiitis was formerly known as Wegener’s granulomatosis.

Question 16

What are the common investigations for systemic lupus erythematosus (SLE)?

Answer 16

ANAs, complement, routine haematology, biochemistry, and urinalysis

These tests are essential for diagnosing and monitoring SLE.

Question 17

What are the common gastrointestinal complications of SLE?

Answer 17

Mouth ulcers and mesenteric vasculitis

Gastrointestinal issues in SLE can include mouth ulcers and serious complications like mesenteric vasculitis.

Question 18

What is a common neurological symptom in SLE?

Answer 18

Fatigue, headache, and poor concentration

Neurological symptoms in SLE often include fatigue, headaches, and difficulty concentrating.

Question 19

What is the risk factor for cardiovascular issues in SLE patients?

Answer 19

Increased risk of atherosclerosis

Patients with SLE have a significantly increased risk of developing atherosclerosis.

Question 20

What is the typical renal lesion in SLE?

Answer 20

Proliferative glomerulonephritis

Renal involvement in SLE typically manifests as proliferative glomerulonephritis.

Question 21

What is the main presenting feature of fibromyalgia?

Answer 21

Widespread pain

The primary symptom of fibromyalgia is widespread pain that is diffuse and unresponsive to typical analgesics.

Question 22

What is a common management strategy for Raynaud’s phenomenon?

Answer 22

Avoidance of cold exposure

Management includes avoiding cold exposure and may involve medications like calcium channel blockers.

Question 23

What is the female predominance ratio for fibromyalgia?

Answer 23

Approximately 7:1

Fibromyalgia exhibits a strong female predominance, with a ratio of about 7:1.

Question 24

What are the recommended treatments for gastrointestinal reflux in SLE?

Answer 24

PPI and anti-reflux agents

Proton pump inhibitors (PPIs) and anti-reflux medications are recommended for managing gastrointestinal reflux.

Question 25

What is renal involvement in systemic lupus erythematosus (SLE) associated with?

Answer 25

One of the main determinants of prognosis ## Footnote Regular monitoring of urinalysis and blood pressure is essential

Question 26

What are the typical renal lesions found in SLE?

Answer 26

Proliferative glomerulonephritis characterized by: * Haematuria * Proteinuria * Casts on urine microscopy ## Footnote These findings are crucial for diagnosis

Question 27

What are the main types of skin involvement in SLE?

Answer 27

The main types of skin involvement are: * Classic facial rash * Discoid rash * Diffuse alopecia ## Footnote The classic facial rash is erythematous, raised, and painful or itchy

Question 28

What are common clinical features during flares of SLE?

Answer 28

Fever, weight loss, and lymphadenopathy ## Footnote These symptoms may indicate increased disease activity

Question 29

What is Jaccoud's arthropathy?

Answer 29

A common symptom of arthritis and arthralgia in 90% of SLE patients ## Footnote Joint erosions are not a feature of this condition

Question 30

What is the cardinal symptom of Giant Cell Arteritis (GCA)?

Answer 30

Headache localized to the temporal or occipital region ## Footnote It may be accompanied by scalp tenderness

Question 31

What complications can arise from GCA?

Answer 31

Visual disturbances, including blindness due to occlusion of the posterior ciliary artery ## Footnote Jaw pain may also develop while chewing or talking

Question 32

What is polymyalgia rheumatica (PMR) associated with?

Answer 32

Giant cell arteritis (GCA) ## Footnote PMR presents with symmetrical neck and shoulder girdle pain and stiffness

Question 33

What are the common features of Sjögren’s syndrome?

Answer 33

Lymphocytic infiltration of salivary and lacrimal glands leading to: * Glandular fibrosis * Exocrine failure ## Footnote Age of onset is typically between 40-50 years

Question 34

What are key clinical features of systemic sclerosis (SScl)?

Answer 34

Typically characterized by: * Raynaud’s phenomenon * Digital ischaemia * Cardiac, lung, gut, and renal disease ## Footnote Peak age of onset is in the 4th and 5th decades

Question 35

What are the types of systemic sclerosis?

Answer 35

Subdivided into: * Diffuse cutaneous systemic sclerosis (dcSScl) * Limited cutaneous systemic sclerosis ## Footnote The prognosis in dcSScl is poorer, with a 5-year survival of about 70%

Question 36

What is the typical management for Behçet’s disease?

Answer 36

High-dose glucocorticoids and cyclophosphamide, followed by maintenance therapy ## Footnote This is crucial for controlling inflammation

Question 37

What is a significant clinical feature of Eosinophilic Granulomatosis with Polyangiitis?

Answer 37

Associated with eosinophilia and a triad of: * Skin lesions (purpura or nodules) * Asymmetric mononeuritis multiplex * Eosinophilia ## Footnote It often follows a long prodromal period

Question 38

What is the significance of the pathergy test?

Answer 38

Involves pricking the skin and looking for pustule development within 48 hours ## Footnote It can be diagnostic for certain conditions

Question 39

What are the primary investigations for Giant Cell Arteritis?

Answer 39

Considered investigations include: * Temporal artery biopsy * Ultrasound of the temporal arteries * 19FDG PET scan ## Footnote A negative biopsy does not exclude the diagnosis

Question 40

What are common gastrointestinal symptoms in systemic sclerosis?

Answer 40

GERD, dysphagia, and odynophagia due to smooth muscle atrophy and fibrosis ## Footnote These gastrointestinal symptoms can lead to significant complications

Question 41

What is the female-to-male ratio in rheumatoid arthritis (RA)?

Answer 41

Approximately 3-4:1 ## Footnote RA prevalence is about 1.0% in Iraq

Question 42

What triggers autoimmunity in rheumatoid arthritis?

Answer 42

Environmental stimuli such as: * Smoking * Infection ## Footnote These factors act in genetically susceptible hosts

Question 43

What are the characteristic deformities seen in rheumatoid arthritis?

Answer 43

Characteristic deformities include: * Ulnar deviation of the fingers * Swan neck deformity * Boutonnière deformity * Z deformity of the thumb ## Footnote These deformities impact hand function significantly

Question 44

What is the typical management approach for systemic sclerosis?

Answer 44

Combination of pharmacological and non-pharmacological treatments ## Footnote Includes DMARDs, physical therapy, and sometimes surgery

Question 45

What is a common ocular complication in Sjögren’s syndrome?

Answer 45

Keratoconjunctivitis sicca (KCS) ## Footnote This condition can lead to significant discomfort and complications