more rheum

Question 1

What are the three ways in which RA causes bone erosions?

Answer 1

1. Focal erosions
2. Periarticular osteoporosis
3. Generalised osteoporosis in skeleton

Question 2

Which joints are most commonly affected in RA?

Answer 2

1. Hands
2. Feet
3. Knees

Question 3

What are the hand deformities associated with RA?

Answer 3

1. Boutonierre - hyperextension of DIPJ
2. Swan neck - hyperextension of PIPJ
3. Z thumb
4. Ulnar deviation

Question 4

Which joint of the hand is usually spared in RA?

Answer 4

DIPJ

Question 5

What nerve is affected in carpal tunnel?

Answer 5

Median nerve

Question 6

What nerve is affected in tarsal tunnel?

Answer 6

Posterior tibial nerve

Question 7

Which nerve is affected by elbow swelling?

Answer 7

Ulnar nerve

Question 8

Which nerve is affected by soft tissue swelling in the popliteal space and fibular head?

Answer 8

Anterior tibial nerve

Question 9

Name 3 DMARDs

Answer 9

Methotrexate
Sulfasalazine
Hydroxychloroquine
Azathioprine

Question 10

Which type of cartilage does OA affect?

Answer 10

articular

Question 11

Name a MAB that is used as an antiresorptive medication for osteoporosis.

Answer 11

Denosumab (mab to RANKL)

Question 12

Why are bisphosphonates the first line treatment for osteoporosis?

Answer 12

• Cheap
• Effective
• Many years of experience

Question 13

Name two bisphosphonates

Answer 13

• Alendronate

- Ibandronate

Question 14

What can cause an acute gouty attack?

Answer 14

1. alcohol/red meat/shellfish binges
2. sepsis/MI/severe illness
3. trauma, surgery
4. dehydration and diuretics
5. cold

Question 15

How would you treat pseudogout?

Answer 15

1. NSAIDs, analgesics
2. Aspiration/injection/physiotherapy
3. DMARDs, synovectomy, surgery

Question 16

What is fibromyalgia?

Answer 16

A chronic condition causing widespread pain through a central processing disturbance - neuropathic

Question 17

What is the difference between the arthritis in RA and the arthritis in SLE?

Answer 17

Arthritis in SLE is non-erosive and less proliferative.
It is non-erosive because the tendons are damaged instead of the bone (as in RA)
It is still deforming and symmetrical.

Question 18

What are the three rashes you get in SLE?

Answer 18

Photosensitive - UV light
Discoid rash - tends to scar
Subacute lupus rash

Question 19

Which areas are most commonly affected in SLE and how do they present?

Answer 19

Skin - rash
Kidneys - nephritis
Joints - arthritis

Question 20

What presentation of lupus affects the hair?

Answer 20

Alopecia

Question 21

What is lupus nephritis?

Answer 21

• Nephritis secondary to lupus
• Used to be a cause of mortality in lupus
• HTN seen
• If detected early - urinalysis (shows proteinuria and haematuria), then kidney failure can be prevented

Question 22

What are the haematological signs associated with SLE?

Answer 22

1. Coombs positive haemolytic anaemia
2. Thrombocytopaenia
3. Neutropaenia
4. Lymphopaenia

(Pancytopaenia)

Question 23

What are the differential diagnoses for SLE Pancytopaenia?

Answer 23

1. Leukaemia
2. Lymphoma
3. Metastatic cancer

Question 24

What is the pathogenesis for SLE?

Answer 24

Inflammation and immune complex mediated tissue damage

Question 25

List the key features of SLE?

Answer 25

1. Symptoms similar to RA 2. Erythema in a butterfly distribution across the cheeks 3. Photosensitive rash 4. Glomerulonephritis with persistent proteinuria 5. Seizures 6. Psychosis 7. Mouth ulcers

Question 26

SLE gives high ESR and low CRP. What would you think of if both ESR and CRP were high?

Answer 26

1. infection 2. serositis 3. arthritis

Question 27

What would you give in acute attack of SLE?

Answer 27

IV cyclophosphamide and high dose prednisolone

Question 28

What are the other uses of cyclophosphamide?

Answer 28

Used for Wegener's (GPA)

Question 29

What are features of reactive arthritis?

Answer 29

(classical triad) + - keratoderma blenorrhagia - circinate balanitis - conjunctivits