rheum

Question 1

mx of acute flares of RA

Answer 1

IM/oral methylprednisolone

Question 2

mx of antiphospholipid syndrome

Answer 2

no VTE - daily low-dose aspirin

after first VTE lifelong warfarin

Question 3

features of psoriatic arthritis

Answer 3

DIP swelling and dactylitis
involves any joint of the body
imaging - pencil in cup and plantar spur

Question 4

most specific and sensitive antibody tests for SLE

Answer 4

specific - anti-dsDNA

sensitive - ANA

Question 5

what medication used in the mx of RA can lead to reactivation of TB

Answer 5

TNF-inhibitor - Etanercept

Question 6

chondrocalcinosis on x-ray

Answer 6

described as ‘linear calcification of articular cartilage’

highly suggestive of pseudogout

Question 7

extra-articular complications of RA

Answer 7

ischaemic heart disease
apical pulmonary fibrosis
pleural effusion

Question 8

blood test results in osteoporosis

Answer 8

all normal

Question 9

what does malignancy plus raised creatinine kinase indicate

Answer 9

polymyositis

Question 10

mx for ankylosing spondylitis

Answer 10

NSAIDs

Etanercept (TNF-alpha inhibitor) if NSAIDs fail

Question 11

features of polymyalgia rheumatica

Answer 11

aching morning stiffness in proximal limb muscles but no weakness
normal CK

Question 12

antibody test for anti-phospholipid syndrome

Answer 12

anti-cardiolipin (aCL) antibodies and lupus anticoagulant (LA)

Question 13

mx of septic arthritis

Answer 13

IV Flucloxacillin (or Clindamycin if penicillin allergic)

Question 14

risk factors for osteoporosis

Answer 14

history of glucocorticoid use
RA
alcohol excess
low BMI
smoking

Question 15

antibody associated with drug-induced lupus

Answer 15

antihistone antibody

Question 16

hand joints in OA vs RA

Answer 16

OA: CMC and DIP joints
RA: MCP and PIP joints

Question 17

what rheumatological condition are chemotherapy patients at increased risk of

Answer 17

gout due to increased urate production

Question 18

what baseline investigation must be done before initiating hydroxychloroquine

Answer 18

ophthalmological examination

hydrox-E-y-E-chloroquine

Question 19

causes of drug-induced lupus

SHIPP

Answer 19

Sulfonamide
Hydralizine
Isoniazid
Phenytoin
Procainamid

Question 20

OA mx

Answer 20

1. paracetamol + topical NSAID (if knee/hand)

2. oral NSAIDs/COX-2 inhibitors

Question 21

risk factors for pseudogout

Answer 21

hyperparathyroidism
haemochromatosis
acromegaly

Question 22

mx of polymyalgia rheumatica

Answer 22

Prednisolone

Question 23

what is measured to monitor SLE flares

Answer 23

complement levels

they are usually low during active disease

Question 24

Marfan’s has a deficiency of what

Answer 24

fibrillin

Question 25

features of ankylosing spondylitis

Answer 25

lower back pain and stiffness insidious onset stiffness improves with exercise pain at night

Question 26

features of OA

Answer 26

pain exacerbated by exercise and relieved by rest | unilateral symptoms

Question 27

pseudogout crystals

Answer 27

weakly positive birefringent rhomboid-shaped crystals

Question 28

gout crystals

Answer 28

negatively birefringent needle-shaped crystals

Question 29

Pre-op imaging for people with RA

Answer 29

AP and lateral C-spine radiographs to check for atlantoaxial subluxation

Question 30

oral and genital ulcers not responding to aciclovir

Answer 30

think Behcet's

Question 31

mx of reactive arthritis

Answer 31

NSAIDs | if NSAIDs CI - intra-articular steroids

Question 32

features of temporal arteritis

Answer 32

``` rapid onset headache jaw claudication visual disturbance (anterior ischaemic optic neuropathy) pyrexia skip lesions on biopsy rapid response to prednisolone ```

Question 33

features of osteogenesis imperfecta | A-F

Answer 33

``` Autosomal dominant Blue sclera Caries Deafness (otosclerosis) Every Fracture unexplained ```

Question 34

adverse effect of hydrocholorquine

Answer 34

bull's eye retinopathy

Question 35

Felty's syndrome

Answer 35

rheumatoid arthritis splenomegaly low WCC

Question 36

advice for conception if taking methotrexate

Answer 36

must want at least 6 months after stopping methotrexate before conceiving

Question 37

anterior ischaemic optic neuropathy

Answer 37

sudden vision loss with disc pallor | seen in temporal arteritis

Question 38

features of antiphospholipid syndrome

Answer 38

venous and arterial thromboses recurrent foetal loss thrombocytopenia prolonged APTT

Question 39

where are crystals found in pseudogout

Answer 39

synovium first then cartilage

Question 40

mx of acute gout

Answer 40

NSAIDs | use Prednisolone if CKD

Question 41

what must be screened for if a person presents with dermatomyositis

Answer 41

underlying malignancy

Question 42

adverse effects of methotrexate

Answer 42

myelosuppression pneumonitis pulmonary fibrosis mucositis

Question 43

anaemia found in SLE

Answer 43

haemolytic anaemia

Question 44

features of osteomalacia (incl. bloods)

Answer 44

bone pain and tenderness proximal myopathy low calcium, phosphate and vitamin D raised ALP and PTH

Question 45

joint aspiration findings in reactive arthritis

Answer 45

cloudy yellow negative culture no crystals WCC 20,000/mm^3