Rheum

Question 1

Why does secondary Raynaud’s phenomenon develop in gold miner’s?

Answer 1

hand-arm vibration syndrome

Question 2

Patients aged 75 and over with a history of fragility fractures should be considered for treatment without requiring a DEXA scan. What is the 1st line treatment?

Answer 2

Oral bisphosphonate

Question 3

What are the features of antiphospholipid syndrome?

Answer 3

(paradoxically) prolonged APTT + low platelets

Question 4

What is the major target for pANCA and its primary role?

Answer 4

Myeloperoxidase (MPO)-neutrophil protein
-primary role is the generation of oxygen free radicals.

Question 5

What is a hallmark feature of ankylosing spondylitis?

Answer 5

Nocturnal pain or pain that worsens during periods of rest, such as at night. This occurs due to increased inflammation when the body is at rest and can often improve with movement or exercise.

Question 6

What blood test should be performed if suspecting osteoporosis in a man

Answer 6

testosterone

Question 7

What is the MOA of bisphosphonates?

Answer 7

inhibit osteoclasts by reducing recruitment and promoting apoptosis.

Question 8

Are Anti-Jo 1 antibodies more commonly seen in polymyositis or dermatomyositis?

Answer 8

Polymyositis

Question 9

What eye disorder is most associated with Marfan’s syndrome?

Answer 9

-upwards lens dislocation (superotemporal ectopia lentis)
-blue sclera
-myopia

Question 10

What score is helpful in diagnosing secondary osteoporosis ?

Answer 10

Z-score- for children, young adults, pre-menopausal women and men under the age of 50

Question 11

What movement worsens lateral epicondylitis (tennis elbow)?

Answer 11

Resisted wrist extension (supination) with elbow extended

Question 12

What progression is unaltered in AS despite treatment with TNF-inhibitors?

Answer 12

radiographic progression of AS is unaltered

Question 13

What indicates poor prognosis in polymyositis?

Answer 13

Interstitial lung disease-e.g. fibrosing alveolitis or organising pneumonia

Question 14

What is affected in De Quervain’s tenosynovitis?

Answer 14

inflammation of the sheath containing the extensor pollicis brevis and abductor pollicis longus tendons

-classic symptom is pain at the radial styloid, which worsens with the Finkelstein test (eliciting pain through the ulnar deviation of the wrist while flexing the thumb into the palm)

Question 15

How is diagnosis of AS best done?

Answer 15

sacro-ilitis on a pelvic X-ray

Question 16

What are Looser’s zones on XR?

Answer 16

pseudofractures or Milkman’s fractures, are characteristic radiographic features seen in Osteomalacia. These are areas of incomplete fracture that appear as lucent bands perpendicular to the surface of the bone, usually bilateral and symmetric. They occur due to insufficient mineralisation of osteoid produced by osteoblasts. This is typically caused by a deficiency in vitamin D, which results in decreased calcium absorption from the gastrointestinal tract and hence impaired bone mineralisation leading to Osteomalacia.

Question 17

When is bull’s eye maculopathy seen?

Answer 17

Hydroxychloroquinolone use

Question 18

What infection is PAN associated with?

Answer 18

Hep B

Question 19

What antibodies are associated in Dermatomyositis ?

Answer 19

ANA most common, anti-Mi-2 most specific

Question 20

What blood test should be taken to identify a cause of gout?

Answer 20

An elevated transferrin saturation may indicate haemochromatosis

Question 21

What HLA association is found in Behcet’s syndrome?

Answer 21

HLA B51

Question 22

What does cANCA target?

Answer 22

Serine proteinase 3 (PR3)

Question 23

What is the minimum steroid intake a patient should be taking before they are offered osteoporosis prophylaxis?

Answer 23

Equivalent of prednisolone 7.5 mg or more each day for 3 months-associated with an increased risk of osteoporosis and fractures.

Question 24

What protein mutation occurs in Marfan’s?

Answer 24

Fibrillin 1

Question 25

Why is the combination of methotrexate and co-trimoxazole contraindicated?

Answer 25

Methotrexate works by inhibiting dihydrofolate reductase while co-trimox works by inhibition of folate metabolism- thus greater risk of pancytopenia/bone marrow aplasia

Question 26

What are the sx of dural ectasia (ballooning of the dural sac at the lumbosacral level), seen in someone with Marfan's?

Answer 26

lower back pain associated with neurological problems such as bladder and bowel dysfunction.

Question 27

What are some features of AS in relation to the spine?

Answer 27

-loss of lumbar lordosis -accentuated thoracic kyphosis -reduced lateral flexion of the lumbar spine

Question 28

What findings might you see in osteoporosis (marble bone disease)? What is it due to?

Answer 28

-normal calcium, phosphate, ALP and PTH levels -'bone within a bone' appearance on XR -defective osteoclast function resulting in failure of normal bone resorption

Question 29

What antibodies are seen in limited (central) systemic sclerosis? What are some features?

Answer 29

-Anti-centromere antibodies -scleroderma affects face and distal limbs predominately -CREST syndrome

Question 31

What are the features of an S1 lesion?

Answer 31

Sensory loss of posterolateral aspect of leg and lateral aspect of foot, weakness in plantar flexion of foot, reduced ankle reflex, positive sciatic nerve stretch test

Question 32

How does radial tunnel syndrome present differently to lateral epicondylitis?

Answer 32

Pain is typically distal to the epicondyle and worse on elbow extension/forearm pronation

Question 33

What are the drug causes of gout?

Answer 33

diuretics: thiazides, furosemide ciclosporin alcohol cytotoxic agents pyrazinamide aspirin