Rheum

Question 1

Signs of OA on XR

Answer 1

Loss of joint space
Osteophytes
Subchondral cysts
Subarticular sclerosis

Question 2

Signs of RA on XR

Answer 2

Loss of joint space
Erosions
Softening (osteopenia)
Soft tissue swelling

Question 3

Signs of RA in hands

Answer 3

Swollen joints
Ulnar deviation
Boutonierre and swan neck deformity
Z deformity of thumb

Question 4

Extra-articular manifestations of RA

Answer 4

Nodules (elbow, lung, cardiac)
Lungs - ILD
Cardiac - IHD, pericarditis
Eye - episcleritis, scleritis

Question 5

What triad forms felty syndrome?

Answer 5

Splenomegaly
Neutropenia
RA

Question 6

Initial Ix in RA

Answer 6

RF
Anti-CCP
XR hands and feet

Question 7

What score can you use to monitor disease activity in RA?

Answer 7

DAS28

Question 8

What are the reasons for failure of biologic tx?

Answer 8

Develop Abs towards it
OA develops as well causing pain
Non-adherence

Question 9

What side effect effects all DMARDS?

Answer 9

Myelosuppression

Question 10

Outline the uric acid cycle

Answer 10

Purine - (xanthine oxidase) - xanthine - uric acid - monosodium urate crystals

Question 11

Which foods predispose to gout?

Answer 11

Alcohol
Fructose
Red meat
Sea food

Question 12

Which crystals cause gout?

Answer 12

Monosodium urate

Question 13

What finding on joint microscopy indicates gout?

Answer 13

Negatively birefrigent needle shaped crystals under polarozed light

Question 14

When should you measure serum urate in an acute gout attack?

Answer 14

6-8 weeks after (down in acute)

Question 15

What are the conditions for starting allopurinol?

Answer 15

More than one attack in last 12 months

Question 16

What drug is an alternative to allopurinol?

Answer 16

Febuxostat

Question 17

Which drug is used to tx tumour lysis syndrome?

Answer 17

Rasburicase or allopurinol

Question 18

Which crystals cause pseudogout?

Answer 18

Calcium pyrophosphate

Question 19

What do the crystals look like in pseudogout?

Answer 19

Positively birefrigent RHOMBOID crystals

Question 20

Mx for acute pseudogout

Answer 20

Ice, rest

Consider intra-articular steroids

Question 21

Which auto Abs are most strongly associated with SLE?

Answer 21

ANA

Anti-dsDNA

Question 22

How is SLE managed?

Answer 22

Avoid sunlight exposure

Question 23

Which Ab is raised in antiphospholipid syndrome?

Answer 23

Anticardiolipin lupus anticoagulant

Question 24

Ix for sjogrens syndrome

Answer 24

Schirmer tear test
Rose-Bengal staining (may show keratitis)
Anti Ro and Anti La

Question 25

Tx for sjogrens syndrome

Answer 25

Artificial tears | Artificial saliva

Question 26

Features of CREST syndrome

Answer 26

``` Calcinosis Raynauds phenomenon Esophageal dysfunction Sclerodactyly Telangiectasia ```

Question 27

Which Abs are associated with limited cutaneous sclerosis?

Answer 27

Anti-centromere | ANA (90% positive)

Question 28

Which Abs are raised in diffuse systemic sclerosis?

Answer 28

Scl-70 | anti-RNA polymerase

Question 29

Which Ix are required annually in diffuse systemic sclerosis?

Answer 29

Echocardiogram | Spirometry

Question 30

What is the leading cause of death in limited cutaneous sclerosis?

Answer 30

Pulmonary htn

Question 31

How can raynauds phenomenon be treated?

Answer 31

Keep hands warm | Nifedipine

Question 32

What is important to rule out in a patient presenting with polymyositis?

Answer 32

Neoplasm

Question 33

What signs are suggestivee of dermatomyositis?

Answer 33

Heliotrope rash Periorbital oedema Purplish Gottron papules over knuckles

Question 34

Ix for dermatomyositis

Answer 34

``` Anti - Jo1 Increased CK Muscle biopsy EMG Screen systematically for malignancy ```

Question 35

Mx for polymyositis

Answer 35

Prednisolone

Question 36

What conditions are associated with Ehler danos syndrome?

Answer 36

Mitral valve prolapse Anuerysms Aortic root dilation

Question 37

Extra-articular manifestations of seronegative arthropathy?

Answer 37

Enthesitis Dactylitis Anterior uveitis IBD

Question 38

What area is inflamed in the joints of rheumatoid arthritis?

Answer 38

Synovial membrane

Question 39

What conditions is marfan syndrome assoc with?

Answer 39

AORTIC DISSECTION/DILATATION Lens dislocation Dural actasia

Question 40

Which Ix are done regularly in marfans?

Answer 40

Echo - aortic root width | MRI of spinal column

Question 41

What are seronegative arthropathies associated with?

Answer 41

HLA B27 | Increased risk sacroiliitis

Question 42

Mx for fibromyalgia

Answer 42

exercise programmes CBT low dose amitriptiline