Rheumatology

Question 1

Calcification of the triangular fibrocartilage suggests chondrocalcinosis - which condition is this associated?

Answer 1

Pseudogout

Question 2

most common cause of osteomyelitis (bacteria)

Answer 2

staph aureus

Question 3

Rheumatoid factor is an Ig? antibody against Ig?

Answer 3

IgM Ab against IgG

Question 4

Rheumatoid arthritis X ray findings:

a) early (3)
b) late (2)

Answer 4

a) Early
- loss of joint space
juxta-articular osteoporosis
soft-tissue swelling

b) Late
- periarticular erosions
- subluxation

Question 5

Patients with aspirin allergy/ hypersensitivity should avoid what medication?

Answer 5

sulphasalazine

Question 6

adult onset Stills management (3)

Answer 6

1. NSAIDS
2. Steroids
3. Methotrexate, IL-1 inhibitor (Anakinra), TNF a

Question 7

Mutation in Collagen type 1

Answer 7

osteogenesis imperfecta

Question 8

Mutation in Collagen type 2 - give rise to

Answer 8

Chondrodysplasia

Question 9

Mutation in collagen type 3 leads to

Answer 9

Elhers Danlos

Question 10

Mutation in collagen type 4

Answer 10

Goodpastures + Alports

Question 11

severe side effect of hydroxychoroquine (often used in SLE)

Answer 11

retinopathy due to ocular toxicity of hydrxychloroquine

Question 12

Ank spon is associated with (6)

Answer 12

• Anterior uveitis
• AV node block
• Achilles tendonitis
• Apical fibrosis
• Amyloidosis
• Aortic regurgitation

Question 13

Cubital tunnel syndrome is compression of which nerve?

Answer 13

ulna - paraesthesia of 4/5th fingers

Question 14

Raynauds phenomena management (2)

Answer 14

1. CCB - nifedipine

2. iv prostocycline (epoprostenol)

Question 15

TNF a inhibitors can lead to reactivation of what condition

Answer 15

TB

Question 16

Familial Mediterranean fever associated with (4)

Answer 16

Peritonitis - abdo pain
Pericarditis - chest pain
Synovitis - joint pain
fever

Question 17

bisphosphonates mechanism

Answer 17

inhibits osteoclasts

Question 18

pseudogout risk factors (6)

Answer 18

haemachromotosis
Acromegaly
wilsons
hypomag
hypophos
hyper PTH

Question 19

methotrexate mechanism

Answer 19

inhibits dihydrofolate reductase

Question 20

lateral epicondylitis test (movement)

Answer 20

wrist extension/ supination whilst elbow fully extended exacerbates the pain

Question 21

Limited (central) cutaneous systemic sclerosis associated with which antibody

Answer 21

anti-centromere

Question 22

Denosumab (used for osteoporosis) mechanism

Answer 22

Denosumab is RANKL inhibitor preventing osteoclast development

Question 23

Ottawa rules - Reasons for X ray in Ankle pain

Answer 23

• any malleolar zone pain
• bone tenderness lat mal
• bone tenderness med mal
• inability to walk after injury and on examination

Question 24

Ank spon management (3)

Answer 24

1 - Exercise + NSAID

2. DMARD (sulfasalazine)
3. TNF a (eg etanercept) if persistence

Question 25

rheumatoid arthritis management

Answer 25

1. DMARD (monotherapy) + steroid | 2. TNF a - if 2 failed DMARDs including methotrexate)

Question 26

mixed connective tissue disease antibody is...

Answer 26

Anti-ribonuclear protein

Question 27

Major target of pANCA is...

Answer 27

myeloperoxidase - neutrophil protein whose primary role is the generation of oxygen free radicals.

Question 28

X ray findings of ank spon (4)

Answer 28

- syndesmophytes - ossification of outer fibres of annulius fibrosis - squaring of lumbar vertebrae - sacroillitis - subchondral erosions, sclerosis - "bamboo spine" - late and uncommon

Question 29

Drugs that cause drug induced lupus

Answer 29

Most common - procainamide, hydralazine | Less common - Isoniazid, phenytoin, minocycline

Question 30

osteoporosis in men, you should test for...

Answer 30

testosterone - hypogonadism is highly linked with osteoporosis in men

Question 31

Dermatomyositis associated with which antibody

Answer 31

Anti-Jo 1

Question 32

methotrexate mechanism

Answer 32

inhibits dihydrofolate reductase

Question 33

In Marfans, there is a defect of...

Answer 33

the Glycoprotein structure that normally wraps around elastin

Question 34

Most common cause of death in systemic sclerosis (crest) (2)

Answer 34

RESP! Interstitial lung disaese Pul HTN

Question 35

Adhesive capsulitis Feature (1)

Answer 35

External rotation impairment (shoulder)

Question 36

Reactive arthritis features (3) cause (2 types) synovial fluid (1)

Answer 36

uveitis, urethritis, arthritis (cant see, pee, knee) chlamydia (sti related) Shigella, campylobater, salmonella (dysentry related) nil synovial fluid organism

Question 37

Familial Mediterranean Fever Mx

Answer 37

Colchicine

Question 38

Dermatomyositis antibodies (2)

Answer 38

ANA - most common | Anti-Mi2 - most specific (less common)

Question 39

SLE antibodies (3)

Answer 39

ANA most sensitive | anti-Sm & anti-dsDNA most specific

Question 40

Sjogren's associated with what malignancy

Answer 40

Non-hodgkins lymphoma

Question 41

Hydroxychloroquine main side effect

Answer 41

retinopathy

Question 42

Osteomalacia features

Answer 42

``` bone pain proximal myopathy (waddling gait) Vit D deficiency (indoors all the time?) ```

Question 43

Anti Jo 1 association

Answer 43

Polymyositis

Question 44

Anti scl 70

Answer 44

diffuse cutaneous systemic sclerosis

Question 45

anti centromere

Answer 45

limited cutaneous systemic sclerosis

Question 46

Behcets features (3)

Answer 46

oral ulcer genital ulcer anterior uveitis (meningitis, DVT)

Question 47

Anti RNP (ribonuclear protein) association

Answer 47

mixed connective tissue disorder

Question 47

Anti RNP (ribonuclear protein) association

Answer 47

mixed connective tissue disorder

Question 48

De Quervains synovitis features

Answer 48

tender radial styloid process

Question 49

HLA B27 association

Answer 49

ank spon reactive arthritis ant uveitis

Question 50

Felty syndrome (3)

Answer 50

rheumatoid arthritis splenomegaly low white cell count

Question 51

Polymyositis antibody

Answer 51

anti-Jo1