rheumatology

Question 1

what is characteristic of many rheumatological conditions

Answer 1

auto antibody production

Question 2

what does a seropositive condition mean

Answer 2

auto antibodies in the serum

Question 3

what is ann auto antibody

Answer 3

it is produced by the immune system and acts against one or more of the individuals proteins

Question 4

anti CCP associated iwth

Answer 4

rheumatoid arthritis

Question 5

ANA non specific associated with

Answer 5

SLE, Sjogrens syndrome, systemic sclerosis, MCTD, antoimmune liver disease

Question 6

dsDNA antibody associated iwth

Answer 6

SLE

Question 7

anti Sm associated with

Answer 7

SLE

Question 8

Anti-Ro associated iwth

Answer 8

SLE, Sjogrens syndrome

Question 9

Anti-La

Answer 9

sjogrens syndrome

Question 10

anti - centromere antobody

Answer 10

systemic sclerosis (limited)

Question 11

anti-scl-70 antibody

Answer 11

systemic sclerosis (diffuse)

Question 12

ti -RNP antibody

Answer 12

SLE, MCTD

Question 13

ANTI-jO-1 ANTIBODY

Answer 13

myositis

Question 14

anti cardiolipin antibody and lupus anticoagulant

Answer 14

anti phospholipid syndrome

Question 15

ANCA

Answer 15

small vessel vasculitis

Question 16

what is the most common form of arthritis

Answer 16

osteoarthrtitis

Question 17

what is osteoarthtrtits

Answer 17

progressive degenerative condition affecting joints due to gradual thinning of cartilage, loss of joint space and formation of bony spurs

Question 18

what are bony spurs

Answer 18

osteophytes

Question 19

what is pathogenesis of osteoarthrtitis

Answer 19

loss of matrix cartiage, release of cytokines including IL-1, TNF, and mixed metalloproteinases as well as prostaglandins by the chondrocytes

Question 20

signs and symptoms of osteoarthritis

Answer 20

gradual onset, mechanical pain, crepitus, stiffness, body swelligs and deformity of the joint, can get effusions and soft tissue swelling which can lead to loss of function and mobility

Question 21

most effected joint of osteoathritis

Answer 21

hands, knees, hip and spine

Question 22

what are the risk factors for osteoarthritis

Answer 22

age, female, genetic, occupation, previous injury, obesity, underlying conditions

Question 23

what is an example of genetic predisposition to osteoarthritis

Answer 23

nodal OA

Question 24

investigations of osteoarthritis

Answer 24

bloods, X ray

Question 25

blood findings in osteoarthtritis

Answer 25

inflammatory markers are usually normal

Question 26

typical radiological findings in osteoarthtritis

Answer 26

joint space narrowing, subchondral sclerosis, bony cysts, osteophytes

Question 27

non pharmalogical managment of OA

Answer 27

education, physio, wgt loss, floot wear, aids sich as walking sticks and jar openers

Question 28

pharmalogical management of OA

Answer 28

analgesia, NSAIDs, pain modulators, intraarticular steroids

Question 29

surgical intervention of OA

Answer 29

arthroscopic washout, loose body, soft tissue trimming, joint replacement

Question 30

what is rheumatoid arthritis

Answer 30

aymmetrical inflammation affecting mainly peripheral joints (mostly synovial) which can lead to joint damage and irreversible deformities leading to loss of function and increased morbidity and mortality

Question 31

who is RA most common in

Answer 31

women

Question 32

what is the prevelance of RA

Answer 32

1% in the uk

Question 33

what is RA mediated by

Answer 33

HLA DR4

Question 34

what are the triggers of RA

Answer 34

infections, stress, cigerrettes

Question 35

what is early RA

Answer 35

less than 2 years of symptoms

Question 36

what is the therapuetic window of opportunity for RA

Answer 36

first 3 months

Question 37

extra articular manifestations in RA

Answer 37

rheumatoid nodules on extensor surfaces, lung involvement - pleaural effusions, interstitial fibrosis and pulmonary nodules, CVS morbidity and mortality increased, occular

Question 38

diagnosis of RA

Answer 38

history and clincial exam, prolonged morning stiffness in small joints, positive compression test, blood testing for anaemia and raised platelets, inflammatory markers raised, auto antibodies RF and ACPA, X ray for periarticular osteopenia and soft tissue swelling, per articular erosions can occur later, US for synovial inflammation and MRI for tendons

Question 39

what score should you use to assess weather the patient is improving or worsening in RA

Answer 39

DAS28^2

Question 40

first line treatment for RA

Answer 40

methotrexate, analgesia and steoirds for symptosm releif

Question 41

second line for RA

Answer 41

biologic therapy - anti TNFAalpha drigs

Question 42

what mist patients have to qualify for biologic therapy

Answer 42

a score larger than 5.1

Question 43

complications of RA

Answer 43

joint damage and deformaties, atlanto axial sublucation causing cervical cord compression

Question 44

what does spondyloaryhropathy affect

Answer 44

spine and joints - sacroiliac

Question 45

what causes spondylarthrtopathy

Answer 45

HLA B27 +ve

Question 46

what is enthesitis

Answer 46

inflammation at insertation of tendons into bones

Question 47

what is dactylitis

Answer 47

sausage digits

Question 48

what is anklyosing spondylitis

Answer 48

inflammation of the spine

Question 49

who is AS more common in

Answer 49

men

Question 50

clinical features of AS

Answer 50

back pain enthestitis, peripheral arthritis

Question 51

extra articular features of AS

Answer 51

anterior uveitis, CVS involvement, pulmonary, asymptomatic enteric mucosal inflammation, nuero involvement

Question 52

what does syndesmophytes mean

Answer 52

fusion of vertebrae

Question 53

diagnosis of AS

Answer 53

examine - occiput to wall test, chest expansion, schober test, bloods, Xrays

Question 54

what % of people have PsA without psoriasis

Answer 54

10-15%

Question 55

clinical features of PsA

Answer 55

inflammatory arthritis, sacrolitis, nail involvement, dactylitis, enthesitis, extra articular

Question 56

diagnosis of psoriatic arthritis

Answer 56

bloods and Xrays

Question 57

treatment of PsA

Answer 57

NSAIDs, corticosteroids, DMARDs, antiTNF if severe, secukinumab, physio, OT, orthotics