Rheumatology

Question 1

What HLA subtype is associated with RA?

Answer 1

HLA-DRB1

Question 2

What ocular manifestations are associated with RA?

Answer 2

Keratoconjunctivitis sicca
Peripheral ulcerative keratitis
Scleromalacia perforans

Question 3

What timeframe can RF and anti-CCP predate onset of RA?

Answer 3

15 years

Question 4

What is the chance of developing RA is a sibling and identical twin have RA?

Answer 4

Sibling - 5%
Twin - 15%

Question 5

Which joints are excluded in the ACR criteria for diagnosis of RA?

Answer 5

DIP, first CMC, first MTP (all commonly affected by OA)

Question 6

What score on the ACR criteria is required for RA diagnosis?

Answer 6

6 or greater

Question 7

What fields are included in the ACR criteria?

Answer 7

Joints involved, RA markers (RF, ACPA), duration of symptoms (more or less than 6 weeks), acute phase reactant levels (ESR/CRP)

Question 8

What is the most useful initial imaging technique for RA?

Answer 8

XR hands and feet

Question 9

What is the earliest sign on XR for RA?

Answer 9

Periarticular osteopaenia

Question 10

What are the most sensitive imaging modalities for RA?

Answer 10

USS and MRI

Question 11

What is first line therapy for RA?

Answer 11

Methotrexate

Question 12

What dose of prednisolone should be aimed for ASAP in patients with RA flares?

Answer 12

<7.5mg/day

Question 13

What is the mechanism of action of tofacitinib?

Answer 13

JAK 1, 2, 3 inhibitor

Question 14

What major infective complication of JAK inhibitors exists?

Answer 14

Herpes zoster infection

Question 15

What other significant adverse effects are associated with JAK inhibitors?

Answer 15

MACE, VTE, cancers

Question 16

What are the three pathways implicated in PAH?

Answer 16

Nitric oxide pathway
Endothelin pathway
Prostacyclin pathway

Question 17

What is the most common presenting feature of GPA?

Answer 17

Upper respiratory disease

Question 18

What differentials exist for saddle nose deformity?

Answer 18

GPA
Congenital syphilis
Cocaine use

Question 19

What is the most common presenting feature of MPA?

Answer 19

Renal disease

Question 20

What neurological feature needs to be monitored for with EGPA?

Answer 20

Mononeuritis multiplex

Question 21

For which AAV is ANCA least sensitive?

Answer 21

EGPA

Question 22

What is the most commonly seen pattern on renal biopsy with AAV?

Answer 22

Crescenteric necrotising glomerulonephritis

Question 23

What is the most commonly seen pattern on renal biopsy with AAV?

Answer 23

Crescenteric necrotising glomerulonephritis

Question 24

What is included in your five factor score?

Answer 24

Age >65
Cardiac involvement
Renal impairment
GI involvement
Absence of ENT involvement

Question 25

What is the most likely AAV to relapse?

Answer 25

GPA

Question 26

What is the initial management for GCA?

Answer 26

High dose prednsiolone (60mg) USS if low or high NPV/PPV Temporal artery biopsy if USS indeterminate or moderate PV Ophthal review if visual symptoms

Question 27

For which rheumatological condition is ANA most specific?

Answer 27

SLE

Question 28

Which ENA is more specific for renal and neurological lupus?

Answer 28

Anti-Sm

Question 29

Which form of lupus is anti-Ro(60) more specific for?

Answer 29

Subacute cutaneous lupus erythematosus

Question 30

What is the most common cause of drug-induced systemic lupus?

Answer 30

Anti-TNF therapies

Question 31

What is the most common cause of drug-induced cutaneous lupus?

Answer 31

PPIs

Question 32

What is the hierarchy of treatment for cutaneous lupus?

Answer 32

Topical steroids HCQ Quinacrine Dapsone MTX or MMF Lenalidomide

Question 33

What antibodies constitute anti-synthetase syndrome?

Answer 33

Jo-1, SL-7, SL-12, OJ, EJ

Question 34

What is the most common cause of death in the anti-synthetase cohort?

Answer 34

Pulmonary fibrosis

Question 35

What antibodies are associated with dermatomyositis?

Answer 35

Mi2, TIF-1y, MDA-5, MJ

Question 36

Which pattern of immune-mediates inflammatory myositis has a higher association with cancer?

Answer 36

Dermatomyositis

Question 37

Which cancers are associated with IMIM?

Answer 37

Adenocarcinomas (oesophagus, pancreas, stomach, cervix, lung, ovarian, bladder)

Question 38

What HLA subtype is associated with spondyloarthritis?

Answer 38

HLA-B27