rheumatology

Question 1

Scoring system for RA

Answer 1

DAS-28

Question 2

Test for herniated disc

Answer 2

Straight leg raise ie it is + if there is back pain

Question 3

X-ray finding for osteoarthritis

Answer 3

loss of joint space, osteophytes, sub-articular sclerosis, subchondral cysts

Question 4

What does CREST stand for

Answer 4

calcinosis
Raynauds
oEsophageal dysmotility
Sclerodactyly
Telangiectasia

Question 5

Most common causative organism for septic arthritis

Answer 5

Staph aureus

(Strep is the next)

E.coli in drug users

Question 6

Difference between gout and pseudo-gout

Answer 6

Gout = negatively birefringent crystals, needle shaped

Pseudo = positively birefringent and envelope shape

Question 7

What seronegative spondylarthropathy is more associated with enthesitis

Answer 7

AS

Especially at the Achilles tendon
*enthesitis = inflammation of tendons, ligaments or joint capsules

Question 8

Most specific antibody test for SLE

Answer 8

ANA (anti-nuclear antibody)

RF as well but not as specific

Question 9

Scl-70 associated disease

Answer 9

CREST - systemic sclerosis

Question 10

Treatment for acute flare up of gout if NSAIDs is not tolerated

Answer 10

colchicine 500mg BD or QDS

Question 11

What is Behcets

Answer 11

A rare multi-organ disease caused by systemic vasculitis - idiopathic

Affects demographics = Turkey , Mediterranean and Japan

Question 12

Features of Behcets

Answer 12

ulceration - oral and genital
Uveitis
Erythema nodosum

HLA B51 associated

Question 13

Mode of action : sulfasalazine

Answer 13

It is a prodrug of 5-ASA which works through decreasing neutrophil chemotaxis alongside suppressing proliferation of lymphocytes and pro-inflammatory cytokines

Question 14

Mode of action : methotrexate

Answer 14

An anti-metabolite that inhibits dihydrofolate reductase
- an enzyme essential for the synthesis of purines and pyrimidines

Question 15

Adverse effects of methotrexate

Answer 15

Mucositis
Myelosuppression
Pneumonitis
Pulmonary fibrosis
Liver fibrosis

= always give methotrexate with folinic acid

Question 16

What needs to be monitored for a patient on methotrexate

Answer 16

FBC and LFTs

Question 17

Treatment for SLE nephritis

Answer 17

Prednisolone + Cyclophosphamide

Question 18

Which part of the spine can rheumatoid arthritis affect

Answer 18

Cervical spine (lumbar and thoracic are usually spared) ie subluxation of the Atlanto-axial joint

Question 19

Most common causative organism for urethritis

Answer 19

Chlamydia trachomatis

Question 20

How to differentiate between eGPA and GPA

Answer 20

GPA = c-ANCA
eGPA = p-ANCA

Question 21

Management of mono or oligo-articular disease (pseudo-gout)

Answer 21

(*accessible to injection)

Intra-articular injection of steroids

Question 22

Antibodies and associated conditions

Answer 22

Question 23

Interpretation of OA x-ray

Answer 23

Question 24

Is RA seropositive or seronegative

Answer 24

Seropositive

Question 25

Cut off values for DAS-28

Answer 25

Question 26

What are the seronegative inflammatory arthropathies

Answer 26

-AS -psoriatic arthritis -enteropathic -reactive

Question 27

Seronegative arthropathy associated with IBDs

Answer 27

Enteropathic arthritis

Question 28

What is Reiters

Answer 28

Triad = urethritis, uveitis, conjunctivitis

Question 29

What complement levels are low in SLE

Answer 29

C3 + C4

Question 30

Management of skin disease and arthralgia SLE

Answer 30

Hydroxychloroquine Topical steroids NSAIDs Are commonly used

Question 31

Severe organ disease SLE treatment (eg lupus nephritis, CNS lupus)

Answer 31

IV steroids and cyclophosphamide

Question 32

What do you need to monitor in someone with SLE

Answer 32

Anti-dsDNA and complement levels Urinalysis - glomerulonephritis CV risk - BP and cholesterol

Question 33

*parotid gland swelling

Answer 33

Sjogrens

Question 34

What is Sjogrens

Answer 34

Autoimmune condition characterised by lymphocytic infiltrates in exocrine organs —> causing dryness of eyes and mouth (sicca)

Question 35

What’s going on here

Answer 35

Schirmers - Sjogrens

Question 36

What criteria is used to diagnose Sjogrens

Answer 36

American-European consensus group classification Need 4/6 for a diagnosis

Question 37

Diffuse systemic sclerosis associated Antibody

Answer 37

Anti-scl70

Question 38

Limited systemic sclerosis antibody

Answer 38

Anti-centromere

Question 39

Management of raynauds

Answer 39

CCBs Iloprost Bosentan

Question 40

*anti-RNP antibodies

Answer 40

= mixed connective tissue disease

Question 41

What is uric acid

Answer 41

The final compound in the breakdown of purines in DNA metabolism

Question 42

Definitive investigation for gout

Answer 42

Sampling synovial fluid with polarised microscopy

Question 43

Chondrocalcinosis refers to what

Answer 43

When calcium pyrophosphate deposition occurs in cartilage = pseudogout

Question 44

What is seen

Answer 44

Chondrocalcinosis at the knee

Question 45

If serum creatinine kinase are crazily high what two conditions are you considering ?

Answer 45

Rhabdomyolysis Polymyositis

Question 46

What immune cells are significant in polymyositis

Answer 46

CD8+

Question 47

Heberdens nodes associated with what disease

Answer 47

Osteoarthritis

Question 48

A 32 year old man is diagnosed with a pulmonary embolus with no clinical risk factors, anti-cardiolipin antibodies are raised What is the most appropriate management

Answer 48

= life long warfarin A thrombotic event in a patient with antiphospholipid syndrome is an indication for life-long anti coagulation

Question 49

Classic radiological findings on RA

Answer 49

Periarticular erosions Loss of joint space

Question 50

T/F large vessel vasculitides are generally ANCA negatives

Answer 50

T - small vessel are more typically ANCA positive (GPA , eGPA)

Question 51

How is fibromyalgia diagnosed ?

Answer 51

Clinical picture only