Rheumatology

Question 1

Difference in ointment involvement between OA and RA

Answer 1

RA affects almost every joint but often spares tyebDIPs

OA spares the MTC and ankles, wrist, shoulders and elbows

Question 2

Derfomities in RA (5)

Answer 2

Botunners
Swan neck
Ulna deviation
Hitchhiker thumb
Flat feet

Scleromalacia

Question 4

Which arthritis gives you mutilans

Answer 4

Psoriatic

Question 5

Which deformity do you find in OA

Answer 5

Bouchards nodes (PIPs)
Heberdens nodes (DIPs)
Squaring at base of thumb
Zig zag base of thumb

Knees
Varus and valgus
Knock eyes or bow legs

Question 6

Deformity in SLE

Answer 6

Jaccoud arthropathy

Question 7

Which investigations do you do for poly arthritis presentation

Answer 7

Imaging:Xray
Bloods: RF, CCP, Uric acid, HIV, ANA

Question 8

Differentials for LBP

Answer 8

Mechanical
Malignancy
Osteoporotic fracture
Inflammatory back problems
Infection (TB etc)
Widespread pain syndrome

Question 9

Red flags for LBP

Question 10

Investigations for LBP

Answer 10

Bloods: FBC, ESR, CRP. If suspecting ca do Ca, Alk phos
Urinalysis
Imaging (rule out tumour, infection, trauma, instability, spondyloarthropathy)

Question 11

Management of LBP

Answer 11

Paracetamol and Tramadol
Antidepressants
Ice, heat
Physiotherapy
RF control (LOW, posture)

Most resolve in 6weeks-3months

Question 12

How long is acute and how long is chronic joint pain

Answer 12

<6weeks -Acute
>6weeks- Chronic

Question 13

How to take history in a patient with joint pain

Answer 13

Acute or Chronic
Distribution (peripheral or axial/large or small joints/ symmetry/how many joints)
Symptoms: inflammatory or mechanical (on activity /EMS/Constitutional sx)
Extraarticular features (skin, mucous membrane,eyes)

Question 15

Rash seen in Reactive Arthritis

Answer 15

Keratoderma blennorrhagica

Question 16

Pustula rash indicates to which cause of arthritis

Answer 16

Disseminated gonoccocal infection

Question 17

Which rash is seen in SLE

Answer 17

Discoid rash
Butterfly malar rash
Rash that spears knuckles (dermatomyositis affects mostly the knuckles)
Non scarring alopecia

Rash in SLE heals with scarring

Question 18

Skin thickening rheumatological condition

Answer 18

Systemic sclerosis

Question 19

Which ta

Question 21

Salt and pepper rash is seen in which rheumatological condition

Answer 21

Systemic sclerosis
The skin basically thickens

Question 22

Melaninonichia points wich condition

Answer 22

SLE and HIV

Question 23

What is capillaroscopy

Answer 23

Test for Connective tissue disease

Question 24

Joint examination

Answer 24

Look, feel, move

Look: Attitude, Skin changes, Wasting, deformity and swelling

Feel: tenderness (op along joint line), swelling (bony or boggy), temp, detect effusion, crepitus

Move: start with active then passive then resistant (assess limitation from pain)

Question 25

What is the pattern of limitation of movement on joint problems

Answer 25

External rotation Abduction Internal roast action For arthritis

Question 26

Capsular vs non capsular pattern of limitation

Answer 26

Capsular: has aarthritis, External rotation affected first then Abdution then IR Non capsular: pain not on joints

Question 27

Two things that confirm that there is arthritis

Answer 27

Swelling in the joint Capsular pattern of restriction of movement

Question 28

How to diagnose a periartivular lesion

Answer 28

Resisted active movement (pt pushes against examiners hand to contract muscle eg lateral epicondylitis Stress test ( reproducing out when passively stretching a strained tendon or ligament eg DeQuervans tenosynovitis

Question 29

Differences between articulate and periarticular