Rheumatology Flashcards
(307 cards)
1
Q
Azathioprine MOA :
A
Inhibits Purine Synthesis
2
Q
Is Azathioprine safe in pregnancy ?
A
Yes
3
Q
K/C/O Sarcoidosis—low TPMT—Started on Immunsupressant drug—pancytopenia + Fatigue + SOB.Dx?
A
Pancytopenia D/t Azathioprine and low TPMT
4
Q
Which of the following factors will predispose her to azathioprine toxicity
A
thiopurine methyltransferase deficiency
5
Q
Muscles involved in Dequervian Tenosynovitis ?
A
Abductor Pollicis Longus (APL)
Extensor Pollicis Brevis (EPB)
Aah Eeeh, oh Pain !
6
Q
Arterial/venous thrombosis, miscarriage, livedo reticulari
A
APLA
7
Q
Diagnosis of APLA
A
Positive anti-cardiolipin antibodies on two occasions at least 12 weeks apart
Positive anti-β2GP1 antibodies on ≥2 occasions at least 12 weeks apart
Positive for Lupus Anticoagulant on ≥2 occasions at least 12 weeks apart
8
Q
Mcardles is caused by which deficiency ?
A
myophosphorylase deficiency,
9
Q
Severe Muscele cramp and dark coloured urine following exercise + Increse in creatine Kinase
A
Mcardle’s Syndrome
10
Q
Mcardle’s Syndrome
A
Severe Muscele cramp and dark coloured urine following exercise + Increse in creatine Kinase + myophosphorylase deficiency.
11
Q
Patient on Steroids + presents with progressive hip pain, particularly with weight-bearing activities + limited range of motion in the left hip. Dx and Ix of choice :
A
Avascular Necrosis of Hip.
Ix—MRI Hip
12
Q
Primary Raynauds is seen in :
A
< 40 years of age and B/L symptoms
13
Q
CXR findings of Ankylosing Spondylitis :
A
Subchondral Erosions, Sclerosis
Syndesmophytes—most commonly seen
14
Q
Earliest clinical sign of Ankylosing spondylitis :
A
Reduced Lateral Flexion Lumbar spine—
15
Q
Diagnostic test for Ankylosing spondylitis :
A
X ray Pelvis—Sacro ilitis
16
Q
What is the most common cardiac defect seen in Marfan’s syndrome:
A
Dilation of Aortic sinuses
17
Q
Osteoarthritis First lie :
A
PPI with NSAIDs
18
Q
What organism is most likely to be present in the Aspirate Fluid of Reactive Arthritis ?
A
No Organism
19
Q
Pseudoxanthoma elasticum is associated with Which cardiac abnormality ?
A
Mitral Valve Prolapse
20
Q
Gymnast or tennis player + Pain on lateral forearm on extension + paraesthesia + tenderness distal to common extensor origin
A
Radial Tunnel Syndrome
21
Q
tingling/numbness of the 4th and 5th finger( Medial fingers ) + Froment’s test positive
A
Cubital Tunnel Syndrome
22
Q
Forment’s test?
A
Checks the addiction of thumb—Adductor policis brevis—which is weak in ulnar nerve problem
Pinch paper between thumb and fingers
23
Q
which nerve is involved in cubital tunnel syndrome ?
A
Ulnar nerve
24
Q
Cubital tunnel syndrome:
A
tingling/numbness of the 4th and 5th finger( Medial fingers ) + Froment’s test positive
25
Radial Tunnel Syndrome
Gymnast or tennis player + Pain on lateral forearm on extension + paraesthesia + tenderness distal to common extensor origin
26
Rickets can present as widening of the wrist joints due to an
excess of non-mineralized osteoid at the growth plate
27
Most commonly seen X ray finding of Ankylosing Spondylitis :
Syndesmophytes— Syndesmophytes (ossification of outer fibres of annulus fibrosus) are a feature of ankylosing spondylitis
28
The most commonly involved joints in the hand of patients with osteoarthritis are the:
carpometacarpal joints and the distal interphalangeal joints.
29
Osteopetrosis all the blood, calcium and PTH value s?
All are normal
30
Joint pain + difficult in hearing + carpal tunnel + Family History
Osteopetrosis
31
DEXA scans: the T score is based on:
bone mass of young reference population
32
Which Collagen defect in Ehler Danlos ?
Type 3
Ehler Danlos—3hler Danlos
33
Which Collagen defect in Osteogenis Imperfecta ?
Type 1
Osteogenesis 1mperfecta
34
Collagen defect in Good pasture ?
Type 4
Good 4sture
35
Collagen defect in Alport ?
4
Al4rt
36
ears (auricular chondritis, vertigo, hearing loss)+the nose (saddle nose deformity)+ the respiratory tract (wheezing, inspiratory stridor, voice changes)+ the eyes (episcleritis, scleritis, iritis,) and the joints (arthralgia).
Relapsing Polychondritis
Main point—Involvement of ears and nose
37
Is Rheumatoid factor present in Still’s Disease ?
No
38
Still’s Disease :
Salmon coloured Rash + Fever + Athralgia + O/e : HIgh temp,Lymphadenopathy, serum ferittin high
Lack of ANA and RA.
39
Salmon coloured Rash + Fever + Athralgia + O/e : HIgh temp,Lymphadenopathy, serum ferittin high
Lack of ANA and RA.
Still’s disease
40
What is raised in still’s disease ?
Serum ferittin
41
Patients with Sjogren's syndrome have an increased risk of which malignancies ?
Lymphoid Malignancies such as Non Hodkin’s Lymphoma
42
Discoid lupus erythematous —topical steroids not working , next step ?
Oral Hydroxychloroquine
43
Risk factor for Pseudogout :
Haemochromatosis—Raised Transferrin Saturation
Hemp-gout
44
What is first raised in Haemochromatosis ?
Transferrin saturation
45
Reactive Arthritis Rx?
NSAIDs
46
H/O Diarrhoea + A 39-year-old man is referred to orthopaedics with a 24-hour history of knee pain. He undergoes aspiration — shows no organisms or .
chemosis +dysuria
Reactive Arthritis
Rx—NSAIDs
47
Butterfly shaped Rash sparing Nasolabial fold+ Tenderness over small joints+ Recurrent Miscarriages with Previous VTE. Dx?
SLE with Secondary APLA Syndrome
48
Complement level in SLE :
Low or Normal
49
Z score > -2.5 + Loss of Libido + Absence of Morning Erection. Which test to be done next ?
Osteoporosis in Man + Loss of libido—Low Testosterone
50
mycophenolate mofetil.
Inhibits Inosine-5-Monophosphate dehydrogenase inhibitor
51
Creatine Kinase in Polymyalgia Rheumatica ?
Normal.
52
Anorexia in Polymyalgia Rheumatica ?
Present
53
High or low phosphate level in PseudoGout ?
Low Phosphate level—predisposes to pseudogout
High PTH—recognised cause
High PTH—leads to —Low phosphate and low magnesium
And high calcium
54
Pseudogout causes :
Haemochromatosis—Hemo Gout
Acromegaly
Hyperparathyroidism—leads to—
High calcium, Low Phosphate , Low Magnesium
55
Pseudogout common location:
Knee
56
Which crystals and substance is found in Pseudogout ?
Calcium Pyrophosphate Dihydrate in synovium
Positively Birifringement rhomboid shaped crystals
57
X ray finding in pseudogout:
Chondrocalcinosis
58
Skin feature in Discoid Lupus
Characterised by follicular keratin plugs.
59
What kind of Alopecia occurs in Discoid Lupus ?
Scarring Alopecia
60
does Discoid Lupus lead to SLE ?
No
61
Age group affected in Discoid :
Young— 20-30 year
62
What is the minimum steroid intake a patient should be taking before they are offered osteoporosis prophylaxis?
Equivalent of prednisolone 7.5 mg or more each day for 3 months
63
Passive abduction of shoulder is painful between 60 and 120 degrees.
Supraspinatus Tendonitis
Adhesive Capsulitis:
Characterised by global reduction of all the movements.Escp external rotation
64
Is Obesity a Risk factor for osteoporosis ?
No
Adipose tissue—androgens converts into oestrogen—helps in maintaining bone density
65
Is nephritis a feature of Drug induced Lupus ?
No
66
Drug Induced Lupus clinical Features and Mnemonic ?
SLAM
Skin—Malar Rash
Lungs—Pleurisy
Arthralgia
Myalgia
67
Most Common drug cause of Drug induced Lupus ?
Isoniazid
68
Works on a construction site + history of painful hands. He advises you that when exposed to cold his fingers become white and numb,
Raynaud’s disease due to vibrating tools
69
Progressive SOB + Bibasal Crepts + thickening of proximal arm
ILD Fatures + proximal arm thickening— Diffuse cutaneous systemic scleroderma
70
Antibodies positive in Diffuse Scleroderma ?
Anti SCL Antibodies
71
Lung complication in diffuse systemic Scleroderma ?
ILD
72
Lung complication in limited scleroderma ?
Pulmonary Hypertension
73
Antibodies in Limited Scleroderma?
Anti Centromere antibodies
CREST=C=Centromere
74
A 32-year-old man presents to the endocrine clinic following a traumatic left-sided hip fracture.
A DEXA scan is performed: Osteoporosis confirmed
What scoring system would be most helpful to determine if the patient has a secondary cause of the underlying condition?
Z score
75
When to offer allopurinol in gout patients?
Offer allopurinol after the first attack of gout ahas resolved
76
External rotation (on both active and passive movement) is Impaired + Flexion + Abduction + Adduction is also impaired. Dx?
Adhesive Capsulitis
Characterised by global reduction of all the movements.
77
K/C/O Breast Cancer + Violaceous papules on proximal and DIP + rash around eyelids + tired and lethargic :
Dermatomyositis
Myopathy-fatigue and weakness
rash —Helicotrope rash and grotton’s papules
It’s very commonly associated with Malignancies
78
Most likely antibody to be positive in Dermatomyositis ?
ANA
79
Most specific in dermatomyositis :
Anti MI 2 antibodies
80
Derma manifestations in dermatomyositis :
helicptrope rash around eyes
Macular rash around shoulder back and chest
Grottoes papules—in Pip and DIP
Mechanic hand
81
Newly diagnosed of Dermatomyositis , next step ?
Urgent Malignancy screen
82
Most common cause of death in systemic sclerosis ?
Respiratory involvement
83
DIP joint + improves with rest, worsens by activity
Hand osteoarthritis
84
Golimumab MOA:
TNF inhibitor
GOLD(Golimumab ) painting of Dali (Dalimubab) caught fire—and its put down by TIN (TNF ) fire extinguisher (inhibitor )
85
Old woman rarely leaves home—c/o: Bone pain, tenderness and proximal myopathy . Dx?
Osteomalacia
Osteoporosis does not cause such symptoms
86
Which clinical test in de quervian ?
Finkelstein test
87
marker of poor prognosis in rheumatoid arthritis
Anti CCP antibodies
88
isolated lateral hip/thigh pain with tenderness over the greater trochanter+ pain is worse when she rolls onto that side during the night
Trochanteric Bursitis
89
PTT and Platelets in APLA :
Raised PTT and Low Platlets in APLA
90
Most specific for SLE ?
Anti Sm
SMecific antibody in SLE
91
Bone pain + Low calcium + Low Phosphate + Raised ALP Dx?
Osteomalacia
It is Malacious and reduces calcium and phosphate
92
Is Aclasia associated with Ankylosing ?
No
No GI stuff in Ankylosing
93
Ankylosing Spondylitis association
Eye to Foot , except GI :
Amyloidosis
Anterior Uveitis
Heart :AV node Bock
Aortic Regurgitation
Lungs : Apical Fibrosis
Foot : Achilies Tendonitis
94
Bisphosphonates are associated with an increased risk:
Atypical stress fractures
95
Marfan’s + headaches, leg pain and intermittent episodes of urinary incontinence. What is the most likely diagnosis?
Dural Ectasia
96
Which drug to be avoided along with Methotrexate ?
Trimethoprim.
The concurrent use of methotrexate and trimethoprim containing antibiotics may cause bone marrow suppression and severe or fatal pancytopaenia
97
H/o Chemotherapy + Limited range of motion of hip in all directions
Avascular Necrosis of hip
Chemotherapy—A known Risk Factor
98
Rheumatoid Factor is Ig__?
IgM antibody against IgG
99
Burning thigh pain. Dx and Nerve involved ?
meralgia paraesthetica - lateral cutaneous nerve of thigh compression
100
Blood test to confirm Osteomalacia diagnosis ?
Vitamin D
101
he has developed a raised, erythematous rash in patches over her scalp. She describes worsening of the lesions if she forgets to wear a sunhat. On examination, there are patches of alopecia where some lesions have healed
Discoid Lupus
102
history of recurrent joint dislocations and easy bruising.
On examination, her skin appears highly elastic and fragile, and you detect a mid-systolic click upon auscultation.
Ehler Danlos
103
Reoccurring episodes of abdominal pain, fever, arthralgia, and chest pain. Improved after colchicine
Familial Mediterranean Fever
104
Familial Mediterranean Fever
Reoccurring episodes of abdominal pain, fever, arthralgia, and chest pain. Improved after colchicine
105
Familial Mediterranean Fever Rx?
Colchicine
106
Rx of choice for SLE :
Hydroxychloroquine
107
gradual onset leg and back pain, weakness and numbness which is brought on by walking + Relieved by bending forward
Spinal Stenosis
108
Is sulfasalazine safe in pregnancy and breast feeding ?
Yes
109
External rotation (on both active and passive movement) is classically impaired in
Adhesive capsulitis
110
Difficulty in unhooking bra
Difficulty in external rotation—Adhesive capsulitis
111
Worst prognosis in rheumatoid arthritis
Anti CCP Antibodies
112
If patient is allergic to sulfasalazine , which drug should be avoided ?
Aspirin is avoided
113
What is the greatest predictor of future thrombosis in patients with anti-phospholipid syndrome?
Lupus Anticoagulant
114
pain and stiffness in her hands—DIP and PIP. Her symptoms are worse in the morning and seem to improve throughout the day.
Psoriatic Arthritis
115
Familial Mediterranean Fever mode of inheritance ?
Autosomal Recessive
Mediterranean Sea is a smaller sea—hence its recessive
116
GIT related side effect in limited Sclerosis ?
Dysphagia
Malabsorption—due to bacterial overgrowth in sclerosed intestine
117
does malabsorption develop in Limited sclerosis ?
Yes due to bacterial overgrowth
118
does constrictive pericarditis develop in limited sclerosis ?
No , Pulmonary hypertension develops
119
Tamoxifen and Breast cancer :
It decreases the chance of breast cancer.
Villain has stomped over pink ribbon
120
> 7.5 MG Steroids each day for 3 months. Next step ?
Calcium + vitamin D + Oral Bisphosphonates
121
Anti Jo antibodies is positive in ?
Polymyositis
Jo-po
Jollymyositis
122
which antibody is positive in Polymyositis ?
Anti Jo antibodies
123
Marfan’s pathology :
A defect in glycoprotein structure that wraps around elastin
124
Anti synthetase syndrome is related to :
Dermatomyositis
125
Recurrent oral ulcers+genital ulcers+ painful red eyes. Dx and HLA ?
Behçet’s disease
HLA 51 ( Area 51)
Behcets= 6 letters—5+1=6
126
Behçet’s disease HLA ?
HLA51
127
DVT + non-blanching reticulated rash throughout both lower limbs.
APLA
128
celecoxib Is :
NSAID
129
Osteopenia T score ?
between -1 and -2.5
130
X ray of Ankylosing spondylitis
Sacro ilitis
131
Dx test of Ankylosing spondylitis
Sacro ilitis on X ray hip
132
Which GIT condition is Polyarteritis nodosa associated with ?
Hepatitis b
133
renal failure + Hematuria+ Mononeuritis multiplex + H/o Hepatitis B . Dx?
Polyarteritis Nodosa
Granulomatosis with polyangiitis classically involves renal impairment, as well as other disease features such as nasal congestion and epistaxis, rather than peripheral neuropathy.
Eosinophilic granulomatosis with polyangiitis is an ANCA-positive vasculitis which classically manifests with renal impairment and respiratory symptoms. For exam purposes, these patients often present with presumed asthma, which is difficult to control, with sensitivity to the prescription of leukotriene receptor antagonists. Blood eosinophilia is also observed.
134
Collagen defect in osteogenesis imperfect:
Collagen type 1
135
Which neurological symptoms positive in PAN ?
Mononeuritis Multiplex
136
First line Rx for Osteoarthritis:
Topical NSAIDs
137
SLE - antibodies associated with congenital heart block:
Anti Ro
Roadblock=heartblock
138
X ray finding of rickets :
widening of the joint
139
Bone within bone appearance is seen in :
Osteopetrosis
140
Normal calcium, Normal phosphate, Normal ALP , Normal PTH + recurrent fracture. Bone within Bone appearance. Dx?
Osteopetrosis
Paget’s will have raised PTH levels
141
K/C/O RA—Hot painful tender swollen Joint. Next appropriate step ?
Suspected septic arthritis—Most appropriate step—Joint aspiration
142
In SLE which Complement level is low ?
C3 and c4
143
Which factor is involved in Rheumatoid arthritis ?
TNF.
144
Septic arthritis Rx:
IV Flucloxacillin
145
First line Rx in Ankylosing spondylitis ?
Exercise + NSAIDs
146
The major target for pANCA is:
myeloperoxidase
147
Osteomyelitis Ix of choice:
MRI
148
After nifedipine which Rx is used in Raynauds ?
IV prostacyclin
149
Leflunomide Side effect :
Hypertension
150
Dorsum of the foot—which nerve root ?
L5
151
Birbeck granules seen in :
Langerhans cell histiocytosis
152
Tennis racket granules are seen in :
Langerhans cell histiocytosis
153
Bone pain + cutaneous nodules + recurrent otitis media + Birbeck granules
Langerhans cell histiocytosis
154
Langerhans cell histiocytosis
Bone pain + cutaneous nodules + recurrent otitis media + Birbeck granules
155
Osteonecrosis of the jaw—caused by Oral or IV Bisphosphonates?
Caused by IV Bisphosphonates
156
Temporal arteritis with eye involvement Rx:
IV methylprednisolone
157
Photosensitive rash + small joint arthritis + Raynauds. Dx?
SLE
158
which joint involvement in SLE ?
Small joints
159
Which antibody is most likely to be positive in SLE ?
ANA
Anti-nuclear (ANA) antibody is the most likely antibody to be present. Approximately 95% of people with SLE have a positive ANA, however it is not very specific.
Anti-Sm are the most specific antibodies for SLE, but only around 35% of patients with SLE will be positive. Anti-dsDNA antibodies are positive in around 70% of SLE cases.
160
Sjgorens patient—which meds for dry mouth ?
Pilocarpine
161
Dry eyes + Dry Mouth + Arthralgia + Anti ro + anti LA + Schrimmer’s test positive. Dx:
Sjogren
162
Sjogren
Dry eyes + Dry Mouth + Arthralgia + Anti ro + anti LA + Schrimmer’s test positive. Dx:
163
Which eminence is involved in Median nerve ?
Thenar eminence
164
Which muscles are supplied by Median nerve ?
LOAF
Lumbricles
Opponens policies
Abductor policies brevis
Flexor policies brevis
165
Which thumb action is affected in carpal tunnel ?
Thumb abduction
166
Which clinical signs are seen in Carpal Tunnel ?
Tinel’s sign—tingling sensation on tapping
Phalen’s test—Phlexion test—symptoms come up after flexion of wrist
167
Which ocular complications is associated with Temporal Arteritis ?
AION
Anterior Ischaemic optic neuropathy
168
Looser’s zone is associated with which ortho condition ?
Osteomalacia
169
Which one of the following cells secretes the majority of tumour necrosis factor in humans?
Macrophages
170
Age group of SLE patients ?
20-40 years
171
Anti-dsDNA titres In SLE :
Useful marker to monitor the disease activity
172
Physical or mental exertion usually makes the symptoms___ in chronic fatigue syndrome
Worse
173
patients aged 75 and over with a history of fragility fractures should be
Start treatment with Oral Bisphosphonates before DEXA
174
If alendronate is not tolerated,
Switch to risedronate
175
Which foods precipitate attack of gout ?
Liver, kidneys, seafood, oily fish (mackerel, sardines) and yeast products
176
Reactive arthritis + Yellow stuff on foot ?
keratoderma blennorrhagicum
177
H/O travel—Weeks later C/o: Knee pain + yellow stuff on foot
Reactive arthritis
Gonococcal arthritis can present similarly but typically occurs during active infection rather than weeks later
178
Does lithium precipitate Gout ?
No
179
Which ANCA in PAN ?
P ANCA
180
Which thyroid issue predisposes to Osteoporosis ?
Hyperthyroidism
181
Does hypothyroidism cause osteoporosis ?
No
182
what does not cause osteoporosis ?
Obesity and hypothyroidism
183
Which congenital disorder predisposes maximum risk for osteoporosis ?
Osteogenesis Imperfecta
184
Which gender is affected more in psoriatic arthropathy ?
male and Female are equally affected
185
Neurological Manifest in Sjogren’s ?
Sensory Polyneurpathy
186
Kindney manifestation in Sjogren ?
Renal tubular Acidosis
187
Does dilated cardiomyopathy occur in Sjogren ?
No
188
Methotrexate MOA :
Reversible Inhibition of dihydrofolate reductase
189
Second wind Phenomenon is seen in :
Mcardle’s
190
Double contour sign is seen in ?
Gout
191
RANK L inhibitor :
Denosumab
192
After Anti Mi 2 , which antibody is specific to dermatomyositis ?
Anti Jo
193
Which defect in Marfan’s ?
Fibril 1
194
Initial therapy for Rheumatoid Arthritis :
DMARD + Short Course of prednisolone
195
Which nerve root in postero-lateral aspect of his right lower leg and foot?
S1
196
Bisphosphonates MOA :
Inhibits Osteoclasts
197
Dactylitis + DIP joint involvement
Psoriatic arthropathy
197
— helps to distinguish pseudogout from gout
Chondrocalcinosis
The correct answer is chondrocalcinosis. This can be seen as linear calcifications of the meniscus and articular cartilage on an x-ray of the knee. This is seen in pseudogout, but not particularly associated with gout, and so it can be used to distinguish between the two.
198
lateral epicondylitis: worse on resisted _____/suppination whilst elbow extended
Wrist extension
199
A diagnosis of mixed connective tissue disease (MCTD) is suspected
Anti RNP(Ribonuclaer protein)
200
diagnosis of lateral epicondylitis is suspected. Which one of the following movements would characteristically worsen the pain?
: worse on resisted wrist extension/suppination whilst elbow extended
201
Most common organism in septic arthritis :
Staph Aureus
202
Most common side effects with alendronate :
Heart Burn
203
Lens dislocation in Marfan’s :
Upward dislocation of lens
204
Is “ Swelling immediately after the injury and now.“ indication for Ottawa X ray ?
No
205
Ottawa rules for X ray ankle ?
bony tenderness at the lateral malleolar zone (from the tip of the lateral malleolus to include the lower 6 cm of posterior border of the fibular)
bony tenderness at the medial malleolar zone (from the tip of the medial malleolus to the lower 6 cm of the posterior border of the tibia)
206
In Marfan’s , What is the most important investigation to monitor their condition?
Echocadiography—to monitor aortic dissection
207
ulnar deviation reproducing the pain Is seen in :
Dequervian
Finkelstein test
208
Eye symptoms in Behcets:
Anterior Uveitis
Not conjuctivitis
209
Behcets triad :
Genital ulcers/Oral ulcers + Anterior uveitis
210
apart from triad what other symptoms are seen in Behcets ?
Athralgia
DVT
Aseptic Meningitis
GI
Erythema Nodosum
211
IV alendronate Side effects :
Osteopetrosis of jaw.
212
Bull’s Eye Maculopathy is seen in :
Hydroxychhloroquine
213
ON Hydroxychloroquine, which test to monitor ?
Eye and fundoscopy
214
In Ankylosing Spondylitis , TNF-inhibitors will improve all of the following except:
Radiological progression
215
Fever/back pain with pain on extension of the hip:
Iliopsoas abscess
216
Which diuretics can precipitate gout ?
Thiazide diuretics—Indapamide
217
Which antibiotic to avoid with Methotrexate ?
Co-trimoxazole
Methotrexate acts by inhibiting dihydrofolate reductase which thereby inhibits the synthesis of purines which, in turn, arrests cell division.
Co-trimoxazole contains sulfamethoxazole and trimethoprim. Both of these antibiotics exert their therapeutic effect through inhibition of folate metabolism. Therefore there is a greater risk of pancytopenia.
218
apremilast MOA :
phosphodiesterase type-4 (PDE4) inhibitor
219
Patient with Vitamin D deficiency :
load with vitamin D and then continue on maintenance.
220
Worst prognosis in Polymyositis :
Interstitial Lung disease
221
A 76-year-old female presents with a 1 month history of left sided temporal headaches and jaw claudication. Biopsy of left temporal artery is negative. Next step ?
Commence Prednisolone
222
HLA associated with Reactive arthritis ?
HLA B27
223
Birth Given—2 weeks later—Arhtralgia + Skin Rash + Fever.
SLE
224
Raynauds is most commonly associated with which condition ?
Systemic Sclerosis
225
A 59-year-old man with a history of gout presents with a swollen and painful first metatarsophalangeal joint. He currently takes allopurinol 400mg od as gout prophylaxis. What should happen to his allopurinol therapy?
Continue allopurinol in current dose.
Allopurinol is a xanthine oxidase inhibitor that reduces the production of uric acid, and it is used as a long-term management strategy for gout. According to the UK guidelines, during an acute attack of gout, existing urate-lowering therapy (like allopurinol) should not be discontinued or altered in dosage. This is because changes in serum urate levels can precipitate acute attacks. Therefore, continuing allopurinol at its current dose would be the most appropriate course of action.
226
Elderly on Warfarin—C/o Gout Attack. Rx?
Colchicine
NSAIDs should be avoided in elderly patients taking warfarin due to the risk of a life-threatening gastrointestinal haemorrhage.
227
CKD + Gout attack Rx?
Colchicine
Avoid NSAID in CKD patient
228
Approximately what percentage of patients with psoriasis develop an associated arthropathy?
10-20%
229
CRP in SLE
Normal
230
Relieving factors in carpal tunnel syndrome ?
Shaking of hands improve symptoms
231
When does carpal tunnel syndrome pain get worse ?
It gets worse at night
232
Mode of inheritance in Marfan’s ?
Autosomal Dominant
233
Hydroxychloroquine in pregnancy ?
It’s considered safe in pregnancy
234
Pain all over her body for the past 4 months + tender areas on her neck, elbow regions, and knees + feeling tired and not being able to sleep because of the pain +
Fibromyalgia
he pain did not appear to be originating from the joints and therefore this makes a diagnosis of rheumatoid arthritis unlikely. The two most likely diagnoses are fibromyalgia and polymyalgia rheumatica. However, polymyalgia rheumatica would have also presented with weight loss and fever. This patient most likely has fibromyalgia. She also feels tired and suffers from sleep disturbances, which are both common complaints in patients suffering from fibromyalgia.
235
Osteoporosis is due to defect in :
Osteoclast Function
236
Serum CK and Muscle Biopsy in Fibromyalgia ?
serum CK and muscle biopsy are normal.
237
Eye symptoms in Behcets and Reactive arthritis :
Behcets—Anterior Uveitis
Reactive arthritis—Conjunctivitis
238
Does aseptic Meningits occur in reactive ?
No
Occurs in Behcets
239
Risk Factor for Carpal tunnel ?
Obesity
240
What is increased in Paget’s disease ?
Serum and urine Hydroxyproline
241
Cardiac features of Pseudoxanthoma Elasticum :-
Mitral Valve Prolapse
Ischaemic Heart disease—D/t damage to Blood vessels
242
GI Features of Pseudoxanthoma Elasticum:-
GI Haemorhage
243
Mode of inheritance in Pseudoxanthoma Elasticum :
Autosomal recessive
244
How to take alendronate ?
Take at least 30 minutes before breakfast with plenty of water + sit-upright for 30 minutes following.
245
After NSAID and Steroids, what’s the treatment for Still’s disease ?
Methotrexate / IL 1 antagonist-Anakinra / Anti TNF therapy-Etanercept
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1st X-ray sign of Rheumatoid arthritis ?
Juxta Articular Osteopenia/Osteoporosis
247
Temporal arteritis with No eye symptoms and eye symptoms :
No eye symptoms—High dose oral prednisolone
Eye symptoms—IV steroids
248
Olecranon Bursitis :
Painful swelling on the posterior aspect of his elbow. There is no history of trauma. On examination an erythematous tender swelling is noted. What is the most likely diagnosis?
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Painful swelling on the posterior aspect of his elbow. There is no history of trauma. On examination an erythematous tender swelling is noted. What is the most likely diagnosis?
Olecranon Bursitis
250
Mixed connective tissue disease Clinical features :
Raynauds + Dactylitis ( Both finger related symptoms ) + Arthritis/ Myalgai + Anti Ribonuclear protein Positive.
Dactylitis—Think MCTD or Psoriatic Arthritis
Psoriatic Arthritis—Dactylitis + DIP + Morning stiffness relieved by activity
MCTD—Raynauds + Dactylitis + Arhritis + Myalgia
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Raynauds + Dactylitis ( Both finger related symptoms ) + Arthritis/ Myalgai. Dx:
Mixed connective tissue disease
Anti ribonuclear protein positive
Dactylitis—Think MCTD or Psoriatic Arthritis
Psoriatic Arthritis—Dactylitis + DIP + Morning stiffness relieved by activity
MCTD—Raynauds + Dactylitis + Arhritis + Myalgia
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Patient has Rheumatoid arthritis + Which one of the following complications is most likely to occur as a result of her disease?
Ischaemic Heart disease
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A 72-year-old man presents with right knee pain, vomiting, and rigors that have persisted for one week and have not improved with oral co-amoxiclav. He has a past medical history including hypertension, type two diabetes and chronic kidney disease (CKD) stage 3.
His medication history includes ramipril, bendroflumethiazide, and dapagliflozin.
His temperature is 38.8ºC, and his blood pressure is 103/72 mmHg. Physical examination reveals a right knee effusion and reduced range of motion.
A joint aspirate shows purulent fluid and polymorphs but no identifiable organisms.
What treatment should be initiated?
Dx: Septic Arthritis—Onset is acute+fever+limited range of motions+ turbid synovial fluid —
Rx: IV Flucloxacillin
Not Gout—fever is not present in gout.
Reactive arthritis— Onset is subacute or insidious, typically occurring 1-4 weeks after a gastrointestinal or genitourinary infection.
Synovial fluid is typically non-purulent (clear or slightly cloudy).
Triad : Conjutivitis + Urhtritis + Arthritis
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What is the most likely underlying mechanism of Gout ?
Decreased renal excretion of uric acid
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Rx for Paget’s
Alendronate
256
Mnemonic for X ray findings of Rheumatoid Arhritis :
LOSERS
Loss of joint space
Osteopenia—1st sign
Soft tissue swelling
Periarticular Erosions—Very Specific Sign
Sublaxation
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In the LOSERS mnemonic for Rheumatoid Arthritis, which is a very specific sign ??
Per articular erosions.
LOSERS
Loss of joint space
Osteopenia—1st sign
Soft tissue swelling
Periarticular Erosions—Very Specific Sign
Sublaxation
258
Which two antibodies are positive in Drug Induced Lupus ?
ANA positive
Anti Histone positive
259
Which antibody differentiates drug induced Lupus from SLE ?
Anti Histone positive only in Drug induced.
260
K/C/O RA + Sudden onset pain + pain during middle portion of abduction + weakness when lifting or rotating objects.
Torn rotator cuff secondary to RA.
Adhesive capsulitis: Causes severe shoulder pain with a complete loss of movement rather than weakness.
Calcific tendinitis: Caused by calcium pyrophosphate deposits, which would be visible on X-ray.
Polymyalgia rheumatica: Typically bilateral, with morning stiffness lasting 30 minutes to hours, along with systemic symptoms (fever, weight loss, depression).
Rotator cuff tendinitis: Usually has an insidious onset rather than sudden pain.
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Torn rotator cuff secondary to RA :
K/C/O RA + Sudden onset pain + pain during middle portion of abduction + weakness when lifting or rotating objects.
262
Gold toxicity
Pancytopenia + Pulmonary Fibrosis.
263
Antibodies in primary Raynauds:
Antibodies are negative as there are no associated auto immune conditions.
264
Failure to relieve symptoms with 2 NSAIDS in Ankylosing spondylitis. Next line Rx:
Add Biological agents :
Adalimumab or Etanercept.
265
Most common site for Lytic and sclerotic changes in Pagets:
Lumbar spine.
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Characteristics of effusion of Rheumatoid arthritis :
Exudative
Acidic—inflammatory cells produce high lactic acid.
Low sugar—inflammatory cells and neutrophils consume glucose.
High LDH—cell lysis—due to chronic inflamation.
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HLA in Felty Syndrome :
HLA DRW 4.
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Obesity + sudden onset back pain radiating to ankles + sensory loss + Straight leg raise—Positive.
Lumbar Disc Prolapse.
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Most common pulmonary manifestation of SLE :
Pleural effusion.
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Pain and swelling of PIP + DIP + MCP + gull wing pattern
Erosive arthritis.
271
Most common GI complication in SLE :
Mouth ulcers.
271
X ray finding of Erosive Arthritis :
Gul wing pattern.
272
Which test is positive in lateral epicondylitis ?
Chair Raise test.
273
Vitamin D active form :
1,25 Dihydroxycholecalciferol
274
SERM increases risk of :
DVT and Clotting.
275
which Nephropathy is associated with Ankylosing spondylitis ?
IgA nephropathy.
276
TNF alpha leads to rise in :
Raised levels leads to increase in insulin resistance
277
Behcet’s Rx:
Colchicine.
278
Nail related disorder in psoriatic arthritis :
Nail dystrophy
279
What blood profile is raised in osteoporosis ?
Slight increase in ALP
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A 74-year-old man with a dual-chamber pacemaker inserted 5 days ago presents with fever, back pain, and restricted movement. He has spinal tenderness but no neurological deficits. Labs show: Raised inflammatory markers. Dx ?
staphylococcal discitis.
Recent surgery → High infection risk
✅ Back pain + fever + high ESR/CRP → Think discitis
Prolapsed Disc → No fever/inflammatory markers
❌ Epidural Abscess → No neurological signs
❌ Pyelonephritis → Negative urine dipstick
❌ Ischemic Colitis → No abdominal symptoms
282
GPA :
ENT + Nodules in Lungs + RPGN + C ANCA
283
E GPA :
Asthma + Eosinophilia + Mononeuritis Multiplex + P ANCA.
284
Lung features in GPA and E GPA :
GPA—Nodules + Cavity lesions
E GPA —Ashtma.
285
RA patient on Adalimubab. It can lead to what ?
Adalimubab increases risk of reactivation of latent TB.
286
Osteomlacia Rx:
calcium and vitamin D
287
Young 20 year athlete + pain and swelling after exercise + Arthroscopy—3-4 loose bodies in synovial joint. Dx?
Osteochondritis dissecans.
OA—at old age + multiple ( 10 ) loose bodies.
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No H/o trauma/injury + repeated movement of wrist + Tenderness at anatomical snuff box + pain on ulnar deviation. Dx?
Preiser’s Disease—Avascular necrosis of scaphoid bone.
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Preiser’s Disease—Avascular necrosis of scaphoid bone.
No H/o trauma/injury + repeated movement of wrist + Tenderness at anatomical snuff box + pain on ulnar deviation. Dx?
290
Osteochondritis dissecans.
Young 20 year athlete + pain and swelling after exercise + Arthroscopy—3-4 loose bodies in synovial joint. Dx?
291
K/C/O RA + power—decreased + loss of fine touch and sensation + Deep tendon reflex—Brisk + Babinski—Extensor B/L.
Cervical Myelopathy secondary to RA.
292
Poor prognosis in Rheumatoid arthritis :
Female sex
Gradual onset over few months
Anaemia developing within 3 months.
Positive IgM rheumatoid factor
Anti CCP antibodies
293
which onset is a bad prognosis in RA?
Gradual onset , developing within few months.
294
Which factor and antibody is a bad prognosis in RA ?
Positive IgM rheumatoid factor
Anti CCP antibodies.
295
when not to give anti TNF inhibitors ?
When there is concurrent multiple sclerosis
296
Known RA + chest pain + Dyspnoea + Small volume complexes. Dx?
Cardiac Tamponade secondary to RA.
297
Which Rheumatoid drugs causes Macrocytic anaemia ?
Methotrexate.
298
Ankle sprain + Tingling numbness and paraesthesia on foot + pain on pressure on medial malleolus
Tarsal Tunnel Syndrome.
Compression of tibial nerve.
299
Which nerve compression in tarsal tunnel syndrome ?
Tibial nerve.
300
Tarsal tunnel location
medial malleolus
301
Most common cause of death in microscopic polyangitis :
Pulmonary Haemorhage.
302
Ischaemic optic atrophy is associated with which rheumat condition ?
Granulomatosis with polyangitis and Giant cell arteritis.
303
Eye symptoms in Granulomatosis with polyangitis :
Ischaemic optic atrophy
304
Analgesia used in osteoarthritis knee and ankylosing spondylitis :
OA —PCM
AS—NSAID.
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