Rheumatology

Question 1

Markers of bone turnover in Paget’s

Answer 1

Raised alkaline phosphatase (ALP)

Serum C-telopeptide (CTx)

Urinary hydroxyproline

Question 2

Management of Paget’s

Answer 2

Bisphosphonate

(either oral risedronate or IV zoledronate)

Question 3

Denosumab

Answer 3

RANKL inhibitor (Human monoclonal antibody)

Prevents the development of osteoclasts

Question 4

Bony metastases - bone protection

Answer 4

Bisphosphonates and denosumab can be used to prevent pathological fractures in bone metastases.

If the eGFR < 30, denosumab is preferred

Question 5

There is an overlap between temporal arteritis and ?

Answer 5

Polymyalgia rheumatica (PMR)

Question 6

GCA - visual complication?

Answer 6

Anterior ischemic optic neuropathy (AION)

Question 7

CREST syndrome

Answer 7

Subtype of limited systemic sclerosis

Calcinosis

Raynaud’s phenomenon

oEsophageal dysmotility

Sclerodactyly

Telangiectasia

Question 8

Anti-centromere AB

Answer 8

CREST

Question 9

Anti scl-70 antibodies

Answer 9

Diffuse cutaneous systemic sclerosis

Question 10

Renal complications of systemic sclerosis - treatment?

Scleroderma renal crisis (SRC)

Answer 10

ACE-inhibitors

(eg. captopril)

Question 11

Discoid lupus erythematous - treatment?

Answer 11

Topical steroids → oral hydroxychloroquine

Question 12

Which medications should never be co-prescribed with Methotrexate?

Answer 12

Co-trimoxazole

Trimethoprim

Question 12

Methotrexate - MOA

Answer 12

Antimetabolite that inhibits dihydrofolate reductase

Which is an enzyme essential for the synthesis of purines and pyrimidines

Question 13

Methotrexate toxicity

Answer 13

Folinic acid

Question 14

Polyarteritis nodosa - define

Answer 14

Vasculitis affecting medium-sized arteries with necrotizing inflammation leading to aneurysm formation.

Question 15

Still’s disease in adults - treatment

Answer 15

1. NSAIDs
2. Steroids
3. Methotrexate / IL-1 inhibitor (Anakinra)

Question 16

Most common cause of discitis

Answer 16

Staphylococcus aureus

Question 17

Treatment of acute gout in patient with acute kidney disease

Answer 17

Steroids

NSAIDs/Colchicine (avoid in severe CKD)

Question 18

Familial Mediterranean Fever - treatment

Answer 18

Colchicine

Question 19

Reactive arthritis

Answer 19

HLA-B27 associated seronegative spondyloarthropathies

Urethritis
Conjunctivitis
Arthritis

Question 20

Osteomalacia - define

Answer 20

Softening of the bones secondary to low vitamin D

Question 21

Vit D levels 30-50 - treatment?

Answer 21

Maintenance Vitamin D

Question 22

Vit D levels <30 - treatment?

Answer 22

Loading Dose Vitamin D

Question 23

Polymyositis - investigations

Answer 23

High CK

LDH

EMG

Muscle biopsy

Anti-synthetase antibodies
Anti-Jo-1 antibodies

Question 24

Treatment for Polymyositis?

Answer 24

High dose steroids (Tapering) Steroid sparing agent: Azathioprine

Question 25

McArdle's disease

Answer 25

Autosomal recessive Type V glycogen storage disease Muscle pain and stiffness following exercise

Question 26

Felty's syndrome

Answer 26

Rheumatoid Arthritis + Splenomegaly + Low white cell count

Question 27

Lateral epicondylitis

Answer 27

Worse on resisted wrist extension/supination whilst elbow extended

Question 28

Worse on resisted wrist extension/supination whilst elbow extended

Answer 28

Lateral epicondylitis (tennis elbow)

Question 29

Resisted wrist flexion and pronation - pain

Answer 29

Medial epicondylitis - Golfer's elbow

Question 30

Letrozole

Answer 30

Aromatise inhibitor Used to treat oestrogen receptor positive breast cancer

Question 31

Trastuzumab

Answer 31

Monoclonal antibody against the HER2 receptor Part of therapy to treat HER2 positive breast cancer.

Question 32

Rheumatoid arthritis: management - initial therapy

Answer 32

DMARD monotherapy +/- a short-course of bridging prednisolone DMARD of choice - Methotrexate Sulfasalazine Leflunomide Hydroxychloroquine

Question 33

Most common causes of drug induced Lupus

Answer 33

Procainamide Hydralazine

Question 34

Important and common side-effects of NSAIDs

Answer 34

Peptic ulceration Exacerbation of asthma

Question 35

Treatment of choice for SLE

Answer 35

Hydroxychloroquine

Question 36

Oral ulcers, genital ulcers and anterior uveitis

Answer 36

Bechet's syndrome

Question 37

Diagnosis of Bechet's

Answer 37

Pathergy Test Puncture site following needle prick becomes inflamed with small pustule forming

Question 38

Mycophenolate - safe in pregnancy?

Answer 38

No

Question 39

? antibodies are specific for drug-induced lupus.

Answer 39

Anti-Histone

Question 40

Pharmacological option for Raynaud's phenomenon

Answer 40

Nifedipine

Question 41

Investigation of choice for Avascular necrosis of the hip

Answer 41

MRI

Question 42

Treatment for Fibromyalgia

Answer 42

Aerobic exercise: has the strongest evidence base Cognitive behavioural therapy Medication: pregabalin, duloxetine, amitriptyline