Rheumatology

Question 1

Which antibodies are highly specific for SLE?

Answer 1

Anti-dsDNA

Question 2

What condition would typically present with back pain that’s worse in the morning and improves with exercise?

Answer 2

Ankylosing spondylitis

Question 3

Which nerve root compression would cause weak hip flexion and knee extension and reduced sensation to inner thigh to knee?

Answer 3

L3

Question 4

Which nerve root compression would cause weak knee extension and reduced sensation over the medial calf?

Answer 4

L4

Question 5

Which nerve root compression would cause weak big toe dorsiflexion and reduced sensation over the lateral leg and dorsum of the foot?

Answer 5

L5

Question 6

Which nerve root compression would cause weak plantarflexion and reduced sensation over the posterior leg?

Answer 6

S1

Question 7

What is Lesch-Nyhan syndrome?

Answer 7

Hypoxanthine-guanine phosphoribosyl transferase (HGPRTase) deficiency

Question 8

How is Lesch-Nyhan syndrome inherited?

Answer 8

X linked recessive

Question 9

What are the features of Lesch-Nyhan syndrome?

Answer 9

• Early onset gout
• Self mutilating behaviour
• Intellectual disability
• Choreoathetosis
• Gouty arthritis
• Uric acid nephrolithiasis

Question 10

What is the first line treatment for septic arthritis?

Answer 10

Flucloxacillin
Clindamycin if penicillin allergic

Question 11

What are the drug causes of gout?

Answer 11

Diuretics, ciclosporin, alcohol, cytotoxic agents, aspirin, pyrazinamide

Question 12

Which tendons are affected by DeQuervain’s tenosynovitis?

Answer 12

Extensor pollicis brevis and abductor pollicis longus tendons

Question 13

Which test can you perform for DeQuervain’s tenosynovitis?

Answer 13

Finkelstein’s test:

Examiner pulls the thumb of the patient in ulnar deviation and longitudinal traction. In a patient with tenosynovitis this action causes pain over the radial styloid process and along the length of extensor pollisis brevis and abductor pollicis longus

Question 14

What are the causes of avascular necrosis of the hip?

Answer 14

Chemotherapy
Alcohol excess
Long-term Steroids
Trauma

Question 15

What’s the best investigation for avascular necrosis of the hip?

Answer 15

MRI

Question 16

How can you distinguish pesudogout from gout?

Answer 16

Chondrocalcinosis in pseudogout

Question 17

What is pseudogout?

Answer 17

Microcrystal synovitis caused by deposition of calcium pyrophosphate dihydrate crystals in the synovium

Question 18

What are the risk factors for young pseudogout?

Answer 18

• Haemochromatosis
• Hyperparathyroidism
• Low Mg, Low Phosphate
• Wilson’s disease, Acromegaly

Question 19

What would you see on joint aspiration in pseudogout?

Answer 19

Weakly positive birefringent rhomboid shaped crystals

Question 20

What is the first line treatment for SLE?

Answer 20

Hydroxychloroquine

Question 21

What are the features of Still’s disease?

Answer 21

Polyarthritis
Salmon pink maculopapular rash
Spiking fevers

Question 22

What would investigations show in Still’s disease?

Answer 22

Very high ferritin
Raised ESR and CRP
Leukocytosis
ANA and RF -ve
Mildly abnormal LFTs

Question 23

What are the treatments for Still’s disease?

Answer 23

1) NSAIDs - trial for 1 week before starting steroids
2) Steroids
3) Methotrexate
4) Anti-TNF alpha/IL-1 - IL-1 inhibitor of choice is Anakinra

Question 24

What is osteogenesis imperfecta?

Answer 24

Brittle bone disease due to abnormal type 1 collagen

Question 25

How is osteogenesis imperfecta inherited?

Answer 25

Autosomal dominant

Question 26

What are the features of osteogenesis imperfecta?

Answer 26

- fractures after minor trauma - blue sclera - deafness due to otosclerosis - dental imperfections

Question 27

What x ray changes would you expect to see in RA?

Answer 27

LESS Loss of joint space Erosions Soft tissue swelling Subluxation Juxta-articular osteoporosis/osteopenia

Question 28

Which antibodies are associated with congenital heart block?

Answer 28

Anti-Ro (roadblock -> heart block)

Question 29

Which movement is impaired in adhesive capsulitis?

Answer 29

External rotation

Question 30

Robert is a 56-year-old man presenting with painful hand movement. He had recently moved homes and had been carrying multiple heavy boxes during this time when the pain came on along his forearm. The pain is acutely worse when he is carrying objects but improves on rest. Physical examination reveals that the pain was recreated with wrist extension and forearm supination when the elbow is extended. Maximal pain is palpated over the insertion of the common extensor tendon. No sensory or motor deficits were noted on examination. What is the likely diagnosis?

Answer 30

Lateral epicondylitis

Question 31

A 34-year-old woman presents with redness around both ears. On questioning, she reports joint pains. She was recently diagnosed with an upper respiratory tract infection and an episode of episcleritis. On examination, she has a saddle-nose deformity and marked erythema around both pinnae, sparing the earlobes. Hearing is reduced bilaterally. Rheumatoid factor and cANCA are negative. What is the diagnosis?

Answer 31

Relapsing polychondritis

Question 32

What is Meltzer's triad in cryoglobulinaemia?

Answer 32

Arthralgia Weakness Palpable purpura

Question 33

What are the common features of cryoglobulinaemia?

Answer 33

Low C4 Membranoproliferative glomerulonephritis

Question 34

Describe Type 1 cryoglobulinaemia?

Answer 34

Raynaud's Monoclonal Assoc with Waldenstrom's macroglobinaemia and multiple myeloma

Question 35

Describe Type II cryoglobulinaemia

Answer 35

Polyclonal - rheumatoid factor Associated with RA, Sjogren's and lymphoma, hep C

Question 36

Describe type III cryoglobulinaemia

Answer 36

Polyclonal - rheumatoid factor Associated with RA, Sjogren's