Rheumatology

Question 0

What is the treatment for Raynaud’s phenomenon?

Answer 0

Calcium channel blockers (e.g. Nifedipine)

Question 1

What is the most common site for pseudogout?

Answer 1

The knee

Question 2

ANA is positive in 95-99% people with which condition?

Answer 2

SLE

Question 3

What is the treatment for acute gout?

Answer 3

Intra-articular injection of corticosteroids, NSAIDs and/or colchicine

Question 4

What is pseudogout?

Answer 4

Chondrocalcinosis (CPPD): accumulation of calcium pyrophosphate dihydrate in connective tissue

Question 5

What blood tests best measure the disease activity of RA?

Answer 5

ESR, CRP, anaemia

Question 6

What blood test is used to monitor the disease progression of SLE?

Answer 6

Anti-dsDNA

Question 7

What is the most common cause of arthritis with enthesitis?

Answer 7

Spondyloarthopathies (Ankylosing spondylitis, then Psoriatic Arthritis)

Question 9

When are DMARDs commenced in RA?

Answer 9

As soon as the diagnosis is confirmed

Question 10

What is the difference between gout and pseudogout on analysis of synovial fluid?

Answer 10

Gout: urate crystals, needle-shaped, negatively birefringent
Psudocout: calcium crystals, rhoboidal, positively birefringent

Question 11

What are the risk factors for gout?

Answer 11

ETOH, diuretics, lead exposure, obesity, low dose aspirin, dehydration

Question 12

What is the most specific test for SLE?

Answer 12

Anti-ds DNA

Question 13

Give 3 differentials for acute monoarthropathy.

Answer 13

Crystal arthritis (gout, pseudogout)
Trauma
Septic arthritis

Question 14

What is rheumatoid factor?

Answer 14

Autoantibody: IgM against IgG

Question 15

Which titre of ANA is strongly associated with autoimmune disease?

Answer 15

1: 160 lower cut off

1: 1280 strong

Question 16

What are the x-ray findings of psoriatic arthritis?

Answer 16

Soft tissue swelling
Periosteal reaction (bone formation)
Erosions
Pencil-in-cup deformities

Question 17

What are the x-ray findings in RA?

Answer 17

Soft tissue swelling
Periarticular osteopenia
Periarticular erosions
Joint space narrowing
Deformities: subluxation, ulnar deviation, swan neck, etc.

Question 18

What are the x-ray findings in OA?

Answer 18

Joint space narrowing
Subchondral sclerosis
Osteophytes
Subchondral cysts

Question 19

What are the extra-articular features of reactive arthritis?

Answer 19

Enthesitis, conjunctivitis/uveitis, urethritis, nail dystrophy, dactylitis, keratoderma blenorrhagicum

Question 20

Which arthropathies are associated with HLA-B27?

Answer 20

Ankylosing spondylitis
Reactive arthritis
Enteropathic spondylitis (IBD-associated)

Question 21

Which rheumatological conditions are associated with giant cell arteritis?

Answer 21

Polymyalgia rheumatica
SLE
RA

Question 22

Give one example of a small, medium and large vessel vasculitis.

Answer 22

Small (ateriole/capillary/venule): granulomatosis with polyangitis
Medium: polyarteritis nodosa
Large: giant cell arteritis

Question 23

Which patterns of ANA are associated with:

(a) SLE
(b) Systemic sclerosis

Answer 23

(a) Homogenous, speckled

(b) Centromere, nucleolar

Question 24

Which connective tissue disease are associated with the following?

(a) Anti-Ro
(b) Anti-Sm
(c) Anti-La

Answer 24

(a) Sjogren’s Syndrome
(b) SLE
(c) SLE and Sjogren’s Syndrome

Question 25

What serology findings can be present in SLE?

Answer 25

``` ANA (homogenous or speckled) RF Anti-dsDNA (specific) Anti-Sm > Anti-La Antibodies against WBCs + RBCs Antiphospholipid antibodies ```

Question 26

What are the adverse effects of NSAIDs?

Answer 26

PUD, exacerbation HF, bronchospasm, renal dysfunction, prothrombosis

Question 27

What are the adverse effects of steroids?

Answer 27

Weight gain, osteoporosis, cataracts/glaucoma, infection, bruising, acne, hypertension, hyperlipidaemia, hyperglycaemia, cushingoid, muscle weakness, hyperlipidaemia

Question 28

What medications can be coprescribed to reduce the adverse effects of NSAIDs?

Answer 28

Fish oil can have NSAID-sparing effect | PPI to reduce incidence of PUD

Question 29

What are the adverse effects of methotrexate?

Answer 29

Oral ulcers, GI symptoms, cirrhosis, pulmonary fibrosis, myelosuppression, deranged LFTs Contraindicated in pregnancy

Question 30

What is the approach to the treatment of RA?

Answer 30

1. Analgesia (NSAIDs, paracetamol) 2. Stop inflammation + Prevent joint damage with DMARDs (or biologics if resistant) 3. Maintain function 4. Control systemic involvement

Question 31

What are the features of mixed connective tissue disease?

Answer 31

Anti-RNP | Serum markers present from >1 different type of connective tissue disease

Question 32

Which 3 investigations are required prior to commencing any DMARD?

Answer 32

CBE LFTs Urinalysis

Question 33

DMARDs are contraindicated in surgery. True or False?

Answer 33

True

Question 34

Is methotrexate appropriate for use in patients with a history of PUD?

Answer 34

Yes; however, it is contraindicated in active peptic ulcer disease.

Question 35

What is the most specific immunological marker for granulomatosis with polyangitis (GPA)?

Answer 35

C-ANCA