Rheumatology

Question 1

Reiters syndrome is precipitated by which infections

Answer 1

Chlamydia
Salmonella
Campylobacter
Shigella
Yersinia

Question 2

antiphospholipid syndrome

Answer 2

multisystem vasculopathy manifested by recurrent thromboembolic events, spontaneous abortions and thrombocytopenia

Question 3

Type I immune reaction

Answer 3

formation of IgE -> release of immunologic mediators from basophils/ mast cells -> diffuse inflammation
Asthma, allergic rhinitis

Question 4

Type II immune reaction

Answer 4

Cytotoxic
Formation of antibody -> deposits and binds to antigen on cell surface -> phagocytosis or lysis of target cell
Autoimmune haemolytic anemia, Graves disease, pernicious anaemia

Question 5

Type III immune reaction

Answer 5

Immune complex
Formation of antigen antibody complexes -> activation of complement -> attracts inflammatory cells and release of cytokines
SLE, PAN, post strep glomerulonephritis, serum sickness

Question 6

Type IV immune reaction

Answer 6

cell mediated/ delayed hypersensitivity
release of cytokines by sensitised T cells and T cell mediated cytotoxicity
contact dermatitis

Question 7

Fibromyalgia

Answer 7

chronic (>3 month) widespread non articular pain with characteristic tender points

Question 8

Fibromylagia epidemiology

Answer 8

F:M 3:1
ages 25-45, some adolescents
strong association with psychiatric illness

Question 9

Signs and symptoms of fibromyalgia

Answer 9

widespread aching, stiffness
easy fatiguability
sleep disturbance
symptoms aggravated by physical activity
patient feels that joints are diffusely swollen although joint examination is normal
neurologic symptoms of hyperalgesia, paraesthesias
associated with IBS, migraines, tension headaches, restless legs syndrome, obesity, depression and anxiety

Question 10

Treatment for fibromyalgia

Answer 10

conservative
education
exercise program
physical therapy
stress reduction, CBT
biofeedback, meditation, acupuncture
Medical: low dose TCSa - amitriptyline

Question 11

Giant cell arteritis

Answer 11

Inflammation of medium and large sized arteries

characteristically involves one or more branches of the carotid artery, particular the temporal artery

Question 12

what condition is giant cell arteritis associated with?

Answer 12

polymyalgia rheumatica

Question 13

Age and sex demographic of giant cell arteritis

Answer 13

almost exclusively occurs in individuals greater than 50 years
more common in women

Question 14

Clinical features of giant cell arteritis

Answer 14

fever, anaemia, high ESR
headaches
systemic inflammation: malaise, fatigue, anorexia, weight loss, sweats, arthralgias, polymylagia rhumatica
In patients with involvement of the cranial arteries headache is the predominant symptom and may be associated with a tender or nodular artery which may pulsate early in the disease
visual disturbances and facial pain on chewing

Question 15

Diagnosis of Temporal Arteritis

Answer 15

Biopsy of the temporal artery

Question 16

Classification criteria for temporal arteritis

Answer 16

Age >50 years at onset
New Headache
Temporal artery abnormality
Elevated ESR
abnormal artery biopsy with mononuclear cell infiltrate, granulomatous inflammation, usually with multinucleated giant cells

Question 17

Local manifestations of temporal arteritis

Answer 17

Temporal headaches
blindness (tranisent amarousis)
sclap necrosis
scalp tenderness
jaw claudication

Question 18

What is psuedogout?

Answer 18

calcium pyrophosphate dehydrate arthropathy

acute monoartropathy similar to gout and typically affects l larger joints: knee, wrist or hip

Question 19

Risk factors for psuedogout

Answer 19

old age
OA
Dm
hypothyroidism
hyperparathyroidism
haemochromatosis
Wilson's Disease

Question 20

Investigations for pseudogout?

Answer 20

polarised light microscopy of synovial fluid - weakly positive birefringent crystals
Associated with chondrocalcinosis: soft tisse calcium deposits on Xray

Question 21

Antibody associated with miced connective tissue disease

Answer 21

anti nRNP (ribonucleoprotein)

Question 22

What joint are Heberdon’s nodes found on?

Answer 22

DIP

Question 23

What joint are Bouchards nodes found on

Answer 23

PIP

Question 24

radiographic Hallmarks of osteoarthritis

Answer 24

Joint space narrowing
subchondral sclerosis
subchondral cysts
osteophytes

Question 25

treatment for osteoarthritis

Answer 25

no treatment alters the natural history of OA
non pharmacologic therapy
- weight loss
- physiotherapy: heat/cold, low impact exercise programs
occupational therapy: aids, splints, cane, walker, bracing
- NSIS, glucosamine
joint injections
topical NSAIDs

Question 26

Polyarteritis Nodosa (PAN)

Answer 26

systemic vasculitis characterised by necrotising inflammatory lesions that affect small and medium sized arteries
preferentially occurs at vessel bifurcations and branch points

Question 27

POlymyalgia rheumatica

Answer 27

characterised by pain and stiffness of the extremities
closely related to giant cell arteritis
no muscle weakness
age of onset >50 years

Question 28

signs and symptoms of polymylagia rheumatica

Answer 28

constitutional symptoms prominent (fever, weight loss, malaise)
pain and stiffness of symmetrical proximal muscles (neck, shoulder and hip girdles, thighs)
muscle pain persisting for at least one month
gel phenomenon (stiffness after prolonged activity)
pysical exam reveals tender muscles but no weakness or atrophy

Question 29

genetic predisposition rheumatoid arthritis

Answer 29

HLA-DR4/DR1

Question 30

Extra articular features of rheumatoid arthritis

Answer 30

cutaneous ulcers
rheumatoid nodules
episcleritis
scleritis
pulmonary fibrosis
pleuritis
peripheral neuropathy: sensory stocking glove
Splenomegaly

Question 31

Felty’s Syndrome

Answer 31

arthritis, splenomegaly, neutropenia

Question 32

Sjogren’s Syndrome

Answer 32

keratoconjuctivitis sicca and xerostomia (dry eyes and mouth)

Question 33

Scleroderma

Answer 33

non inflammatory autoimmune disorder
widespread small vessel vasculopathy and fibrosis
affects T cells, b cells, affects fibroblasts
scl70
ANA positive

Question 34

CREST

Answer 34

limited systemic sclerosis
Calcinosis: calcium deposits on the skin
Raynaud’s phenomenon
Esophageal dysfunction: acid reflux
Sclerodactyly: tightening of skin on digits
Telangiectasia: superficial dilated blood vessels