Rheumatology

Question 1

Type 1 immune reaction

Answer 1

Anaphylatic
IgE, basophils, mast cells
Asthma, allergic rhinitis, anaphylaxis

Question 2

Type 2 immune reaction

Answer 2

Cytotoxic
Antibody formation, phagocytosis of oponised cells
autoimmune haemolytic anaemia, Goodpasture’s syndrome, Grave’s disease, pernicious anaemia

Question 3

Type 3 immune reaction

Answer 3

Immune complex
Antibody-complement formation, attract inflammatory cells
SLE, PAN, PSGN

Question 4

Type 4 immune reaction

Answer 4

Cell-mediated/delayed hypersensitivity
T-cell mediated
Contact dermatitis

Question 5

HLA-B27

Answer 5

Ankylosing spondylitis
Reactive arthritis
Enteropathic arthritis

Question 6

HLA-DR4, DR1

Answer 6

Rheumatoid arthritis

Question 7

HLA-DR3

Answer 7

Sjogren’s syndrome
SLE
Non-rheumatic diseases (celiacs, DM1, graves)

Question 8

Joint Pain causes (SOFTER TISSUE)

Answer 8

Sepsis
OA
Fracture
Tendon/muscle
Epiphyseal
Referred
Tumour
Ischaemia
Seropositive arthritis
Seronegative arthritis
Urate
Extra-articular rheumatism

Question 9

Seropositive disease

Answer 9

Rheumatoid arthritis
SLE/antiphospholipid syndrome
Scleroderma
Dermatomyositis/polymyositis
Sjogren's syndrome
Mixed connective tissue disease

Question 10

Seronegative disease

Answer 10

Ankylosing spondylitis
Enteropathic arthritis
Reactive arthritis
Psoriatic arthritis

Question 11

Seropositive features

Answer 11

Female predominance
Symmetrical affecting small and large joints
Does not affect spine or enthesis.
Others: rheumatoid nodules, vasculitis (SLE), dryness (Sjogren’s), Raynaud’s (scleroderma)

Question 12

Seronegative

Answer 12

Predominantly males
Usually assymetrical affecting larger joints. Affects axial and enthesis.
Others: iritis (reactive), dactylitis, DIP (psoartic), oral ulcers, GI (enteropathic), skin conditions

Question 13

SLE antibodies

Answer 13

ANA
RhF
anti-dsDNA
Anti-SM
Lupus anticoagulant
Anti-cardiolipin

Question 14

Sjogern’s antibodies

Answer 14

ANA
RhF
Anti-La
Anti-Ro

Question 15

CREST antibodies

Answer 15

Anti-centromere

ANA

Question 16

Dermatomyositis, polymyositis antibodies

Answer 16

Anti-Jo

Question 17

Rheumatoid arthritis antibodies

Answer 17

RhF

Anti-CCP

Question 18

Negatively birefringent

Answer 18

Monosodium urate

Question 19

Positively birefringent, rhomboid shape

Answer 19

Calcium pyrophosphate dihydrate

Question 20

OA radiographic signs

Answer 20

Joint space narrowing
Subchondral sclerosis
Subchondral cysts
Osteophytes

Question 21

Vasculitides (seropositive)

Answer 21

Small: non-ANCA associated, Sjogern’s (Wegener’s granulomatosis)
Medium: polyarteritis nodosa, Kawasaki’s
Large: giant cell arteritis, Takayasu’s

Question 22

Anti-neutrophil cytoplasmic antibodies (ANCAs)

Answer 22

Wegener’s granulomatosis
Microscopic polyangiitis
Primary pauci-immune necrotizing crescentic glomerulonephritis Churg-Strauss syndrome
Drug induced vasculitides

Question 23

Antiphospholipid syndrome antibodies

Answer 23

Lupus anticoagulant

Anti-cardiolipin

Question 24

Wegener’s granulomatosis antibodies

Answer 24

c-ANCA

Question 25

SLE (MD SOAP BRAIN)

Answer 25

``` Malar rash Discoid rash Serositis Oral ulcers ANA Photosensitivity Blood Renal Arthritis Immune Neurological ```

Question 26

Antiphospholipid syndrome

Answer 26

Thromboembolic events Spontaneous abortions Thrombocytopenia

Question 27

Raynauds phenomen causes (COLD HAND)

Answer 27

``` Cryoglobulins Obstruction/Occupation Lupus erythematous Diabetes/Drugs Haematologic Arterial Neurologic Disease of unknown origin ```

Question 28

CREST syndrome

Answer 28

``` Calcinosis Raynauds Esophageal dysfunction Sclerodactyl Telangiectasia ```

Question 29

PM/DM

Answer 29

Symmetric proximal muscle weakness (shoulders, hips) Elevated muscle enzymes (CK, LDH, AST, ALT) EMG changes Muscle biopsy (necrosis, regeneration, perivascular inflammation) Rash (Gottron's papules, helitrope rash, shawl sign) Associated malignancies: breast, lung, colon, ovaries

Question 30

Sjogern's triad

Answer 30

Dry eyes Dry mouth/dysphagia Arthritis

Question 31

Wegener's granulomatosis

Answer 31

Nasal/oral involvement (inflammation, ulcers, epistaxis) Abnormal CXR (nodules, cavitations) Urinary sediment (protein RBC casts) Biopsy (granulomas in lung, necrotising segmantal GN) c-ANCA positive, small vessel vasculitis

Question 32

Polyarteritis Nodosa

Answer 32

``` Weight loss Mylagias/weakness Livedo reticularis Neuropathy Testicular pain Diastolic BP >90 Elevated Cr Hep B positive Arteriography abnormal Biopsy of artery ``` ANCA negative, medium vessel vasculitis

Question 33

Giant cell arteritis

Answer 33

``` Age >50 New headache/loss of vision/jaw claudication Temporal artery abnormality Elevated CRP Abnormal biopsy ``` Large vessel vasculitis

Question 34

Ankylosing spondylitis

Answer 34

``` Age onset 20's Axial, LE distribution Sacroilitis Enthesitis Aorticic regurge HLA-B27 ```

Question 35

Psoriatic arthritis

Answer 35

``` Age onset 35-45 Peripheral arthritis Any distribution Dactylitis, enthesitis Psoriasis Uveitis, urethritis ```

Question 36

Reactive arthritis

Answer 36

``` Age onset 20's Peripheral arthritis, LE Sacroilitis Dactylitis, enthesitis Urethritis, aortic regurge HLA-B27 ``` Onset: post Shigella, Salmonella, Campylobacter, Yersinia, Chlamydia, Mycoplasma

Question 37

Enteropathic arthritis

Answer 37

Peripheral arthritis, LE Pyoderma, erythema nodosum IBD

Question 38

AS extra-articular manifestations (6 A's)

Answer 38

``` Atlanto-axial subluxation Anterior uveitis Apical lung fibrosis Aortic incompetence Amyloidosis (kidneys) Autoimmune BD (UC) ```

Question 39

Gout

Answer 39

First MTP Erosion of bone Tophi, gout nephropathy

Question 40

Pseudogout

Answer 40

Knee, wrist, polyarticular | Chondrocalcinosis, OA

Question 41

Gout precipitants (drugs are FACT, foods are SALT)

Answer 41

Furosemide Aspirin/alcohol Cytotoxic drugs Thiazide diuretics ``` Shellfish Anchovies Liver and Kidney Turkey Sardines ```

Question 42

Polymyalgia Rheumatica

Answer 42

``` Pain and stiffness of the proximal extremities, fever, weight loss mylagia Age >50 Bilateral aching/morning stiffness Increased ESR Rapid response to corticosteroids ```

Question 43

Fibromylagia

Answer 43

Chronic, widespread pain with tender points (occiput, trapezius, low cervical, lateral epicondyle, gluteal, greater trochanter)