Rheumatology

Question 1

Examples of vasculitis

Answer 1

Large - GCA
Medium - Kawasakis
Small - Granulomatosis with polyangitis (wegners granulomatosis)

Question 2

Difference between gout and pseudogout

Answer 2

Gout - Uric acid crystals

Pseudogout - Calcium pyrophosphate

Question 3

Antiphosholipid syndrome serum antibodies

Answer 3

Anti cardiolipin

Lupus anticoagulant

Question 4

Antiphospolipid cardinal features

Answer 4

C - Clotting derangement
L - Livedo reticularis
O - Obstetric complications
T - Thrombocytopenia

Question 5

What is Felty’s syndrome

Answer 5

Complication of RA characterised by splenomegaly and neutropenia

Question 6

Deformities in RA

Answer 6

Rheumatoid nodules
Swan neck deformity
Boutonniers deformity
Ulnar deviation
Guttering 
Z thumb

Question 7

Common hand joints in RA

Answer 7

MCPs and PIPJs (not DIPJs)

Question 8

Common hand joints in psoaritic arthritis

Answer 8

DIPJs

Question 9

Deformities in Psoaritic arthritis

Answer 9

Nail pitting
DIJP (pencil in cup X Ray)
Dactylysis
Psoartitic patches - elbows and extensor surfaces

Question 10

Extra articular RA

Answer 10

Lungs - Pulmonary fibrosis, pleural effusion
Skin - Rheumatoid nodules
Eyes - Dryness and uveitis 
Bones - osteopenia
Felty's syndrome

Question 11

RA X ray findings

Answer 11

L - loss of joint space
E - Erosions
S - Soft tissue changes
S - Soft bones

Question 12

Test for Sjogren syndrome

Answer 12

Schirmers test

Question 13

Dermatomyositis

Answer 13

Proximal muscle weakness
Heliotrope rase - periorbital
Early morning stiffness
Gotren’s papules

Question 14

RA serum antibodies

Answer 14

Anti - CPP (Anti-cyclic citrullinated peptide)

and Rheumatoid factor

Question 15

Scleroderma/ diffuse systematic sclerosis antibody

Answer 15

Scl - 70

Question 16

Dermatomyositis and SLE serum antibodies

Answer 16

Antinuclear antibodies (ANA)

Question 17

SLE Antibodies

Answer 17

ANA and Anti - dsDNA

Question 18

Vasculitis serum antibody

Answer 18

ANCA

Question 19

Srojen’s syndrome serum antibodies

Answer 19

Anti - Ro/ Anti-La

Question 20

Primary Biliary sclerosis serum antibody

Answer 20

Antimitochondrial antibody (AMA)

Question 21

Antibody positive in 20% of polymyositis and associated with worse disease outcome (interstitial lung disease)

Answer 21

Anti - Jo1

Question 22

Which disease is commonly associated with GCA (50% of people have it too)

Answer 22

Polymyalgia rheumatica

Question 23

What is fibromyalgia

Answer 23

Inappropriate central and peripheral pain processing

Question 24

Investigations for GCA

Answer 24

Bloods - FBC and CRP/ESR & temporal artery biopsy (>1cm for skip lesions)

Question 25

Treatment for uncomplicated GCA

Answer 25

Oral prednisolone (40-60mg) tapering regime

Question 26

Treatment for complicated GCA

Answer 26

IV methlyprednisolone (5oomg-1g) daily for 5 days, continue on oral steroids for 2 years after

Question 27

Histological features of GCA

Answer 27

Granulomas and paint cells infiltration, skip lesions

Question 28

Investigations for gout

Answer 28

Serum urate (>300), joint aspirate looking for needly shaped negatively bifringent crystals YELLOW on polarised light microscopy

Question 29

Management of gout

Answer 29

1 - NSAIDS (naproxen) (in conjunction with PPI) 2 - Colchicine (if NSAIDs contra indicated) 3 - allopurinol (1-2 weeks after its settled and if serum urate is less than 300, then this is for prevention of a further attack) OR you could use febuxostat if allopurinol is contraindicated

Question 30

Polymyalgia rheumatica symptoms

Answer 30

Proximal muscle pain and stiffness (worse in the mornings, inflammatory pain). Associated with GCA. Systemic features of lethargy