Rheumatology

Question 1

What can cause a monoarthritis?

Answer 1

Septic arthritis
Gout/pseudogout
Oesteoarthritis
Trauma eg. haemarthrosis

Question 2

What can cause an oligoarthritis?

Answer 2

Psoriatic arthritis
Gout/pseudogout
Oesteoarthritis
Ankylosing spondylitis
Reactive arthritis

Question 3

What can cause a symmetrical polyarthritis?

Answer 3

Rhematoid arthritis
Oesteoarthritis
Hep A/B/C
Systemic disease eg. SLE, sickle cell anaemia, sarcoidosis, leukaemia

Question 4

What can cause an asymmetrical polyarthritis?

Answer 4

Psoriatic arthritis
Reactive arthritis
Systemic disease

Question 5

What are the key sign/ symptoms of osteoarthritis?

Answer 5

Pain on movement
Worse with prolonged activity
Pain relieved on resting
Nodes on fingers- Heberdens and Bouchards
Varus knees
Square hands

Question 6

What are the key radiological features of osteoarthritis?

Answer 6

Loss of joint spaces
Osteophytes (Bony projections)
Subarticular sclerosis
Subchondral cysts (sacks of fluid)

Question 7

What are the risk factors for septic arthritis?

Answer 7

Diabetes
CKD
Joint disease
Recent joint surgery
Immunocompromised

Question 8

What is the investigation for septic arthritis?

Answer 8

Joint aspiration-> Synovial fluid culture and microscopy.

Question 9

What is the treatment for septic arthritis?

Answer 9

IV antibiotics eg Flucloxacillin

Question 10

What are the risk factors for rhematoid arthritis?

Answer 10

Female
Smoking
HLA DR41
CCP Autoantibodies

Question 11

What are the features indicative of RA on investigation?

Answer 11

CCP Autoantibodies
Raised CRP, C3, C4 and ESR
RF

Question 12

What treatments are available for RA?

Answer 12

NSAIDS
Steroids
Anti TNFalpha eg. Infliximab
Surgery

Question 13

What are the risk factors for gout?

Answer 13

Increased urate production eg. alcohol, red meat, sea food, psoriasis
Decreased urate excretion eg. CKD, diuretics, hypertension, metabolic syndrome

Question 14

What are the features indicative of gout on investigation?

Answer 14

Negative bifringent urate crystals
Increased serum urate
Punched out erosions on bone

Question 15

What plasma autoantibodies are found in RA?

Answer 15

RF, CCP autoantibodies

Question 16

What plasma autoantibodies are found in coealiac?

Answer 16

Anti TTG

Question 17

What plasma autoantibodies are found in SLE?

Answer 17

ANA, Anti dsDNA

Question 18

What plasma autoantibodies are found in antiphospholipid syndrome?

Answer 18

Anti cardiolipin

Question 19

What plasma autoantibodies are found in PBC?

Answer 19

Antimitochondrial

Question 20

What plasma autoantibodies are found in vasculitis?

Answer 20

cANCA, pANCA

Question 21

What are osteophytes?

Answer 21

Bony projections associated with cartilage degeneration at joints

Question 22

What would be found on a blood culture in a patient with septic arthritis?

Answer 22

Usually strep, S. Aureus, N. Gonorrhoea or gram negative bacilli

Question 23

What are the features of rheumatoid arthritis on X ray?

Answer 23

Loss of joint space, soft tissue swelling and joint deformity

Question 24

How should synovial fluid normally appear?

Answer 24

Clear, colourless, no neutrophils

Question 25

How does synovial fluid appear in osteoarthritis?

Answer 25

Clear, straw coloured, viscous | WBC <1000mm

Question 26

How does synovial fluid appear in an acutely inflamed joint (crystal or Rheumatoid)?

Answer 26

Turbid, yellow, decreased viscosity, high number of neutrophils

Question 27

How does synovial fluid appear in septic arthritis?

Answer 27

Turbid, yellow, decreased viscosity, high number of neutrophils

Question 28

How does gout appear on Xray?

Answer 28

Soft tissue swelling Bony erosion Normal joint space

Question 29

What are the most likely causes of back pain in patients aged >50years?

Answer 29

``` Degenerative changes Vertebral collapse (due to osteoporosis) Paget's disease Malignancy Myeloma Spinal stenosis ```

Question 30

What is the most likely cause of back pain in patients aged 15-30years?

Answer 30

``` Prolapsed disc Trauma Fracture Ankylosing spondylitis Pregnancy ```

Question 31

What are the key signs that cauda equina is present?

Answer 31

1. Leg pain (alternating/ bilateral) 2. Saddle anaesthesia (perianal) 3. Loss of anal tone 4. Bladder and bowel incontinence

Question 32

What is ankylosing sponylitis?

Answer 32

Chronic inflammatory disease of spine | Unknown cause

Question 33

What is the typical patient that suffers anykylosing spondylitis and what are their symptoms?

Answer 33

Typical patient is male <30yrs with gradual onset lower back pain Pain worse at night Spinal morning stiffness Relieved by exercise Radiates from sacro-iliac joints to hips/buttocks

Question 34

Which diseases are associated with HLA B27?

Answer 34

Ankylosing spondylitis Uveitis Reactive arthritis Psoriatic arthritis

Question 35

What are the key clinical features of SLE?

Answer 35

``` Malar rash Discoid rash Synovitis Serositis Alopecia Oral/nasal ulcers Haemolytic anaemia, leucopenia, neutropenia ```

Question 36

Erythema nodosum is painful red/blue raised lesions on shins, caused by _______________

Answer 36

Sarcoidosis Drugs Strep infection

Question 37

Erythema marginatum is pink rings on the trunk which come and go, seen in _________________

Answer 37

Rheumatic fever

Question 38

Dermatitis herpetiformis is itchy blisters in groups on the knees, elbow and scalp, usually seen in ____________

Answer 38

Coeliac disease