rheumatology

Question 1

In what condition may you got Gotrrons papules

Answer 1

Dermatomysostis- they are roughedned red paupules over the knuckels mainly seen in dermatomysositis

Question 2

What is first line treatment for AS

Answer 2

NSAIDs + physio

Question 3

X-ray apperance of AS

Answer 3

sacroiliatis- subchondroal erosions, sclerosis

Squaring of lumbar vertebrae
bamboo spine
Syndespmophytes: due to ossification of outer fibres of annulus firbosus

Question 4

When would DMARDs be used in AS

Answer 4

Only if there is peripheral joint involvement - sulfasalzine

Question 5

When can use biologicals in AS

Answer 5

If in spite of having taken 2 NSAIDs for 4 wks each and pts has active disease can go onto biolgicals such as ANTi-TNF and IL-17 blockers (secukinimub)

Question 6

What happens if someone is on azathoprine and allopurinal

Answer 6

Can have a severe interaction causing bone marrow suppresion

Question 7

What is a positive schirmer’s test and what condition is it positive in

Answer 7

filter paper near conjunctival sac to measure tear formation. If not enough tears is posiive and can indicate Sjorgens.

Question 8

What test would you expect to be positive with these clinical features with a 3 month history of dry eyes, dry mouth, arthralgia and fatigue. On examination there is evidence of conjunctival injection, decreased salivary pool, dry mucous membranes and oral ulceration.

Answer 8

Anti Ro and and Anti LA antibodies

- Sjrogens sydrome

Question 9

What is the mg of Sjrogens

Answer 9

largely symptoamtic- artifical saliva and tears
pilocarpine may stimulate saliva production.

immunospupressive if major organ involvement.

Question 10

Suggest a drug which can be used first line in pregnant patinet with RA

Answer 10

hydroxychloroquine

Question 11

What underlying condition is associated with dermatomyositis

Answer 11

internal malignancy- can be a paraneoplastic disease with ovarina, breat and lung tumours being the most common underlying cancer.

The possibilyt of underlying malignancy should be considered, especially in older patients.

Question 12

What is the most useful rule out test for SLE

Answer 12

ANA as it is very sensitive (99%), is not that specific. The presnece of anti-dsDNA antibodies, low complement levels r anti Sm antibodes are highly precicive of a diagnosis of SLE when there are clinical features, however none of these are as a good rule out test as ararnt as sensitive.

Question 13

What is first line treatment for acute flare of gout

Answer 13

NSAIDs or colchicine

Question 14

What should be avoided in elderly patient taking warfain

Answer 14

NSAIDs due to risk of a life thretening GI haemorrhage.

Question 15

What is the mangement of glucocoicoid induced osetoporosis- sometimes offered prohphlaxis

Answer 15

Alendronate (bisphsophanate). patient should also be on calcium and Vi D replete

Question 16

DEXA scan of between 0 and -1.5

Answer 16

repeat bone density scan in 1-3 years

Question 17

DEXA scan of less than -1.5

Answer 17

offer bone protection

Question 18

What 6 As is AS associated with

Answer 18

Apical fibrosis 
Anterior uveitis 
Aortic regurgutation 
Achilles tendonitis 
AV node block 
Amyloidosis

Question 19

What is the likely diagnose in a patient with bone pain and an isolated raised ALP, headaches and hearing loss

Answer 19

Pagets disease of bone which is caused by excessive bone remodely by oseolclasts followed by disordered fromation of new bone. The mainstay of treatment is bisphosphanates as they inhibt osteoblasic acvitvity

Question 20

What condition are Hebrdens nodes assocaited with

Answer 20

OA.