Deck 2

Question 1

Name 3 diseases related to Calcium pyrophosphate deposition

Answer 1

Acute CPP crystal arthritis (previously pseudogout), provoked by illness/surg/trau
Chronic CPD: inflammatory like RA, polyarthritis and synovitis
Osteoarthritis with CPPD

Question 2

Risk factors for CPPD

Answer 2

Old age
Hyperparathyroidism
Haemochromatosis
Hypophosphataemia

Question 3

Rx of CPPD

Answer 3

Polarised light microscopy
X-ray

RICE
Aspiration
Intra-articular steroids
NSAIDs +/- colchicine

Question 4

Ankylosing Spondylitis typical presentation

Answer 4

<30yo male with gradual onset of back pain, worse at night, relieved by exercise, morning stiffness
Progressive loss of spinal movement, thus decreased thoracic expansion
Enthesitis: inflammation of a site of insertion (plantar fasciitis, achilles tendonitis)
Acute iritis – leads to blindness

Question 5

Tests for Ankylosing Spondylitis

Answer 5

FBC + ESR + CRP
HLA B27+ve

X-rays: sclerosis, erosions
Calcifications of ligaments

Question 6

Management for Ankylosing spondylitis

Answer 6

Exercise (intense regiments)
Maintain posture and mobility
NSAIDs remove pain in 48h
TNF-alpha blockers
Local steroid injections
Surgery: hip replacement

Question 7

What is enteric arthropathy

Answer 7

IBD, GI bypass, coliac and whipple’s

Treat bowel symptoms (beware NSAIDs)

Question 8

What is Psoriatic arthritis

Answer 8

Arthritis that presents before skin changes
Can be both a/Symmetrical
DIP joints
Spinal
X-ray: pencil in cup

Question 9

Management of Psoriatic arthritis

Answer 9

NSAIDs
Sulfasalazine
Methotrexate
Ciclosporin
Anti-TNF agents

Question 10

Reactive arthritis

Answer 10

Sterile arthritis affecting lower lib after urethritis or dysentery
Chronic or relapsing
Ass/w iritis, keratoderma blenorrhagica, circinate balanitis
Reiter’s syndrome: urethritis, arthritis, conjunctivitis

Question 11

Tests for Reactive arthritis

Answer 11

ESR
CRP
Culture stool if diarrhoea
X-ray: enthesitis with periosteal reaction

Question 12

Management of Reactive arthritis

Answer 12

Splint
NSAIDs or topical steroid injections
Sulfasalazine/methotrexate

Question 13

Name 4 Spondyloarthritides

Answer 13

Ankylosing spondylitis
Reactive arthritis
Psoriatic arthritis
Enteric arthropathy

Question 14

What are the shared features of spondyloarthropathies

Answer 14

Seronegativity (RF -ve)
HLAB27
Axial arthritis
Asymmetrical
Enthesitis
Dactylitis
Extra-articular manifestation

Question 15

Name 3 connective tissue diseases

Answer 15

Systemic sclerosis
- limited
- diffuse
Mixed connective tissue disease (combined ft of SS, SLE, polymyositis)
Relapsing polychondritis (attacks all cartilage)

Question 16

Presentation of Limited Cutaneous systemic sclerosis

Rx

Answer 16

Calcinosis (subcut tissue)
Raynaud’s
Esophageal + gut dysmotility
Sclerodactyly
Telangectasia

Anti-centromere antibodies

Rx: sildanefil/bosentan

Question 17

Presentation of Diffuse Cutaneous systemic sclerosis

Rx

Answer 17

Early organ fibrosis: lung, cardiac, GI, renal

Anti-topoisomerase-1 antibodies
Anti-RNA polymerase

Rx: Nil

Question 18

Name 5 Dermatomyositis features

Answer 18

Macular rash
Lilac-purple heliotrope with oedema
Nailfold erythema
Gottron’s papules
Subcut calcifications

Question 19

Tests of Polymyositis and dermatomyositis

Answer 19

Plasma Muscle enzymes: ALT, AST, LDH, CK, Aldolase
MRI
Autoantibodiy associations: anti-Mi2, Anti-Jo1

Question 20

How does SLE present

Answer 20

Variable presentation with malaise, fatigue, myalgia, fever

Lymphadenopathy, wt loss, alopecia, nail-fold infarcts, non-infective endocarditis, Raynaud’s migrain, stroke

Can be drug induced

Ass/w Antiphospholipid syndrome

Question 21

Diagnosis for SLE

Answer 21

Anti-dsDNA antibody
Complement C3 and C4
ESR

Malar rash
Discoid rash
Photosensitivity
Oral ulcers
Non-erosive arthritis
Serositis
Renal disorder
CNS disorder
Hameatological disorder
Immunological disorder
Antinuclear antibody (ANA) +ve

Question 22

Rx for SLE

Answer 22

Acute? Cyclophosphamide + high dose prednisolone
Cutaneous? Topical steroids
Maintenance: NSAIDs, hydroxychloroquine, azathioprine
Interferon A

Question 23

Antiphospholipid syndrome present with…. CLOTS

Answer 23

Coagulation defect
Livedo reticularis
Obstetric (recurrent miscarriage)
Thrombocytopenia

Question 24

Presentation of vasculitis

Answer 24

Overwhelming fatigue
Inc ESR/CRP

Systemic – skin – eyes
ENT – Pulmonary - Cardiac
GI – Renal – Neurological
GU

Question 25

Classification of Vasculitis

Answer 25

Large: Giant cell arteritis, Takayasu’s arteritis
Medium: polyarteritis nodosa, Kawasaki
Small
- ANCA +ve: resp tract + kidneys
- ANCA -ve: Henclock Schonlein purpura

Question 26

Presentation of Polyarteritis nodosa

Answer 26

Aneurysms, thrombosis
Severe systemic symp
Ass/w hep B
Skin (rash/punched out ulcers)
Renal – Cardiac – GI – GU

Question 27

Inv For Polyarteritis nodosa

Answer 27

Inc WCC
Mild eosinophilia
Anaemia
Inc ESR
Inc CRP
ANCA -ve

Question 28

Rx for polyarteritis nodosa

Answer 28

Control BP

Corticosteroids, Cyclophosphamide

Question 29

Features of Fibromyalgia

Answer 29

Chronic pain which is widespread with normal investigation results. Requires Cognitive behavioural therapy, exercise programs, low-dose antidepressants and pregabalin.

Question 30

Name 8 amount of skin manifestations of systemic diseases

Answer 30

Erythemia nodosum (crohns)
Erythema multiforme
Erythema migrans
Erythema marginatum
Pyoderma gangrenosum (Crohns)
Vitiligo
Dermatitis herpetiformis (coeliac – gluten-sensitive enteropathy – Rx: dapsone)
Pretibial myxoedema (Hyperthyroidism)