final tutorial

Question 1

Septic

Answer 1

septic arthritis - one joint
gout -

Question 2

Management of acute gout

Answer 2

NSAID - naproxen
Hx of alcohol disease, CVD, renal failure, peptic ulcer disease or if 65

If no NSAID possible
Colcichine - SE = diarrhoea, so don’t give elderly patient,
Steroids

Question 3

What do you give for prevention of gout?

Answer 3

Allopurinol - xanthine oxidase inhibitor - give lifelong, but can trigger an attack of gout so give 3 months of colchicine

Question 4

RA management - name four drugs. When would you use biologics>

Answer 4

Methotrexate - use double contraception
Sulfasalazine - reduces sperm count
Leflunamide
Hydroxychloroquine

If 2 of these don’t work over 6 months, consider a biologic add on and then reduce

Question 5

What is azathioprine? What is it used for?

Answer 5

Azathioprine - steroid sparing agent - lupus and connective tissue diseases

Question 6

Management of osteoporosis, side effects and how to use

Answer 6

Alendronic acid - SE - oesphageal/GI ulcers or GORD
Or give zolendronate infusion

Question 7

Granulomatosis polyangiitis

Answer 7

Wegener’s
Middle aged/elederly men

Upper respitatory tract
Sinusitis
Saddle shaped nose
Lower respitaroty tract
CXR - pulmonary nodules

pulmonary haemorrahge

Question 8

Granulomatosis polyangitis antibody

Answer 8

c-ANCA, proteinase 3

Answer 9

Churgs strause - MYPO - myeloperoxindase - p ANCA

Question 10

HLA B27 features

Answer 10

Crohns, IBD, enthesitis, uveitis, dactylitis, psoriasis,

Question 11

Most common organism for reactive arthritis

Answer 11

Chlamydia

Question 12

When you would suspect gonorrhoea

Answer 12

Rash on hands and feet

Question 13

Investigation work up for reactive arthritis picture

Answer 13

ESR/CRP
Serology RF, CCP, ANA
Urate level to exlude gout
Refer to GUM
Aspirate joint

Question 14

Management of reactive arthritis

Answer 14

NSAIDs, rest, splinting
Steroid injection
DMARDs if more than 3 months

Question 15

When does ESR go up?

Answer 15

ESR - infection, inflammation, malignancy, anaemia, renal failure, pregnancy

Ca - 2.84

Question 16

High calcium, high ESR up, what might you see on x ray of spine

Answer 16

Vertebral compression fracture

Question 17

Differentials for vertebral fracture

Answer 17

Multiple myeloma - send of bloods for electrophoresis, urine for

Question 18

when do you give hydroxychloroquine

Answer 18

hydroxylchol - for connectiv tissue disaees

Question 19

what do you give to treat ankylospondylitis

Answer 19

NSAIDs, if they don’t work, give biologics - anti-TNF, or anti-IL17 - secucinumab

Question 20

give an example of anti-TNF

Answer 20

infliximab = anti-TNF

Question 21

What is arthralgia

Answer 21

Pain and stiffness without swelling

Question 22

First line drug for SLE

Answer 22

Hydroxychloroquine

Question 23

Three key tests for SLE

Answer 23

dsDNA
ESR
c3/c4

Question 24

What are the symptoms of SLE in mild, moderate and severe disease?

Answer 24

mild - rash, arthritis, lymphadenopathy
moderate - pleurisy, pericarditis, cytopenias
severe - CNS lupus, glomerulonephritis

Question 25

SLE antibodies

Answer 25

Always ANA positive Anti-SM specific for SLE

Question 26

Ro antibody - pregnancy consequence

Answer 26

2 percent risk of neonatal heart block

Question 27

Tx of SLE

Answer 27

Hydroxychloroquine for skin/joints Prednisolone - for flares Azathioprine - for long term Mycophenolate Rituximabl/cyclphosphamide for worse diseaes

Question 28

how do you diagnose psoriatic arthritis

Answer 28

Psoriasis - not symmetrical Dactylitis Nail oncholysis

Question 29

How much prednisolone do you give for steroids?

Answer 29

visual disturbance - give 60mg no visual disturbance - give 40mg GCA - large vessel vasculitis, systemic unwellness, fever, malaise, fatigue, myalgias etc

Answer 30

Over 50s, Rare in asians, more in caucasians associated PMR Temporal artery biopsy US temporal CT PET scan to screen for other parts of the body always do dexa scan and bisphonate alongside steroids weight gain cetnarl obesity htn diabetes cataracts poor wound healing bruising thin skin

Answer 31

weight gain cetnarl obesity htn diabetes cataracts poor wound healing bruising thin skin

Question 32

Which antibody should you never give with methotrexate and why?

Answer 32

Trimethorprim - never give with methotrexate as it depletes folate levels and causes a pancytopenia

Answer 33

Chest xray - to exlude pulmonary fibrosis, interstitutional pneumonitis

Question 34

What symptoms does sacroiliitis cause

Answer 34

sacral pain and stiffness no numbness in leg, impingement etc