Finals

Question 1

Gout ivx

Answer 1

CRP
URate

Mx

NSAIDS
Colchicine

Prevention - avoid purine in alcohol, beer, red meat, shellfish, pulses, spinach, asparagus
Weight loss to reduce

Question 2

Rheumatoid investigations

Answer 2

CRP and ESR
CCP antibody and RF positive

US - synovitis
XR - for erosive damage

Question 3

Generic ladder of support in rheum

Answer 3

analgesics
NSAIDS

Steroids to damp down inflammation

Conventional DMARD - methotrexate

DMARDS - synthetics - Jakinib

Biological DMARDs - TNF

Question 4

When do you move onto biological DMARDS?

Answer 4

If two conventional DMARDS haven’t worked e.g. methotrexate and sulfasalazine

Answer 5

Refer to physio, support groups

Question 6

Symptoms in axial spondyloarthritis

Answer 6

Pain worse in the morning

Question 7

Movement findings in axial spond

Answer 7

Occiput to wall disatance
Thoracic expansion an drotation
Lumbar spine forward flexion and lateral flexion

Question 8

Axial spond investigations

Answer 8

CRP, HLA B27

MRI to detect pre-radiographic changes

Question 9

MRI and X ray findings for ax spond

Answer 9

Shiny corners - oedema
Sacroilitiitis

X ray

Widening of joints
Fusion of joints

Question 10

Mx of ax spond

Answer 10

Analgesics
NSAIDS
Steroids
Biologics

DMARDS DO NOT WORK GO STRAIGHT TO BIOLOGICS

Question 11

Joint distribution of psoriatic arthritis

Answer 11

PIP, DIP, dactylitis

Question 12

Psoriatic nail changes

Answer 12

Oncholysis
Pitting
Subungal hyperkeratosis
Discolouration

Question 13

Psoriatic investigations short and long term

Answer 13

Short term - soft tissue changes - US, MRI for synovitis

X ray in longer term

Question 14

Invs for reactive arthritis

Answer 14

CRP, HLA-B27
ASOT for strep
Lyme serology - chronic lyme disease
GUM - Chlamydia

Question 15

Reaactive

Question 16

Osteopenia vs osteoporosis

Answer 16

T score -1 to -2.5 = osteopenia
T score -2.5 or below = osteoporosis

Question 17

After a fracture how do you manage

Answer 17

T score
Input data into FRAX score
NOGG guidelines

Question 18

Low risk osteoporosis mx

Answer 18

Oral alendronic acid

Question 19

High risk osteoporosis mx

Answer 19

IV zolendronic acid annually
SC denosumab 6 monthly
PTH analogue - SC teriparatide
Anti sclerostin antibody - romosozumab monthly for 1 year then bisphosphonate

Question 20

Connective tissue disease/small vessel vasculitis investigation

Answer 20

Urine dip for nephritis
ANA for connective tissue
ANCA for subset of small vessel vasculitis

Question 21

SLE investigations

Answer 21

dsDNA = SLE
ENA - Ro, La, Sm, RNP

Full blood tests incl. LFT

Question 23

Management of SLE

Answer 23

Pred
Hydroxychloroquine

Steroid sparing - methotrexate, mycophenolate, tacrolimus

Severe disease - cyclophosphamide

Question 24

Anti centromere abx is for

Answer 24

Limited scleorderma

Question 25

anti scl70

Answer 25

specific for diffuse cutaneous scleroderma

Question 26

Idiopathic inflammatory myositis

Answer 26

Dermatomyositis + polymyositis

Question 27

Invs for Idiopathic inflammatory myositis

Answer 27

Creatinine kinase ANA and myositis antibody panel MRI scan involving muscles EMG Muscle biopsy PET scan to investigate for underlying malignancy

Question 28

Mx of dermatomyositis/polymyositis

Answer 28

Prednisolone Steroid sparing agents

Question 29

cANCA

Answer 29

GPA

Question 30

p-ANCA

Answer 30

eGPA

Question 31

Another name for HSP

Answer 31

IgA Vasculitis

Question 32

When does IgA vasscsulitis present

Answer 32

After an infection, with purpuric rash, glomerulonephritis, abdo pain, joint pain

Question 33

Investigation for IgA vasculitis

Answer 33

Urinalysis IgA CRP Renal function Skin/kidney

Question 34

Mx of IgA vasculitis

Answer 34

Conservative in adults monitor urinalysis, consider nephrology follow up

Question 35

When do you do a PET scan for GCA?

Answer 35

if it's large vessel

Question 36

when do you refer to opthal for GCA

Answer 36

SAME DAY opthal review

Question 37

How much prednisolone for GCA

Answer 37

40mgs OD or 60mgs if visual symptoms)

Answer 38

Biopsy

Question 39

pseudogout

Answer 39

knees and wrists Calcium pyrophosphate crystals positive birefringent Rhomboid crystals

Question 40

gout

Answer 40

first MTP Negative birefringent