Massive resvision

Question 1

Poor prognostic indicators for RA

Answer 1

• young age at onset
• male
• HLA DR4 positive
• many active joints
• delayed referral
• high CRP/PV at outset
• RhF/CCP positive
• early radiological erosions
• poorer functional scores at outset
• adverse socioeconomic circumstances
• extraarticular features

Question 2

Anti-CD20

Biologic agent –> B cell depletion

Answer 2

Rituximab

Question 3

Disruption of T cell costimulation

Answer 3

Abatacept

Question 4

IL-1 inhibitor

Answer 4

Anakira

Question 5

IL-6 inhibitor

Answer 5

Tocilizumab

Question 6

Genes in RA

Answer 6

HLA-DR4, HLA-DR1

Question 7

Who is SLE more common in

Answer 7

Women, asian, afro-carribean, hispanic etc

Not african blacks

Question 8

Hormonal factors influencing SLE

Answer 8

incidence increased in those with higher oestrogen exposure - early menarche, on oestrogen containing contraceptives and HRT

Question 9

Environmental factors and SLE

Answer 9

Viruses eg Epstein-Barr Virus
UV light may stimulate skin cells to secrete cytokines stimulating B-cells
Silica dust (found in cleaning powders, cigarette smoke and cement) may increase risk of developing SLE

Question 10

Anti-Blys

Answer 10

Belimumab

Question 11

What do patients with SLE die from?

Answer 11

Infection important cause of death in the early / medium stage of disease
Cardiovascular disease the major the cause of death in the late stages

Complications of SLE in the first few years
Late onset of disease
Male SLE
Lower socioeconomic class

Question 12

Anti-ENA in SLE and

Answer 12

Secondary sjogrens features

Congenital heart block

Question 13

Definition of vasculitis?

Answer 13

Presence of leukocytes/immune complexes in the vessel wall with reactive damage to mural structures

Question 14

How do you assess vasculitis?

Answer 14

BVAS (Birmingham vasculitis score)

Question 15

Takayasu arteritis

Answer 15

Large vessel

Question 16

Giant cell arteritis

Answer 16

Large vessel

Question 17

Kawasaki’s

Answer 17

Medium vessel

Question 18

PAN

Answer 18

Medium vessel

Question 19

Isolated CNS vasculitis

Answer 19

Medium vessel

Question 20

Churg-strauss

Answer 20

Small vessel

Question 21

Wegeners

Answer 21

Small vessel

Question 22

Microscopic polyangitis

Answer 22

Small vessel

Question 23

HSP

Answer 23

Small vessel

Question 24

Essential cryoglobulinemia

Answer 24

Small vessel

Question 25

Hypersensitivity vasculitis

Answer 25

Small vessel

Question 26

Spondylolysis

Answer 26

Defect in the pars interarticularis of the vertebra

Question 27

Spondylolisthesis

Answer 27

Forward slippage of one vertebra on another

Question 28

Kyphosis

Answer 28

``` Centre of gravity anterior to spine High pre – load May be “opposite” of scoliosis Treatment of limited success Surgical treatment very risky ```

Question 29

When do you give surgical treatment for kyphosis?

Answer 29

When conservative treatment has failed Adolescent with > 50% slip Progressive neurological deficit Postural deformity

Question 30

Treatment for spondylolisthesis?

Answer 30

Grade 1 or 2: Abnormal neighbouring discs -Posterolateral stabilisation in situ Grade 3+ : Combined discogenic + nerve root problem -one stage combined anterior and posterior stabilisation

Question 31

Epimysium

Answer 31

Surrounds entire muscle

Question 32

Endomysium

Answer 32

Surrounds individual muscle fibres

Question 33

Perimysium

Answer 33

Surrounds bundles of muscle fibre

Question 34

Red fibres

Answer 34

(Type 1, slow twitch); large mitochondria &  myoglobin

Question 35

White fibres

Answer 35

White fibres (Type 2, fast twitch); small mitochondria & large motor end-plates

Question 36

Definitive test for Dermatomyositis?

Answer 36

Muscle biopsy!!

Question 37

CK levels lower than in PM Muscle biopsy shows inclusion bodies Responds poorly to therapy

Answer 37

Inclusion body myositis

Question 38

Treatment for polymyositis/dermatomyositis?

Answer 38

``` Glucocorticoids Azathioprine Methotrexate Ciclosporin IV immunoglobulin ```