MIca week 8

Question 1

What is this rash?

Answer 1

butterfly

SLE

Question 2

What is the antibody in SLE

Answer 2

Anti nuclear

Question 3

IN what demographic is SLE?

Answer 3

chcinese, asian, afrocaribean

Question 4

What are characteristics of SLE

Answer 4

Serositis

Oral ulcers
Arthritis
Photosensitivuty
Blood
Renal

ANA
Immune
Neurologoic
Malar
Discoid

Question 5

What are tests yo woudl like to do

Answer 5

FBC normochromic normocytic anaemia, ESR, ANA,anti-dsDNA

Auto antibodies- anti-SM, anti dsDNA,

complement

CXR

renal biopsy

MRI/CT

Question 6

What conditions that are associated with SLE

Answer 6

Autoimmune: scleroderma, polymyositis, Rheumatoid, Sjogren

anti phospholipid syndrome

CVD, HTN, OSteoporosis, Non Hodkiin Lymphoma

Question 7

What is the mangement of SLE

Answer 7

carful counselling

lifestyle- diet exercise, mentalwellbeing, flu jab, family planning

symptomatic- pain control, NSAIDS, analgesia, physiottherapy

Specialist- steroid, hydroxychlorouiune,cyclophosphamide,mycophenolate, azathioprine, boilogics

Question 8

what is a poor indication in SLE?

Answer 8

renal involvement

Question 9

What is Sjogren disease?

What are the types

Answer 9

lymphocytic infiltration of exocrine glands

primary

secondary: rheumatoid artrithis,SLE, systemic, sclerosis

Question 10

What are the symptoms of Sjogrens?

Answer 10

raynauds

dysparunia

eye dry

dry mouth - drink a lot

dry skin

fatigue

PArotid or submandibular swelling

Question 11

What do you do in examination of Sjogrens?

Answer 11

Schirmer’s test- filter paper put in lower conjuctiva

drool test

submandibular or parotid swelling, lymphadenopathy

Question 13

What investigation would you do for Sjogrens

Answer 13

anti Ro, Anti La antibodies

FBC- anaemia of chronic disease

U&E

ESR - high

LFT’s
immunoglobulin (RhF +, ANA+, anti Ro/ La ab +)

USS of salivary gland

biopsy and immunohistology

Question 14

Answer 14

Question 15

What is the managementof Sjogren’s

Answer 15

mouth- artificial saliva, good dental hygien, hugh fluoride

2. Eyes- artificial tears, ophtalmology- puntal plug, cyclosporin eue drops
3. Other symtoms- analgesia for arthralgia, emolient for skin, raynauds specific

4,- systemeci therapy - Hydroxychloroquine

Question 16

WHat are patietns with Sjoegren at higher risk of getting?

Answer 16

non Hodgekin Lymphoma

Question 17

What are distinguishing feature between OA and RA

Answer 17

OA: unilateral, worse at night, weight baring joints (heberden adn bouchards)
RA: symmetrical, better in the morning, (swann neck deformity, boutonniere, z thumb, ulnar deviation), poly

Question 18

Answer 18

Question 19

Answer 19

loss of joint space

subchondral cyst

osteophyte

Question 20

What does the trendelenberg test and what condition does it show

Answer 20

stand but one leg up

look at the hip adductors

missalignement

DAMAGED in osteoarthritis

Question 21

What is the thomas test

Answer 21

ask patient to bring knee to the chest when lying down

Can not keep the other leg hanging down

SIGN OF osteoarthritis

Question 22

What is polymyalgia rheumatica

Answer 22

inflammatory condition

with severe bilateral pain and stiffness in the morning

Hip and shoulder and neck

Question 23

in what demographic do you find patients with polymyalgia rheumatica?

Answer 23

old lady

Question 24

what does polymyositis present with?

Answer 24

weakness

NOT really pain

Question 26

What is the treatment for patients with polyathraliga rheumatica

Answer 26

RISk of diabetes melitus prednisolilone 3 weeks and wean them down treatment for 1-2 year Bisphophonates, Vit D3 Diet exercise PPI lipid and BP

Question 27

in polymyaligia rheumatica what are the marker you use to identify if your treatemnt is working?

Answer 27

ESR symptoms

Question 28

What are symtpoms of Giant cell arteritis

Answer 28

unilateral headache vision changes- shades, blurred, double vision, visual loss jaw claudication scalp tenderness PMR

Question 29

How do you manage a patient with GCA

Answer 29

**no visual sympoms**- _40-60 mg prednisolone_ , PPI and arrange bloods if possible - refere urgently to _rheumatology_ within 3 days- may arrange biopsy if **visual symptoms**- _start prednisolone 60-100mg_, PPI cover and same day assesment with _ophtalmology_

Question 30

reactive arthrits

Answer 30

seronegative clinically associatedwith inflammationback pain

Question 31

What are symptoms seen in reactive arthritis

Answer 31

FEVER, Malaise GU/GI lower back pain heel pain - achilles tendonitis erythema nodosum _uvitis_ _urethritis_ _arthritis_ can't see, can't pee and climb a tree

Question 33

WHat are investigations for a monoarthritis

Answer 33

Esrr/ CRP FBC HLA B27 Joint aspiration underlying GI/GU

Question 34

What are management

Answer 34

treat infection phy

Question 35

What are bloods to monitor paitients on methotrexate

Answer 35

FBC U&E- look at creatinine LFT

Question 36

What are drugs you can not give patientts on methotrexate

Answer 36

trimethoprim

Question 37

What areside effect

Answer 37

photosensitivity agranuloysitossi liver imparement lung fibrosis

Question 38

What areinvestigations for GOUT

Answer 38

exclude: septic arthritis, pseudo gout adn RA or OA serum urate

Question 39

What is the management for gout

Answer 39

RICE: rest, ice, compression and elevation NSAIDS,colchicine, steroids think of PPI Allopurinol for prevention but not in acute episode because precipitates symptome