MRCP Rheumatology

Question 1

Which autoantibodies are associated with limited systemic sclerosis (CREST)?

Answer 1

anti-centromere

Question 2

Which antibodies are associated with dermatomyositis?

Answer 2

ANA (60%)

Anti-Mi-2 (25%) - more specific than ANA

Question 3

Describe T scores and what they signify

Answer 3

> -1.0: normal

-1 to -2.5: osteopenia (lifestyle modifications)

Question 4

When is a Z score used?

Answer 4

In younger patients to assess their bone mineral density

Question 5

Describe mechanism of action of bisphosphonates

Answer 5

Decreased osteoclastic bone resorption and increased osteoclastic apoptosis

Question 6

Method of action of allopurinol

Answer 6

Xanthine oxidase inhibitor

Question 7

Earliest x-ray finding in ank spond?

Answer 7

Blurring of the upper and/or lower vertebral rims at the thoracolumnar junction

Question 8

What osteoporosis prevention is offered to people on LT steroid therapy?

Answer 8

Alendronic acid, calcium carbonate and vitamin D

Question 9

Ank spond symptoms remain uncontrolled by 2 NSAIDS - next step

Answer 9

anti-TNF eg adalimumab, etanercept

Question 10

Autoantibodies associated with diffuse systemic sclerosis

Answer 10

Anti-Scl-70

Question 11

Which anti-TB drug is most likely to cause raised serum urea and therefore gout?

Answer 11

Pyrazinamide

ethambutol also raises serum urea but to a lesser extent

Question 12

Autoantibodies associated with polymyositis

Answer 12

ANA (33%)

Anti-Jo-1 (more commonly seen in patient who also have pulmonary fibrosis)

Question 13

Best investigation for confirming diagnosis of polymyositis or dermatomyositis?

Answer 13

Muscle biopsy

Question 14

What are the most common pulmonary manifestations of SLE?

Answer 14

Pleurisy and pleural effusions (often bilateral)

Question 15

Which typically comes first in psoriasis - rash or arthritis?

Answer 15

Rash

Question 16

HLA type associated with Felty’s syndrome

Answer 16

HLA-DRW4

Question 17

Biochemical evidence of ACTIVE SLE

Answer 17

Low complement
Raised anti-dsDNA
Rising ESR
Falling Hb/WCC/platelets

Question 18

Cause of vision loss in GCA

Answer 18

Anterior ischaemic optic neuropathy

Question 19

Episcleritis vs scleritis

Answer 19

Episcleritis - gritty, red eyes. Visual acuity preserved. Self-limiting.
Scleritis - very painful (esp when moving), red eyes. Watering, photophobia, decreased vision. Requires systemic treatment.

Question 20

Red hot swollen joint with meniscal calcification on x-ray

Answer 20

Pseudogout (calcium pyrophosphate)

Question 21

HLA type most commonly associated with rheumatoid arthritis

Answer 21

HLA-DR4

Question 22

Most common reason for hyperuricaemia in gout?

Answer 22

Decreased renal excretion (around 90% of cases)

Only 10% is increased dietary intake

Question 23

All patients with lupus nephritis regardless of stage should receive which drug?

Answer 23

Hydroxychloroquine

Stage III/IV require immunosuppression with steroids + cyclophosphamide/mycophenolate mofetil

Question 24

Most common site affected by Paget’s disease

Answer 24

Spine, esp lumbar

Question 25

Commonest abnormality of renal biopsy in EGPA (ie Churg-Strauss)

Answer 25

Necrotising glomerulonephritis

Question 26

Generalised joint pains, high fever (spiking at night), rash

Answer 26

Adult onset Stills disease

May also have hepatosplenomegaly
Bloods: v high ferritin. autoantibody negative

Question 27

First line treatment for psoriatic arthritis

Answer 27

Methotrexate

Treat as for RA

Question 28

How long after acute gout flare can urate lowering therapy be commenced?

Answer 28

2 weeks

Question 29

PMR vs polymyositis symptoms

Answer 29

PMR - stiffness & pain/ache (only 50y+)

Polymyositis - stiffness & WEAKNESS. NO pain

Question 30

Positive Schirmers test

Answer 30

<5mm in 5min signifies defective tear production

Question 31

Test for monitoring disease activity in Paget’s disease

Answer 31

6-12 monthly alk phos levels (aim is to normalise bone turnover)

Question 32

Haemochromatosis is associated with PSEUDOGOUT

Answer 32

yes it is!

Question 33

Rescue medication to counteract the effects of accidental methotrexate overdose

Answer 33

Calcium folinate (folinic acid)