MSK/Rheum/Ortho

Question 1

Which joints in the hand are most likely to be affected in osteoarthritis?

Answer 1

Proximal and Distal interphalangeals

DIPs and PIPs

Question 2

Which joints in the hand are most likely to be affected in rheumatoid arthritis?

Answer 2

Metocarpal phalangeal joints and Proximal interphalangeals

MCPs and PIPs and wrist

Question 3

Where are heberden and bouchard’s nodes

Answer 3

Heberden = PIP
Bouchard = DIP

Question 4

Describe the daily pattern of stiffness/pain in osteoarthritis?

Answer 4

less than an hour of pain in the morning, made worse on exercise
Asymmetrical

Question 5

What are the radiological/X ray features in osteoarthritis?

Answer 5

Loss of joint space
Osteophytes
Subchondral sclerosis
Subchondral Cysts

Question 6

Pattern of stiffness/pain in rheumatoid arthritis?

Answer 6

> 1 hour early morning stiffness, relieved on movement, symmetrical

Question 7

Name the 3 deformities seen in rheumatoid arthritis?

Answer 7

Z-thumb/boutonniere deformity
Ulnar deviation
Swan neck deformity

Question 8

Which antibody is most specific to rheumatoid arthritis?

Answer 8

Anti CCP

Question 9

How is disease monitored in rheumatoid arthritis?

Answer 9

CRP and DAS28 score

Question 10

What monitoring is required with methotrexate?

Answer 10

FBC & LFTs Risk of myelosuppression and liver cirrhosis

Question 11

1st line prevention of osteoporotic fractures in post menopausal women?

Answer 11

Alendronate (bisphosphonates)

Question 12

Blood results in osteoporosis?

Answer 12

All normal

Question 13

Blood results in primary hyperparathyroidism?

Answer 13

Increased calcium, ALP and PTH

Decreased phosphate

Question 14

Blood results in CKD?

Answer 14

Low calcium

High phosphate, ALP and PTH

Question 15

What crystals are responsible for pseudogout?

Answer 15

Calcium pyrophosphate

Question 16

Antibodies present in SLE?

Answer 16

Anti phospholipid
Anti nuclear antibodies
Anti double stranded DNA

Question 17

Inflammatory marker findings in SLE?

Answer 17

Raised ESR, normal CRP

Question 18

How to prevent SLE flares?

Answer 18

Avoid sunlight

Hydroxychloroquine

Question 19

How to test for Sjrogen’s?

Answer 19

Schrimer’s test (tear production <5mm)

Question 20

What is CREST syndrome?

Answer 20

Complete manifestation of systemic sclerosis

Calcinosis
Raynaud's
Esophageal dysfunction
Sclerodactyly
Telangiectasia

Question 21

Diagnostic antibodies in Systemic sclerosis?

Answer 21

Anti topoisomerase antibodies (ATA)

Question 22

WHat is polymyositis?

Answer 22

Inflammation of skeletal muscle

Question 23

What muscles are affected in polymyositis?

Answer 23

Shoulder and neck

Question 24

Diagnosis of polymyositis?

Answer 24

CPK - Creatinine phosphokinase positive

RF and ANA NEGATIVE

Question 25

What diseases are associated with HLA B27

Answer 25

Ankylosing spondylitis Psoriatic arthritis Reactive arthritis

Question 26

Clinical features of ankylosing spondylitis? (SPINE ACHE)

Answer 26

``` Saussage digit Psoriasis Inflammatory back pain NSAID response Enthesitis (heel) Arthritis Crohns/Colitis association/raised CRP HLA B27 Eye (uveitis) ```

Question 27

What are the first joints affected in ankylosing spondylitis?

Answer 27

Sacroiliac joints

Question 28

What is the triad of reactive arthritis?

Answer 28

Arthritis + conjunctivitis + urethritis

Question 29

Most common causes of reactive arthritis?

Answer 29

Salmonella, shigella and chlamydia

Question 30

What would you see on X ray of the finger in psoriatic arthritis?

Answer 30

Pencil in cup deformity

Question 31

How do bisphosphonates work?

Answer 31

Inhibit osteoclasts

Question 32

Side effects of bisphosphonates

Answer 32

Oesophagitis Osteonecrosis of the jaw atypical stress fractures

Question 33

What do pseudogout crystals look like?

Answer 33

weakly positive birefringent rhomboid shaped

Question 34

Blood results in osteomalacia?

Answer 34

low calcium, low phosphate

Question 35

Name 2 drugs contraindicated in prescribing methotrexate?

Answer 35

Trimethoprim Co trimoxazole High dose aspirin

Question 36

Describe gout crystals?

Answer 36

Negative birefringence, needle shaped

Question 37

Which antibody is present in nearly 100% of those with Sjrogen's?

Answer 37

Rhematoid factor

Question 38

Paget's disease treatment?

Answer 38

Bisphosphonate

Question 39

What may predispose pseudogout?

Answer 39

hyperparathyroidism

Question 40

First line treatment of raynaud's?

Answer 40

CCB e.g. nifedipine

Question 41

What virus is associated with polyarteritis nodosa?

Answer 41

Hepatitis B

Question 42

Causes of drug induced lupus?

Answer 42

Isoniazid, procainamide, hydralazine

Question 43

What drug interacts with azathioprine?

Answer 43

Allopurinol

Question 44

What drug is used as gout prophylaxis?

Answer 44

Allopurinol

Question 45

Acute gout treatment?

Answer 45

Colchicine

Question 46

How does colchicine work?

Answer 46

Inhibits mitosis, limits neutrophil mobility

Question 47

Guve examples of type 1 hypersensitivity

Answer 47

Atopy and anaphylaxis

Question 48

give an example of type 2 hypersensitivity?

Answer 48

Goodpasture's syndrome

Question 49

Give an example of type 3 hypersensitivity

Answer 49

SLE

Question 50

Type 4 hypersensitivity example

Answer 50

TUBERCULOSIS

Question 51

Triad of symptoms in Bechet's syndrome?

Answer 51

oral ulcers, genital ulcers and anterior uveitis

Question 52

What infection is associated with polyarteritis nodose?

Answer 52

Hepatitis B

Question 53

What antibody is associated with Wegener's granulomatosis?

Answer 53

cANCA

Question 54

What antibody is associated with Churg-Strauss syndrome

Answer 54

pANCA

Question 55

Where is the pain felt in polymyalgia rheumatica?

Answer 55

Neck, shoulders and hips i.e. [roximal muslces

Question 56

What activities would a patient with polymyalgia rheumatica struggle with?

Answer 56

Combing hair, climbing stairs, getting out of chairs

Question 57

What medication is associated with an increased risk of gout?

Answer 57

Thiazides and chemotherapy

Question 58

What are gout crystals composed of?

Answer 58

Monosodium urate

Question 59

What are pseudogout crystals made of?

Answer 59

Calcium pyrophosphate

Question 60

treatment of psuedogout?

Answer 60

Intraarticular corticosteroids

Question 61

Blood results in paget's disease of bone?

Answer 61

Isolated raised alkaline phosphatase (ALP) reflecting osteoblast activity

Question 62

Treatment of paget's disease?

Answer 62

Bisphosphonates

Question 63

X ray features of osteomyelitis

Answer 63

Mixed lucency New bone formation Cortical erosion

Question 64

Most common causative organism of septic arthritis in native joints?

Answer 64

S.aureus

Question 65

Proximal muscle weakness + skin lesions =?

Answer 65

Dermatomyositis

Question 66

Blood test results seen in antiphospholipid syndrome?

Answer 66

raised APTT and thrombocytopenia

Question 67

Side effect of colchicine

Answer 67

diarrhoea

Question 68

Antibodies positive in SLE?

Answer 68

anti DNA RF and ANA

Question 69

First line treatment of ankylosing spondylitis?

Answer 69

NSAIDs and exercise

Question 70

Anti JO1 antibodies are more specific to...

Answer 70

polymyositis

Question 71

Anti Ro/Anti La are specific to...

Answer 71

Sjrogens

Question 72

How to distinguish gout and psuedogout on x ray?

Answer 72

Chondrocalcinosis is present in pseudogout (calcium deposits in the joint space)

Question 73

What score confirms a diagnosis of osteoporosis?

Answer 73

t-score -2.5

Question 74

1st line bisphosphonate drug used in osteoporosis?

Answer 74

alendronate

Question 75

1st line treatment of acute reactive arthritis?

Answer 75

Ibuprofen/NSAIDs

Question 76

Treatment of Raynaud's?

Answer 76

CCB - Nifedipine

Question 77

Where does the sclerosis stop in limited cutaneous systemic sclerosis?

Answer 77

at the elbows. | Sclerosis affects face and distal limbs

Question 78

What antibody is present in drug induced lupus?

Answer 78

Anti histone

Question 79

Name a drug that interacts with azathioprine?

Answer 79

allopurinol

Question 80

What should be tested before azathioprine is commenced?

Answer 80

TPMT - thiopurine methyltransferase

Question 81

What score is used to assess hypermobility?

Answer 81

Beighton score

Question 82

Antibody in antiphospholipid syndrome?

Answer 82

Anti-Cardiolipin antibody

Question 83

low calcium, low phosphate, raised ALP?

Answer 83

Osteomalacia

Question 84

What underlying thing would you be worried about in a patient with dermatomyositis?

Answer 84

malignancy!

Question 85

Which muscle is responsible for the first 20 degrees of shoulder abduction?

Answer 85

Supraspinatus

Question 86

4 features of antiphospholipid syndrome?

Answer 86

``` CLOT: Coagulation defect (raised APTT) Livido reticularis Obstetric complications Thrombocytopenia ```

Question 87

Which antibody is associated with diffuse systemic sclerosis?

Answer 87

Anti-Scl70

Question 88

Cardiac complication of EDS?

Answer 88

Aortic regurgitation

Question 89

What would cause pain in lateral epicondylitis?

Answer 89

extending wrist against resistance with the elbow extended