Musc

Question 1

What are the symptoms of osteomalacia

Answer 1

Bone pain/tenderness
Fracture (horizontal fractures at Looser’s zone at the neck of the femur are commonly seen)
Proximal weakness
Bone deformity

Question 2

consequences of hyperparathyroidism

Answer 2

Hypercalcaemia (increased Ca2+ reabsorption)
Hypophosphataemia (increased phosphate excretion in the urine)
Osteitis fibrosa cystica (due to increased osteoclast activity)

Question 3

indications for bone biopsy

Answer 3

Most of the time, you don’t need to do it because eg x rays is suffice
Confirm the diagnosis of a bone disorder
Find the cause of or evaluate ongoing bone pain or tenderness
Investigate an abnormality seen on X-ray
For bone tumour diagnosis (benign vs malignant)
To determine the cause of an unexplained infection
To evaluate therapy performance

Question 4

2 main autoantibodies in RA

Answer 4

Rheumatoid factor

Anti-cyclic citrullinated peptide antibody

Question 5

What family of diseases does ankylosing spondylitis belong to

Answer 5

seronegative spondyloarthropathies

Question 6

location of inflammation in ankylosing spondylitis

Answer 6

enthesis - connects ligaments/tendons to bones

Normally happens to bones in the spine hence spondylo

Question 7

Lupus causes multi-site inflammation but state some sites that are particularly badly affected.

Answer 7

joint, skin, kidney

Question 8

SLE autoantibodies

Answer 8

Anti-nuclear antibodies

Anti-double stranded DNA antibodies

Question 9

SLE is part of which family of diseases

Answer 9

connective tissue diseases

Question 10

MHC associations of RA, SLE and AS (ankylosing spondylitis)

Answer 10

Rheumatoid arthritis – HLA-DR4
SLE –HLA-DR3
Ankylosing spondylitis – HLA-B27

Question 11

diffuse systemic sclerosis antibody

Answer 11

Anti-Scl-70 antibody

anti-topoisomerase antibody

Question 12

limited systemic sclerosis antibodies

Answer 12

Anti-centromere antibodies

Question 13

Dermato-/Polymyositis

Answer 13

Anti-tRNA transferase antibodies

Question 14

Mixed connective tissue disease

Answer 14

Anti-U1-RNP antibodies

Question 15

What is the difference in the specificity of the autoantibodies in SLE?
Out of the 2 autoantibodies you need to know for SLE, which one of them correlates with disease activity?

Answer 15

Anti-nuclear antibodies are found in all cases of SLE BUT isn’t specific to SLE

Anti-dsDNA antibodies ARE specific to SLE
serum level of this antibody correlates with disease activity

Question 16

What are the features of a sick lupus patient in terms of complement levels and serum levels of anti-dsDNA antibodies?

Answer 16

Low complement levels (used up)

High serum levels of anti-dsDNA antibodies (ie a lot of immune complexes)

Question 17

Name a monoclonal antibody that targets RANKL.

Answer 17

denosumab

Question 18

What is RANKL produced by and what does it do?

Answer 18

RANKL is produced by T cells, osteoblasts and stromal cells (means cells of connective tissue, eg synovial fibroblasts)
It stimulates osteoclast formation

RANKL can be upregulated by eg TNF alpha in RA which leads to osteoclast activation and bone destruction in RA. Hence there are drugs stopping RANKL

Question 19

What drug targets CD20
What drug targets BLYS

What do these drugs do

Answer 19

Rituximab – anti-CD20 monoclonal antibody
Belimumab – anti-BLYS monoclonal antibody (BLYS is a B cell survival factor)

Reduces B cell survival

Question 20

what do glucocorticoids do

Answer 20

phospholipase a2 inhibition

Question 21

define RA

Answer 21

Chronic autoimmune disease characterised by pain, stiffness and symmetrical synovitis (inflammation of the synovial membrane) of synovial (diarthrodial) joints

Question 22

what type of Antibodies are rheumatoid? (class, what do they bind to)

Answer 22

typically IgM antibodies, binds to Fc portion of the IgG

Question 23

Name 2 deformities of RA if left untreated

Answer 23

Swan-neck deformity 
 Hyperextension of PIP 
 Hyperflexion of DIP 
Boutonniere deformity (button-like) 
 Hyperflexion at PIP

Question 24

which enzymes are involved in citrullination of arginine?

Answer 24

Peptidyl arginine deaminases (deamination because you are removing an amine group when converting arginine to citrulline)

Question 25

what type of collagen is present in articular cartilage

Answer 25

type 2

Question 26

3 dominant cytokines in the pathogenesis of RA

Answer 26

IL-1
IL-6
TNF-alpha

Question 27

Reactive arthritis can cause enthesopathy. Which entheses are likely to get affected and what symptoms will that cause?

Answer 27

Achilles tendonitis
Dactylitis *
Metatarsalgia (painful feet because of inflammation of the palmar fascia)

*Ligaments in fingers insert into bones etc hence theres enthesis. Often presented as Swollen whole finger, not just joints (aka dactylitis)