Musculoskeletal

Question 1

Reiter’s syndrome

Answer 1

Acute (reactive) arthritis
Conjunctivitis
Non-specific urethritis

Can’t see, can’t pee, can’t climb a tree

HLA-B27

Question 2

Psoriasis

Answer 2

Can mimic RA
Psoriatic skin and nail changes
Asymmetrical arthritis (DIP) +/- sacroiliitis

Question 3

Felty’s syndrome

Answer 3

Rheumatoid disease + splenomegaly

Splenomegaly –> pancytopenia + recurrent infex

Question 4

anti-dsDNA

Answer 4

SLE

Question 5

anticentromere

Answer 5

systemic sclerosis

Question 6

anti-Scl-70

Answer 6

diffuse cutaneous systemic sclerosis

Question 7

anti-Jo-1

Answer 7

dermatomyositis

Question 8

c-ANCA

Answer 8

Wegener’s granulomatosis

Question 9

p-ANCA

Answer 9

PAN, AI hepatitis, IBD, sclerosing cholangitis

Question 10

anticardiolipin

Answer 10

antiphospholipid syndrome

Question 11

anti-La/anti-Ro

Answer 11

Sjoegren’s syndrome

Question 12

GCA

Answer 12

Unilateral headache, scalp tenderness, jaw claudication, vision loss and PMR

Question 13

Takayasu’s

Answer 13

Young japanese women, weak distal pulses, arm claudication

Question 14

PAN

Answer 14

HepB, renal/mesenteric/skin involvement

Rosary sign on renal angiography

Question 15

Kawasaki’s

Answer 15

Conjuctivitis
rash
Arthralgia
Strawberry tongue
Oedema
Fever

Question 16

Ankylosing spondylitis

Answer 16

Affects YOUNG people, chronic back pain, sacroiliitis, uveitis

++ ESR/CRP

****HLA-B27 90% specific

***x-ray = flattening of the lumbar curve with subchondral bone erosion involving the sacroiliac joints

TREAT with NSAIDs

Question 17

Diagnostic criteria for diagnosing rheumatoid arthritis

Answer 17

Morning stiffness (>1 hour for 6+ weeks)

Arthritis in 3+ joints (>6 weeks)

Arthritis of hand joints (>6 weeks)

Symmetrical arthritis (>6 weeks)

Rheumatoid nodules

Positive rheumatoid factor

Radiographic changes

Question 18

Jones criteria - major manifestations

Answer 18

Diagnosing RHEUMATIC FEVER

Carditis
Polyarthritis
Chorea
Erythema marginatum
Subcutaneous nodules

Question 19

Jones criteria - minor manifestations

Answer 19

Diagnosing RHEUMATIC FEVER

Fever
Arthralgia
Previous Hx rheumatic fever/heart disease

Question 20

What are the clinical features of Paget’s disease of bone?

Answer 20

Deep, boring pain
Gout
Heat
Bone expansion + deformity (pelvis/lumbar spine)
Fractures
Neurological Sx
High output cardiac failure

Question 21

What would you expect to see when investigating Paget’s disease of bone?

Answer 21

Alkaline phosphatase ++++++

Also plain x-ray / bone scan