Ortho/rheum

Question 1

Gout vs OA on X-Ray

Answer 1

Gout: 
- may be normal 
-Punched out lesions 
- joint spaces preserved until late disease 
No sclerotic changes

Question 2

Pseudogout

Answer 2

Acute calcium pyrophosohate dehydrate arthropathy

Question 3

Gout vs pseudogout

Answer 3

Polarised light microscopy:

• gout - negatively bifringent urate crystals
• pseudogout - positively bifringent crystals

Pseudogout typically affects larger joints

Question 4

Spondyloarthritides

Answer 4

Ankylosing spondylitis
Enteropathic spondyloarthropathy
Psoriatic arthritis
Reactive arthritis

Question 5

Reiters syndrome

Answer 5

Reactive arthropathy

Triad:

• conjunctivitis
• urethritis
• arthritis

Question 6

DEXA scan scores

Answer 6

> -1.0 normal

-1 to -2.5 osteopaenia

Question 7

Myxoid cyst

Answer 7

Mucous cyst
Benign ganglion cyst
Distal dorsal aspect of finger, usually OA in surrounding joint
Middle aged women

Question 8

Osteoarthritis X-Ray changes

Answer 8

LOSS
Loss of joint space
Osteophytes
Subchondral sclerosis
Subchondral cysts

Question 9

Rheumatoid arthritis

Answer 9

LESS
LoSs of joint space
Erosions 
Soft tissue swelling 
Soft bones - osteopaenia

Late findings: peri articulate erosions, subluxation

Question 10

Differentials of claudication

Answer 10

peripheral vascular disease
spinal claudication
Sciatica
Musculoskeletal 
OA
DVT

Question 11

Falls history

Answer 11

seizure
stroke/tia
strong emotions
stoke-adams attack
CVS - vasovagal, arrythmia, postural hypotension, silent MI, carotid sinus syncope, aortic stenosis
Visual
Poor mobility
Pharmacy

Question 12

Scleroderma antibodies

Answer 12

diffuse - anti-topoisomerase

limited - anti-centromere antibodies

Question 13

Paeds - pain walking up stairs

Answer 13

chondromalacia patellae

Question 14

paeds - knee pain after exercise

Answer 14

osgood-schlatter disease

Question 15

Drug induced lupus

Answer 15

Isoniazid
Hydralazine
Procaine die
Quinidine
Chlorpromazine
Minocycline
Phenytoin

Question 16

Antibodies in SLE

Answer 16

ANA positive in 95%
dsDNA antibody positive 60%
RhF positive 40%
ENA positive 20-30%

Question 17

Monitoring lupus

Answer 17

dsDNA on antibody
C3 and C4 levels
ESR

Question 18

Test for drug induced lupus

Answer 18

Antihistone antibodies positive in 100%

Question 19

Antiphospholipid antibodies

Answer 19

Anticardiolipin

Lupus anticoagulant

Question 20

Features of antiphospholipid syndrome

Answer 20

CLOT
C coag defect
L livedo reticularis
O obstetric complications - recurrent miscarriages 
T thrombocytopenia

Question 21

Fibromyalgia diagnosis

Answer 21

Females ten times more likely
>3 month history
Widespread pain
11/18 joints

Question 22

M.E diagnosis

Answer 22

Persistent disabling fatigue >6 months