Passmed specifics

Question 1

Malignancy (or suspected) + raised CK suggests what?

Answer 1

Polymyositis

Question 2

What is seen on fundoscopy in temporal arthritis?

Answer 2

• Pale and oedematous optic disc
• Due to anterior ischaemic optic neuropathy secondary to inflammation of the posterior ciliary arteries

Question 3

Most common causative organism of septic arthritis (generally and IVDU)?

Answer 3

Staph Aureus

Question 4

Most common causative organism of septic arthritis in sexually active young people?

Answer 4

Neisseria Gonorrhoea

Question 5

What antibody is most specific for limited cutaneous sclerosis?

Answer 5

• Anti-centomere antibodies
• Remember: limited (CENTRAL) systemic sclerosis = anti-CENTROmere

Question 6

Patients who are allergic to aspirin may also be allergic to what the drug?

Answer 6

Sulfasalazine

Question 7

How many different NSAIDs must a patient have failed to respond to before they can be started on anti-TNF alpha inhibitors, in someone with predominantly axial ankylosing spondylitis?

Answer 7

2

Question 8

What is first line treatment for ankylosing spondylitis?

Answer 8

Exercise regimes and NSAIDs

Question 9

What is the treatment for moderate/severe psoriatic arthropathy?

Answer 9

• DMARDs
• Preferably methotrexate

Question 10

What is the treatment for methotrexate toxicity?

Answer 10

• Folinic acid
• (folic acid prescribed with methotrexate)
• (Methotrexate inhibits dihydrofolate reductase (DHFR), preventing the synthesis of purines and pyrimidines required to create DNA and RNA)
• (Folinic acid is the treatment of choice for methotrexate overdose as it allows for purine and pyrimidine synthesis to occur despite the presence of DHRF inhibitors, therefore allowing for some normal DNA replication to take place)

Question 11

What major side effect does azathioprine cause and what is done to investigate it?

Answer 11

• Myelosupression
• FBC
• TPMT activity measured before commencing azathioprine

Question 12

What medication should be started in all housebound patients?

Answer 12

• Vitamin D
• (Likely lack due to minimal exposure to sunlight)

Question 13

How long must someone wait to conceive after stopping methotrexate?

Answer 13

6 months (both sexes)

Question 14

How does pneumonitis (secondary to methotrexate) present and show on X-ray?

Answer 14

• Dry cough, fever, malaise, dyspnoea within a year of commencing treatment
• X-ray shows interstitial infiltration and alveolar shadowing

Question 15

What antibody is associated with dermatomyositis?

Answer 15

ANA (80%)

Question 16

Polymyalgia rheumatica responds dramatically to what medications?

Answer 16

• Steroids

Question 17

How should bisphosphonates be taken?

Answer 17

• Take at least 30 mins before breakfast with plenty of water
• Sit upright for 30 mins after taking

Question 18

What investigation needs to be done before starting biologics for RA and why?

Answer 18

• Chest X-ray
• Look for signs of TB as biologics can cause reactivation

Question 19

What are the blood test results of someone with osteoporosis?

Answer 19

• Normal blood tests
• Normal ALP, normal calcium, normal phosphate, normal PTH

Question 20

What is the X-ray finding of psoriatic arthritis?

Answer 20

Erosions with pencil in cup appearance

Question 21

What needs to be corrected before giving bisphosphonates?

Answer 21

• Calcium/vitamin D
• Doing so without may cause subsequent presentation of hypocalcaemia (tingling sensations, muscle spasms and aches, and nausea and vomiting)