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MRCP PART 1 > Rheum > Flashcards

Rheum Flashcards

1
Q

Slow onset progressive ‘deep, boring’ bone pain.
Xray shoes lytic lesion with sclerotic edges

A

Brodies abscess

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2
Q

Acute osteomyelitis most common bug? What consider if neonates? if sickle cell? IVDU?

A

S aureus - most common for all

Group A b haemolytic strep / H inflenzae in neonates

Salmonella ssp in sickle cell

IVDU - consider Pseudomonas

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3
Q

Haematogenous osteomyelitis is most common in kids. What part of bone is affected?

A

Metaphysis
[bone cant swell and puss collects under periosteum -> sore]

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4
Q

Early morning stiffness of shoulders / neck. Mild anaemia, mild raised inflam? Key condition this is assoc with?

A

Polymyalgia

Giant cell arteritis (25% get)

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5
Q

Arthritis. Back predominant + uveitis in 15-40 year old =?
What else is common assoc? Gene? Most common heart issue?

A

Ankylosing spond
IBD
HLA B27 in 90%

Aortic incompetence
[also get arrhythmias etc…]

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6
Q

Ankylosing spond XR of spine shows? Pelvis?

A

Bamboo / tramtrack appearance

Fusion of sacroiliac joints

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7
Q

TNFa - key endocrine issue

A

Raised levels increase insulin resistance

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8
Q

Fever, malaise. The short duration of multiple asymmetric arthritis. conjunctivitis. Crusted skin lesion - where is this common? What positive

A

Reactive arthritis
[Usually follows infection - may not be such an easy giveaway in Q]

Skin lesion on palms / soles (brown in colour)

HLA-B27

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9
Q

Which arthritis have positive HLA B27

A

PEAR

Psoriatic
Enteric
Ankylosing spond
Reactive

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10
Q

Which arthritis has positive HLA B27

A

PEAR

Psoriatic
Enteric
Ankylosing spond
Reactive

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11
Q

Reactive arthritis. Often cause following enteric infection Eg salmonella, shigella …. What is the usual cause if urogenital? If Respiratory ?

A

Uro - chlamydia trachomatis

Respiratory - group a strep / chlamydia pneumonia

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12
Q

Sensitive and specific for Rheum A? Gene?

A

Anti ccp
HLA-DR4

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13
Q

DMARD of choice in RA? Other key Rx ?

A

Methotrexate (Usually with a course of steroids as DMRDS can take a couple months to work)
STOP SMOKING

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14
Q

Differentiate gonococcal arthritis from reactive arthritis

A

Gonococcal - Migratory polyarthritis
-Tendosynovitis
-Rash not really on hands / feet and may pustulate. Bit more extensive too

Reactive - Usually affects less joints (max 4)
-Tendosynovitis rare
-Rash usually on palms / soles

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15
Q

Which condition has bouchard / heberdens nodes ?

A

Osteoarthritis

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16
Q

OA most common finding on XR>?

A

Joint space narrowing
(may see ostoeophytes)

[subchrondral thickening]

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17
Q

Pseudogout other name? Seen on xray

A

Pyrophosphate arthropathy

chondrocalcinosis (calcified cartilage in articular space)

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18
Q

Oral / genital ulcers.
Erythema nodosum
Anteror uveitis ?

Common test done?
Gene?

A

Bechets syndrome
[Recurrent oral ulcers is key]

Skin prick with sterile needle -> pustule within 48hrs
HLA-B51

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19
Q

Rx if isolated mild oral ulcers in bechets?

A

Topical steroids
eg. triamcinolone

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20
Q

Drug-induced lupus? Antibodies?

A

procainamide, isonazid, hydralazine, sulphasalazine, penicillamine , antiepileptics ….
Basically if its a weird drug it might have caused it.

often ANA positive / anti-histone positive

but anti-dsDNA negative

Rx is to sop drug obvs

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21
Q

Most common antibody in lupus ? Specific? Which should all lupus also be tested for?

A

ANA - not specific tho
Anti ds-DNA more specific

Anti-phospholipid

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22
Q

Which inflam condition may develop bakers cyst

A

Rheum A

Also gout / OA

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23
Q

What is osteomalacia? Who classically gets it in questions? On Xr?

A

Inadequate mineralisation of bone

Vit D deficiency
- Sometimes Malabsorption - Coeliac / Crohns

Areas of low density with sclerotic zones

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24
Q

What is pagets ? Usual bloods finding? Rx? Monitoring blood test?

A

Essentially rapid bone turnover ->Disorganised
-Bone increases in size but more brittle + prone to fracture

Raised ALP (normal Ca, PO4 and PTH)
Bisphosphonates

Monitor bone specific ALP

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25
Q

Pagets XR? Skull specific?

A

Cotton wool spots on skull

Mixed lytic/sclerotic. Bone expansion / trabecular thickening

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26
Q

Pagets rx if cant tolerate bisphophonates ?

A

Calcitonin

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27
Q

Complement levels in lupus

A

Low

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28
Q

WHO nephritis in SLE. Rx for Class I, II, III, IV, v

A

I and II - Hydroxychloriquine

III-V - Add cyclophosphamide and high-dose steroids

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29
Q

Rash in antipospholipid ? Antibodies?

A

Livedo reticularis

Anti-phospholipid, anti-cardiolipin, anti-B2-Glycoprotein2

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30
Q

TB drug -> gout

A

Pyrazinamide
[reduces uric acid clearance]

Cyclosporin also similar

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31
Q

Gout aspiration

A

negatively birefringent needle-shaped crystals

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32
Q

Knee swelling with
Positively birefringent brick shade crystals

A

CPDD
[Calcium pyrophosphate deposition disease]

WHICH IS PSEUDOGOUT

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33
Q

Chronic gout XR

A

punched out lesions

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34
Q

Hx of TB with plan to start biologic Rx. What needs to happen?

A

Prev adequate treated TB - Monitor 3 monthly

Not adequately treated - chemoprophylaxis prior to Rx

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35
Q

Teenager with marked thoracic kyphosis =

A

Scheuerman’s disease
->loss of disk space height (more in anterior region -> kyphosis)

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36
Q

Polymyositis
Lung fibrosis
Rhabdomyolysis =? Differnetiate from glomerulonephritis?
What is injury to kidneys?

A

Anti-jo syndrome

Glomerulonephritis would have protein and blood in urine
Also more likey pulm haemorrhage than dry cough

ATN secondary to myoglobin crystals in kidneys

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37
Q

Teen recent URTI. rash on legs and bum, joint pain, abdo pain, vomiting…=?
Seen on renal biopsy ?

A

HSP
IgA deposition

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38
Q

Positive ANA. What titre to imply connective tissue disease

A

> 1:160

Low Titre eg 1:40 very unspecific

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39
Q

Early most common sign of OA

A

Limited range of movement

crepitus is later sign

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40
Q

OP is usually treated with bisphosphonates. What if not tolerated, high-risk breast Ca? What if severe refractory disease?

A

Not tolerated / Breast Ca risk = Selective oestrogen receptor modulator (SERM) Eg. RALOXIFINE

Teriparatide (PTH analogue) / strontium for severe bad disease

[Strontium high risk CV complications]

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41
Q

Most important Management in Ankylosing spond

A

spinal extension exercises

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42
Q

Pagets disease of bone - common CN involved

A

CN VIII -> deafness from compression

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43
Q

Nephrotic syndrome + hip pain. What we worried about

A

Avascular necrosis
(secondary to prothrombotic state)

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44
Q

Fevers, malaise.
Upper limb claudication / upper limb hypotension =?Other Sx?

A

Takayasu disease ‘pulseless syndrome’

Narrowing of main branches off aorta

Sx based on where Stenosis may affect
renal artery -> hypertension
Coronaries -> angina
Jaw claudication

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45
Q

Key trigger in quesion on jaw claudication as to takayasu vs GCA

A

GCA older + temoral tenderness

Takayasu - young Asian women with vaguer complaints

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46
Q

CREST antibody vs systemic scelerosis

A

Anti centromere

Systemic = anti-scl70

[ANA will be positive in 90% too]

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47
Q

Rx of scleroderma renal crisi

A

ACE inhibitors

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48
Q

What is seen in joint aspiration of gout alongside needle crystals

A

lots of neutrophils

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49
Q

Abdo pain and arthralgia following RTI. Kidney impairment.

A

HSP again brother

IgA - get it in the brain

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50
Q

Differentiate post strep glomerulonephritis and HSP from q

A

Post strep - 1-2 weeks following

HSP - 1-2 days + abdo pain + arthralgia

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51
Q

2 causes of arthralgia and painless oral ulcers

A

Reactive arthritis
-Rash on soles / palms

Behcet’s

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52
Q

Muscle pain / weakness with reduced tendon reflexes? What blood test will be high? Key assoc? Diagnosis?

A

polymyositis
CK high
-3fold risk of malignancy associated

Diagnosis with Muscle biopsy
[emg can help]

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53
Q

Dermatomyositis is polymyositis with what?

A

Heliotrophic rash / gottron papules
=Reddish/purple rash round eyelids

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54
Q

Which disease is raynauds most associated with

A

Systemic sclerosis
=100% of systemic sclerosis have raynauds

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55
Q

Sjogren’s most specific antibody

A

Anti Ro

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56
Q

Polymyositis antibody

A

Anti Jo

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57
Q

Marfanoid habitus. What enzyme deficient ?

A

CBS
Cystathione beta synthase

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58
Q

Mutation in which gene for Marfan’s

A

Fibrillin 1

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59
Q

Egg allergy, which vaccine no no

A

influenza

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60
Q

classical finding on XR RA?

A

periarticular osteopenia

[OA and RA both get joint space narrowing so less specific]

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61
Q

Subchondral sclerosis in which arthritis?

A

OA

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62
Q

Punched out erosions in which arthritis

A

gout

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63
Q

Lipping at joint margins in which arthritis

A

OA

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64
Q

Ankylosing spond 1st line? Then?

A

Early PHYSIO [preventative of progression]
NSAID - must have a trial of 2x NSAID first

Then Anti TNF-a eg Adalimumab, enteracept, infliximab

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65
Q

How does eosinophilic granulomatosis with poly angitis usually present ? Super common blood tests? Ix of choice? Rx?

A

Wheeze / asthma 90% / nasal polyps

70% have mononeuritis multiplex

Eosinophillia and p ANCA

Skin biopsy - small vessel arteriopathy with granuloma formation

Usually just IV steroids. may need cytotoxic / plasma exchange 2nd line

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66
Q

Rheum A gene? strongest environmental?

A

HLA DR4
Smoking

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67
Q

Rheum A which type of joint affected? 1st line rx?

A

Only synovial joints affected

Methotrexate 1st line
-TNFa drugs 2nd

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68
Q

What does Rheumatoid factor target

A

Fc portion of IgG1

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69
Q

Heaviness/aching in both legs while walking. Worse symptoms on spinal extension (normal XR) =?

What if Sx worse on bending forward -> shooting pain?
What test often used to differentiate these?

A

Spinal stenosis

Lumbar disk Prolapse (sciatica type pain)
Straight leg raise - pain positive in prolapse

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70
Q

When is OP diagnosed

A

when bone mineral density 2.5 standard deviations below mean peak mass on DXA scan

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71
Q

Contra indications to bisphophonates

A

HypoCa
Uveitis
Delayed gastric emptying if oral

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72
Q

Couple drugs 2nd line for OP. Key side effects:
Raloxifine?
Denosumab?
Strontium?

A

Raloxifine - Hot flushes, cramps and clots

Denosumab - higher risk of osteonecrosis of jaw

Strontium - CV including PE and steven johnsons

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73
Q

Raloxifine especially good in OP for prevention of

A

Vertebral fractures

[doesn’t help with Hips]

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74
Q

Bilateral AVN of scaphoid called

A

Presiers disease

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75
Q

Poorly controlled diabetes and restricted shoulder movement? Rx? How long does condition last?

A

adhesive capsulitis

Physio -> if no good
intra articular steroid

18 - 24 months

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76
Q

Arthralgia, purpura, skin ulcers, glomerulonephritis and peripheral neuropathy =? Key associations?
Rx?

A

Cryoglobulinaemia

HepC
HIV, MGUS / Haemonc and connective tissue disease

Treat underlying condtion

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77
Q

What temp for cryoglobulins to give Sx

A

<37

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78
Q

Types of cryoglobulinaemia 1-3 key assoc with each ? Which has Rheum factor

A

Type 1 - Haem
-MGUS
-Myeloma
-CLL
-Waldenstrom macroglobulinaemia

Type 2 - Hep C / connective tissues
-Has Rhem factor

Type 3 - Hep C / connective tissue - no Rhem Factor

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79
Q

Which cryoglobulinaemia types have all 3 of
Purpura, arthralgia and weakness?[Meltzer’s triad]

A

Type 2 and 3
[think connective tissue = arthralgia]

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80
Q

Renal damage in cryiglobulinaemia

A

Membranoproliferative glomerulonephritis

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81
Q

Rheumatoid pleural effusion
ph?
Lactate?
glucose?
Trans/exudate?

A

Low PH and high lactate
Low glucose [This is key for Rhem effusion]
Exudate - inflammatory

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82
Q

Pleural effusion - protein for trans / exudate? what if in middle?

A

Trans <25g/L
Exudate >35g/L

Lights criteria

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83
Q

Pleural effusion with
High triglycerides?
High amylase?
Very low glucose?

A

Triglycerides = chylothroax

Amylase - pancreas

Low glucose - rheumatoid

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84
Q

Pleural effusion needs drained if +ve culture, frank pus or what other biochem finding

A

ph <7.2

85
Q

What has poorer prognosis in Rheum A
Positive IgM or IgG antibody?
Fast / slow onset?
Male/female?
Anaemia development by?

A

IgM bad
Slow onset
Females
Anaemia within 3 months

86
Q

Hydroxychloroquine key side effects

A

Visual disturbance / alopecia in excess

87
Q

How to test for conjuntival dryness in sjorgens syndrome? Antibody?

A

Schirmer’s test
(filter paper touched to eye and see how far tears go)
[Schirmer, Schjorgen]

Anti - Ro

88
Q

normal ESR in old people

A

Men Age / 2
Women (Age + 10)/2

89
Q

Rheum A >10years with splenomegaly and neutropenia

If presented earlier in Rhem history Eg in first year - what do you need to consider?

A

Felty syndrome

If early - consider Large Granular lymphocytic (LGL) leukaemia
[need marrow biopsy to differentiate]

90
Q

Earliest sign on XR of ankylosing spond

A

Blurring of upper/lower vertebral rims at SI junction

91
Q

Which inflammatory cytokine found in synovial joints of Rheum A

A

TNFa

[IL-1,6]

92
Q

Long standing poorly controlled rheum A -> nephrotic syndrome? Whats happened

A

Secondary AA amlyloidosis

93
Q

Which amyloid if primary? Secondary? Familial?

A

AL

AA

ATTR -Dominant inheritance

94
Q

Primary Amlyoid is what? What is this closely related to?

A

Plasma cells producing light chains

Closely related to myeloma

95
Q

Who gets AA amyloidosis

A

Chronic inflam conditions - Eg Rhem A / TB especially if poorly controlled
Presents very slowly

96
Q

Most sensitive test for AL amyloid

A

Immunoglobulin free light chain assay
-raised kappa lambda ratio

97
Q

Rx of AA amyloid? What about specifically AA amyloid in familial Mediterranean fever?

A

Rx of inflam condition

Colchicine

98
Q

Symptoms of weakness / tingling / cold / parasthesia in 1 arm worse when abducted / above head? Normal bloods

A

Thoracic outlet syndrome

90% neurogenic
1% arterial

99
Q

Surgery eg cholescystectomy -> swelling red painful ankle / knee / foot =?

A

Gout
Acute attack provoked by
-surgery
-fasting
-aspirin
-aki

100
Q

XR of osteomyelitis in first week? After this?

Chronic osteomyelitis?

A

Nothing visible in first week

then periosteal reaction/elevation

Chronic - patchy sclerosis with honeycomb appearance
[+new bone formation]

101
Q

Who gets epislceritis/ scleritis ?
Differentiate them
Pain
Level of hyperaemia (engorged vessles)
Photophobia
visual acuity

What if there was discharge?

A

Scleritis
More painful
Diffuse hyperaemia and vessles do not move when probed with cotton bud
photophobia and reduced acuity common

Episcleritis
Less painful
Focal vessles which move
Less photophobia and normal acuity

If discharge - think conjunctivitis
-Especially if diffuse hyperaemia

101
Q

Who gets epislceritis/ scleritis ?
Differentiate them
Pain
Level of hyperaemia (engorged vessles)
Photophobia
visual acuity

What if there was discharge?

A

Scleritis
More painful
Diffuse hyperaemia and vessles do not move when probed with cotton bud
photophobia and reduced acuity common

Episcleritis
Less painful
Focal vessles which move
Less photophobia and normal acuity

If discharge - think conjunctivitis
-Especially if diffuse hyperaemia

101
Q

Who gets epislceritis/ scleritis ?
Differentiate them
Pain
Level of hyperaemia (engorged vessles)
Photophobia
visual acuity

What if there was discharge?

A

50-70% have another systemic disease Eg Rheum A

Scleritis
More painful
Diffuse hyperaemia and vessles do not move when probed with cotton bud
photophobia and reduced acuity common

Episcleritis
Less painful
Focal vessles which move
Less photophobia and normal acuity

If discharge - think conjunctivitis
-Especially if diffuse hyperaemia

102
Q

Scleritis vs epi with administration of phenyephrine drops

A

Epi - blanching of vessels

scler - no blanching

103
Q

Primary vs secondary raynauds
Age?
Sex?
Tissue damage?
symmetry?
Capilliary scope ?
Antibodies?

A

Primary
30
Female
No damage
Symmetrical
Normal capilliaries
No antibodies

Secondary
50
Male
May get gangrene
asymmetrical
positive capillary scope
antibodies common

104
Q

Allergic to allopurinol can get what in gout?

A

Probenicid (uricosuric agent)

105
Q

White people often have which gene in SLE

A

HLA DR2 / HLA DR3

106
Q

Who is most likely to get SLE

A

African-american
Women
20-40

107
Q

High inflam markers with ++ lymphocytes and fracture of spine?

A

Potts disease
-spinal TB

108
Q

What % of PA are HLA-B27 positive

A

20%

109
Q

PA with skin lesions and nail involvement rx?

What if just joints?

If DMARDs no good

A

Methotrexate
[may use steroids for bridging]

joints only - sulphasalazine

TNFa - Adalidumab, enteracept, infliximab

110
Q

Back pain, muscle weakness and bony tenderness.
Raised ALP and low Ca = ? What might PTH be? What may be found in urine? XR appearace?

A

Osteomalacia
-vit D deficiency

May have raised PTH (Secondary)
-> increased phosphate excretion in urine
[hypoPO4 in blood]

Translucent bands on XR

111
Q

What class is allopurinol

A

Xanthine oxidase inhibitor

112
Q

Which connective tissue disorder has highest maternal death -> recommended abortion until well controlled

A

Systemic sclerosis

113
Q

Blood in pagets

A

ISOLATED raised ALP

114
Q

Bechets Rx
Limited ulcers? 2nd line 3rd?

Evidence of Eye / GI / CNS / vascular

A

Topical steroid
->pred / azathioprine (for up to 2 years)
3rd line - TNFa inhibitors

Any systemic involvement
Pred + anti-TNFa

115
Q

Which abx is contra indicated in methotrexate therapy? Why

A

Trimethoprim (or septrin of course)

Both folate antagonists -> methotrexate toxicity and bone marrow suppression

116
Q

Why get you get gout in G6PD

A

Increased production of pentose sugars

[they basically mean more purines get produced]

Haemolytic anaemia and -> uric acid release may contribute a little bit

117
Q

Persistent spiking fever, swollen DIPs, hepatosplenomegaly and transient salmon pink rash each time gets a fever?

A

Adult onset Still’s

118
Q

Which drugs may precipitate stills flare

A

Penicillamine, rifampicin

119
Q

Stepwise approach to stills Rx

A

NSAIDs
Steroids
Methotrexate
Anti-IL-1 / IL-6 or TNFa inhibitor

120
Q

What theray is most effective for stills ? eg?

A

Anti IL-1 / 6

Toculizumab - IL-6
-Only licensed one

[Anakinra - IL-1]

121
Q

Plaques on extensor surfaces + telescoping deformity on fingers with nail changes

A

Arthritis mutilans

122
Q

Most common GI issue in SLE

A

Mouth ulcers

123
Q

Old bogy with posterior displacement of cervical vertebrae with slowly progressing pain due to what?

A

Osteoarthritis

[get instability of the posterior facet joints]

124
Q

Rheum A mab examples and explain which cytokine target by each?

A

TNFa - 3 of them

IL-6 - Eg toculizumab

125
Q

Rx acut gout with slightly raised creatinine and on warfarin with INR 3

A

Still colchicine - can give renal dose (500mg BD in stead of QDS)

126
Q

Big trauma/surgery to joint

->Severe pain which is often disproportionate to signs found. Also some skin changes eg dry / scaly

A

Reflex sympathetic dystrophy

127
Q

What is the name of the test to measure lumbar flexion in ankylosing spond

A

Schobers

128
Q

When would you use IV bisphophonates in Pagets?

A

History of GORD / oesophagitis….

129
Q

What type of infection precedes reactive arthritis

A

GI/GU

[not flu like illness]

130
Q

What is keratoderma blenorrhagica

A

Aseptic abscess which occurs on palms / soles in reactive arthritis

ONLY in 10%

131
Q

Why do people have raised uric acid in gout

A

Impaired renal excretion 90%

132
Q

Long history of rheum A. Now chest pain hypotensive and low voltage qrs

A

Tamponade (rheum effusion)

133
Q

What bloods might you expect in PMR

A

High ESR (not just a bit raised)
normochromic/normocytic anaemia
[Often deranged LFTs]

134
Q

Non-productive chronic cough with global wheeze - often in a chronic inflammatory disease eg RA/SLE/Polymyositis

A

Bronchiolitis obliterans

Rx with steroids - though poor prognosis

135
Q

What is more common in reactive arthritis: Neg RheumFactor or presence of a rash

A

Neg rheum factor - seronegative arthritis
Rash in 10%

136
Q

Polyarteritis Nodosa
Vessels affected - which are spared?
ANCA?
30% associated with?
Males-females
Rx?

A

Medium - Usually just renal + Abdo - SPARES lungs
[mononeeuritis multiplex too]
ANCA Negative
30% HepB
Males more affected
Pred/cyclophosphamide

137
Q

How to make diagnosis of PAN if no accessible vessels?

A

Angiogram - eg of kidneys - will demonstrate string of aneurysms ‘rosary sign’

138
Q

How to make a diagnosis of PAN if no accessible vessels?

A

Angiogram - eg of kidneys - will demonstrate Aneurysms

139
Q

Most common cause of death in systemic sclerosis

A

Pulm fibrosis
[used to be renal issues but Rx has improved]

140
Q

Most common cardiac involvement SLE

A

Pericarditis with small pericardial effusion

141
Q

GPA most commonly affects

A

Lungs 90%
kidneys 80%

142
Q

Rx of PAN who HepB positive

A

Antivirals + plasma exchange

143
Q

Usual exam of joint pain in SLE

A

Often normal - but may have some swelling

144
Q

1st line/ Best Ix for diagnosis of ank spond

A

XR first line
MRI sacroiliac spine

145
Q

Inflam arthritis - best drugs for men/women wanting to have babies \DMARD?
Stronger?

A

Hydroxychloriquine

Anti-TNFa

146
Q

A young man wanting to start a family but realises is infertile. What dmard was he given

A

Cyclophosphamide
-May irreversibly affect male fertility

147
Q

why no sulfasalasine in men wanting to have a baby

A

May drop sperm count while taking

148
Q

most definitive diagnostic test for sjorgrens

A

Biopsy of labial gland
[behind lower lip]

149
Q

Why lose pulses in takayasu?

A

Inflammation -> transmural fibrosis -> obstruction

150
Q

Loose bodies in knee joint + locking of joint? Cause?

A

Osteochondritis dissecans
Local necrosis of cartilage - most commonly medial femoral condyle

151
Q

Antibodies in stills disease

A

Usually all negative
[occationally ANA - which linked to uveitis]

152
Q

Plateltes in antiphopholipid

A

Usually low

153
Q

Management of antiphopholipid?
What if all 3 antibodies are positive ? What are the 3?

A

Anti coag eg doac / warfarin
If all 3 positive - warfarin

phospholipid, cardiolipin and anti-beta-2-glycoprotein?

154
Q

Antiphospholipid rx in preg?

A

Low dose aspirin
[low dose LMWH if not tolerated]

155
Q

Gull wing / T pattern on Xray of PIPs in

A

Erosive osteoarthritis

156
Q

When do you use febuxostat

A

Chronic hyperUric acid when allopurinol not tollerated

157
Q

polymyositis and interstitial lung disease =

A

Anti-Jo syndrome

158
Q

Erythematous rash and polyarthralgia, Dry eyes/mouth, Raised IgG, ANA, Anti-Ro, RF =

A

Primary Sjogren’s

Anti ro remains pretty specifi. In secondary sjorgrens anti Ro is likely to be negative

159
Q

Felty syndrome HLA

A

HLA DRW4

160
Q

Pain in hips / knees. Bloody diarrhoea, abdo pain and fever. Barium enema shows ‘rose thorn’ ulcers. What is it?

A

Crohns - enteropathic arthritis

Barium enema may show rose thorn ulcers, cobblestone and strictures

161
Q

Dermatomyositis. Key Ix for Dx

A

Muscle biopsy

162
Q

Arthroscopy in Rhem A

A

Marked vascular proliferation in synovial membrane

[Fluid is usually turbid with reduced viscosity ]

163
Q

HLA DR2

A

Rheumatic fever - but proftective agaisnt Rheum A

[Also in good pastures]

164
Q

HLA DR 3

A

Anti-CCP negative Rhem A
T1DM

165
Q

Key feature on biopsy of EGPA

A

Necrotising granuloma with an eosinophilic core
[in small and medium-sized vessles]

166
Q

Single most common blood finding osteomalacia

A

ALP raised

167
Q

AVN of hip suspected what is the Ix

A

MRI

168
Q

Bilat erosions of SI joints on XR

A

Ankylosing spond

169
Q

Marfinoid, osteoporosis, learning disability? Key eye symptoms?

A

Homocystinuria
posterior lens dislocation

170
Q

Joint hyperlaxity / dislocations, skin laxity and easy bruising in normal height? Inheritance? Genes?

A

Ehlers-danlos
Variable
-Dominant in classical form
-Kyphoscoliotic / vardio-valvular - ressessive

COL5, COL3, TNXB, PLOD1

171
Q

Rhem with raised MCV anaemia

A

Methotrexate fucking with folate

172
Q

HLA B8 and DR3 in

A

Graves

173
Q

Dermatomyositis Rx

A

Pred +
MTX or Azathioprine
[May give you a TPMT level in Q]

174
Q

Pagets most common location

A

Lumbar spine
[pelvis second]

175
Q

Lupus on pred / hydroxychloroquine
Fever + cough
ESR 80, CRP 50, Lymphopenia, thrombocytopenia
Rx?

A

Increase steroids as active lupus
[thrombo/lymphopenia, raised ESR]

Abx as cough
[raised CRP]

176
Q

Swollen PIPs with ulnar deviation bilat
Pitting of nails and onycholysis

A

Psoriatic arthritis
Nail changes = psoriatic

177
Q

Tests for lateral epicondylitis

A

wrist extension / supination
Chair raise test

178
Q

Acute gout given allopurinol what happens

A

GOUT GETS WORSE

179
Q

How reduced are platelets in active SLE

A

Minorly reduced

180
Q

Diffuse cutaneous scleroderma Antibodies

A

Anti- RNA polymerase

181
Q

Anti-topoisomerase-1 also called

A

Anti-Scl70

182
Q

the single most important thing for peak bone mass

A

Genetic

[More than physical activity / weight]

183
Q

HIV gout prophylaxis if prev attacks

A

Colchicine
Allopurinol messes with concentrations of antiretrovirals

184
Q

Neck pain radiating to the arm
Weakness of biceps and triceps
XR narrowing c5/c6 =

A

Disk prolapse

185
Q

Man with connective tissue disease wants to start a family
Which DMARD ?

A

Azathioprine

186
Q

Bar MTX what other DMARDs first line for rheum A

A

Sulphasalzine, leflunomide

187
Q

first sign of Rheum a in a knee

A

Effusion

188
Q

Best way to differentiate gout

A

Trial of colchicine

[Better and raised uric acid, erosion son Xray, and elbow nodules]

189
Q

Deaf, bowing of legs raised ALP, normal Ca

A

Pagets

190
Q

Most common cause for pain at base of thumb in older person

A

OA

De Quervains would have Hx of repetitive action
AVN - Hx of trauma

191
Q

Ank Spond which nephropathies do they get
Enlarged kidneys and when older?
Effect of drugs?
If Haematuria?

A

AA amyloid - apple green birefringence

NSAID induced

IgA nephropathy - linked to ankylosing spond

192
Q

Why Adalidumab / enteracept over infliximab

A

Cheaper

193
Q

Rx of chronic fatigue

A

CBT

[Graded exercise therapy no longer recommended]

194
Q

Long-term steroids planned - prevention of osteoporosis

A

Bisphosphonates, Ca and Vit D

195
Q

Gets gout which cardiac meds need stopped

A

Thiazides / thiazide like eg indapamide

196
Q

Which vasculitis do the Japanese get

A

Takayasu

197
Q

Swelling of forearms with peaud’orange. Raised eosinophils and carpal tunnel =? What else is seen

A

Eosinophilic fasiculitis
Hypergammaglobulinaemia

198
Q

Which complement factors reduced in early onset SLE

A

C4 deficiency most assoc

199
Q

Osteoperosis but GFR < 35. What Rx

A

Denosumab

200
Q

Orogenital ulceration
Arthritis
DVT
uveitis
Anti-phospholipid antibodies

A

Bechets
20% positive for antiphpholipid

201
Q

polymyositis 1st line rx

A

Pred

202
Q

2 months polyarthralgia, dry eye, fevers, ANA, RF, Anti-Ro, AntiDsDNA

A

SLE (DsDNA) with secondary Sjogren’s

203
Q

Calcificic tendonitis usual crystals

A

Calcium hydroxyapatite

204
Q

no eye involvement GCA how much pred

A

60mg

205
Q

Most common pulm involvement in SLE

A

Effusions

206
Q

Rheum A with pancytopenia and lung fibrosis 2 possible drugs

A

MTX
Gold

MRCP PART 1 (22 decks)

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