RHEUM

Question 1

pANCA main target

Answer 1

myleoperoxidase

Question 2

anti nuclear antibodies (ANA)- what condition

Answer 2

dermatomyositis

Question 3

Dermatomyositis treatment

Answer 3

predisolone

Question 4

pANCA and cANCA

Answer 4

(p)ANCA - (C)hurg-Strauss.
(c)ANCA - G(P)A.

wrong way round

Question 5

Treatment termporal arteritis

Answer 5

ASAP prednisolone glucocorticoid
- even before temporal aa biopsy

Question 6

SLE affects fetus in pregnancy?

Answer 6

causes fetal bradycardia

Question 7

how to take bisphosphonates

Answer 7

take 30 mins before food and sit up for 30 mins after

Question 8

old man, bone pain, raised ALP=== what condition?

Answer 8

pagets disease

Question 9

anti ro- which condition

Answer 9

SLE

Question 10

Marfan syndrome affected gene

Answer 10

fibrillin

Question 11

low calcium
low phosphate
raised ALP and raised PTH

Answer 11

osteomalacia

CFs
widespread bone pain, proximal myopathy

Question 12

golimumab=?MOA

Answer 12

TNF ALPHA antagonist

tumour necrosis factor alpha

MABS= type of TNF inhibitor

Question 13

anti tnf meds= (4)

Answer 13

I AGE

infliximab, adalimumab, golimumab, etaercept

Question 14

bulls eye retinopathy with which type of DMARD ?

Answer 14

hydroxychloriquine

Question 15

most common cause of gout ?

Answer 15

decreased renal excretion of uric acid

Question 16

Lesch-Nyhan syndrome

Answer 16

Lesch-Nyhan syndrome
hypoxanthine-guanine phosphoribosyl transferase (HGPRTase) deficiency
x-linked recessive therefore only seen in boys
features: gout, renal failure, neurological deficits, learning difficulties, self-mutilation

Question 17

drug induced lupus– HOW is it different to normal SLE

Answer 17

renal and neuro symptoms unlikely

Question 18

DEXA SCAN INTERP:
t and z sore

Answer 18

T score: based on bone mass of young reference population – GENERAL
T score of -1.0 means bone mass of one standard deviation below that of young reference population
Z score is adjusted for age, gender and ethnic factors

T score
> -1.0 = normal
-1.0 to -2.5 = osteopaenia
< -2.5 = osteoporosis

T-score of - 2.5 SD or below
BUT GIVE oral bisphosphonate whilst waiting for DEXA scan

Question 19

reactive arthritis management

Answer 19

NSAIDS
INTRA ART STEROIDS

Question 20

hydroxychloriquine affect eyes

Answer 20

severe or perm RETINOPATHY- flashes, floaters

Question 21

PREDISPOSITIONs of pseudogout

Answer 21

Positively bifringent rhomboid crystals
haemochromatosis
hyperparathyroidism
low magnesium, low phosphate
acromegaly, Wilson’s disease

DOUBLE CONTOUR sign

Question 22

Urinary hydroxyproline - Paget’s disease of bone.

Urinary porphobilinogen - acute intermittent porphyria

Urinary uroporphyrin - porphyria cutanea tarda

Urinary coproporphyrin - Dubin-Johnson syndrome

Answer 22

Urinary hydroxyproline - Paget’s disease of bone.

Urinary porphobilinogen - acute intermittent porphyria

Urinary uroporphyrin - porphyria cutanea tarda

Urinary coproporphyrin - Dubin-Johnson syndrome

Question 23

what type of cell secretes TNF

Answer 23

macrophages

Question 24

OA features LOSS

Answer 24

Loss of joint space
Osteophytes
Subchondral cysts
Subchondral sclerosis

Question 25

periarticular osteopenia specific to ?

Answer 25

RA

Question 26

polyarteritis nodosa cfs antibody

Answer 26

CANCA medium vasculitis ass'd with hep b and middle aged men mononeuritis multiplex= multiple nerve trunks affected

Question 27

allergic to aspirin may also be allergic to ?

Answer 27

sulfasalzine

Question 28

azathioprine in pregnancy and breasfteeding

Answer 28

safe to use , mesalazine and sulfasalazine (with folic acid)

Question 29

treatment raynauds

Answer 29

first line- nifedipine if this CI or not tolerated; IV prostacyclin

Question 30

first XR finding on ANK SPON

Answer 30

syndesmophytes= first sign late sign= bamboo spine

Question 31

bradycardia heart block newborn from mum with sle

Answer 31

anti ro

Question 32

early onset SLE assd with def in what complement

Answer 32

C4

Question 33

all lab criteria to diagnose antiphospholipid syndrome:

Answer 33

need to be twice at least 12 weeks apart

Question 34

familial mediterranean fever

Answer 34

aut rec turkish armenian arabic Features - attacks typically last 1-3 days pyrexia abdominal pain (due to peritonitis) pleurisy pericarditis arthritis erysipeloid rash on lower limbs Management colchicine may help

Question 35

RANK ligand inhibitor eg

Answer 35

denosumab

Question 36

complications of pagets

Answer 36

Complications deafness (cranial nerve entrapment) bone sarcoma (1% if affected for > 10 years) fractures skull thickening high-output cardiac failure

Question 37

mycophenolate mofetil MOA

Answer 37

Inosine-5'-monophosphate dehydrogenase inhibitor

Question 38

SLE treatment

Answer 38

hydroxyhloriquine

Question 39

which DMARD is safe in pregnancy anc breastfeeding

Answer 39

sulfasalazine

Question 40

stills disease

Answer 40

Features arthralgia elevated serum ferritin rash: salmon-pink, maculopapular pyrexia typically rises in the late afternoon/early evening in a daily pattern and accompanies a worsening of joint symptoms and rash lymphadenopathy rheumatoid factor (RF) and anti-nuclear antibody (ANA) negative Management NSAIDs should be trialled for at least a week before steroids are added. steroids if symptoms persist, the use of methotrexate, IL-1 or anti-TNF therapy can be considered ANAKINRA= IL1

Question 41

bisphosphonates moa

Answer 41

inhibit osteoclasts

Question 42

syndesmophytes in ANK SPON = ?

Answer 42

Syndesmophytes (ossification of outer fibres of annulus fibrosus) are a feature of ankylosing spondylitis

Question 43

is RF usually positive or negative in stills disease

Answer 43

negative RF

Question 44

widening of the wrist joints due to an excess of non-mineralized osteoid at the growth plate ===?

Answer 44

rickets

Question 45

marfan syndrome chr affected cfs defect in what/???

Answer 45

A defect of the glycoprotein structure which usually wraps around elastin= fibrillin chr 15

Question 46

common bowel problem in systemic sclerosis

Answer 46

bacterial overgrowth

Question 47

homogentisic acid in urine = ?

Answer 47

Alkaptonuria (ochronosis) autosomal recessive disorder of phenylalanine and tyrosine metabolism caused by a lack of the enzyme homogentisic dioxygenase (HGD) Alkaptonuria is generally a benign and often asymptomatic condition. Possible features include: pigmented sclera urine turns black if left exposed to the air intervertebral disc calcification may result in back pain renal stones Tx= high dose vit c

Question 48

hydroxychloriquine retinopathy symptoms

Answer 48

flashes, photophobia, decreased visual acuity caused by central depigmentation, speckled rings, hyperpigmentation,

Question 49

fibromyalgia how many tender points out of 18 needed

Answer 49

11/18 for diagnosis

Question 50

which TB medication can cause drug induced lupus

Answer 50

isoniazid

Question 51

LOW Ca and LOW phosphate and HIGH ALP and HIGH PTH

Answer 51

osteomalacia

Question 52

tennis elbow= and which mm affected

Answer 52

lateral epicondyle EXTENDOR CARPI radialis brevis affected

Question 53

double contour sign. = ?

Answer 53

gout

Question 54

pregnancy and infliximab

Answer 54

stop infliximab at 16 weeks

Question 55

which joint condition is associated with polycythaemia

Answer 55

GOUT