Rheum

Question 1

What form is Zoledronic acid

Answer 1

IV

Question 2

Polymyalgia rheumatica and features

Answer 2

PMR is an inflammatory disorder that causes muscle pain and stiffness.
- Shoulder and hip stiffness
- Lethargy
- Raised ESR

Question 3

PMR mx

Answer 3

Prednisolone

Question 4

Acute gout mx

Answer 4

Strong NSAID (e.g., naproxen) + PPI until infx settled
or colchicine 5-7days

— if CKD/MM :PREDNISOLONE

Question 5

Acute gout trx, but CKD :(

Answer 5

PO Prednisolone or colchicine

Question 6

Osteomalacia and features

Answer 6

Bones become weak and soft due to Vit D def
- Pain affecting hips and lower back
- Proximal muscle weakness
- Hypocalcaemia

Question 7

Granulomatosis with polyangiitis (Wegener’s granulomatosis) and features

Answer 7

autoimmune disease that causes inflammation in small and medium-sized blood vessels, resulting in damage to various organs and tissues
- Upper resp tract: SINUSITIS, epistaxis, SADDLE SHAPED NOSE
- Lower resp tract: HAEMOPTYSIS, nodules/cavities (CXR)
- Eyes: red/dry
- Kidneys: Proteinuria/haematuria - nephritic syndrome
- Skin: rash/ulcers/nodules
+ joint pain

Question 8

Osteoarthritis features

Answer 8

• Pain of weight bearing joints
• Stiffness in AM but less in duration than RA
• Reduced ROM on passive movement - elicits pain

Question 9

OA initial mx

Answer 9

NSAIDs
(alt paracetamol)

Question 10

PMR v dermatomyositis

Answer 10

Dermato
- Muscle weakness
- Skin involvement - rashes

Question 11

OA analgesia mx

Answer 11

PR diclofenac

Question 12

What should be given to prevent steroid induced osteoporosis?

Answer 12

a. Alendronic acid + vitamin D

Question 13

Ankylosing spondylitis mx

Answer 13

1. NSAIDs
2. DMARDs
3. Biologics
4. Steroids - only for short amounts of time

Question 14

Which ix confirms polymyositis?

Answer 14

Muscle biopsy

Question 15

What type of eye changes in ank spond?

Answer 15

anterior uveitis

Question 16

CREST syndrome

Answer 16

Associated with ltd systemic sclerosis
- Ca deposits
- Raynaud’s
- Esophageal dysmotility ± GERD
- Sclerodactyly (thickening and hardening of skin on finger/toes -> may appear shiny)
- Telangiectasia (face/hands/body)

Question 17

asthma + eosinophilia + ANA +ve

Answer 17

eGPA (Churg Strauss)

Question 18

Telescopic digit

Answer 18

arthritis mutilans (psoriatrics arthr)

Question 19

Red, scaly lesions on finger joints

Answer 19

Gottron’s papule (dermatomyositis)

Question 20

RA ix

Answer 20

• XR
• RhF, anti-CCP

Question 21

RA mx

Answer 21

• lifestyle mods
• analgesia
• DMARDs
• bridging steroids

Question 22

Gout chronic mx

Answer 22

allopurinol
/ febuxostat

Question 23

Gout v pseudogout deposits

Answer 23

Gout: urate crystals
pseudogout: calcium pyrophosphate

Question 24

Reactive arthritis fluid aspirate

Answer 24

straw coloured

Question 25

Septic arthritis mx

Answer 25

Aspirate to dryness + IV abx based on culture

Question 26

Reactive arthritis mx

Answer 26

Treat underlying infx + NSAIDs ± steroids/DMARDs

Question 27

Pseudogout mx

Answer 27

NSAIDs/ colchicine

Question 28

Skin and nail diseases for psoriatic arthritis

Answer 28

• dactylitis
• Onycholitis (nail separates from bed)
• Pitting

Question 29

SLE manifestation

Answer 29

• Arthritis
• Malar + discoid rashes
• Constitutional syx

Question 30

SLE mx

Answer 30

High dose steroids + hydroxychloroquine + biologics

Question 31

Ankylosing spondylitis mx

Answer 31

NSAIDs/analgesia

Question 32

Osteoarthritis v RA xr

Answer 32

Osteoarthritis
- Some normal joints
- More DIPJ, rather than PIPJ

RA
- Erosions

Question 33

Rheum ABs
1RF
2 anti-CCP
3 anti-dsDNA & anti-Smith
4 anti-centromere

Answer 33

1 RA + Sjogrens
2 RA
3 SLE
4 Limited systemic sclerosis

Question 34

Rheum ABs
1 Anti-Scl70 (anti-topoisomerase)
2 Anti-ro and anti-La
3 Anti Jo and Anti Mi2
4 Anti histone
5 ANCA

Answer 34

1 diffuse systemic sclerosis
2 Sjogrens
3 Poly/dermatomyositis
4 drug induced lupus
5 Vasculitides

Question 35

What are the ABs for
1 RA + Sjogrens
2 RA
3 SLE
4 Limited systemic sclerosis

Answer 35

1 anti RF
2 anti CCP
3 anti dsDNA and anti Smith
4 anti centromere

Question 36

What are the Abs for
1 diffuse systemic sclerosis
2 Sjogrens
3 Dermato/polymyositis
4 Drug induced lupus
5 vasculitides

Answer 36

1 Anti-Scl70 (anti-topoisomerase)
2 Anti-ro and anti-La
3 Anti Jo and Anti Mi2
4 Anti histone
5 ANCA

Question 37

3 small vessel vasculitides

Answer 37

1 granulomatosis with polyangiitis
2 microscopic polyangiitis
3 eosinophilic granulomatosis with polyangiitis

Question 38

Mx for small vessel disease - treating for remission

Answer 38

cyclophosphamide and corticosteroids

Question 39

heavy smoker with recurrent digit ischaemia

Answer 39

Thromboangiitis obliterans (Buergers)

Question 40

haemoptysis, haematuria and anti GBM

Answer 40

goodpasture’s syndrome

Question 41

transmural inflammation, ‘beads on a string’ angiography

Answer 41

polyarteritis nodosa

Question 42

Recurrent mouth and genital ulcers not due to infx

Answer 42

Behçet syndrome

Question 43

psoriatic arthritis mx

Answer 43

Treat to target
1st line DMARD - methotrexate (+bridging steroids)
(2nd biologics - adalimumab)

Syx control
- Pain and swelling: NSAIDs
- Scaly skin/psoriasis: topical steroid

(Treatment of PsA aims to:

Reduce inflammation.
Clear skin and nails.
Relieve pain.
Protect joint mobility.
Make it less likely that you develop other health conditions.)