Rheum

Question 1

What is seen on joint aspiration with Reactive arthritis ?

Answer 1

organism cannot be recovered from the joint aspiration

Question 2

Ehler-Danlos syndrome what is defective

Answer 2

AD
affects type III collagen

Question 3

What causes pain on the radial side of the wrist

tenderness over the radial styloid process

abduction of the thumb against resistance is painful

Finkelstein’s test: +ve

Answer 3

De Quervain’s tenosynovitis

sheath containing the extensor pollicis brevis and abductor pollicis longus tendons is inflamed.

Question 4

How do you distinguish btwn primary (Raynaud’s disease) or secondary (Raynaud’s phenomenon).
What causes 2nadry raynauds

Answer 4

Raynaud’s disease typically presents in young women (e.g. 30 years old) with bilateral symptoms.

2dary causes;
1. connective tissue disorders
- scleroderma (most common)
RA
SLE
erythematosus
leukaemia
type I cryoglobulinaemia, cold agglutinins
use of vibrating tools

2. drugs: oral contraceptive pill, ergot
3. cervical rib

Question 5

Rx raynauds

Answer 5

CCB- nifedipine

Question 6

double-contour sign

Answer 6

Gout

Question 7

Ankylosing spondylitis features

Answer 7

Apical fibrosis
Anterior uveitis
Aortic regurgitation
Achilles tendonitis
AV node block
Amyloidosis

Question 8

Repeated cramping and myoglobinuria after short bouts of exercise

Answer 8

McArdle’s disease
autosomal recessive type V glycogen storage disease

Question 9

Dermatomyositis antibodies

Answer 9

ANA most common,
anti-Mi-2 most specific
but seen in 25% of pts

anti-Jo-1 antibodies are not commonly seen in dermatomyositis - they are more common in polymyositis where they are seen in a pattern of disease associated with lung involvement, Raynaud’s and fever

Question 10

Anti-cardiolipin antibodies and anti-beta2 glycoprotein I

Answer 10

Antiphospholipid syndrome: arterial/venous thrombosis, miscarriage, livedo reticularis, prolonged APTT.

Question 11

SE Azathioprine

Answer 11

bone marrow depression

nausea/vomiting

pancreatitis

increased risk of non-melanoma skin cancer

significant interaction may occur with allopurinol and hence lower doses of azathioprine should be used.

Question 12

Sulfasalazine MAO and cautions

Answer 12

1. decreasing neutrophil chemotaxis
2. suppressing proliferation of lymphocytes and pro-inflammatory cytokines.

Cautions:
- G6PD deficiency
- allergy to aspirin or sulphonamides (cross-sensitivity)

Question 13

Sjogren’s syndrome has increase risk of what type of cancer

Answer 13

lymphoid malignancies

Question 14

What is Chondrocalcinosis and what is it ass w/

Answer 14

pseudogout,
Calcification on articular cartilage

Question 15

T-score of X indicating osteoporosis.

Answer 15

-2.7

Question 16

mao OF Bisphosphonates

Answer 16

inhibit osteoclasts

Question 17

abnormality in type 1 collagen

Answer 17

osteogenesis imperfecta
AD

Question 18

Abnormal Type 4 collagen

Answer 18

Alport’s syndrome - thinning and splitting of the glomerular basement membrane, presenting with isolated haematuria, sensorineural hearing loss, and ocular disturbances.

Question 19

What caused
1. arthralgia
2. elevated serum ferritin
3. rash: salmon-pink, maculopapular
4. pyrexia- typically rises in the late afternoon/early evening w/ worsening of joint symptoms and rash
WHAT is IX & RX

Answer 19

Still’s disease in adults

Ix :
RF& ANA negative
Yamaguchi criteria

RX: NSAID or steroids

Question 20

Denosumab SE

Answer 20

Dyspnoea and diarrhoea

Question 21

‘large, dark shadow’ covering the superior visual field

Answer 21

GCA
anterior ischemic optic neuropathy (AION).

Question 22

Sulfasalazine SE

Answer 22

oligospermia
Stevens-Johnson syndrome
pneumonitis / lung fibrosis
myelosuppression, Heinz body anaemia, megaloblastic anaemia
may colour tears → stained contact lenses

safe to use in both pregnancy and breastfeeding.

Question 23

Low serum calcium, low serum phosphate,
raised ALP and raised PTH

Answer 23

osteomalacia

Question 24

Bone disease: causes of LOW Calcium (2)

Answer 24

Osteomalacia & CKD

Question 25

Bone disease: causes of HIGH PTH (3)

Answer 25

Primary hyperparathyroidism CKD Osteomalacia

Question 26

How do you differentiate Osteomalacia and CKD

Answer 26

Both will have Low Ca2+ and High PTH But CKD has high phosphate and Osteomalacia has low Phosphate

Question 27

Difference between Buerger’s & Berger’s disease

Answer 27

Buerger’s (thromboangiitis obliterans) med. vessel vasculidity commonly in the arms and leg Men 20-40 y/o use Tabacco Jews Indian Berger’s disease – IgA nephropathy

Question 28

defect in the FBN1 gene on chromosome 15 that codes for the protein fibrillin-1.

Answer 28

Marfan's syndrome

Question 29

Marfan's syndrome heart abnormalities

Answer 29

heart: dilation of the aortic sinuses (seen in 90%) which may lead to aortic aneurysm, aortic dissection, aortic regurgitation mitral valve prolapse (75%),

Question 30

What Cause 1. Tingling/numbness of the 4th & 5th finger 2.wasting & paralysis of intrinsic hand muscles (except lateral two lumbricals) & the hypothenar muscles. Froment's test - pinch a piece of paper between the thumb and index

Answer 30

Cubital tunnel syndrome

Question 31

What are Syndesmophytes

Answer 31

ossification of outer fibres of annulus fibrosus are a feature of ankylosing spondylitis

Question 32

pilocarpine and what is it used for

Answer 32

stimulates the parasympathetic nervous system. = stimulating salivary gland secretion, Sjogren's syndrome

Question 33

Avascular necrosis of the hip x -ray findings

Answer 33

-may be normal initially. Osteopenia & microfractures -early . Collapse of the articular surface= crescent sign MRI is the investigation of choice. It is more sensitive than radionuclide bone scanning

Question 34

Joint space narrowing, osteophytes and subchondral cysts

Answer 34

OA

Question 35

Marginal erosions, soft tissue swelling and periarticular osteoporosis

Answer 35

RA

Question 36

Soft tissue swelling, punched-out bone lesions and overhanging sclerotic margins

Answer 36

gout.

Question 37

What causes back pain associated with neurological problems in Marfan's

Answer 37

dural ectasia

Question 38

Drug causes of gout

Answer 38

diuretics: thiazides, furosemide ciclosporin alcohol cytotoxic agents pyrazinamide aspirin:

Question 39

Leflunomide SE what needs to be monitored

Answer 39

gastrointestinal, especially diarrhoea hypertension weight loss/anorexia peripheral neuropathy myelosuppression pneumonitis Monitor BP, LFTs FBC

Question 40

Anti-U1 RNP

Answer 40

mixed connective tissue disease arthralgia, myositis and Raynaud's

Question 41

pain & tenderness localised to the **lateral epicondyle** pain worse on **wrist extension** against resistance with the elbow extended or **supination** of the forearm with the elbow extended

Answer 41

Lateral epicondylitis tennis elbow hurts to straighten your fingers, bend your wrist back you may have tennis elbow. Tennis, Lateral and outside all have T‘s,

Question 42

tenderness over the medial epicondyle of the humerus. Pain is usually elicited by resisted wrist **flexion** with pronation while keeping the elbow flexed 90 degrees or resisted forearm **pronation** w/ the elbow extended.

Answer 42

Medial epicondylitis, or golfer's elbow hurts to close your hand in a grip, you may have golfer's elbow affects the inside of the elbow

Question 43

numbness, tingling, and pain in the **thumb, index finger, middle finger, and half of the ring finger**. nocturnal sx relieved by shaking hands.

Answer 43

carpal tunnel syndrome

Question 44

Methotrexate MOA SE

Answer 44

1. folic acid analog = decreased levels of THF 2. Inhibits purine snx= halts DNA production (S phase ) Pneumonitis bone marrow suppression Megaloblastic anaemia oral ulcers, gum bleeding, peptic ulcers, and hemorrhagic enteritis Liver cirrhosis teratogenic,

Question 45

Leflunomide mao & se

Answer 45

arresting the cell in the G1 phase of growth. = the proliferation of T-cells suppressed Liver impairment Interstitial lung disease Hypertension teratogenic

Question 46

MOA & SE Hydroxychloroquine

Answer 46

Takes 3-6 mo before effective Inbitits TNF A & IL 1 Retinopathy Corneal deposits ventricular arrhythmias. Use: RA and lupus Safe in pregnancy

Question 47

MOA & SE Sulfasalazine

Answer 47

safe in both pregnancy and breastfeeding take w/ folic acid Inbitits TNF A & IL 1 by macrophages Rashes Oligospermia Heinz body anaemia Interstitial lung disease

Question 48

Low level intermitted PTH

Answer 48

= anabolic level= bone formation

Question 49

Chronic High level PTH =

Answer 49

Catabolic effect = bone reabsorption

Question 50

RX osteoporosis

Answer 50

1st line Alendronate if can tolerate offered risedronate or etidronate 2nd line Raloxifene and strontium ranelate

Question 51

Indications for bisphosphonates

Answer 51

Indications: paget’s, Osteogenesis imperfecta, osteoporosis, metastatic disease, hypercalcaemia

Question 52

MOA bisphosphonates

Answer 52

Death to osteoclasts

Question 53

Denosumab moa & SE

Answer 53

prevents the maturation of osteoclasts by inhibiting RANKL.Given 2 yearly good in CKD Subcutaneous SE: Dyspnoea and diarrhoea, hypoca, hypoMg

Question 54

MOA Calcitonin

Answer 54

Direct inhibition of osteoclast & stim osteoblasts Increase secretion of phosphate & Ca2 in the urine Indications: Post-men osteoporosis, steroid induced osteoporosis, hyperCa, & Pagets

Question 55

Teriparatide moa & SE

Answer 55

Recombinant PTH = prevent osteoblast death administered in pulse like fashion = stim osteo blast SE: osteosarcoma, transient HYPRca2 Limited to 2 year use

Question 56

MAO & SE SERM (Raloxifene & Tamoxifen)

Answer 56

oestrogen receptor antagonist and partial agonist. Inhibit bone reabsorption Reduces risk of breast ca – not for pre menopausal wmn (it induces menopause via estrogen) * may worsen menopausal symptoms * increased risk of thromboembolic events * may decrease risk of breast cancer * endometrial cancer * menstrual disturbance: vaginal bleeding, amenorrhoea