rheum

Question 1

tightening of skin + Raynaud’s + telangiectasia –> ?
(may also have oesophageal dysmotility)

Answer 1

systemic sclerosis

Question 2

Anti-Ro antibodies are most associated with _______? Typical hx for this pt?

Answer 2

Sjögren’s syndrome
dryness of the eyes and mouth

Question 3

what are the 3 patterns of systemic sclerosis? What’s the difference between them?

Answer 3

limited Cyteaneous systemic sclerosis = antiCentromere ab
- Raynaud’s
- scleroderma on face and limbs
- subset: CREST syndrome

Diffuse cutaneous Systemic sclerosis = anti-Scl-70 ab
- scleroderma on trunks and proximal limbs
- interstitial lung disease (most common cause of death), pulmonary arterial hypertension
- renal disease, HTN (start ACEI)

just scleroderma
- plaques or linear

Question 4

which ab may be positive in all types of sclerosis

Answer 4

ANA, RF

Question 5

polymyalgia rheumatica blood tests:
ESR:
CRP:
anti-ccp:
CK:

Answer 5

ESR: raised
CRP: raised
anti-ccp: -
CK: -

Question 6

polymyalgia: ____ is common, _____ is uncommon, _____ raised

Answer 6

stiffness
weakness
inflammatory markers

Question 7

polymyalgia rheumatica tx

Answer 7

prednisolone

Question 8

Patients that will be taking hydroxychloroquine long-term now require

Answer 8

baseline ophthalmologic examination at the outset of treatment (Bull’s eye retinopathy)

Question 9

It is important to perform a _______________prior to starting biologics for rheumatoid arthritis as _________________

Answer 9

chest X-ray to look for TB
they can cause reactivation

Question 10

Dupuytren’s contracture can be a side effect of __________treatment

Answer 10

phenytoin

Question 11

___________________ should be used when starting allopurinol

Answer 11

NSAID or colchicine ‘cover’

Question 12

There is no _____________ in polymyalgia rheumatica on examination

Answer 12

true weakness of limb girdles

Question 13

A key point for the exam is to appreciate that antiphospholipid syndrome causes a paradoxical rise in the _______

Answer 13

APTT

Question 14

the As of ankylosing spondilitis

Answer 14

Apical fibrosis
Anterior uveitis
Aortic regurgitation
Achilles tendonitis
AV node block
Amyloidosis
and cauda equina syndrome
peripheral arthritis (25%, more common if female)

Question 15

1st line Ix for ankylosing spondylitis and what will it show?

2nd line Ix for ankylosing spondilitis and what will it show?

Answer 15

XRAY of sacroiliac joints: squaring of vertebrae, sacroiiliatis, bamboo spine (late and uncommon), syndesmophytes

MRI: bone marrow oedema

Question 16

what rheum drug has a significant risk with allopurinol?

Answer 16

azathiopurine

Question 17

___________________ should be corrected before giving bisphosphonates

Answer 17

Hypocalcemia/vitamin D deficiency

Question 18

isolated increase in ALP =

Answer 18

Pagets

Question 19

what is normally given alongside bisphosphonate Tx? What is only given if needed?

Answer 19

Vitamin D normally given
Calcium only given if dietary intake is insufficient

Question 21

calcium, phosphate, ALP, PTH in:
1. osteoporosis
2. osteomalacia
3. primary hyperparathyroid
4. secondary hyperparathyroid (CKD)
5. CKD
6. Paget’s

Answer 21

Question 22

ankylosing spondylitis acronym

Answer 22

sausage digit dactylitis
psoriasis
inflammatory back pain
nsaids
enthesitis
arthritic/apical fibrosis/aortic regurg
chrons/uc
hlab27
eye (anterior uveitis)

Question 23

which antibody marker is negative in drug-induced lupus

Answer 23

anti double-stranded dna

Question 24

xray feaures of gout

Answer 24

joint effusion, erosion, relative preservation of joint space, NO periarticular osteopenia (as opposed to RA)

later: soft-tissue tophi

Question 25

____________ is the first sign of hip osteoarthritis

Answer 25

Reduction in internal rotation

Question 26

avascular necrosis may occur following ________

Answer 26

high dose steroid therapy or previous hip fracture of dislocation

Question 27

most common pulmonary manfiestation of methotrexate?

Answer 27

pneumonitis

Question 28

stepwise Mx of osteoarthritis

Answer 28

1st: topical NSAIDs
2nd: oral NSAIDs + PPI cover
3rd: DO NOT offer paracetamol/weak-opiades
4th: intra-articular steroid injections
5th: joint replacement

Question 29

RA can eventually lead to ________

Answer 29

osteoporosis

Question 30

sjrogens is linked to increased risk of which malignancy?

Answer 30

lymphoid

Question 31

if you’re allergic to aspirin you’re probably also allergic to

Answer 31

sulfasalazine (sulphonamides)

Question 32

drugs that cause drug-induced lupus

Answer 32

SHIPP is a mnemonic that u can use
sulfonamindes
hydralazine
isoniazid
procainamide
phenytoin

Question 33

Intermittent limb claudication, absent or weak peripheral pulses in a young woman, →

Answer 33

Takayasu’s arteritis