Rheum (2)

Question 1

Rheumatoid Arthritis Mx?

Answer 1

• Weekly methotrexate +short course of prednisolone

Question 2

What condition has ‘pencil-in-cup’ and ‘plantar spur’ deformity?

Answer 2

Psoriatic Arthritis: these are x-ray findings

Question 3

Rheumatoid Arthritis X-Ray findings presents with?

Answer 3

‘LESS’- Loss of joint space, Erosions, Soft bones, Soft tissue swelling.

Question 4

Osteoarthritis mx?

Answer 4

• 1st) topical NSAID eg. diclofenac
• 2nd) oral ibuprofen + PPI (omeprazole)

Question 5

what test must be carried out before starting Azathioprine? (for Crohn’s long term remission and maintenance)

Answer 5

TPMT: Thiopurine Methyltransferase deficiency

Question 6

before starting Biologics medication, what must you do?

Answer 6

do CXR: to look for TB as biologics could cause reactivation.

Question 7

diagnosis of Ankylosing Spondylitis? (inv)

Answer 7

Pelvic x-ray/MRI (whichever is an option): as will see sacro-ilitis
1st line Tx: NSAIDS and encourage regular exercise eg. swimming

Question 8

When to think of Felty’s Syndrome?

Answer 8

Felty’s syndrome is a condition characterised by SPLENOMEGALY and NEUTROPENIA (LOW NEUTROPHILS) in a patient with rheumatoid arthritis.

Question 9

side effect of Azathioprine? and what inv to do to test it?

Answer 9

• may cause myelosuppression: do FBC: if infection/bleeding occurs

Question 10

Septic arthritis mx?

Answer 10

if growth is Staph Aureus: IV Flucloxacillin

Presents with: IVDU with acute, hot, swollen knee
- fever, inability to weight-bear, raised inflammatory markers
- patient must be systemically unwell and likely to have been precipitated by trauma, if not ddx: Rheumatoid Arthritis

Question 11

blood result findings of osteomalacia?

Answer 11

• Low serum calcium,
• Low serum phosphate,
• Raised ALP
• raised PTH

ddx: osteoporosis: blood results would all be NORMAL.
- paget’s disease: isolated raised ALP, mostly asymptomatic.

Question 12

how to manage renal complications of Systemic Sclerosis?

Answer 12

ACE-inhibitors eg. ramipirl

Question 13

SLE antibodies? most specific and most sensitive?

Answer 13

• Specific: anti dsdna and anti-Smith
• Sensitive: ANA +

Question 14

which condition has juxta-articular osteoporosis/osteopenia?

Answer 14

• Rheumatoid Arthritis

Question 15

Acute reactive arthritis mx?

Answer 15

NSAIDs= 1st line
if resistant to NSAIDS, then:
oral glucocorticoids

Question 16

Acute Gout: Mx?

Answer 16

1st line) high-dose NSAID eg. aspirin/coxib
2nd line) if contraindicated for eg. have a peptic ulcer: then start on colchicine

Question 17

oral ulcers + genital ulcers + anterior uveitis (gunky, painful eyes), what diagnosis?

Answer 17

Behcet’s disease