Rheum

Question 0

Sjogrens have an increased risk of what type of malignancy

Answer 0

44 fold increase in NHL especially MALT
risk factors: disappearance of RF, low C4, cutaneous vasculitis and mixed monoclonal cryoglobulinaemia
Salivary glands most common location but can get unilateral or bilateral swelling that is benign

Question 1

What is the prognostic importance of rheumatoid factor positivity in RA?

Answer 1

Erosive disease
Response to Rituximab
Extra-articular manifestations

Question 2

What causes false positive anti-CCP?

Answer 2

TB
Psoriatic arthritis
SLE

Question 3

If suspect RA and serology negative, should you repeat the test?

Answer 3

Probably not- low risk of seroconverting

Question 4

Where to aspirate knee?

What does NORMAL fluid look like?

Answer 4

1cm medial to junction between the upper and middle thirds of the patella
Fluid is clear and VISCOUS (abnormal is cloudy and THIN)

Question 5

How many white cells per mm3 do you expect for septic joint, inflammatory joint, non inflammatory and normal joint?

Answer 5

Normal less than 200
Noninflammatory 200-2000
Inflammatory 2000 - 100000
Septic usually over 50000

Question 6

Aim for urate levels below this level reduces gout attacks?

Answer 6

35micromol/L

Question 7

What are the SECONDARY causes of pseudogout which need to be considered in a younger patient who presents?

Answer 7

haemochromatosis
hyperparathyroidism
low phosphate
low magnesium
hypothyroidism

Question 8

Difference between oral ulcers in SLE and Becet’s?

Answer 8

Becet’s PAINFUL

SLE PAINLESS

Question 9

What things in psoriasis increase the chance of getting psoriatic arthritis?

Answer 9

nail dystrophy
scalp involvement
intergluteal involvement
involvement three or more areas

Question 10

Do you get renal involvement in MCTD?

Answer 10

No

Remember, ANA often up, RF often up, RNP MUST be up
but dsDNA, Sm, scleroderma Ab are ABSENT

Question 11

IgG4 disease biopsy

Answer 11

plasma cells
small lymphocytes
often fibrosis

Question 12

If looks like pancreatic cancer but then serum IgG4 up?

Answer 12

could still be cancer

cannot rely

Question 13

Strongest evidence for fibromyalgia

Answer 13

aerobic exercise

first med choice is amitriptyline as per etg, or duloxetine, or pregabalin (pain sleep fatigue)
NOT SSRIs

for pain, also panadol, tramadol, tapentadol

Question 14

Classic Becet’s picture

Answer 14

youngish mediterranean man with anterior uveitis, painful gentital and mouth ulcers

positive pathergy test suggests

also get thrombophlebitis, aspetic meningitis, arthritis, erythema nodosum, DVT

Question 15

percent PMA to GCA

Answer 15

10-20%

but 40-60% GCA have PMR

Question 16

Most specific GCA symptom?

Answer 16

jaw claudication

Question 17

pathogenesis GCA?

Answer 17

TLR activate vascular dendritic cells–>Al17 and IFNgamma

Question 18

What other imaging would you do in GCA?

Answer 18

CTA or MRA to look for other organ involvement

Question 19

Muscle enzymes in PMR

Answer 19

normal
normal EMG too
normal muscle biopsy

Question 20

What interferes with response to TNF treatment?

Answer 20

smoking

Question 21

how many of the sjogrens are seroneg?

Answer 21

20%

can get small fibre neuropathy

Question 22

most common presenting feature scleroderma is

Answer 22

Raynauds

Question 23

Classic cause enthesitis

Answer 23

psoriatic
next reactive
next ankylosing spondylitis

Question 24

Classic OA joints in hands

Answer 24

1st CMC and PIPs hand splints good for CMC NSAIDS out these days

Question 25

Patellofemoral joint RA typical presentation

Answer 25

classically get pain getting out of chair and WALKING DOWN THE STAIRS

Question 26

How do APL induce thrombosis

Answer 26

interfere with clotting cascade especially protein C induce tissue factor expression induce adhesion molecule expression promote thrombosis

Question 27

Contraindications for TNF

Answer 27

``` previously untreated TB recurrent LRTI septic arth last 12 months MS or demyelinating illness IDC infected prosthesis malig within 10 years- BCC within 5 years preg CCF skin ulcers NOT pyoderma gangrenosum ```

Question 28

which system NOT affected by PAN

Answer 28

pulmonary think if vasculitis with orchitis without glom neph idiopathic PAN-->steroids and cyclophos hepatitis PAN-->plasmapheresis and antiviral

Question 29

good prognosis in RA if present with

Answer 29

large joint just a few acute seroneg

Question 30

can you be CPPD positive and asymptomatic?

Answer 30

YES!

Question 31

Sjogrens and what type lymphoma

Answer 31

NHL

Question 32

ORganism most likely in vertebral OM

Answer 32

random: s aureus-->e coli | after surg on spine--->s epiderm-->propionebacterium acnes

Question 33

most specific Ab for APL syndrome

Answer 33

anticardiolipin ab most sensitive | APL ab most specific

Question 34

What to avoid in psoriatic arthritis

Answer 34

hydroxychloroquine | oral steroids- increase pustular psoriasis

Question 35

where are the most SPECIFIC SLE ulcers

Answer 35

palate

Question 36

Complement low in HSP

Answer 36

NO! | unlike cryo

Question 37

what is SAP in amyloid

Answer 37

all amyloid people have serum amyloid protein which is a GP that binds amyloid independently of the protein of origin