Rheum

Question 1

4 extra articular RA

Answer 1

Scleritis / episcleritis 
lymphadenopathy 
pleural effusion 
nodules - elbow / pleura 
percardial effusion 
neuropathy 
raynauds 
carpal tunnel

Question 2

how do NSAIDS work

Answer 2

inhibiy COX -> reduce prostaglandins -> reduce inflammation

Question 3

2 times you wouldn’t use methotrexate first line for RA? Alternative DMARD?

Answer 3

pregnancy, liver disease

sulphasalazine

Question 4

Gout
3 precipitants
1 early 1 late XR finding
Seen on joint aspiration

Answer 4

diuretics, dehydration
alcohol, purine-rich foods
surgery, trauma, infection

Normal joint space, soft tissue swelling
periarticular erosions

Negatively birefringent needle-shaped crystals

Question 5

seen on XR of pseudogout ?
3 common places
3RFs
key Ix and finding

Answer 5

chondrocalcinosis
knee, hip, wrist

hypothyroid, HPT, Wilsons, OA, age

polarised light microscopy of synovial fluid
->weakly birefringent rhomboid-shaped crystals

Question 6

increasing Mx of OA

Answer 6

conservative - weight loss, exercise, physio

medical - NSAIDs, opioids, intraarticular injections

Surgical - replacement

Question 7

Bar miscarrigae 3 features of antiphospholipid syndrome

Mx options

Answer 7

CLOT
coagulation defects, livedo reticularis, Obstetric problems, thrombocytopenia

aspirin, clopidogrel, warfarin, heparin

Question 8

2 key antibodies in SLE

Answer 8

anti-dsDNA

ANA

Question 9

dermatomyositis …
Called when purple discolouration of eyelids?
rough red papules on knuckles?
Name 2 antibodies ?

Answer 9

heliotrope
gottron’s papules

anti Jo
anti Mi2
RF
ANA

Question 10

4 Causes of raynauds

Answer 10

SLE
RA
dermatomyositis/polymiositis 
B blockers 
PV
Atherosclerosis 
buergers disease

Question 11

Name 3 seronegative spondyloarthropathies

Answer 11

Ank spond 
reactive arth
psoratic arth 
enteropathic arth
rieters 

All HLA-B27

Question 12

2 XR findings of ankspond

Answer 12

calcification of intervertabral ligaments
fusion of spinal facets
formation of bridging syndesmophytes

[Bamboo spine]

Question 13

2 medical mx of ank spond

Answer 13

NSAID
Intra articular joint injections
anti TNFa - Eg entercept, infliximab

Question 14

what might you hear on auscultation of chest in ank spond

Answer 14

fine end expiratory crackles in apices

early diastolic murmur (AR)

Question 15

3 bugs that can -> reactive arthritis

Answer 15

campylobacter
chlamidydia
salmonella
shigella

Question 16

most common joint in PA

Answer 16

DIPs

[get dactylitis]

Question 17

Name 2 small vessle ANCA+

ANCA-

Answer 17

+ Churg strauss, Wegner, microscopic polyangotos

-ve - HSP, AntiGBM

Question 18

name 3 causes of mononeuritis multiplex

Answer 18

HIV
RheumA
Diabetes
sarcoidosis 
PAN