rheum

Question 1

signs of rheumatoid arthritis

Answer 1

swan-neck deformity (DIP flexion + PIP extension)
boutonierre deformity (DIP hyperextension + PIP flexion)
Z-shaped thumb
ulnar deviation at MCP joint
radial deviation at wrist
subcutaneous nodules (elbows)

Question 2

rheumatoid arthritis investigations

Answer 2

bloods: FBC, CRP / ESR
autoimmune screen: anti-CCP, RF, ANA
X-ray
DAS28 score

Question 3

X-ray findings rheumatoid arthritis

Answer 3

LOSE: 
loss of joint space 
osteopenia
soft tissue swelling 
erosions

Question 4

rheumatoid arthritis management

Answer 4

conservative: physiotherapy, occupational therapist, exercise, monitor disease w das28 scoring
medical:
1. NSAIDs e.g. ibuprofen (+PPI)
2. DMARDs e.g. methotrexate, hydroxychloroquine, sulfasalazine, leflunomide
3. steroids (oral / IM / intra-articular injection)
4. biologics e.g. anti-TNF (etanercept, infliximab)

Question 5

Felty’s syndrome

Answer 5

splenomegaly 
arthritis (rheumatoid)  
neutropenia 
thrombocytopenia 
anaemia

Question 6

Boutonnierre deformity vs swan neck

Answer 6

Boutonnierre: DIP hyperextension + PIP flexion

swan neck: DIP flexion + PIP hyperextension

Question 7

features systemic sclerosis

Answer 7

CREST features: calcinosis, raynaud’s, oesophageal dysmotility, sclerodactyly, telangiectasia
facial features: beaked nose, microstomia
ILD
GI: dysphagia, bloating, GORD
arrhythmias (cardiac conductive defects)
acute hypertensive crisis

Question 8

features SLE

Answer 8

SOAP BRAIN MD
serositis: pleuritis, endocarditis, pericarditis
oral ulcers
arthritis
photosensitivity
blood: anaemia, thrombocytopenia, leukopenia
renal: lupus nephritis (proteinuria, haematuria)
ANA positive
immunological: anti-dsDNA, anti-Sm, anti-phospholipid
neurological: psychosis, seizures
malar rash
discoid rash

Question 9

Ab limited vs diffuse systemic sclerosis

Answer 9

limited: anti-centromere
diffuse: anti-topoisomerase (Scl70)

Question 10

complications of systemic sclerosis

Answer 10

diffuse →

pulmonary HTN / fibrosis

Question 11

features dermatomyositis

Answer 11

proximal muscle weakness + wasting (insidious onset, symmetrical)
Gottren’s papules: discrete erythematous papules over MCP and IP joints
heliotrope / iliac rash
shawl sign
mechanics hands (cracking over fingertips)
periungual telangiectasia
ILD
respiratory muscle weakness
dysphagia, dysphonia

Question 12

signs giant cell arteritis

Answer 12

temporal artery: tender, pulsatile, palpable, headache
ophthalmic artery: visual disturbance
facial artery: jaw claudication (pain on chewing)
signs of polymyalgia rheumatica: morning / evening proximal muscle aching + stiffness

Question 13

gout vs pseudogout

Answer 13

gout: monosodium urate (needle)
pseudogout: calcium pyrophosphate (rhomboid)
+ve birefringence w polarised light

Question 14

causes of raynaud’s

Answer 14

primary: raynaud’s disease (no specific cause)
secondary:
autoimmune: SLE, RA, systemic sclerosis
drugs: OCP, ergotamine
haematological: leukaemia, polycythaemia

Question 15

management raynaud’s

Answer 15

1. CCBs e.g. nifedipine

2. IV prostacylin (epoprostenol) infusion

Question 16

symptoms ankylosing spondylitis

Answer 16

morning stiffness better w activity
lower back pain 
eyes: iritis / conjunctivitis 
enthesitis: inflammation at sites of insertion of ligaments & tendons into bone (e.g. Achilles tendonitis) 
peripheral arthritis

Question 17

management ankylosing spondylitis

Answer 17

cons: regular exercise / physio
med: NSAIDs (1st line)
biologics: anti-TNF e.g. etanercept
DMARDs (like in RA) only if peripheral arthritis

Question 18

investigations ankylosing spondylitis

Answer 18

bloods: raised ESR / CRP, HLA-B27
imaging: X-ray (MRI if -ve XR)
CXR → apical fibrosis
lung function testing
BASDAI score (disease activity index)

Question 19

ankylosing spondylitis

associated conditions

Answer 19

8As: 
apical fibrosis
arthritis (peripheral)
aortic regurgitation
achilles tendonitis 
amyloidosis
atlanto-axial subluxation 
anterior uveitis 
AV node block

Question 20

x-ray findings for ankylosing spondylitis

Answer 20

sacroiliitis: subchondral erosions, sclerosis
squaring of lumbar vertebrae
syndesmophytes: ossification of outer fibers of annulus fibrosus

Question 21

drugs causes of SLE

Answer 21

procainamide, hydralazine
isoniazid, phenytoin
carbamazepine, sulfasalazine

Question 22

RFs for pseudogout

Answer 22

hyperparathyroidism
low magnesium / phosphate
Wilson's disease 
haemochromatosis 
acromegaly

Question 23

management of gout

Answer 23

acute: oral NSAIDs / colchicine (1st) 
oral prednisolone (2nd) 

chronic:
cons: weight loss, reduce alcohol: low purine diet (reduce liver, kidneys, seafood, oily fish, yeast products)
med: allopurinol (1st), febuxostat (2nd), probenecid

Question 24

Ab for SLE

Answer 24

ANA: most sensitive
anti-dsDNA: most specific (can be used for disease monitoring if present)
rheumatoid factor (25%)
anti-smith: also highly specific

Question 25

features takayasu arteritis

Answer 25

large vessel vasculitis
FLAWS + syncope
weak / absent pulses, claudication 
unequal L + R BP 
renal artery stenosis 
arthralgia
aortic regurgitation, carotid bruit 
transient visual disturbance
TIAs, CVAs

Question 26

features granulomatosis w polyangiitis

Answer 26

Wegener's (small vessel vasculitis)
upper airway: saddle nose, sinusitis, nasal ulcers, epistaxis 
lower airway: cough, haemoptysis 
glomuerulonephritis
cANCA (PR3 Ig) +ve

Question 27

features eosinophilic granulomatosis w polyangiitis

Answer 27

Churg-Strauss (small vessel vasculitis)
Hx of atopic disease (→ nasal polyps) 
eosinophilia
haemoptysis
rash
renal damage 
focal neurology 
pANCA (MPO Ig) +ve