Rheum

Question 1

IgA nephropathy (Berger’s diseae) with systemic vasculitic involvement =

Answer 1

IgA vasculitis (Henoch-Schonlein Purpura)

Question 2

Features of IgA Vasculitis (Henoch-Schonlein Purpura)

Answer 2

Purpura on extensors/buttocks

Abdo pain (GI bleeding)

Nephritis

(Polyarthritis)

Question 3

IgA vasculitis (HSP) usually presents in

Answer 3

Children following an infection

Question 4

anti-scl-70 (anti-topoisomerase) is highly specific for:

Answer 4

Diffuse cutaneous systemic sclerosis (+ increased risk pulmonary fibrosis)

Question 5

anti-centromere is highly specific for:

Answer 5

Limited cutaneous systemic sclerosis

Question 6

anti-dsDNA is highly specific for:

Answer 6

SLE

Question 7

anti-Smith is highly specific for:

Answer 7

SLE

Question 8

anti-Mi-2 is highly specific for:

Answer 8

Dermatomyositis

but only present in 25%

Question 9

anti-Jo-1 is seen in

Answer 9

Polymyositis (in disease with lung involvement, Raynauds & fever)

Question 10

Indications for plasma exchange (plasmapharesis)

Answer 10

Guillain-Barre

Myasthenia gravis

Goodpastures

ANCA vasculitis with rapidly progressive GN

ANCA vasculitis with pulmonary haemorrhage

TTP/HUS

Cryoglobulinaemia

Hyperviscosity (eg in MM)

Question 11

Anti-Ro are seen in

Answer 11

Sjogrens

Also SLE

Question 12

SLE and pregnant - Which antibody signifies risk of neonatal heart block

Answer 12

Anti-Ro

Question 13

Initial management of RA

Answer 13

DMARD monotherapy (usually methotrexate)

+/- bridging steroids

Question 14

Other DMARD options in RA

Answer 14

Sulfasalazine
Leflunomide
Hydroxychloroquine

Question 15

Management of RA - inadequate response to DMARDs

at least 2 DMARDs, including MTX

Answer 15

TNF-inhibitors:
Etanercept
Infliximab
Adalimumab

Question 16

Before starting TNF-inhibitor

Answer 16

Screen for TB, Hep B

(+/-Hep C if risk) due to risk of re-activation

Question 17

Abatacept (anti-CTLA4) used in

Answer 17

RA not controlled with anti-TNF therapy

Question 18

Canakinumab (anti-IL1) used in

Answer 18

Gout flares

Resistant Still’s disease

Question 19

Management of RA - next step after TNF inhibition

Answer 19

Rituximab (anti-CD20)

Question 20

Tocilizumab (anti-IL6) used in

Answer 20

RA not controlled with anti-TNF therapy

Question 21

Management of dermatitis herpetiformis

Answer 21

GF diet

Topical dapsone

Question 22

Side effect of dapsone

Answer 22

Haemolytic anaemia

Peripheral neuropathy

Question 23

Management of scalp psoriasis

Answer 23

Potent topical corticosteroid (Beclomethasone)

Question 24

Features of Adult Onset Still’s Disease

Answer 24

Daily fevers
Salmon-pink rash
Oligoarthritis
Serositis

Question 25

Management of Still's disease

Answer 25

``` NSAIDs -> Steroids -> MTX -> anti-TNF -> anti-IL1 (canakinumab) -> anti-IL6 (Tocilizumab)/anti-CD20 (rituximab) ```

Question 26

1st line therapy for plaque psoriasis

Answer 26

Topical steroids / Vit D analogues / Dithranol / Coal tar

Question 27

2nd line therapy for plaque psoriasis

Answer 27

UVB light therapy | Ciclosporin/MTX

Question 28

3rd line therapy for plaque psoriasis (or with arthritis)

Answer 28

anti-TNF (infliximab)

Question 29

Aspirate findings in pseudogout

Answer 29

Positively birefringent rhomboid crystals

Question 30

Aspirate findings in gout

Answer 30

Negatively birefringent needle-shaped crystals

Question 31

Management of pseudogout

Answer 31

``` NSAIDs > Steroids > Colchicine ```

Question 32

Management of gout

Answer 32

``` NSAIDS/colchicine -> Oral steroids -> IM steroid ```

Question 33

Alemtuzumab (anti-CD52) is used in

Answer 33

Multiple sclerosis

Question 34

Commonest causes of drug-induced lupus

Answer 34

Hydralazine Procainamide Isoniazid Phenytoin

Question 35

Typical antibodies in drug-induced lupus

Answer 35

anti-dsDNA negative | anti-histone positive

Question 36

Features of thromboangiitis obliterans

Answer 36

``` Young men, smokers Peripheral limb ischaemia Cockscrew vessels Lack of CVD RF Lack of multisystem inflammation ```

Question 37

Features of antiphospholipid syndrome

Answer 37

``` VTE Thrombocytopenia Prolonged APTT Livedo reticularis Recurrent fetal loss Pre-eclampsia, pulmonary HTN ```

Question 38

Management of antiphospholipid syndrome (no previous VTE)

Answer 38

Low-dose aspirin

Question 39

Management of antiphospholipid syndrome (previous VTE)

Answer 39

Lifelong warfarin with INR target 2-3

Question 40

Management of antiphospholipid syndrome (recurrent VTE whilst on warfarin)

Answer 40

Lifelong warfarin INR 3-4 | Add aspirin

Question 41

Management of antiphospholipid syndrome (previous arterial thrombosis)

Answer 41

Lifelong warfarin INR 2-3