rheum passmed year 5

Question 1

when is denosumab used in OP tx

Answer 1

after bsiphospphonate tried - two different types

or if renal function is under 30

Question 2

methotrexate toxicity tx

Answer 2

Folinic acid

antidote to folic acid antagonists (ie, methotrexate and pyrimethamine)

Question 3

livedo reticularis caused by what thrombotic disease

Answer 3

anitphospholipid syndrome

Question 4

primary thromboprophylaxis
in antiphsipholipid syndrome

Answer 4

low dose aspirin

Question 5

Psoriatic arthropathy is an inflammatory arthritis associated with psoriasis and is classed as one of the seronegative spondyloarthropathies. It correlates poorly with cutaneous psoriasis and often precedes the development of skin lesions
what is MX

Answer 5

methotrexate

Question 6

where do ewing sarcomas arise

Answer 6

Ewing sarcoma typically occurs in the diaphysis or metaphyseal–diaphyseal portion of long bones

Question 7

what is the periosteum

Answer 7

The periosteum is the medical definition for the membrane of blood vessels and nerves that wraps around most of your bo

Question 8

what is a periosteal reaction

Answer 8

eriosteal reaction results when cortical bone reacts to one of many possible insults. Tumor, infection, trauma, certain drugs, and some arthritic conditions can elevate the periosteum from the cortex and form various patterns of periosteal reaction

seen in ewing

Question 9

Chondrosarcoma - cartilage - normally affects where

Answer 9

axial skeleton - skull, v body, rib cage pelvis

Question 10

osteosarcoma occurs where and pre what

Answer 10

occurs most frequently in the metaphyseal region of long bones prior to epiphyseal closure.

Question 11

causes of drug induced lupus

Answer 11

Most common causes
procainamide
hydralazine

Less common causes
isoniazid
minocycline
phenytoin

Question 12

when do you lower your dose of aziothiopurine

Answer 12

A significant interaction may occur with allopurinol and hence lower doses of azathioprine should be used.

preg keep same as safe

Question 13

how does haemachromatosis lead to psedogout

Answer 13

Hemochromatosis (HH) is a condition that can cause calcium pyrophosphate (CPP) crystal deposition in the joints, which is also known as pseudogout. The exact mechanism that causes CPP crystal formation in HH patients is not fully understood, but some studies suggest that iron may play a role:

Iron damage: Excess iron can damage bone cells and chondrocytes.

Osteoclastogenesis: Iron may stimulate osteoclastogenesis, which is associated with premature and severe CPPD

Question 14

A postmenopausal woman who’s had an osteoporotic vertebral fracture should be started on a bisphosphonate straight away

Answer 14

true

Question 15

GCA suspected given high dose oral pred - temp biopsy done but comes back normal what to do next and why

Answer 15

Continue high-dose prednisolone and repeat biopsy as Skip lesions occur in giant cell arteritis and may show a normal biopsy

Question 16

two movement associated with lateral epicondylitis

Answer 16

worse on resisted wrist extension/suppination whilst elbow extended

Question 17

pagets( increased uncontrolled bone turnover) tx

Answer 17

bisphosphonate (either oral risedronate or IV zoledronate)

Question 18

pANCA may be positive in which crohns or UC

Answer 18

pANCA may be positive in UC, but will likely be negative in Crohn’s

Question 19

in septic arthritis what IX is important to do before giving abx

Answer 19

synovial fluid sampling is obligatory
this should be done prior to the administration of antibiotics if necessary

Question 20

peptic ulcers contradict what drug

Answer 20

NSAID
steriod

Question 21

polymorphonuclear neutrophil predominance

Answer 21

RA

Question 22

reactive a. - synovial fluid appears how

Answer 22

Sterile synovial fluid with a high white blood cell count

Question 23

household bound pt what should they have

Answer 23

vitamin d

Question 24

what are we worried about in people with marfans which is why we do echocardiography

Answer 24

dilation of the aortic sinuses which may predispose to aortic dissection

Question 25

Before giving a bisphos what do you need to make sure is checked and corrected if low

Answer 25

calclium

and then give bsipho and vit d and maybe Ca (dietary)

Question 26

if pt with polymyaglia rheymatica do not repsond to steriods what do you do

Answer 26

cosnider other dx

Question 27

finger swelling - dactylitis feature of what arthritis

Answer 27

psoriasitic

Question 28

in gout under what level of uric acid should you measure again 2 weeks later after flare has settled

Answer 28

360

Question 29

in women when should they be started on bisphos straight away

Answer 29

osteoporotic vertebral fracture in postmenopausal women - dont wait fro dexa

or if over 50 and post on PO steriods

Question 30

acute gout tx for future recurrence

Answer 30

allopurinol

colchine for flare

Question 31

Proximal muscle weakness + raised CK + no rash

Answer 31

polymyositis

rheumatica raised ESR

Question 32

XR findings in ank spond

Answer 32

x-ray findings: subchondral erosions, sclerosis
and squaring of lumbar vertebrae

Question 33

Bone pain, tenderness and proximal myopathy (→ waddling gait)

Answer 33

osteomalacia

rickets kids

Question 34

acute flares of RA managed how

Answer 34

flares of RA are often managed with corticosteroids - oral or intramuscular

Question 35

what needs to be checked with methotrexate

Answer 35

FBC & LFTs i

Question 36

reflex tachycardia is caused by what drug and what is the mech

Answer 36

nifidipine

Nifedipine causes peripheral vasodilation which leads to the heart compensating for the drop in blood pressure by beating faster.

Question 37

dermatomyositis what rash is seen over the knuckles

Answer 37

Gottron’s papules, roughened red papules over the knuckles mainly

Question 38

A 37-year-old man sees his GP complaining of ‘a flu that won’t go away’. On further questioning he has had a 2-week history of fever, nausea and vomiting, myalgia and weakness, and a sensation of itchiness. He also describes a few episodes of red urine. He denies any cough, haemoptysis or any other respiratory symptoms. On examination you notice he has some slight scleral icterus, alongside small palpable purpura on his lower legs and arms.

Given these features, which of the following would be the most likely diagnosis?

Answer 38

The stem may seem overwhelming at first but breaking it down will help reveal clues to the question. His symptoms/signs appear to be rather viral, with the exception of the itchiness, scleral jaundice, haematuria, and purpura. With the systemic symptoms alongside the haematuria and purpura the first thought should be vasculitis, thus eliminating polymyalgia rheumatica.

The scleral jaundice and itchiness suggest a obstructive hepatic impairment. Alongside this, we are also told that the patient has not had any respiratory symptoms. Combining these would help exclude a further three answers and lead to the correct answer of polyarteritis nodosa, which is strongly associated with hepatitis B infection and does not tend to have respiratory features unlike the other 3 vasculitides.

Question 39

hep b associated with what condition

Answer 39

polyarteritis nodosa

Question 40

what is PTH raised in osteomalacia and rickets

Answer 40

Raised ALP and PTH and decreased calcium and phosphate are incorrect as this is caused by osteomalacia/rickets. This is a condition characterised by impaired mineralization of bone and has several causes such as vitamin D deficiency, liver disease. PTH is raised in an attempt to increase calcium stores for bone mineralisation, leading to increased PTH and ALP.

Question 41

difference between methotrexate and felty syndrome with blood results and splenomegaly or not

Answer 41

Felty’s syndrome is a condition characterized by splenomegaly and neutropenia in a patient with rheumatoid arthritis. Hypersplenism results in destruction of blood cells which classically results in neutropenia but can also cause pancytopenia.

methotrexate would not cause splenomegaly

Question 42

long term steriod use what do you need to also be taking immediately

Answer 42

bisphosphonates

Start oral alendronate + ensure calcium and vitamin D replete

Question 43

In newly-diagnosed active rheumatoid arthritis what should you tx with

Answer 43

with methotrexate (or sulfasalazine or leflunomide) and oral steroids.

Steroids (oral or intra-articular) can be used to alleviate flares, and patients are often also prescribed paracetamol for pain relief.

Question 44

is obesity a risk factor for OP

Answer 44

no

Question 45

malignant tumour that occurs most frequently in the diaphysis of the pelvis and long bones

Answer 45

ewings tumour - onion skin

Question 46

chrondrosarcoma commonly affects where

Answer 46

axial skeleton - and in middle age people

Question 47

osteoma are benign and commonly occur where

what condition are they associated with

Answer 47

skull

This condition is also classically associated with Gardner’s syndrome (a variant of familial adenomatous polyposis, FAP).

Question 48

most common benign bone tumour.

cartilaged capped projection

Answer 48

Osteochondroma

Question 49

osteosaroma associated with what gene

Answer 49

retinoblastoma gene (and hence retinoblastoma tumours).