Rheumatolgy

Question 1

Painful red swollen knee. Differentials?

Answer 1

Septic arthritis- often post joint injectin
Reactive arthritis- GI or sex infection
Gout- needle shaped -vely birefringent
Pseudogout- rhomboid crystals +vely birefringent

Question 2

Examples of ESBLs? And abx that usually treats them

Answer 2

E.coli
Klebsiella
Usually cause UTIs but can cause pneumonia
Tx: meropenam or imipenem

Question 3

AIDS defining illnesses?

Answer 3

Kaposi’s sarcoma
PCP- pneumocystis jirovecii pneumonia
CMV
Candidiasis- oesophageal or bronchial
Lymphomas - excluding Hodkins
TB

Question 4

Examples of cephlosporins?

Answer 4

Ceftriaxone, cefotaxime
All the cephs….

Question 5

What medication class can cause atheroscleosis?

Answer 5

Atypical antipsychotics- e.g. olanzapine, risperidone, clozapine, quitiapine
As can cause hyperlipidaemia

Question 6

Two types of systemic sclerosis?

Answer 6

Diffuse cutaneous systemic sclerosis
Limited cutaneous systemic sclerosis
Scleroderma- w/o organ involvement

Diffuse- affects trunk and limbs mostly. Poor prognosis due to resp involvement in 80% interstitial lung disease and pulmonary arterial hypertension

Question 7

Most specific antibody for diffuse cutaneous systemic sclerosis

Answer 7

Anti-Scl-70 abx

Question 8

Which antibody is most specific for limited cutenous systemic sclerosis?

Subtype of limited systemic sclerosis?

Answer 8

Anti centromere antibodies

CREST syndrome: Calcinosis, Raynaud’s phenomenon, oEsophageal dysmobility, Sclerodactyly, Telangiectasia

Question 9

Which anti body is associated with Sjögren’s syndrome?

Answer 9

Anti-Ro in 70%
Anti-La in 30%
RF +ve in 50%
ANA +ve in 70%

Autoimmune disorder affecting exocrine glands, ,ears to dry mucosal surfaces e.g. dry mouth, eyes, vagina

Question 10

Immunologicical +ve findings in RA?

Answer 10

Rheumatoid factor
Anti-CCP (anti- cycling citrullinated protein)

Question 11

Hand findings in RA?

Answer 11

Swollen joints
Ulnar deviation in fingers
Boutonnière deformity- flexion at PIP, hyperextention at DIP
Swan neck deformity- hyper extension at PIP, flexion at DIP
Z-shaped deformity if thumb
Wrist subluxation
Rupture of extensor tendon
Muscle wasting

Question 12

X ray findings of RA hands?

Answer 12

Loss of joint space
Soft tissue swelling
Jutta-articulate osteopenia
Bkny erosions

Question 13

Extra articulate features in RA?

Answer 13

Key ones
Pulmonary fibrosis w/ nodules- Caplans syndrome
Bronchiolitis obliterans- small airway destruction
Felty’s syndrome- RA, neutropenia, splenomegaly

Others:
Scleritis
Episcleritis
Lymphadenopathy
Pleural effusion
Pericardial effusion
Rheumatoid nodules e.g. elbow, pleura
Amyloidosis
Vasculitis
Raynaud’s phenomenon
Carpal tunnel syndrome

Question 14

X-ray of a joint with gout findings?

Answer 14

Normal joint space
Soft tissue swelling
Erosion of periarticular bone

Question 15

Light microscopy findings in gout and pseudogout?

Answer 15

Gout- negatively birefringent needle shaped crystals (made out of urate crystals)
Pseudo gout- positively birefringent rhomboid shaped crystals (made out of calcium pyrophosphate crystals)

Question 16

X-ray findings in OA?

Answer 16

LOSS
loss of joint space
Osterphytes
Subchondral sclerosis
Subchondral cysts

Question 17

Why might someone with SLE suffer from recurrent miscarriages?

Answer 17

20%+ of patients with SLE also have antiphospholipid syndrome, a condition that increases the risk of both arterial and venous clotting and recurrent miscarriages

Question 18

4 most common features of antiphospholipid syndrome?

Answer 18

‘CLOT’
Coagulation defect- clots!
Livedo reticularis
Obstetric- recurrent miscarriage
Thrombocytopenia

Question 19

What is Raynaud’s phenomenon?

Answer 19

Peripheral digital Ischaemic caused by vasospasm which is precipitated by cold or emotion

Question 20

What can cause Raynaud’s phenomenon?

Answer 20

Raynaud’s disease-
SLE
RA
Dermatomyositis/polymyositis
Beta blockers
Polycythaemia rubra vera
Occupations e.g. vibrating tools
Hypothyroidism
Atherosclerosis
Beugers disease

Question 21

39yo patient comes in with recent fatigue, aches and pains in shoulders and legs and a rash on eyes and hands, what is it? And the features of this?

Answer 21

Dermatomyositis
An autoimmune disease causing inflammation of the muscles and skin
(Polymyositis is same but without skin involvement)

Features
Muscle pain, most commonly shoulder and girdle bilaterally ie PROXIMAL
Fatigue and weakness
Skin features:
- Gottron lesions- scaly erythematous rash on knuckles, elbows and knees
- Heliotrope- purple rash over eyelids
- a photosensitive erythematous rash across back, shoulders and neck
- Subcutaneous calcinosis- calcium in sucut tissue

Question 22

Suspecting Dermatomyositis, what first commonly done test would indicate this?

Answer 22

Raised CK

Question 23

Extraarticular associations of anklylosing spondylitis?

Answer 23

Aortic regurg- early diastolic murmur
Pulmonary fibrosis
Anterior uveitis
Amyloidosis