Rheumatology

Question 1

Spinal stenosis symptoms (4)

Answer 1

Back/buttock pain
Worse walk downhill, improve when sit/lean forward
Numb / paraesthesia
Pseudo / neurogenic claudication (intermittent leg pain from compression of nerves emanating from spinal cord)

Question 2

what is the Classification that osteoarthritis falls under

Answer 2

Primary degenerative arthritis

Question 3

Broad classification of arthritis

Answer 3

Inflammatory and degenerative

Question 4

Sub -classification of inflammatory arthritis and examples (4)

Answer 4

Seropositive eg RA, SLE
Seronegative: symmetrical (AS) or asymmetrical (psoriatic)
Crystal eg gout
Infectious or septic eg Lyme disease

Question 5

Hand clinical signs of osteoarthritis (5)

Answer 5

Heberden's nodes (DIP)
Bouchard's nodes (PIP) ("Bouchard" closer to "body")
Base of Thumb squaring (CMC)
Sparing of MCPJs
Asymmetrical!

Question 6

Which crystal causes gout

Answer 6

Uric acid

Question 7

Which crystal causes pseudogout

Answer 7

Calcium crystals

Question 8

Which joints are commonly affected in pseudogout

Answer 8

Wrist and knee

Question 9

Common precipitants of gout (8)

Answer 9

Drugs are FACT
Furosemide (loop diuretic)
Aspirin
Cytotoxic drugs ( antineoplastics)
Thiazides and loop diuretics!

Food are SALT
Seafood
Alcohol
Liver and kidney
Turkey (meat)

Question 10

What are gouty tophi and where do they occur (5)

Answer 10

Monosodium urate deposits in tissues (synovium = microtophi)

Commonly first MTPJ! , ear helix, Olecranon bursae, tendon insertions esp Achilles

Question 11

Hypertrophic osteoarthropathy symptoms and signs (3)

Answer 11

Acute severe burning bone pain, worse by dependency
Clubbing
Periostitis of long bones
Arthritis

Question 12

What is rheumatoid arthritis- like syndrome? (4)

Answer 12

A paraneoplastic condition associated with breast, colon, lung, ovarian, lymphoproliferative cancer. Presents similar to rheumatoid arthritis except is Rf negative and the condition is assymmetric polyarthritis

Question 13

Name 7 cardiac manifestations of SLE

Answer 13

Pericarditis (SEROSITIS NB)
Coronary artery disease
Endocarditis (non bac:Libman-Sachs)
Myocarditis
Coronary Vasculitis - life -threat
Malignant HT- life threat
Tamponade - life threat

Question 14

Vascular manifestations of SLE (4)

Answer 14

Raynaud’s phenomenon
Livedo reticularis
Thrombosis
Vasculitis

Question 15

Investigations to do for SLE? (3)

Answer 15

ANA (very sensitive but not specific-screening )
Anti-dsDNA (specific)
Anti - Sm

Question 16

Which cancers is the paraneoplastic lupus-like syndrome associated with? (2)

Answer 16

Ovarian and breast

Question 17

Dermatological symptoms of dermatomyositis (6)

Answer 17

Heliotrope rash: violaceous over eyelids ,oedema
Gottron’s papules: pink-violaceous, flat-topped on dorsal IPJ (pathopneum!)
Gottron’s sign: erythematous patches over dorsal IP, MCPJ, elbows,knees, medial malleoli (pathopneum!)
Shawl sign: poikilodermatous erythematous rash neck, upper chest, shoulders
Mechanic’s hands: dark, dry, thick scale on palmar and lat digits
Periungual erythema

Question 18

What classification does dermatomyositis fall under

Answer 18

Idiopathic inflammatory seropositive myopathy (connective tissue disorder)

Question 19

Malignancies associated with dermatomyositis? ( 4 )

Answer 19

Breast, ovarian, lung, colon

Question 20

Which classification does polymyalgia rheumatica fall under?

Answer 20

Generalised non-articular rheumatism

Question 21

Polymyalgia rheumatica symptoms (4)

Answer 21

Constitutional: fever, weight loss, malaise
Pain and stiff of symmetrical prox muscles: shoulders and pelvic girdle, neck, thighs
Gel phenomenon (stiff after prolonged activity)
Tender muscles on examination, but no weak

Question 22

Polymyalgia rheumatica complications (2)

Answer 22

Giant cell arteritis! (15%)

Anemia of chronic disease

Question 23

How does swan neck deformity present?

Answer 23

Hyperextended PIP, flexed DIP

Rheumatoid arthritis

Question 24

How does boutonnière deformity present?

Answer 24

Hyperextended DIP, flexed pIP

Rheumatoid arthritis

Question 25

What is Paget’s disease?

Answer 25

Chronic disease of skeleton that disrupts replacement of old bone with new. Over time, bones fragile and misshapen.
Aka osteitis deformans,