Rheumatology

Question 1

MTX MOA?

Answer 1

Inhibits dihydrofolate reductase

Question 2

give some SEs of MTX

Answer 2

mucositis
myelosuppression
pneumonitis
pulmonary fibrosis
liver fibrosis
folate deficiency

Question 3

What drugs should you avoid prescribing with MTX?

Answer 3

Trimethoprim + Co-trimoxazole –> Risk of marrow aplasia

High dose aspirin –> risk of MTX toxicity (by reducing excretion)

Question 4

What is discoid lupus characterised by?

Answer 4

Follicular keratin plugs - when lesiosn peeled off skin looks like “carpet tack”

Scarring + scarring alopecia

Common in face, neck, scalp

Question 5

Antibodies in limited vs diffuse systemic sclerosis

Answer 5

Limited: anti-centromere

Diffuse: anti-Scl-70

Question 6

What antibodies in RA?

Answer 6

Anti-CCP

Question 7

Give a common side effect of MTX therapy?

Answer 7

mucositis

Question 8

Polymyositis antibodies

Answer 8

Anti-Jo-1

Question 9

Dermatomyositis antibodies

Answer 9

Anti-Mi-2

Question 10

low serum calcium, low serum phosphate, raised ALP and raised PTH - what condition?

Answer 10

Osteomalaxia

Question 11

What might be seen on XR in pseudogout

Answer 11

Chondrocalcinosis of the knee (linear calcifications of the meniscus + articular cartilage)

Question 12

Antibodies associated with Sjogrens

Answer 12

RF
Anti Ro
Anti La

Question 13

Ankylosing spondylitis features

Answer 13

A's:
Apical fibrosis
Anterior uveitis
Aortic regurgitation
Achilles tendonitis
AV node block
Amyloidosis

Question 14

How does dural ectasia present and what is it associated with?

Answer 14

Ballooning of dural sac at lumbosacral level

Back pain, urinary incontinence, headaches, leg pains

Associated with marfan’s syndrome

Question 15

Pesudogout joint aspirate

Answer 15

Positively birefringent rhomboid shaped crystals under light microscopy

calcium pyrophosphate

Question 16

What cells secrete the majority of tumour necrosis factor?

Answer 16

Macrophages

Question 17

What might you see on the palms/soles in someone with reactive arthritis?

Answer 17

waxy yellow/brown papules on palms and soles (keratoderma blenorrhagica)

Question 18

commonest cause of osteomyelitis in general? What about in patients with sickle cell disease

Answer 18

S Aureus

Salmonella

Question 19

What is anti-RNP associated with?

Answer 19

Mixed connective tissue disease

RNP - raynaoud, N swollen hands No synovitis, P Pain in musces + joints

Question 20

Dactylitis and DIP joint swelling indicate what?

Answer 20

Psoriatic arthritis

Question 21

In patient’s allergic to aspirin, what else might they react to?

Answer 21

Sulfasalazine (5-ASA)

Question 22

What joints are characteristically affected in the hand in osteoarthritis?

Answer 22

Carpometacarpal + DIPJs

Question 23

What is the minimum steroid intake a patient should be taking before they are offered osteoporosis prophylaxis?

Answer 23

7.5mg or more each day for 3 months

Question 24

What collagen is defected in Ehler-Danlos syndrome?

Answer 24

Type 3

Question 25

What collagen is defected in osteogenesis imperfecta?

Answer 25

Type 1

Question 26

What collagen is defected in goodpasture's?

Answer 26

Type 4

Question 27

What protein is effected in marfan's syndrome?

Answer 27

Fibrillin 1

Question 28

What antibody is highly sensitive for SLE? what antibodies are highly specific for

Answer 28

Sensitive: ANA (therefore good rule out test) - has low specificity Specific: ant dsDNA + anti Sm

Question 29

How does anikinra work?

Answer 29

IL-1 inhibitor

Question 30

Restless leg syndrome drug treatment + MoA

Answer 30

Ropinirole (dopamine agonist)

Question 31

Poor prognosis RA

Answer 31

``` rheumatoid factor positive anti-CCP antibodies poor functional status at presentation X-ray: early erosions (e.g. after < 2 years) extra articular features e.g. nodules HLA DR4 insidious onset ```

Question 32

When are topical NSAIDs indicated in OA?

Answer 32

Knee or hand involvement

Question 33

What rheumatological drug might patients be allergic to if they are allergic to aspirin?

Answer 33

Sulfasalazine

Question 34

Antibodies in sjogren's?

Answer 34

anti Ro + La

Question 35

HLA in RA?

Answer 35

DRB1 04:01

Question 36

In RA what Ix is best for detecting early disease/synovial inflammation?

Answer 36

Colour doppler US (detects earlier than MRI)

Question 37

EXAM Q: What part of the nephron does PTH act on?

Answer 37

Proximal tubule decreases phosphate reabsorption

Question 38

Gout vs pseudogout radiological features?

Answer 38

Pseudogout: chondrocalcinosis (white lines)

Question 39

Gout vs pseudogout birefringment + microscopy?

Answer 39

Gout: negative + needle shaped of uric acid crystals Pseudogout: rhomboid crystals + weakly positive. Calcium pyrophosphate crystals

Question 40

In thrombocytopaenia in SLE, what drug should be used?

Answer 40

Hydroxychloroquine

Question 41

Calcium level in osteomalacia?

Answer 41

Low

Question 42

Systemic sclerosis + chronic diarrhoea --> what is this likely to be? What is the treatment?

Answer 42

small intestine bacterial overgrowth syndrome Metronidazole

Question 43

In reactive arthritis what might you see on the palms and soles?

Answer 43

Keratoderma blennhoragiccum

Question 44

3 antibodies seen in antiphospholipid syndrome?

Answer 44

Lupus anticoagulant Anti-cardiolipid anti-B2 glycoprotein

Question 45

Felty syndrome triad

Answer 45

RA Splenomegaly Low wcc