Rheumatology

Question 1

Which antibody is associated with diffuse systemic sclerosis?

Answer 1

Anti-Scl-70

Question 2

Which antibody is associated with limited systemic sclerosis?

Answer 2

Anti-centromere

Question 3

Which antibody is associated with Polymyositis?

Answer 3

Anti-Jo-1

Question 4

Which antibody is associated with Dermatomyositis?

Answer 4

Anti-Mi-2

Question 5

What x-ray signs are seen in rheumatoid arthritis?

Answer 5

LESS

Loss of joint space
Periarticular erosions
Sublaxation
Soft tissue swelliing

Also: Juxta-articular osteoporosis

Question 6

What are extra-articular features of ankylosing spondylitis?

Answer 6

Chest pain due to costrochondritis
Anterior uveitis
Plantar fasciitis
Inflammatory bowel disease
Pulmonary fibrosis
Achilles tendonitis
Amyloidosis
Aortic regurgitation

Question 7

What are complications of SLE?

Answer 7

Pericarditis/Myocarditis
Pulmonary fibrosis
CVD
Antiphospholpid syndrome
Anaemia
Lupus nephritis

Question 8

How does Dermatomyositis present?

Answer 8

Weakness of shoulders and pelvic girdle

Gottron lesions, Photosensitive rash on back/shoulders/neck, periorbital oedema, purple rash around eyes

Question 9

What is seen on XR in pseudo gout?

Answer 9

Chondrocalcinosis

Question 10

How can you interpret a T score?

Answer 10

-1 to -2.5 = Osteopenia

Less than -2.5 = Osteoporosis

Question 11

What are dermatological features of SLE?

Answer 11

Livedo reticularis
Photosensitive malar rash
Lichen planus

Question 12

What is seen on CXR in ankylosing spondylitis?

Answer 12

Apical fibrosis

Question 13

What kind of retinopathy does Hydroxychloroquine cause?

Answer 13

Bulls eye retinopathy - loss of central vision

Question 14

Which bones are most commonly effected in Paget’s disease?

Answer 14

Skull
Spine + Pelvis
Femur + tibia

Question 15

Which clotting marker is raised in antiphospholipid syndrome?

Answer 15

APTT

Question 16

How does reactive arthritis present?

Answer 16

Acute monoarthritis
Cant see = Anterior uveitis, Conjuntivitis
Cant pee = balanitis
Cant climb a tree = dactylitis, Keratoderma blenorrhagica

Question 17

What are features of SLE?

Answer 17

Arthrits/arthralgia
Myalgia
Butterfly malar rash (photosensitive)
Fatigue

Question 18

What is discoid lupus erythematosus?

Answer 18

More in women with darker skin
Photosensitive lesions
Associated with scarring alopecia
Management= topical steroids

Question 19

What drugs cause drug induced lupus?

Answer 19

Hydralazine
Isoniazid
Phenytoin
Minocycline
Procainamide

Question 20

What is seen on nailfold capillaroscopy in systemic sclerosis?

Answer 20

Avascular necrosis
Micro-haemorrhages
Abnormal capillaries

Question 21

What antibodies are raised in antiphospholipid syndrome?

Answer 21

Lupus anticoagulant
Anticardiolipin antibodies
Anti-beta-2 glycoprotein 1 antibodies

Question 22

How does Behcet’s disease present?

Answer 22

MAIN TRIAD OF

1) Recurrent oral ulcers
2) Recurrent genital ulcers
3) Recurrent anterior uveitis

Also:
Erythema nodosum
Morning stiffness + arthralgia
DVT, thrombophlebitis
Abdo pain, diarrhoea

Question 23

What is polyarteritis nodosa?

Answer 23

Medium vessel vasculitis

Fever, malaise, arthralgia
Mononeuritis multiplex 
Livedo reticularis
Haematuria
Renal failure
Necrotic ulcers

Question 24

What abnormal blood results are present in temporal atertis?

Answer 24

Raised ESR+CRP
Raised ALP
Normocytic anaemia
Raised platelets

Question 25

Which autoantibodies are present in Sjorgen's syndrome?

Answer 25

Anti-Ro and Anti-La

Question 26

What are features of Marfan's syndrome?

Answer 26

``` Tall stature High arched palate Pectus excavatum Pes planus Scoliosis Dilation of aortic sinuses —> Mitral regurg, aortic regurg, aortic dissection Upwards lens dislocation Repeated pneumothoraces Dural ectasia (ballooning of the dural sac) ```

Question 27

What are features of Ehler-Danlos syndrome?

Answer 27

``` Hypermobility Stretchy elastic fragile skin Easy bruising Aortic regurg Mitral valve prolapse Aortic dissection SAH ```

Question 28

What is Adult Still's disease? How is it managed?

Answer 28

``` Arthralgia Raised serum ferritin Salmon pink rash Pyrexia Lymphadenopathy ``` Management = NSAIDs

Question 29

What are examples of large vessel vasculitis?

Answer 29

Temporal arteritis | Takayasu’s arteritis

Question 30

What are examples of medium vessel vasculitis?

Answer 30

Polyarteritis nodosa | Kawasaki disease

Question 31

What are examples of a small vessel vasculitis?

Answer 31

ANCA associated - GPA, eGPA | Immune mediated - HSP, Anti-GBM

Question 32

How can you differentiate between polymyositis and polymyalgia rheumatica clinically?

Answer 32

Polymyalgia rheumatica = NO WEAKNESS | Polymyositis = WEAKNESS

Question 33

What to do if someone with polymyalgia rheumatic does not respond to steroids?

Answer 33

Consider alternative diagnosis - Polymyalgia rheumatica should respond really well to steroids

Question 34

When are bisphosphonates CI?

Answer 34

CKD 4 or 5

Question 35

What is an alternative to bisphosphonates if they are CI?

Answer 35

Denosumab - needs to be started in secondary care

Question 36

What is second line in someone who cannot tolerate the side effects of oral alendronate?

Answer 36

IV Risedronate

Question 37

What is seen on skull x-ray in Paget's disease?

Answer 37

``` Thickened vault Osteoporosis circumscripta (Cotton-wool appearance) ```

Question 38

Which things are associated with HLA-b27?

Answer 38

Reactive arthritis Ankylosing spondylitis Anterior uveitis

Question 39

What EARLY x-ray findings are seen in RA?

Answer 39

* loss of joint space * juxta-articular osteoporosis * soft-tissue swelling

Question 40

What LATE x-ray findings are seen in RA?

Answer 40

* periarticular erosions | * subluxation

Question 41

What are poor prognostic features of RA?

Answer 41

* 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 42

What does the joint aspirate in RA show?

Answer 42

Yellow cloudy fluid | high WCC

Question 43

What is Z score adjusted for?

Answer 43

Age, gender, ethnicity

Question 44

How to start allopurinol?

Answer 44

Always start allopurinol with either colchicine or NSAID for up to 6 months

Question 45

How is an acute flare of RA managed?

Answer 45

IM Methylprednisolone

Question 46

What shape are the crystals in gout and pseudo gout?

Answer 46

``` Gout = rhomboid shaped Pseudogout = needle shaped ```

Question 47

How do you manage a first episode of RA?

Answer 47

Methotrexate + short bridging course of oral prednisolone

Question 48

What are complications of Paget's disease?

Answer 48

``` Deafness Bone sarcoma Fractures Skull thickening High-output cardiac failure ```