Rheumatology

Question 1

Specific autoantibody for:

SLE

Answer 1

Anti-dsDNA

Question 2

Sensitive autoantibody for SLE

Answer 2

ANA (anti-nuclear antibody)

Question 3

Autoantibody for diffuse scleroderma vs. limited scleroderma (CREST)

Answer 3

Anti-scl70

Anti-centromere

Question 4

Autoantibody for polymyositis and Sjogren’s syndrome

Answer 4

Polymyositis - anti-Jo1

Sjogren’s sndrome - anti-Ro, anti-La

Question 5

Autoantibody for primary biliary cirrhosis, autoimmune hepatitis

Answer 5

PBC - anti-mitochondrial

Autoimmune hepatitis - anti-smooth muscle

Question 6

Autoantibodies for Churg-Strauss vs Wegener’s granulomatosis

Answer 6

Wegener’s granulomatosis - c-ANCA

Churg-Strauss - p-ANCA

Question 7

Most specific autoantibody for rheumatoid arthritis

Answer 7

Anti-CCP

***IN fact, it is more sensitive and specific for RA compared to RF. (RA Revision Guide)

Question 8

Autoantibodies for coeliac disease

Answer 8

Anti-tissue transglutaminase
Anti-gliadin
Anti-endomysial

Question 9

Autoantibody for Graves disease

Answer 9

TSH-receptor antibody

Question 10

Drugs causing lupus

Answer 10

INH - (INH causes SLE)
Chlorpromazine
Hydralazine

Question 11

SLE and antinuclear antibody. Clinchers

Answer 11

Initial tests
Most sensitive test
Best screening test

Question 12

SLE and antidsDNA

Answer 12

Most specific test

Most discriminative

Question 13

Definitive test for polymyositis

Autoantibody for polymyositis

Answer 13

Muscle biopsy

Anti-Jo1

Question 14

Treatment for polymyositis

Answer 14

Steroids

Question 15

Treatment for dermatomyositis

Answer 15

Steroids

Sun-blocking agent

Question 16

Differentiate polymyositis from dermatomyositis

Answer 16

In polymyositis, you will be given a stem of a patient having difficulty standing from the chair or combing hair while in dermatomyositis, you have a patient with dermatologic manifestations in addition to weakness. They are both managed with steroids, however, in dermatomyositis, you also given sunblocking agent.

Question 17

Features and associated condition of polymyalgia rheumatica

Answer 17

Bilateral pain (neck, shoulder or pelvic girdle) and morning stiffness
Difficulty standing from bed or raising arm to comb hair

Associated with giant cell arteritis

Aged (>50y/o)

Question 18

Best initial test for giant cell arteritis

Answer 18

Elevated ESR

Question 19

Definitive test for giant cell arteritis

Answer 19

Tamporal artery biopsy

Question 20

Why would you not wait for biopsy if you suspect giant cell arteritis?

Answer 20

Give HIGH—DOSE prednisolone as delaying can result in permanent loss of vision

Question 21

In addition, to high-dose prednisolone, what other medication should be given in a patient with giant cell arteritis?

Answer 21

Low-dose aspirin

Question 22

GEMS of Behcet’s Disease

Answer 22

Genital ulcer
(Eye) Uveitis
(Mouth) Oral ulcer
Skin injury exaggerated after minor trauma

Question 23

Treatment of Behcet’s disease

Answer 23

Topical corticosteroids

Question 24

Seronegative spondyloarthropathies - associated with HLA-B27

Answer 24

PAIR-B

Psoriatic arthritis
Ankylosing spondylitis
IBD-associated arthritis
Reiter’s syndrome
Behcet’s disease

Question 25

Features of ankylosing spondylitis

Answer 25

Morning stiffness, improves with physical activity | Also associated with anterior uveitis (or iritis, or iridocyclitis)

Question 26

Ankylosing spondylitis : uveitis :: Reiter’s syndrome: ________

Answer 26

Conjunctivitis

Question 27

Most commonly involved joint in gout

Answer 27

1st metatarsal phalangeal joint

Question 28

What is HEALS of Lofgren?

Answer 28

``` Hilar Erythema nodosum Arthritis Lofgren Sarcoidosis ```

Question 29

Difference between Mikulicz’s disease and Mikulicz’s syndrome

Answer 29

Mikulicz’s disease - no specific cause | Mikulicz’s syndrome - symptoms are secondary to sarcoidosis or TB

Question 30

Four steps in managing rheumatoid arthritis

Answer 30

Refer to rheuma Steroids - to reduce inflammation NSAIDs - to relieve pain DMARDs (MTX) - first line

Question 31

What are the associated eye condition with ankylosing spondylitis?

Answer 31

Uveitis, Iritis, Iridocyclitis

Question 32

What are the associated eye condition with rheumatoid arthritis?

Answer 32

Scleritis | Episcleritis

Question 33

JONES criteria’s Major manifestations in the diagnosis of Rheumatic Fever

Answer 33

``` Joints (arthritis) O-heart (carditis) Nodules (SC nodules) Erythema marginatum Sydenham chorea ```

Question 34

Sensitive and specific lab tests in the diagnosis of Rheumatic Fever

Answer 34

Sensitive - ESR | Specific - ASO