Rheumatology

Question 1

Define rheumatology

Answer 1

Investigation, diagnosis and management of patients with arthritis and other MSK conditions affecting joints, bones and muscle

Question 2

Constitutional symptoms of rheumatology

Answer 2

Fatigue
Lethargy
Flu-like 
Loss of appetite 
Weight loss
Unexplained fever

Question 3

Type of joint pain: articulate pain

Answer 3

Deep and diffuse pain relieved by active movement

Question 4

Type of joint pain: periarticular

Answer 4

Pain on active movement

Question 5

When do pts with inflammatory conditions experience stiffness

Answer 5

In the morning for over 1 hour

Question 6

When do pts with non inflammatory conditions experience stiffness

Answer 6

Early morning for less than 30 minutes

Question 7

Monoarticular conditions

Answer 7

Gout

Septic arthritis

Question 8

Oligoarticular conditions

Answer 8

Seronegative spondylarthropathies

Question 9

Polyarticular conditions

Answer 9

RA

Question 10

Conditions affecting joints with a symmetrical pattern

Answer 10

RA

SLE

Question 11

Conditions affecting joints with a asymmetrical pattern

Answer 11

Axial SpA
Psoriatic arthritis
Reactive arthritis 
Gout
Bacterial arthritis

Question 12

Conditions affecting joints with a intermittent pain pattern

Answer 12

Gout

Question 13

3 samples to take when testing for rheumatic conditions

Answer 13

Blood
Urine
SF

Question 14

What to look for in blood tests for rheumatic conditions

Answer 14

Anaemia of chronic disease
Leukopenia, thrombocytopenia

RA reduces immune system response which results in reduced RBC

Question 15

Which liver condition mimics osteoarthritis

Answer 15

Metabolic liver disease

Question 16

Effect of SLE on liver

Answer 16

Increase liver enzymes

Cause symptoms of liver disease

Question 17

Common inflammatory markers raised in rheumatic conditions

Answer 17

ESR

CRP

Question 18

Common antibodies present in rheumatic conditions

Answer 18

ANA
ANCA
Rheumatoid factor
Anti-CCP
HLA-B27
dsDNA

Question 19

Which antibody does rheumatoid factor target

Answer 19

fcy chain of IgG

Question 20

Which conditions have elevated rheumatoid factor

Answer 20

RA
SLE
Sjogren syndrome
Cryiglobulinemia

Question 21

What is Anti-CCP

Answer 21

Anti cyclic citrullinated peptide antibodies

Question 22

3 effects of rheumatoid arthritic individual joints

Answer 22

Synovial membrane thickening
Increase synovial fluid
Destruction of joint
Reduced joint space as a result

Question 23

Aetiology of RA

Answer 23

Women> men

Age 30-55

Question 24

Joints most affected in RA

Answer 24

PIP» MCP&raquo_space; Wrist

Question 25

RA symptoms

Answer 25

Hot, swollen, tender joints | EMS > 45 mins

Question 26

RA signs

Answer 26

``` Ulnar deviation Swan neck deformity Boutonnière deformity Z thumb MCP subluxation Bone erosion ```

Question 27

RA systemic symptoms

Answer 27

``` Weight loss Fever Fatigue Anaemia of chronic diseases Increased CVS risk ```

Question 28

What to do if pt with polymyalgia rheumatica does not respond to steroids

Answer 28

Consider alternative diagnosis as patients respond drastically to steroids. Symptoms usually resolve within 2 weeks

Question 29

What happens when pt given methotrexate combined with trimethoprim

Answer 29

Bone marrow suppression and severe / fatal pancytopenia (deficiency in all 3 components of blood)

Question 30

RA scoring system

Answer 30

DAS 28 (disease activity score, 28)

Question 31

Prognosis for RA given pt has high CRP

Answer 31

Poor prognosis

Question 32

2 antibodies determining severity of RA

Answer 32

RF + anti-CCP

Question 33

What helps distinguish gout form pseudo gout

Answer 33

Chondrocalcinosis (calcification of hyaline and/or fibrocartilage in joint)

Question 34

What is the most sensitive test for detecting SLE

Answer 34

ANA

Question 35

Inflammatory markers for SLE

Answer 35

Raised ESR | CRP is usually normal. Raised CRP may indicate infection

Question 36

Pt has positive Tinel’s test. Cause out of these options: ``` Methotrexate use RA crohn’s Hyperthyroidism TB ```

Answer 36

RA as rheumatological diseases are common cause of carpel tunnel

Question 37

bisphosphonates be given to Pt prophylactically with which T score

Answer 37

T score of < -1.5 if they’re going to be on steroids for more than 3 months as steroids put pt at risk of osteoporosis

Question 38

Oral ulcers + genital ulcers + anterior uveitis =

Answer 38

Behçet’s disease rare disorder that causes blood vessel inflammation throughout your body. typically affecting men more than women in their 20s and 30s.