Rheumatology

Question 1

In drug induced SLE what antibody can be present?

Answer 1

Anti - Histone

Question 2

First line investigation in Ankylosing Spondylitis

Answer 2

Lower Spine X - Ray

if negative but strong suspicion - use MRI to determine if early signs

Question 3

Fluctuating fever - spiking in the evening
Salmon pink rash
Arthralgia
Increased ferritin
Lymphadenopathy

Answer 3

Stills Disease

Question 4

Stills Disease Diagnosis

Answer 4

Increased Ferritin

RF and ANA -ve

Question 5

Stills disease - Management

Answer 5

NSAIDs - 1 week
Steroids + NSAIDs
Methotrexate
IL-1 or anti TNF

Question 6

Commonest cardiac complication of SLE

Answer 6

Pericarditis

Question 7

Causes of drug induced lupus

Answer 7

Procainamide
Hydralzine
Isoniazide
Phenytoin

Question 8

Management of drug induced lupus

Answer 8

Stop offending agent

Question 9

Management of Psoriatic arthritis

Answer 9

NSAIDs -> Intrarticular corticosteroid injections -> Methotrexate

AVOID oral steroids as can cause psoriasis flairs

Question 10

Arthritis
Uveitis
Urethritis
Yellow waxy rash on soles of feet = keratoderma Blennorrhagica

Answer 10

Reactive Arthritis
Chlamydia
Shigella, Campylobacter, salmonella

Question 11

Reactive arthritis diagnosis and management

Answer 11

Joint aspirate shows elevated WCC but no culture or gram stain
Chlamydia - STI
Campylobacter or salmonella if diarrhoea prodrome

NSAID + interarticular steroid
Methotrexate or sulfasalazine for persistent

Question 12

Commonest Juvenile Idiopathic Arthritis

Answer 12

Pauciauricular or oligoarticular

Question 13

Child + systemically well
Tired
Arthritis affecting medium sized joints - knee ankle etc
Limp 
ANA +ve
Duration over 6 weeks

Answer 13

Oligoarticular Juvenile Idiopathic Arthritis

Question 14

Child
Pyrexia
Salmon Patches
Lymphandenopathy
Uveitis 
Arthritis 
Weight loss

Answer 14

Systemic Juvenile Idiopathic Arthritis

Question 15

juvenile idiopathic arthritis management

Answer 15

NSAIDs
DMARDS
Intrarticular corticosteroids
Ensure physical activity is continued

Question 16

Fuzzy brain
Poor sleep
Generalised pain -> focal very painful areas

Answer 16

Fibromyalgia

Explain diagnosis -> aerobic exercise -> CBT -> pregablin duloxetine

Question 17

In gout what should be started alongside allopurinol?

Answer 17

6 months cover of colchicine should be given. Even if no current flair up.

Question 18

Anti dsDNA vs ANA - SLE

Answer 18

Anti dsDNA - very specific not very sensitive

ANA - Very sensitive but not very specific

Question 19

Shobers test

Answer 19

Distance should increase by more than 5 cm
Find L5 - find and mark 10cm above and 5cm below this.
- ask patient to bend forward. The distance should increase by >5cm

Question 20

What pulmonary involvement is linked to Limited systemic Sclerosis

Answer 20

Pulmonary Hyertension

Question 21

What pulmonary involvement is linked to Diffuse Systemic Sclerosis

Answer 21

Pulmonary fibrosis

Question 22

In Polymyalgia Rheumatica with no GCA signs what is the management.

Answer 22

Prior to starting steroids screen for issues that can be compounded by long term steroid use.
Random Blood glucose and a HbA1c
DEXA scan if FRAX score is high

Question 23

What is used if there is ophthalmic artery involvement in GCA?

Answer 23

IV methyprednisilone

Question 24

1st line management of raynauds phenomenon

Answer 24

Nifedipine

Question 25

HSP management

Answer 25

NSAIDs and antihypertensives if required | Regular urine dip for 12 months post episode

Question 26

Management of SLE

Answer 26

NSAID + Hydroxychloroquine +/- steroid for flair up Neuro/renal/haem involvement = cyclophosphamide + high dose steroid

Question 27

Rheumatoid Arthritis management

Answer 27

DMARD usually methotrexate + bridging steroid | Inadequate response to two DMARDs = Etanercept or Infliximab

Question 28

How is disease activity monitored in Rheumatoid Arthritis

Answer 28

DAS28 and CRP

Question 29

Small and medium vessel arteritis linked to hepatitis B

Answer 29

Polyarteritis Nodosa

Question 30

What vessels aren't affected in polyarteritis nodosa?

Answer 30

Pulmonary

Question 31

Management of polyarteritis nodosa

Answer 31

Steroids + cyclophosphamide

Question 32

10-40 year old asian female Absent limb pulses Fatigue

Answer 32

Takayasu Arteritis - Large vessel arteritis | Steroids is mainstay of management

Question 33

Which DMARD can be used to manage a severe unremitting relapse of Rheumatoid arthritis in pregnancy?

Answer 33

Hydroxychloroquine | Sulfasalazine

Question 34

Mild psoriatic arthritis can be managed how?

Answer 34

NSAIDs

Question 35

Management of Sjogrens

Answer 35

Arthritis - hydroxychloroquine + NSAID Rest is symptomatic - lubrication artificial tears etc

Question 36

What antibody has the highest specificity for Rheumatoid Arthritis?

Answer 36

Anti CCP | Rheumatoid Factor - as specific but not as sensitive as occurs more often in general population