rheumatology

Question 1

what monitoring is required for patients taking hydroxychloroquine?

Answer 1

eye examinations

risk of retinal toxicity

Question 2

antibodies specific in SLE

Answer 2

most specific= Anti-ds-DNA
ANA positive
Anti-smith positive

Question 3

symptoms of SLE

Answer 3

Serositis (pericarditis, pleuritis)
Oral ulcers
Arthralgia
Photosensitivity
Bloods low (anaemia, leukopenia, thrombocytopenia)
Renal (proteinuria)
ANA positive
Immunology (dsDNA)
Neuro (psych sx, seizures)
Malar rash
Discoid rash

Question 4

treatment of SLE

Answer 4

NSAIDs
hydroxychloroquine- first line- (eye examination needed- risk of retinopathy)
prednisolone

Question 5

what is pagets disease of bone?

Answer 5

increased bone turnover (increased osteoclast and osteoblast activity)

Question 6

clinical presentation of pagets disease of bone

Answer 6

bone pain/ weak bones
fracture history 
bone deformities 
kyphosis and pelvic asymmetry 
bone enlargement

HEARING LOSS if it affects the small bones of the ear

VISION LOSS is skull enlargement compresses optic nerve

Question 7

diagnosis of pagets disease of bone

Answer 7

X-ray findings:

• lytic lesions
• bone enlargement and deformitiy
• cotton wool appearance due to uneven bone redistrubution- sclerotic and lytic areas of bone

RAISED ALP

NORMAL LFT’S OTHERWISE, NORMAL Ca AND PHOSHPATE

Question 8

management of pagets disease of bone

Answer 8

bisphosphonates, NSAIDs, Calcium and vitamin D supplementation

Question 9

complications of pagets disease of bone

Answer 9

osteosarcoma

spinal stenosis/ compression

Question 10

what is ankylosing spondylitis?

Answer 10

inflammation of the sacriliac joints and vertebrae

seronegative spondyloarthropathy

associated with HLA-B27

Question 11

Presentation of ankylosing spondylitis

Answer 11

Lower back pain and stiffness- worse in morning, eases during the day

systemic symptoms- WL, fever, costochondritis, anaemia, IBD

Question 12

diagnosis of ankylosing spondylitis

Answer 12

Shobers test- bend forward test- <20cm= lumbar restriction

x-ray- bamboo spine

Question 13

management of ankylosing spondylitis

Answer 13

NSAIDs, steroids

anti-tnf- entanercept

monoclonal antibodies- infliximab, adalimunab

Question 14

presentation of antiphospholipid syndrome

Answer 14

venous/arterial thrombosis
recurrent fetal loss

livedo reticularis
thrombocytopenia
prolonged APTT
other features: pre-eclampsia, pulmonary hypertension

Question 15

antibodies in antiphospholipid syndrome

Answer 15

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

Question 16

management of antiphospholipid syndrome

Answer 16

lifelong warfarin

IF PREGNANT= LWMH (enoxaparin) and aspirin

Question 17

what condition does antiphospholipid syndrome commonly occur alongside?

Answer 17

SLE

Question 18

osteoporosis- bloods (calcium, PTH, phosphate)

Answer 18

all normal !!

Question 19

Ewings sarcoma- presentation on x-ray

Answer 19

onion skin appearance

Question 20

risk of using TNF-α inhibitors (enteracept)

Answer 20

TNF-α inhibitors may reactivate TB

Question 21

Which antibody is most specific for diffuse cutaneous systemic sclerosis?

Answer 21

anti-Scl-70

Question 22

bloods in antiphospholipid syndrome

Answer 22

very long APTT

low platelets