rheumatology

Question 1

what may distinguish psoriatic arthritis from rheumatoid arthritis?

Answer 1

Psoriatic arthritis usually rheumatoid factor negative and instead associated with HLA-B27.

Question 2

65 y/o female

pc: increasing pain + swelling of left knee. associated decrease in mobility.

oe: swollen, painful left knee + swelling of DIPS

likely diagnosis?

Answer 2

Osteoarthritis

why?

age, distribution of arthritis.

most common in hands and weight bearing joints (knee, hips , spin)

PIP - bouchards nodes
DIP - heberdens nodes

Question 3

21 y/o male

pc: ulceration affecting mouth + scrotum.

oe: painful, swollen ankles, knees and right elbow

some associated d + v

likely diagnosis?

Answer 3

exacerbation of behcets
- idiopathic
- caused by inflammation of venules

Question 4

what gene is behcets associated with?

Answer 4

HLA-B51

Question 5

behcets disease characterised by:

Answer 5

1. reccurrent ulceration (mouth + genatalia)
2. uveitis
3. skin lesions (erythema nodosum)

often affects young people from the mediterranean, middle east and far east.

Question 6

17 y/o female

pc: rash over both cheeks, pain swelling in hands and feel.

ix: anti-double stranded DNA antibodies (anti-dsDNA)

likely diagnosis?

Answer 6

SLE
- characterised by butterfly facial rash, pathognomic anti-dsDNA autoantibodies

Question 7

xerostomia is

Answer 7

dry mouth

Question 8

why does sjogren syndrome occur?

Answer 8

T cell infiltration of the lacrimal and salivary glands

Question 9

what is the patellar tap test and when is it performed?

Answer 9

indicates if there is swelling in the knee joint.

if you can feel patella floating when you’re tapping it means fluid has accumulated under it

Question 10

what is shown in the aspirate of a patient with gout?

Answer 10

negatively birefringenet needle shaped crystals.

patient unlikely to be systematically unwell.

Question 11

what might be present in the aspirate of patients with pseudogout?

Answer 11

positively birefringement crystals.

psuedogout
- classically affects knee
- deposition of calcium pyrophosphate crystals in joint

Question 12

characteristic deformities in rheumatoid arthritis?

Answer 12

• ulnar deviation
• boutonniere
• swan neck
• z deformity of thumb

Question 13

what is granulomatosis with polyangiitis

Answer 13

necrotizing small vessel vasculitis.

GPA associated with palpable purpura on extremities.

classic triad of involvement
1. upper resp tract and sinuses
2. lungs (–> haemoptysis pulmonary cavitary lesions)
3. kidneys

c-ANCA

Question 14

recap CREST syndrome

Answer 14

• calcinosis
• raynaud syndrome
• oesophageal dysmotility
• sclerodactyly
• telangiectasia

diagnosis requires presence of at least two of the symptoms.

Question 15

what type of condition is crest syndrome?

Answer 15

autoimmune
- associated with dysfunction of fibroblasts
- leads to organ fibrosis
- leads to scarring

Question 16

what antibodies is CREST syndrome associated with?

Answer 16

positive anti-centromere

anti-nuclear antigen antibodies

Question 17

name a disease characterised by
- pain
- muscle weakness
- heliotrope rash around eyelids
- gottron pappules

Answer 17

dermatomyositis
- autoimmune, inflammatory
- causing symmetrical weakness of proximal muscles

ANA antidbody

Question 18

discrete erythematous scaly papules found in dermatomyositis are known as :

Answer 18

dermatomyositis

Question 19

which antibodies are positive in sjogrens syndrome?

Answer 19

anti-la antibodies

Question 20

the antibody Scl70 is raised in:

Answer 20

diffuse systemic sclerosis

Question 21

24 y/o male presents with lower back pain + early morning stiffness which slowly improves throughout the day

positive schobers test:

diagnosis

Answer 21

ankylosing spondylitis

Question 22

name a condition which classically causes the following symptoms:

pain + stiffness
- neck
- shoulders
- pelvic girdle

Answer 22

polymyalgia rheumatica

• associated with giant cell arteritis

demographics
> 50
women >
caucasians >

ESR key investigation as PMR characterised by raised levels of inflammatory markers

Question 23

examples of appropriate pharmacological treatments for severe pain disturbance in fibromyalgia?

Answer 23

• duloxetine
• pregabalin
• tramadol

Question 24

what condition is characterised by the following triad:
- splenomegaly
- neutropenia
- rheumatoid arthritis

Answer 24

Felty’s syndrome

Question 25

seropositive arthritis is characterised by the presence of what:

Answer 25

rheumatoid factor

Question 26

example of seronegative spondyloarthropathies?

Answer 26

PEAR

Psoriatic arthritis

Enteropathic arthritis (associated with IBD)

Ankylosing spondylitis

Reactive arthritis

Question 27

describe pagets disease?

Answer 27

1. excessive bone resorption & haphazard bone growth
2. usually asymptomatic
3. results in weak, misshapen bones

mneumonic : PANICS
P - pain in bone
A - arthralgia
N - neural deafness, nerve compression
I - increased bone density
C - cardiac failure
S - skull or sclerotic vertebra

Question 28

Anti-saccharomyces cerevisiae antibodies are immune proteins that are frequently present in patients who have what condition?

Answer 28

inflammatory bowel disease

may also be present in behcets disease.

Question 29

what is the first line intervention for a patient presenting with a history of SLE limited to joints and skin

Answer 29

first tried on hydroxychloroquine
- antimalarial

severe SLE
- DMARDS (disease modifying ant rheumatic drugs)
- methotrexate (if acute joint synovitis)

Question 30

anti-mitochondrial antibody is associated with:

Answer 30

primary biliary cholangitis

Question 31

what is takayasu arteritis?

Answer 31

aka pulseless disease

1. affects aorta and its large branches
   - causes thickening and fibrosis of vessel wall. narrows lumen
2. ISHCAEMIA
   - weak / absent pulse
   - chest pain / claudication
   - renal artery stenosis
3. non specific symptoms
   - weakness, fatigue, fever, weight loss, arthralgia

Epidemiology
- women < 40
- esp asian

Question 32

most common bacteria to cause septic arthritis?

Answer 32

staph aureus

notes
- strep pyogenes also common, often associated with autoimmune disease, trauma.

• pseudomonas aeruginosa may be cause of septic arthritis in children, elderly or IVDU or immunocompromised