Rheumatology

Question 1

Isolated 1st carpometacarpal joint swelling and pain in post meno female, most likely diagnosis

Answer 1

Oesteoarthritis

Note: RA and psoriatic arthritis also can be here but would be unlikely to be in isolation

Question 2

What is the first line treatment of acute gout?

Answer 2

Colchicine or NSAID

NB colchicine is safe in renal failure

Question 3

Allopurinol is first line in treatment of acute gout T/F

Answer 3

F - allopurinol is not used in acute gout

Question 4

Anti hypertensive med of choice in scleroderma renal crisis

Answer 4

Oral ACEi

IV medications will drop BP to quickly and using an ACEi is associated with improved survival and preservation of renal fxn

Question 5

Ocular toxicities with hydroxychloroquine

Answer 5

Keratopathy
Ciliary body involvement
Lens opacities
Retinopathy

NB most concerning is retinopathy

Question 6

Treatment of diffuse proliferative glomerulonephritis (GN) (WHO class IV) in systemic lupus erythematosus (SLE).

Answer 6

Prednisolone and IV cyclophosphamide

Note: it is the commonest GN in SLE and also carries the worst prognosis

Question 7

Which is associated with a positive RF - mixed cryoglobulinaemia or PAN?

Answer 7

Mixed cryoglobulinaemia

Question 8

+ cANCA and + PR3 vs MPO, likely pathology

Answer 8

+ cANCA and + PR3: granulomatosis with polyangitis

+ cANCA and + MPO: microscopic polyangitis

Question 9

Antiphospholipid antibodies cause raised aPTT which fails to correct after the addition of normal human plasma. T/F

Answer 9

T

Note: anticardiolipin and lupus anticoagulant cause coagulation defect in-vitro

Question 10

Features of penicillamine toxicity

Answer 10

Nephrotic syndrome
Myasthenia syndrome

Question 11

Which is a more common cause of abnormal LFTs in a patient with RA - methotrexate or AI hepatitis?

Answer 11

Methotrexate

Note: RA is associated with AI hepatitis but it is less common

Question 12

Gout findings on xray?

Answer 12

Punched out lesions and/or tophi

Question 13

Tx of granulomatosis with polyangitis?

Answer 13

Standard tx: IV cyclophosphamide and steroids. However in severe life threatening cases, or in patients with primarily renal involvement needing dialysis, plasmapheresis is used to rapidly remove the immune complexes.

Question 14

Patients with polymyositis without any associated antibodies (for example, anti-Jo1, anti-Pm/Scl) should be screened for malignancies with CT TAP T/F

Answer 14

T

Also dermatomyositis has a stronger association with malignancy, polymyositis also has an association.

Question 15

Febuxostat MOA

Answer 15

Non-purine, selective inhibitor of xanthine oxidase

Note: allopurinol is a purine analogue inhibitor of xanthine oxidase.

Question 16

1st line investigation for poly myalgia rheumatica?

Answer 16

ESR

Note: if high indication to start tx with steroids

Question 17

Triad of Felty syndrome?

Answer 17

Splenomegaly
RA
Pancytopaenia (mainly neutropenia)

Question 18

Most likely AI disease associated with Grave’s

Answer 18

Vitiligo

Question 19

SLE tends to cause a mild non erosive arthritis T/F

Answer 19

T

Question 20

Before starting what drug should blood for thiopurine methyltransferase be checked?

Answer 20

Azathioprine