Rheumatology 🅾️

Question 1

sx of temporal/giant cell arteritis

Answer 1

rapid onset <1 month
headache and jaw claudication
morning stiffness
temporary visual loss
anterior ischaemic optic neuropathy
diplopia

Question 2

ix of temporal/giant cell arteritis

Answer 2

tender palpable temporal artery
raised ESR, CRP
temporal artery biopsy - skip lesions

Question 3

Sx of rheumatoid arthritis

Answer 3

Stiffness worse in mornings
Swollen and painful joints in hands and feet
PIP and MCP swelling

Question 4

Investigations that should be ordered for rheumatoid arthritis

Answer 4

First line rheumatoid factor
Anti-CCP
X-ray hands and feet

Question 5

Mx rheumatoid arthritis

Answer 5

DMARDs
If no response TNF inhibitors e.g. infliximab

Question 6

Symptoms of osteoarthritis

Answer 6

Pain worse on movement and towards the end of day
Pain improves with rest
Morning stiffness not prolonged
Decreased ROM

Question 7

On x ray what would you see for a patient with osteoarthritis

Answer 7

LOSS
Loss of joint space
Osteophytes
Subchondral cysts
Subarticular sclerosis

Question 8

Investigations for osteoarthritis

Answer 8

X ray

Question 9

Mx osteoarthritis

Answer 9

If high BMI - weight loss
Analgesia

Question 10

Symptoms of gout

Answer 10

Episodes lasting a few days
MTP joint generally affected
Can affect hands

Question 11

What would an x ray look like for gout

Answer 11

Joint effusion
Punched out erosions
Peri-articulate tophi
Joint space reduction in later stage

Question 12

Mx of gout

Answer 12

Analgesia
Urate lowering therapy - allopurinol
Lifestyle modification

Question 13

Difference between pseudo gout and gout

Answer 13

Pseudogout caused by rhomboid calcium crystals
Positive birefringence
Pseudogout usually occurs in knee rather than big toe MTP in gout

Question 14

Symptoms of fibromyalgia

Answer 14

Chronic pain at multiple sites
Lethargy
Cognitive impairment
Sleep disturbance
Headaches
Dizziness

Question 15

Symptoms of polymyalgia rheumatica

Answer 15

Proximal joint pain
Pain/stiffness in morning
Reduced ROM
Fever
Weight loss
Fatigue

Question 16

Investigations for polymyalgia rheumatica

Answer 16

ESR and CRP,
If these are normal unlikely to be Polymyalgia rheumatica
But sometimes ESR is normal and CRP is raised which is more likely to indicate polymyalgia rheumatica

Question 17

Mx polymyalgia rheumatica

Answer 17

Corticosteroids
Prevention and management of steroid induced osteoporosis
Screen for complications

Question 18

what is systemic lupus erythematosus

Answer 18

inflammatory autoimmune connective tissue disease

affects multiple organs and systems

more common in women and those of afro-Caribbean descent and in Asians

Question 19

how would SLE present

Answer 19

non-specific sx
systemic upset
joint and/or skin involvement - photosensitive malar rash “butterfly shaped rash across the nose and cheek bones”

Question 20

management of gout

Answer 20

1st line - NSAIDs unless contraindicated e.g GI problems, CKD or heart failure
2nd line - colchicine - CI in end-stage kidney failure or on dialysis

steroids can be used too

Question 21

risk factors

Answer 21

male sex
obesity
diet
chronic kidney disease
age over 50
family history
hypertension
diabetes

Question 22

lab findings for gout

Answer 22

negatively birefringent needle-shaped crystals

Question 23

what would you see on an x-ray for gout

Answer 23

normal joint space
soft tissue swelling
periarticular erosions