Rheumatology

Question 1

GCA Treatment dose

Answer 1

With evolving visual loss/hx of transient vision loss: IV Methylpred

Without vision loss: Oral Prednisolone 1mg/kg daily (40-60mg) min 4 weeks, then taper

Question 2

Aspects of monitoring of patients on long-term steroids (5)

Answer 2

1) Bone health - BMD 4 months post-commencement, then every 2-3 years if stable

2) Lipids/CVS risk - lipids every 6-12 months

3) BSL parameters - 3-6 monthly first year, then annually

4) Opthal - annual eye examination

5) Falls risk - assess annually

Question 3

Lupus clinical features
(Cutaneous features)
(Cardiac/pulmonary involvement)

Answer 3

Inflammatory joint pain

Cutaneous features:
Rash
Photosensitivity
Mouth/nasal ulcers
Red eyes
Alopecia
Raynaud’s phenomenon

Cardiac/pulm:
Cough, dyspnoea, chest pain

Question 4

Lupus - other system involvements

Answer 4

Lupus nephritis (glomerular haematuria, active sediment, raised urine PCR)

Haem manifestations - anaemia, thrombocytopenia/leukopenia

Question 5

Lupus Ix (autoimmune screen)

Answer 5

ANA!!

Others: anti-dsDNA, Anti-Smith, complement, antiphosphlipid, Direct Coomb’s

Question 6

Manifestations for diagnosis of acute rheumatic fever (7)

Answer 6

-Polyarthritis/septic arthritis
-Carditis
-Sydenham chorea
-Erythema marginatum
-Subcutnaeous nodules
-Fever >38
-Elevated ESR