Rheumatology

Question 1

CREST
(Acronym)

Answer 1

C: Calcinosis
R: Reynauds
E: Eosophageal dysfunction
S: Sclerodacyly
T: Telangiectasias

Question 2

Systemic sclerosis (classification/terminology)

Answer 2

AKA scleroderma

Limited cutaneous systemic sclerosis previous known as CREST syndrome

Question 3

Pulmonary involvement from systemic sclerosis

Answer 3

-ILD
-Pulmonary HTN
-Pleural effusion
-Chronic pulmonary thromboembolic disease
-Pneumonitis (Drug induced: methotrexate, ACEi)

Question 4

Poor prognostic features of Rhematoid arthritis

Answer 4

• Smoking
• Raised ESR
• High RF titre
• Positive anti-CCP
• Bony erosions on xray in early disease
• Functional impairment early
• Swelling in more than 20 joints

Question 5

Maintenance of clinical remission of rheumatoid arthritis (clinical and laboratory)

Answer 5

• Normal ESR, CRP
• No: joint pain, stiffness or swelling

Question 6

Methotrexate counselling and safety

Answer 6

• NO etOH
• Dosing times: weekly
• Teratogenicity (& contraception, cease 3 months prior to conception)
• Folic acid on days not taking methotrexate
• Regular monitoring FBC, EUC LFT
• Photosensitvity
• NO trimethoprim (folate antagonist)

Question 7

Reynauds pharmacological management

Answer 7

Amlodipine 5-10mg Daily
OR
Nifedipine 30-120mg Daily

Question 8

Triggers for acute gout

Answer 8

• Alcohol intake
• Dehydration
• Diet high in meat or seafood
• Consumption of fructose-sweetened soft drinks
• Crash dieting or systemic illness (catabolic state)
• Hydrochlorothiazides
• chronic kidney disease

Question 9

Acute gout options

Answer 9

Indomethacin 50mg PO QID for 3-5 days

Prednisolone 15-30mg PO daily for 3-5 dyas

Question 10

Chilblains treatment

Answer 10

Betamethasone dipropionate 0.05% BD

Question 11

Gout precipitating diet & medications

Answer 11

• Alcohol
• Purine rich foods
• Fructose sweetened drinks
• Thiazide diuretics

Question 12

Positive MCP/MTP squeeze test - consistent with?

Answer 12

Rheumatoid arthritis

Question 13

Symptom relief in gout first line options

Answer 13

1. Corticosteroid injection
2. NSAID
3. Prednisolone 15mg-30mg 3-5 days

SECOND LINE
Colchicine 1mg initially, then 500mg 1 hour later

Question 14

Dose of allopurinol

Answer 14

50mg PO daily for 4 weeks then increase by 50mg every 2-4 weeks (up to 900mg)

Question 15

Second line option for gout

Answer 15

Feboxostat 40mg for 2-4 weeks increasing by 40mg up to 120mg

Question 16

Gout flare prophylaxis

Answer 16

FIRST LINE
Colchicine 500mg once or BD

SECOND LINE
NSAID

note: can combine

Question 17

Cortisone injection specifics:

Answer 17

Triamcinolone acetonide 10mg/1mL intraarticular injection stat

Question 18

Urethritis, conjunctivitis +- iritis and arthritis….what is this?

Answer 18

Reactive arthritis

Question 19

Weakness + joint & muscle pain + violaceous facial rash ….What is this?

Answer 19

Dermatomyositis

Question 20

Urate treatment target
a) normal gout
b) tophaceous

Answer 20

0.36
0.30

Question 21

Which is more specific for RA?
- Anti- CCP
- RF

Answer 21

Anti-CCP

Question 22

Medications for pain in remission for RA

Answer 22

NSAIDS
Fishoil

Question 23

PMR complications

Answer 23

1) GCA
2) Functional disability
3) Depression
4) Stroke

Question 24

RF or CCP more indicative of RA?

Answer 24

CCP better test