Rheumatology

Question 1

Lower back and alternating buttock pain
Worse in the mornings
Disturbs the patient’s sleep

Answer 1

Ankylosing spondylitis

Question 2

X ray in ankylosing spondylitis

Answer 2

syndesmophytes (fusion of vertebra)
Bamboo spine (fusion of spinal column)
squared vertebra

Question 3

4 conditions associated with ankylosing spondylitis

Answer 3

anterior uveitis
upper lobe pulmonary fibrosis
inflammatory bowel disease
achilles tendonitis

Question 4

Lace like rash on the back of the legs

Answer 4

Livedo reticularis
found in antiphospholipid syndrome

Question 5

Mx of antiphospholipid syndrome

Answer 5

Warfarin
in pregnancy: LMWH + aspirin

Question 6

Gout and common Px

Answer 6

uric acid buildup
paintful MTP joint in the big toe, red, swollen

Question 7

Pseudogout cause and Ix

Answer 7

calcium pyrophosphate crystal buildup
Positive rhomboid

Question 8

Px and Ix of churg-strauss syndrome

Answer 8

eosinophilic granulomatosis with polyangiitis
rash, asthma
raised eosinophils
pANCA positive

Question 9

Px and Ix of Wegener’s granulomatosis

Answer 9

Granulomatosis with polyangiitis
1. URT: epistaxis’s saddle shaped nose
2. LRT: haemoptysis, dyspnoea
3. glomerulonephritis: proteinuria (frothy urine) + haematuria
cANCA +

Question 10

Mx of Giant Cell Arteritis

Answer 10

oral prednisolone

Question 11

Px of Rheumatoid arthritis

Answer 11

swan neck deformity, boutonnieres hand, C spine involvement
morning stiffness that is better after activity

Question 12

Px of reactive arthritis

Answer 12

conjunctivitis
urethritis
arthritis

Question 13

pregnant woman with rhuematoid. meds?

Answer 13

hydroxychloroquine, sulfasalazaline, folic acid

Question 14

GCA mx

Answer 14

oral prednisolone if no visual compromise
IV methylprednisolone if there is visual compromise

Question 15

antibody in SLE

Answer 15

anti ds DNA

Question 16

antibody in polymyositis/dermatomyositis

Answer 16

anti Jo 1

Question 17

antibody in rheumatoid arthritis

Answer 17

Anti CCP

Question 18

autoimmune hepatitis antibody

Answer 18

anti smooth muscle

Question 19

antibody in cutaneous systemic sclerosis

Answer 19

anti centromere

Question 20

young, history of Hep B, systemic upset (CNS, GI, fever upset), nodular rash

Answer 20

polyarteritis nodosa

Question 21

Mx of polyarteritis nodosa

Answer 21

corticosteroids

Question 22

young woman presents acutely with blood pressure discrepancy, absent extremity pulses, fever, night sweats, limb claudication, stroke

Answer 22

takayasu’s arteritis

Question 23

what is sjogrens syndrome

Answer 23

decreased secretion production from lacrimal & salivary glands

Question 24

fatigue, dry mouth, dry eyes, dysapereunia,

Answer 24

sjogrens syndrome

Question 25

antibody in sjogrens

Answer 25

anti ro

Question 26

limited cutaneous systemic sclerosis acronym

Answer 26

CREST calcinosis raynauds oesophageal dysmotility sclerodactyly telangectasia

Question 27

what is the key Ix in gout

Answer 27

joint aspiration to look for sodium monourate crystals

Question 28

key features of polymyositis

Answer 28

proximal muscle weakness (hip and shoulder girdle) leads to respiratory and then pharyngeal muscles

Question 29

key features of dermatomyositis

Answer 29

same muscle weakness as polymyositis heliotrope rash on eyelids gottrons papules

Question 30

Mx of reactive arthritis

Answer 30

oral NSAIDs then oral prednisolone

Question 31

Pt with diffuse systemic sclerosis sudden headache, renal dysfunction hypertension what is it and MX???????

Answer 31

scleroderma renal crisis 1. ACEis 2. calcium channel blockers 3. dialysis

Question 32

Fetlys syndrome

Answer 32

rheumatoid arthrtiis splenomegaly neutropenia

Question 33

Difference between diffuse vs limited systemic sclerosis

Answer 33

Limited is hands, fingers, face Diffuse is elbows, knees

Question 34

Polymyalgia rheumatica vs polymyositis

Answer 34

PMR is proximal joint pain and stiffness Polymyositis is proximal muscle pain, raised myoglobin and creatine kinase

Question 35

what investigation to do when you suspect ankylosing spondylitis

Answer 35

pelvic MRI

Question 36

Antibody in diffuse systemic sclerosis

Answer 36

Anti scl 70

Question 37

causative agents of reactive arthritis

Answer 37

chlamydia salmonella shigella campylobacter

Question 38

Bone pain, tenderness and proximal myopathy

Answer 38

osteomalacia vitamin D deficiency

Question 39

chronic stiffness and pain in the distal interphalangeal (DIP) joints symmetrical indicates what? asymmetrical indicates what?

Answer 39

symmetrical = rheumatoid assymmetrical = psoriatic

Question 40

Blood tests results for rheumatoid arthritis

Answer 40

Anemia of chronic disease Raised crp Raised platelets

Question 41

Mx of patients at risk of glucocorticoid-induced osteoporosis: two ways depending on age

Answer 41

> 65 IV alendronic acid <65 do a DEXA scan. if. < -1.5 give IV alendronic acid

Question 42

methotrexate monitoring

Answer 42

FBC, U+E, LFTs every 3 months