Rheumatology

Question 1

What joints are Heberden’s and Bouchard’s found and what condition are they associated with?

Answer 1

Heberden’s = DIPJ
Bouchard’s = PIPJ

Associated with OA

Question 2

1st line management for ankylosing spondylitis

Answer 2

Exercise regimes
NSAIDs

Question 3

Presentation of reactive arthritis and 1st line treatment

Answer 3

Asymmetrical oligoarthritis
Associated with dysuria and conjunctivitis
Often following diarrhoea
CAN’T SEE, PEE OR CLIMB A TREE

1st line treatment = NSAIDs

Question 4

Features of Still’s disease

Answer 4

Arthralgia
Diurnal, salmon-pink rash
Pyrexia (fluctuant) - worse in evenings
Lymphadenopathy
RF and ANA negative

Question 5

Dermatomyositis presentation and relevant antibody

Answer 5

Symmetrical, proximal muscle weakness (i.e. both thighs)
Blue-purple rash on face, upper eyelids and trunk
Pathognomonic papules over MCPJs (Gottron papules)

Question 6

What is Paget’s disease and what does it usually affect?
What blood test is raised on its own?

Answer 6

Disease of increased, uncontrolled bone turnover
Usually affects skull, spine, pelvis, long bones of legs
Raised ALP

Question 7

What can methotrexate cause as an adverse effect?

Answer 7

Pneumonitis - cough, dyspnoea, fever

Question 8

Key investigation in suspected septic arthritis

Answer 8

Joint aspiration and synovial fluid analysis

Question 9

When to offer bone protection when treating with steroids

Answer 9

Offer prophylactic bisphosphonates when:

They are over 65
T score is below -1.5 if they are under 65

Question 10

X-Ray features of ankylosing spondylitis

Answer 10

Squaring of lumbar vertebral bodies
Syndesmophytes (bony growths within spinal ligaments)
Sacroilitis
Subchondral erosions

Question 11

1st line treatment of OA

Answer 11

Paracetamol
Topical NSAIDs if knee/hand

Question 12

Treatment of Paget’s disease of the bone

Answer 12

Bisphosphonates e.g risedronate, alendronic acid

Question 13

Examination finding of polymyalgia rheumatica

Answer 13

No true weakness of shoulder, any weakness due to pain

Question 14

When should calcium be prescribed for bone protection?

Answer 14

If calcium intake is inadequate

Question 15

Pharmacological treatment of Raynaud’s phenomenon

Answer 15

CCB e.g. nifedipine

Question 16

Mainstay treatment of SLE and a potential complication

Answer 16

Hydroxychloroquine - may result in severe/permanent retinopathy
Requires regular visual acuity testing every 6-12 months

Question 17

What is used as cover when giving allopurinol for gout?

Answer 17

Colchicine

Question 18

X-ray features of psoriatic arthritis

Answer 18

Pencil and cup deformity
Plantar spur

Question 19

What DMARD should be avoided in aspirin allergy?

Answer 19

Sulfasalazine

Question 20

Blood tests for osteomalacia?

Answer 20

Vit D deficiency so decreased calcium and phosphate (decreased absorption)
PTH elevated (negative feedback)
Raised ALP

Question 21

Paget’s disease on skull X-ray feature

Answer 21

Thickening of the calvarium

Question 22

Joint aspirate analysis of RA

Answer 22

Yellow, cloudy appearance
Raised WBC (mainly neutrophils)
Absence of crystals on microscopy

Question 23

What drugs can induce lupus? How does it present and what antibodies may be seen?

Answer 23

Isionazid for TB
Symmetrical annular papulosquamous (raised, scaly rash) on sun-exposed areas
Anti-histone antibodies may be seen

Question 24

What does a clotting screen show for antiphospholipid syndrome?

Answer 24

Thrombocytopenia
Paradoxically raised APTT

Question 25

Antibodies seen in APS?

Answer 25

Anti-cardiolipin antibodies

Question 26

Features of Marfan’s?

Answer 26

Tall
Arachnodactyly
Pectus excavatum
Mitral valve prolapse
Aortic sinus dilatation
Recurrent pneumothoraxes