rheumatology

Question 1

X ray features that distinguish pseudogout vs gout

Answer 1

chondrocalcinosis = Calcification of the cartilage suggests
This occurs in pseudogout (calcium crystals) but is not associated with gout.

Question 2

reactive arthritis (formerly known as Reiter’s syndrome but he was a Nazi so we cancelled it)

Answer 2

recent episode of diarrhoea may have represented Campylobacter or Salmonella infection

–> arthritis, conjunctivitis, and urethritis (can’t pee, can’t see, can’t climb a tree)

mx. NSAIDs, intra-articular steroids

usually clears in 12 months

Question 3

most useful investigation in establishing the diagnosis ank spond

Answer 3

Radiographs may be normal early in disease, later changes include:
sacroiliitis: subchondral erosions, sclerosis
squaring of lumbar vertebrae
‘bamboo spine’ (late & uncommon)
syndesmophytes: due to ossification of outer fibers of annulus fibrosus
chest x-ray: apical fibrosis

Question 4

Which type of collagen is primarily affected by Ehlers-Danlos syndrome?

Answer 4

defect in type III collagen

Question 5

Schober’s sign

Answer 5

done by measuring the distance from 10 cm above and 5 cm below the level posterior iliac spine on anterior flexion. An increase in distance less than 5 cm indicates reduced lumbar flexion and is characteristic of ankylosing spondylitis.

Question 6

which drugs to avoid prescribing with methotrexate

Answer 6

avoid prescribing trimethoprim or co-trimoxazole concurrently

— risk of pancytopenia

Question 7

Anti-cardiolipin antibodies and anti-beta2 glycoprotein I antibodies

Answer 7

anti phospholipid syndrome

Question 8

pred vs methylpred for temporal arteritis

Answer 8

Uncomplicated GCA (no visual involvement and/or jaw/tongue claudication) = oral pred

Complicated GCA (with visual involvement and/or jaw/tongue claudication), should be given IV methylprednisolone 500-1000mg for 3 days before starting oral prednisolone.

Question 9

Patients who are allergic to aspirin may also react to what other drug?

Answer 9

sulfasalazine

Question 10

risk factors for pseudogout

Answer 10

haemochromatosis
hyperparathyroidism
low magnesium, low phosphate
acromegaly, Wilson’s disease

Question 11

Septic arthritis - most common organism:

Answer 11

Staphylococcus aureus

Question 12

opthalmology finding with temporal arteritis

Answer 12

anterior ischemic optic neuropathy
- Fundoscopy typically shows a swollen pale disc and blurred margins
may result in temporary visual loss - amaurosis fugax

Question 13

which people are at high risk of dermatological side effects of allopurinol? what should they be screened for?

Answer 13

Chinese, Korean and Thai people

risk screen for: HLA-B *5801 allele.

Question 14

distinguishing psoriatic and RA

Answer 14

psoriasis - DIP swelling and dactylitis, nail changes, unilateral picture

Question 15

Diffuse vs. Limited scleroderma

Answer 15

Diffuse = dermatology. Anti-scl70. the most common cause of death is now respiratory involvement, which is seen in aroundg 80%: interstitial lung disease,) and pulmonary hypertension (PAH)
other complications include renal disease and hypertension

Limited=central= CREST. Anti-centromere
Calcinosis, Raynaud’s phenomenon, oEsophageal dysmotility, Sclerodactyly, Telangiectasia

Question 16

Mx. Gout

Answer 16

NSAIDs or colchicine

Or if renal impairment - colchicine

Question 17

Familial Mediterranean fever (FMF)
- inheritance pattern
- symptoms
- treatment

Answer 17

Familial Mediterranean fever (FMF) is an autosomal recessive, hereditary inflammatory disorder characterised by reoccurring episodes of abdominal pain, fever, arthralgia, and chest pain

mx. colchicine

Question 18

Sarcoidosis CXR stages

Answer 18

1 = BHL
2 = BHL + infiltrates
3 = infiltrates
4 = fibrosis

Question 19

which monoclonal antibody is used in osteoporosis and mechanism of action and side effects

Answer 19

Denosumab
prevents the development of osteoclasts by inhibiting RANKL

side effects: Dyspnoea and diarrhoea, atypical femoral fractures

Question 20

Mixed connective tissue disease (MCTD, Sharp’s syndrome)

Answer 20

features of systemic lupus erythematosus (SLE), systemic sclerosis (SSc) and myositis

Anti-U1 RNP (an extractable nuclear antigen, ENA), must be positive*.

Question 21

Anakinra mechanism of action

Answer 21

is an interleukin-1 (IL-1) receptor antagonist.

IL-1 is secrete by macrophages to cause inflammation and fever

Question 22

acute intermittent porphyria -most suitable drug for sedation?

Answer 22

chlorpromazine

Question 23

Lofgren’s syndrome

Answer 23

acute form sarcoidosis characterised by bilateral hilar lymphadenopathy (BHL), erythema nodosum, fever and polyarthralgia.

good prognosis

Question 24

beyond what T score should oral bisphosphonates be prescribes?

Answer 24

-1.5

alongside vit d and ca

Question 25

duration of pred that justifies starting bisphosphonates

Answer 25

3mo or more

Question 26

diagnosing Adult-onset Still’s disease

Answer 26

is a diagnosis of exclusion and can only be diagnosed if rheumatoid factor and anti-nuclear antibody are negative

Question 27

Behcet’s syndrome symptoms

Answer 27

is a rare multisystem inflammatory disorder characterized by recurrent oral and genital ulcers, uveitis, and systemic vasculitis.

Question 28

specific antibody for dermatomyositis vs polymyositis

Answer 28

both - ANA positive
anti-Mi-2 antibodies are highly specific for dermatomyositis

anti-Jo-1 antibodies - polymyositis where they are seen in a pattern of disease associated with lung involvement, Raynaud’s and fever

Question 29

saddle shaped nose

Answer 29

relapsing polychondritis
+ other cartilage points

cANCA positive: granulomatosis with polyangitis