Rheumatology

Question 1

symptoms of reactive arthritis

Answer 1

conjunctivitis
arthritis
urethritis

“Can’t see, can’t pee, can’t stand on one knee”

Question 2

features of polymyositis

Answer 2

proximal muscle weakness and wasting
problems getting out of chairs/walking up stairs
can also have oesophageal dysmotility problems and sclerodactyly
low grade fever

Question 3

Ix for polymyositis

Answer 3

anti-Jo antibodies
raised CK
ANA positive

Question 4

anti-Jo association

Answer 4

polymyositis

Question 5

anti-Ro associations

Answer 5

Sjogren’s, SLE, congenital heart block

Question 6

anti-La association

Answer 6

Sjogren’s syndrome

Question 7

anti-scl-70 association

Answer 7

diffuse cutaneous systemic sclerosis

Question 8

anti-centromere association

Answer 8

limited cutaneous systemic sclerosis (CREST syndrome)

Question 9

symptoms in limited cutaneous systemic sclerosis

Answer 9

CREST
calcinosis
raynaud's
oesophogeal dysmotility
sclerodactyly
telangectasia

Question 10

areas affected in limited cutaneous systemic sclerosis

Answer 10

face, forearms and lower legs

Question 11

diseases predisposing to osteoporosis

Answer 11

endo: cushings, GH def, hyperthyroid, hypogonadism (Turner's syn, testosterone def), hyper PTH
GI: IBD, malabsorption, liver disease
multiple myeloma, lymphoma
CKD
RA
osteogenesis imperfecta, homocystinurea

Question 12

OA Mx

Answer 12

weight loss, exercise
1: paracetamol and topical NSAID (for knee/hand)
2: oral NSAID/COX2i + PPI, opiods, capsaicin cream
non pharm: supports, TENS

Question 13

secondary causes of Raynaud’s phenomenon

Answer 13

CT dz: scleroderma (most common), RA, SLE,
type I cryoglobulinaemia, cold agglutinins
OCP
use of vibrating tools (hand-arm vibration syndrome)

Question 14

Mx of raynauds

Answer 14

calcium channel blocker eg nifedipine

IV prostacyclin infusions - last several weeks/months

Question 15

pathology behind Paget’s disease

Answer 15

increased and uncontrolled bone turnover

Question 16

RFs for Paget’s disease

Answer 16

increasing age
male
increased latitude
FH

Question 17

clinical features of Paget’s disease?

Answer 17

bone pain (lumbar spine, femur, pelvis)
raised ALP - calcium and phos are typically normal
classically untreated: bowing of tibia, bossing of skull

Question 18

indication for Rx of Pagets and what is the Rx

Answer 18

bone pain, fracture, skull or long bone deformity, periarticular Pagets
bisphosphonates (eg risedronate)
calcitonin (less commonly used now)

Question 19

complications of Pagets

Answer 19

deafness (CN entrapment)
high output cardiac failure
fracture
osteosarcoma

Question 20

classical history of ankylosing spondylitis

Answer 20

25 yo male with insidious onset lower back pain and stiffness that is worse in the morning and improves with exercise. He gets pain at night which improves when he gets up

Question 21

features of Ank Spond

Answer 21

reduced chest expansion and lumber flexion
apical fibrosis
anterior uveitis
aortitis
achilles tendonitis
amyloidosis
arthritis (peripheral)

Question 22

cANCA association

Answer 22

Wegener’s in >90%

Question 23

pANCA association

Answer 23

immune crescentic glomerulonephritis (80%)
microscopic polyangitis (60%)
Churg-Strauss syn (60%)
primary sclerosing cholangitis (70%)

Question 24

Anti-cyclic citrullinated peptide antibody association

Answer 24

Rheumatoid Arthritis - detectable 10 yrs before symptomatic

Question 25

conditions with positive RF

Answer 25

RA 70-80%
Sjogrens 100%
Felty's syn 100% (RA, neutropenia, splenomegaly)
infective endocarditis 50%
SLE 25%
systemic sclerosis 30%
general population 5%

Question 26

classical triad of Behcet’s syndrome

other Sx

Answer 26

1: oral ulcers, 2: genital ulcers, 3: uveitis
thrombophlebitis
arthritis
GI: abdo pain, diarrhoea, colitis
erythema nodosum, DVT

Question 27

features of Churg-Strauss syndrome

Answer 27

Allergic phase - asthma or allergic rhinitis
Eosinophilic phase - hypereosinophilia, causing abdominal pain, GI bleeding, night sweats
Vasculitic phase - RF, abdo or heart problems
~50% die from cardiac disease, eosinophilic coronary myocarditis

Question 28

Mx of Churg-Strauss

Answer 28

glucocorticoids. 20% need cytotoxics (azathioprine and cyclophosphamide)

Question 29

Most common organism causing septic arthritis

Mx

Answer 29

staph. aureus
Mx - synovial aspiration and culture.
fluclox and fusidic acid (clinda if pen allergic) - 2wks IV, 4 weeks PO
May need surgical wash out or repeat aspirations
If young monoarthritis - think gonococcus (10/7 ceftriaxone)
if older/immunosuppressed - ?listeria ?gram neg. Taz instead of fluclox

Question 30

What is Schirmer’s test?

What does it test for?

Answer 30

Litmus paper in lower eyelid, Sjögren’s syndrome

Positive if <5mm in 5mins

Question 31

What is Takayasu arteritis?

Answer 31

granulomatous vasculitis of large vessels, with intimal fibrosis
Sx: TIAs, claudication, hypertension (renal artery stenosis)
Mx: steroids

Question 32

Which bacterial infection is linked with RA in susceptible individuals?

Answer 32

Proteus mirabilus - urine infections.

Question 33

Mx of Ank Spond

Answer 33

NSAIDs and physio in early disease
sulphasalazine improves peripheral joint arthritis
later TNF-a antagonists (eg etanercept) can be used.

Question 34

Risk factors for avascular necrosis

Answer 34

lupus, steroids, antiphospholipid syndrome, sickle cell disease, alcoholism
Caisson’s disease (decompression sickness “the bends”)
Gaucher’s disease (genetic lipid accumulation disease)

Question 35

Indication for starting osteoporosis treatment following DEXA scan

Answer 35

T score < -2.5 in normal adults or < -1.5 in patients on steroids.
Oral bisphosphonates used 1st line.

Question 36

Mx of Feltys syndrome

Answer 36

(hepatosplenomegaly, RA and neutropenia)
pulsed corticosteroid and/or cyclophosphamide
splenectomy if medical Rx fails.