Rheumatology

Question 1

Autoantibody associated with congenital heart block?

Answer 1

Anti-Ro
(Ro=slow)

Question 2

Before commencing azathioprine…

Answer 2

Check Thiopurine methyltransferase (TPMT) deficiency
- predisposes to azathioprine related pancytopenia

Question 3

Azathioprine side effects

Answer 3

• bone marrow depression
  (consider a full blood count if infection/bleeding occurs)
• nausea/vomiting
• pancreatitis
• increased risk of non-melanoma skin cancer
• Safe in pregnancy

Question 4

DEXA T scores are a measure of

Answer 4

bone density compared to young healthy adults

Question 5

DEXA Z scores are a measure of

Answer 5

bone density comapred to same age gender and ethnicity as patient
for assessing secondary causes of osteoporosis

Question 6

T score cut offs

Answer 6

-1 to -2.5 = osteopenia
Less than -2.5 = osteporosis

Question 7

Z score cut offs

Answer 7

Less than -2 suggests bone mineral density below expected for patient

Question 8

Hydroxychloroquine adverse effects

Answer 8

Retinopathy - may be permanent
‘Bulls eye’
Need yearly eye screening

Question 9

Hydroxychloroquine in pregnancy

Answer 9

safe during conception pregnancy and breastfeeding

Question 10

Pain on the radial side of the wrist/tenderness over the radial styloid process

Answer 10

De Quervians tenosynovitis

Question 11

Affected protein in Marfans

Answer 11

Fibrillin-1

Question 12

Low serum calcium, low serum phosphate, raised ALP and raised PTH

Answer 12

Osteomalacia

Question 13

Reactive arthritis features

Answer 13

Arthritis
Uveitis
Urethritis
Keratoderma blenorrhagica
circinate balanitis

Question 14

increased serum and urine levels of hydroxyproline

Answer 14

Pagets

Question 15

Extra articular manifestations of Ank SPond

Answer 15

Apical fibrosis
Anterior uveitis
Aortic regurgitation
Achilles tendonitis
AV node block
Amyloidosis

Question 16

Poor prognostic features of RA

Answer 16

rheumatoid factor positive
anti-CCP antibodies
poor functional status at presentation
X-ray: early erosions (e.g. after < 2 years)
extra articular features e.g. nodules
HLA DR4
insidious onset

Question 17

antibody associted with MCTD

Answer 17

antiribonuclear protein
(anti-RNP)

Question 18

Sjogrens and malignancy

Answer 18

increased risk of lymphoid malignancies

Question 19

Pseudoxanthoma elasticum

Answer 19

autosomal recessive condition characterised by an abnormality in elastic fibres
- retinal angioid streaks
‘plucked chicken skin’ appearance
- small yellow papules on the neck, antecubital fossa and axillae
- mitral valve prolapse
- increased risk of ischaemic heart disease
- gastrointestinal haemorrhage

Question 20

mycophenolate mofetil mechanism

Answer 20

iosine-5’-monophosphate dehydrogenase inhibitor
- reduces lymphocyte production

Question 21

most common cause of death in systemic sclerosis

Answer 21

respiratory involvement

Question 22

Key cytokine in RA pathology

Answer 22

TNF

Question 23

Osteporosis in man. Check…

Answer 23

Testosterone
(Hypogonadism is a common cause of osteoporosis in men)

Question 24

Reactive arthritis joint aspirate

Answer 24

No organisms seen

Question 25

Antibody for diffuse systemic sclerosis

Answer 25

Anti-Scl-70

Question 26

Antibody for limited cutaneous systemic sclerosis

Answer 26

Ant-centromere

Question 27

Apremilast mechanism

Answer 27

phosphodiesterase type-4 (PDE4) inhibitor

Question 28

Anti-TNF agents

Answer 28

Adalimumab,
etanercept
infliximab
May reactivate TB

Question 29

Ciclosporin mechanism

Answer 29

calcineurin inhibitor

Question 30

Antiphospholipid syndrome

Answer 30

Recurrent miscarriage
Arterial or venous thrombus
Livedo Reticularis
Paradoxically prolonged APTT
Thrombocytopenia
Antibodies- anticardiolipin,
anti-beta2 glycoprotein I (anti-beta2GPI) antibodies,
lupus anticoagulant

Question 31

Management of discoid lupus

Answer 31

1st - Topical steroids
2nd -Oral hydroxychloroquine

Question 32

Pagets treatment

Answer 32

1st - Bisphosphonates
2nd - Calcitonin

Question 33

Pagets biochemistry…

Answer 33

Normal calcium and phosphate
Isolated elevated ALP
Elevated hydroxyproline

Question 34

Drug induced lupus

Answer 34

arthralgia
myalgia
skin (e.g. malar rash) and pulmonary involvement (e.g. pleurisy) are common
ANA positive in 100%, dsDNA negative
anti-histone antibodies are found in 80-90%

Question 35

Antibody for granulomatosis with polyangiitis (Churg Strauss)

Answer 35

c-anca

Question 36

Antibody for eosinophilic granulomatosis with polyangiitis

Answer 36

p-anca

Question 37

Methotrexate is a…

Answer 37

dihydrofolate reductase inhibitor
avoid co-trimoxazole (will worsen any potential pancytopenia)

Question 38

Denosumab mechanism

Answer 38

RANKL inhibitor
- prevents osteoclast development

Question 39

Causative drugs in drug-induced lupus

Answer 39

Common- procainamide, hydralazine
Less common - isoniazid, phenytoin, minocycline

Question 40

Neurological complication of polyarteritis nodosa

Answer 40

Mononeuritis multiplex

Question 41

Azathioprine in pregnancy…

Answer 41

safe in pregnancy and breastfeeding alongside sulfasalazine and mesalazine

Question 42

Rheumatoid factor is…

Answer 42

an IgM antibody against IgG

Question 43

Most SENSITIVE antibody for SLE

Answer 43

ANA

Question 44

Most SPECIFIC antibodies for SLE

Answer 44

anti-dsDNA
anti-Smith

Question 45

Most specific antibody for dermatomyositis

Answer 45

Anti-Mi-2

Question 46

McArdle’s disease

Answer 46

• autosomal recessive type V
• glycogen storage disease
  caused by myophosphorylase deficiency
• cramping, myoglobinuria, ‘second wind’ phenomenon