rheumatology

Question 1

women, recurrent miscarriages, purple lace like rash with mottled appearance, migraines

Answer 1

antiphospholipid syndrome

Question 2

investigations for antiphospholipid syndrome

Answer 2

anticardiolipin antibodies
anti beta 2
FBC

Question 3

management antiphospholipid syndrome

Answer 3

dalteparin
warfarin

Question 4

hot swollen joint, abrupt onset

Answer 4

gout

Question 5

investigation for gout

Answer 5

synovial fluid analysis
serum uric acid
ultrasound

Question 6

management of gout

Answer 6

acute: NSAIDs, colchicine

after 4 weeks - allopurinol

Question 7

chronic pain, diffuse tenderness, fatigue, headaches

Answer 7

fibromyalgia

Question 8

unilateral headahces tender on direct palpation, scalp pain, aching and stiffness, absent pulses, fever

Answer 8

giant cell arteritis

Question 9

investigation for giant cell arteritis

Answer 9

CRP, ESR - elevated
temporal artery biopsy
opthalmoscopy - swollen optic disc

Question 10

management of GCA

Answer 10

prednisolone 40-60mg
aspirin 75mg

Question 11

pain in weight bearing joints, functional difficulities, limited range of movement, crepitus

Answer 11

osteoarthritis

Question 12

investigation for osteoarthritis

Answer 12

Xray - LOSS (loss joint space, osteophytes, sclerosis, subchondral cysts)
MRI - cartilage loss

Question 13

management of osteoarthritis

Answer 13

lifestyle - weight loss, exercise
topical analgesia
intra articular corticosteroids
paracetamol
NSAIDs
opioid
surgery

Question 14

shoulder/hip girdle stiffness, morning stiffness, pain, fever, weight loss

Answer 14

polymyalgia rheumatica

Question 15

investigation for polymyalgia rheumatica

Answer 15

ESR - elevated
CRP - elevated
(can occur in patients with GCA)

Question 16

management of polymyalgia rheumatica

Answer 16

prednisolone - 15mg
methotrexate

Question 17

female 40-60, symmetrical proximal weakness, gradual onset, interstitial lung disease

Answer 17

polymyositis

Question 18

investigations for polymyositis

Answer 18

ANA
anti-Jo1
anti SRP
creatinine kinase
muscle biopsy

Question 19

management of polymyositis

Answer 19

prednisolone

Question 20

Gottons papules - red flat topped papule over knuckels, rash red rash in a V over their neck, proximal muscle weakness

Answer 20

dermatomyositis

Question 21

investigations for dermatomyositis

Answer 21

serum creatinine kinase
muscle biopsy
ANA - positive
anti Mi 2 postiive

Question 22

management of dermatomyositis

Answer 22

prednisolone

Question 23

joint pain, morning stiffness, swan neck deformity, boutiennieres deformity, ulnar deviation

Answer 23

rheumatoid arthritis

Question 24

investigation for rheumatoid arthritis

Answer 24

rheumatoid factor
anti CCP
Xray
ultrasound

Question 25

dry eyes - feel gritty dry mouth bad dental health myalgia

Answer 25

sjorgen syndromen

Question 26

investigation for sjorgen syndrome

Answer 26

schimer test anti Ro anti La

Question 27

management of sjorgen syndrome

Answer 27

artiificial tears salivary substitute paracetamol, NSAIDs

Question 28

back pain - early morning stiffness iritis fatigue kyphosis psoriasis question mark spine

Answer 28

ank spon

Question 29

investigation for ank spon

Answer 29

XRAy - bamboo spine HLA b27 schober ASAS classification

Question 30

management of ank spon

Answer 30

physio NSAIDs steroids surgery

Question 31

female rash after sun exposure over her cheeks photosensitive rash fever weight loss raynauds renal

Answer 31

SLE

Question 32

SLE investigations

Answer 32

FBC - anaemia ANA +ve anti dsDNA anti Sm urinalysis

Question 33

ANCA -ve fever purple mottle rash weight loss proteinuria

Answer 33

polyarteritis nodosa

Question 34

rash, dry red lips, strawberry tongue

Answer 34

kawasaki

Question 35

investigation kawasaki

Answer 35

FBC ESR CRP echo LFT

Question 36

management of kawsaki

Answer 36

IV immunoglobulin