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AMC MCQ - Key points > Rheumatology > Flashcards

Rheumatology Flashcards

1
Q

Describe the most important findings in an x-ray of a patient with osteoarthritis.

A

Narrow joint space and osteophytes.

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2
Q

What is the most common risk factor for osteoarthritis?

A

Obesity.

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3
Q

How should a patient with osteoarthritis approach lifestyle changes?

A

By losing weight.

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4
Q

Define the sequence of treatment in osteoarthritis starting with the first line.

A

Paracetamol.

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5
Q

What is the next step in treatment if paracetamol fails in osteoarthritis?

A

NSAIDs.

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6
Q

What is the recommended treatment if NSAIDs fail in osteoarthritis?

A

Opioids.

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7
Q

What is the subsequent step if opioids fail in treating osteoarthritis?

A

Intraarticular steroid injection.

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8
Q

Do you replace the joint in cases of marked impairment of daily activities due to osteoarthritis?

A

Yes.

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9
Q

Where should a patient hold the stick when walking with the diseased leg on the ground?

A

On the opposite side.

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10
Q

Describe the laboratory findings in osteoarthritis.

A

All labs are normal.

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11
Q

What condition is characterized by an old patient with chronic neck pain and sensory deficit?

A

Cervical spondylosis.

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12
Q

What are the X-ray findings in cervical spondylosis?

A

Bony spurs and sclerotic facet joints.

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13
Q

What is the first-line treatment for acute gouty arthritis (podagra)?

A

NSAIDS
Colchicine
glucocorticoids prednisolone - if above two are contraindicated

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14
Q

What is the most important test in diagnosing acute gouty arthritis?

A

Synovial fluid analysis (arthrocentesis).

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15
Q

Describe the findings in arthrocentesis for acute gouty arthritis.

A

WBCs 2000-50000, needle-shaped, negatively birefringent crystals, negative gram stain & culture.

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16
Q

What are the X-ray findings in gout?

A

Punched out erosions.

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17
Q

What is the main lifestyle modification to prevent gout?

A

Stop alcohol consumption.

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18
Q

What is the first-line treatment for an acute gout attack excluding patients with renal failure or gastrointestinal bleeding?

A

Indomethacin.

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19
Q

What is the second-line treatment for an acute gout attack?

A

Colchicine.

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20
Q

What is the recommended treatment for tophaceous gout?

A

Allopurinol.

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21
Q

What is the main side effect of colchicine?

A

Diarrhea.

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22
Q

What is the main side effect of allopurinol?

A

Rash.

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23
Q

What should be done if an acute gout attack occurs while a patient is on allopurinol?

A

Administer indomethacin and continue allopurinol.

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24
Q

What is the most common drug causing gout attacks?

A

Thiazide diuretics.

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25
Q

What is the main indication for long-term medication use in gout?

A

Renal failure.

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26
Q

What is the starting dose of allopurinol?

A

50-100 mg.

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27
Q

Describe the side effects of thiazide diuretics.

A

Hyponatremia, hypokalemia, hyperglycemia (induces diabetes mellitus), hyperuricemia (contraindicated in gout), hypercalcemia (hypocalciuria, prophylaxis against renal stones), hyperlipidemia.

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28
Q

What is the diagnosis for an old patient with hypercalcemia developing acute knee joint pain?

A

Pseudo-gout.

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29
Q

What are the crystal characteristics in arthrocentesis for pseudo-gout?

A

Rhomboid-shaped crystals, positive birefringent.

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30
Q

What is the first-line treatment for pseudo-gout?

A

NSAIDs.

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31
Q

Describe the treatment for a patient with low back pain not radiating to the lower limb and examination showing paravertebral muscle spasm.

A

Treatment involves analgesics and activity, with no bed rest.

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32
Q

What is the diagnosis for a patient with low back pain radiating to the lower limb and a positive straight leg test on examination?

A

The diagnosis is a herniated disc.

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33
Q

Define the term ‘Cauda Equina’ in the context of severe radicular lower limb pain, lower motor neuron lesion, and urine and stool incontinence.

A

Cauda Equina refers to a collection of nerve roots at the lower end of the spinal cord.

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34
Q

How is spinal stenosis diagnosed and treated in a patient with low back pain that worsens with leaning forward and walking uphill?

A

Diagnosis is done through MRI, and treatment of choice is surgery.

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35
Q

Describe the management approach for a post-menopausal patient with severe localized back pain and tenderness to one vertebra.

A

Initial investigation involves X-ray, and if no fracture appears, a DEXA scan is recommended.

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36
Q

What is the important laboratory finding in Ankylosing Spondylitis (AS) and how is it managed?

A

An important finding is a positive HLA-B27 and negative RF. Management includes NSAIDs as first-line, infliximab as second-line, and sulphasalazine as third-line treatment.

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37
Q

Define the term ‘Anterior uveitis’ in the context of Ankylosing Spondylitis (AS).

A

Anterior uveitis refers to inflammation of the uvea in the front of the eye, commonly associated with AS.

38
Q

How is acute pancreatitis investigated and treated?

A

Investigations include amylase and lipase levels, ultrasound, and CT scans. Treatment involves analgesics, intravenous fluids, and NPO (nothing by mouth).

39
Q

Describe the management of acute cholecystitis in a female patient with severe right upper quadrant pain.

A

Initial investigation is done through ultrasound to identify stones at the cystic duct. Treatment starts conservatively and may progress to scheduled cholecystectomy.

40
Q

What are the diseases that can cause pain referred to the back?

A

Diseases include perforated peptic ulcer, acute pancreatitis, aorta dissection or rupture, acute cholecystitis, renal colic, and pyelonephritis.

41
Q

Describe the differential diagnosis of shoulder pain.

A

Differential diagnosis of shoulder pain includes rotator cuff tendonitis, rotator cuff tear, adhesive capsulitis, sub-acromial bursitis.

42
Q

What is the treatment of choice for rotator cuff tendonitis?

A

NSAIDs.

43
Q

Define fibromyalgia.

A

Fibromyalgia is a condition characterized by generalized musculoskeletal pain, disturbed sleep, and normal lab results.

44
Q

How is polymyalgia rheumatica (PMR) diagnosed and treated?

A

Diagnosed by symptoms of pain at shoulder & pelvic girdle with morning stiffness >1h, treated with low-dose steroids. If associated with giant cell arteritis, high-dose steroids are given.

45
Q

Describe the diagnosis and treatment of polymyositis.

A

Diagnosed by muscle weakness, elevated CK & aldolase, treated with muscle biopsy and cortisone.

46
Q

What is the diagnosis and treatment for dermatomyositis?

A

Diagnosis is muscle weakness, elevated CK & aldolase, heliotrope rash, and gottron papule. Treatment involves cortisone.

47
Q

Define Sjogren’s syndrome.

A

Sjogren’s syndrome is a condition characterized by keratoconjunctivitis, difficult swallowing, dyspareunia, and enlarged parotid gland.

48
Q

What are the important investigations for Sjogren’s syndrome?

A

Anti-SSA (RO) and anti-SSB (LA) antibodies are crucial. Biopsy of enlarged parotid gland may be needed.

49
Q

Describe the diagnosis and treatment of polymyalgia rheumatica (PMR) associated with giant cell arteritis.

A

Diagnosed by symptoms of PMR with high ESR. Treatment involves high-dose steroids and temporal artery biopsy for confirmation.

50
Q

What is the diagnosis and treatment ) in a young female with rash over face and arthralgia?

A

Diagnosis is SLE, and
First Ana
Diagnosis - anti D
More accurate anti Smith

treatment involves anti-DNA or anti-Smith antibodies.

Hydroxychloroquine is important for mild joint affection or skin manifestations.

51
Q

Describe the presentation of a patient with sarcoidosis.

A

Young female with chronic dry cough, bilateral hilar lymphadenopathy, increased Ca level, and elevated ACE.

52
Q

What is the treatment of choice for sarcoidosis?

A

Oral steroids.

53
Q

What is the immediate management for a patient with suspected septic arthritis?

A

Immediate joint aspiration.

54
Q

Define a Baker’s cyst and its potential complication.

A

Swelling at the back of the knee; if ruptured, can cause severe pain at the calf.

55
Q

How can septic arthritis be differentiated from other causes of knee swelling?

A

Immediate aspiration is needed to confirm the diagnosis, with Staph aureus being the most common organism.

56
Q

Describe the next step in management for an elderly female with rheumatoid arthritis presenting with severe knee pain.

A

Aspiration to exclude septic arthritis.

57
Q

What is the most common organism causing septic arthritis?

A

Staphylococcus aureus.

58
Q

Describe the presentation of a patient with rheumatoid arthritis.

A

Joint pain, morning stiffness that improves with activity.

59
Q

What is the most important investigation before considering surgery for a rheumatoid arthritis patient?

A

X-ray of the cervical vertebrae to exclude C1-C2 involvement.

60
Q

Describe the presentation of Felty’s syndrome.

A

Rheumatoid arthritis, splenomegaly, and neutropenia.

61
Q

What is the most common cause of death in patients with rheumatoid arthritis?

A

Cardiovascular disease.

62
Q

What is the preferred drug for treating rheumatoid arthritis?

A

Methotrexate.

63
Q

Describe the characteristics of limited scleroderma (CREST syndrome).

A

Calcinosis cutis, Raynaud’s phenomenon, Esophageal dysmotility, Sclerodactyly, Telangiectasia, positive Anti-Centromere antibody.

64
Q

What is the most common cause of death in scleroderma patients?

A

Pulmonary hypertension.

65
Q

What is the treatment of choice for renal crisis in scleroderma?

A

ACE inhibitors.

66
Q

What test should be performed before initiating azathioprine therapy?

A

Thiopurine methyltransferase genotype.

67
Q

Describe the presentation of a patient with scleroderma.

A

Basal crepitations over the back, colored fingers, some fingers amputated, and difficulty swallowing.

68
Q

What is the management for avascular necrosis in a patient on high-dose cortisone?

A

MRI is the imaging modality of choice.

69
Q

Describe the presentation of a patient with scleroderma in CREST syndrome.

A

Calcinosis cutis, Raynaud’s phenomenon, Esophageal dysmotility, Sclerodactyly, Telangiectasia, positive Anti-Centromere antibody.

70
Q

Describe the treatment for Rheumatoid Arthritis.

A

Methotrexate is usually the first line agent in the management of rheumatoid arthritis but simple analgesia and nonsteroidal anti-inflammatory drugs are also important for symptom control. Rheumatoid arthritis (RA) is a chronic disease with significant cost to both the individual and the community.
https://www.racgp.org.au › …PDF
Rheumatoid arthritis - RACGP

71
Q

What is the drug of choice for Gout prevention of new attacks?

A

Allopurinol.

72
Q

How is Fibromyalgia treated?

A

Amitriptyline.

73
Q

Define the drug of choice for Polymyositis.

A

High dose steroids.

74
Q

Do you immobilize a Charcot joint?

A

Yes, the next step is cast and immobilization.

75
Q

What is the initial treatment for an acute Gout attack?

A

NSAIDs, Indomethacin.

76
Q

Describe the treatment for Epidural abscess.

A

Vancomycin.

77
Q

What is the management for Cord compression?

A

Steroids.

78
Q

How is Spinal stenosis managed?

A

Weight loss & Steroid injection.

79
Q

Define the treatment for Temporal Giant cell arteritis.

A

High dose steroids.

80
Q

What is the drug of choice for Ankylosing Spondylitis?

A

NSAIDs.

Nonsteroidal anti-inflammatory drugs (NSAIDs) are first-line therapy and recent studies suggest that regular use among patients with AS slows radiographic progression.
https://www.racgp.org.au › …PDF
Ankylosing spondylitis: an update - RACGP

81
Q

Describe the treatment for Reactive arthritis (Reiter’s syndrome).

A

NSAIDs.

Reactive arthritis
Reactive arthritis, although not a form of juvenile idiopathic arthritis, can present in adolescence, and like ERA, has an association with HLA-B27 positivity. The classic triad of arthritis, conjunctivitis and urethritis is not present in all cases. Enteric or genitourinary infections, including sexually transmissible infections (STIs; eg chlamydia), are typical triggers and should be considered in adolescents presenting with arthritis and relevant symptoms on systems review.14 The pattern of arthritis is variable; however, it most commonly involves the lower limbs, and prominent pain and erythema are classically described. Differentiating reactive arthritis from juvenile idiopathic arthritis can be challenging; however, reactive arthritis is generally self‑limited, requiring treatment with NSAIDs only. RACGP

82
Q

What antibiotics are used in Septic arthritis?

A

Ceftriaxone & Vancomycin.

83
Q

How is Polymyalgia Rheumatica treated?

A

Low dose steroids.

84
Q

Do you use wrist splint and NSAIDs for Carpal Tunnel syndrome?

A

Yes.

85
Q

What is the treatment for SLE (Systemic Lupus Erythematosus)?

A

High dose steroids.
hydroxychloroquine

86
Q

Describe the treatment for Psoriatic arthritis.

A

NSAIDs.

Arthritis Australia
https://arthritisaustralia.com.au › Types of Arthritis
What treatments are there for psoriatic arthritis? · non-steroidal anti-inflammatory drugs (NSAIDs) · disease-modifying anti-rheumatic drugs (DMARDs) · biological …

87
Q

What is the treatment for Gonococcal arthritis?

A

Ceftriaxone or cefotaxime.

88
Q

How is Scleroderma investigation ?

A

Anti-topoisomerase (Scl 70).

89
Q

Define the antibodies associated with Wegener’s granulomatosis.

A

Anti-neutrophil cytoplasmic Antibody (C-ANCA).

90
Q

What antibodies are linked to Churg-Strauss syndrome?

A

Anti-myeloperoxidase antibody (P-ANCA).

AMC MCQ - Key points (49 decks)

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