Rheumatology

Question 1

What HLA antigen is RA assoc with?

Answer 1

HLA-DRB1, HLA-DR4

Question 2

What respiratory complications can RA present with?

Answer 2

1. pulmonary fibrosis/nodules, pleural effusion
2. Caplan’s syndrome (fibrosis + nodules)
3. bronchiolitis obliterans

Question 3

What haem complications can RA present with?

Answer 3

1. lymphoma
2. Felty syndrome - neutropaenia, splenomegaly
3. anaemia of chronic disease

Question 4

X-ray findings in RA?

Answer 4

1. loss of joint space
2. juxta-articular osteopenia
3. soft tissue swelling
4. late signs - periarticular erosions, subluxation

Question 5

1st line management in RA?

Answer 5

DMARD (e.g. methotrexate) + bridging steroids

Question 6

HLA antigens assoc with SLE?

Answer 6

HLA-DR2, HLA-DR3, HLA-B8

Question 7

one highly sensitive, two high specific autoimmune antibodies in SLE?

Answer 7

highly sensitive: ANA
highly specific: anti-dsDNA, anti-Smith

Question 8

mainstay of SLE treatment?

Answer 8

hydroxychloroquine, steroids +/- other DMARDs e.g. mycophenilate, azathiorpine, methotrexate

Question 9

What autoimmune Ab and clinical problem is SLE in pregnancy/neonatal SLE assoc with?

Answer 9

autoimmune Ab: anti-Ro
clinical: congenital heart block

Question 10

treatment in discoid SLE?

Answer 10

steroid TOP, hydroxychloroquine

Question 11

What autoimmune Ab is particularly seen in drug-induced lupus?

Answer 11

anti-histone

Question 12

What is the most common and severe form of lupus nephritis?

Answer 12

Class IV-S: diffuse proliferative

Question 13

1st line treatment for lupus nephritis?

Answer 13

steroids + mycophenilate/cyclophosphamide

Question 14

4 X-ray findings in ankylosing spondylitis?

Answer 14

1. sacroilitis
2. squaring of lumbar vertebrae
3. syndesmophytes
4. bamboo spine

Question 15

3 cardio/pulmonary manifestations of AS?

Answer 15

1. AV regurgitation
2. AV block
3. apical pulmonary fibrosis

Question 16

What class of drugs is apremilast and what is it used for?

Answer 16

PDE4 inhibitor. Psoriatic arthropathy

Question 17

What is the mechanism of allopuriniol?

Answer 17

xanthine oxidase inhibitor

Question 18

Name 3 major interactions with allopurinol

Answer 18

1. azathioprine
2. cyclophosphomide
3. theophylline

Question 19

Name 3 main clinical features seen in Takayasu’s arteritis and one major end organ damage

Answer 19

1. limb claudication on exertion
2. absent limb pulse
3. unequal BP in upper limbs

renal artery stenosis

Question 20

what infection is polyarteritis nodosa associated with?

Answer 20

Heptatitis B

Question 21

3 systems affected in polyarteritis nodosa?

Answer 21

1. skin - livedo reticularis
2. neuro - sensorimotor neuropathy/mononeuritis
3. renal ischaemia

Question 22

What is a cardiovascular complication seen in Kawasaki’s

Answer 22

coronary aneurysm - need serial echo +/- warfarin

Question 23

2 medications used first-line in Kawasaki’s?

Answer 23

IVIg, aspirin

Question 24

What antibodies is GPA associated with?

Answer 24

c-ANCA

Question 25

triad of system involvement seen in GPA?

Answer 25

1. ENT - nasal crusting, saddle nose 2. Resp - pulmonary haemorrhage 3. renal - crescentic GN

Question 26

What antibodies is Churg-Strauss syndrome associated with?

Answer 26

p-ANCA (in 50%)

Question 27

What feature is unique to Churg-Strauss syndrome compared to other small-vessel vasculitis?

Answer 27

eosinophilia, and asthma

Question 28

What is the key pathological feature in Goodpasture's?

Answer 28

IgG deposition in glomerular and pulmonary basement membranes

Question 29

How does Goodpasture's present?

Answer 29

RPGN, pulmonary haemorrhage

Question 30

4 main features of IgA vasculitis (Henoch-Schönlein purpura)

Answer 30

1. purpuric rash over buttocks and extensor surface 2. large joint arthritis 3. intussusception 4. IgA nephropathy