Rheumatology

Question 1

What do you use for bone protection for a patient on long-term steroids?

Answer 1

In over 65s:
Oral alendronate
Ensure calcium and vitamin D replete

Question 2

What would you expect from bone profile in Paget’s disease?

Answer 2

High ALP
Normal Calcium
Normal Phosphate

Question 3

What does CREST stand for? (limited cutaneous systemic sclerosis)

Answer 3

Calcinosis
Raynaud’s
E- oesophageal dysmotility
Sclerodactyly
Telangiectasias

Question 4

What antibodies are associated with limited cutaneous systemic sclerosis?

Answer 4

Anti-centromere

NOTE:
ANA positive in 90%
RF positive in 30%

Question 5

What antibodies are associated with diffuse cutaneous systemic sclerosis?

Answer 5

anti scl-70

NOTE:
ANA positive in 90%
RF positive in 30%

Question 6

What are the possible complications of diffuse cutaneous systemic sclerosis?

Answer 6

More commonly (80%)
1) interstitial lung disease (ILD)
2) pulmonary arterial hypertension (PAH)

Also:
renal disease
hypertension

Question 7

What would coag look like in Antiphospholipid syndrome?

Answer 7

Prolonged APTT
Low platelets

Question 7

Which antibody has the highest specificity for Rheumatoid arthritis?

Answer 7

Anti-CCP

Question 8

What are the antibodies for SLE?

Answer 8

99% ANA posiive
nti-dsDNA highly specific\anti-Smith highly specific

Question 9

What is an early X-Ray feature of Rheumatoid arthritis?

Answer 9

Juxta-articular osteoporosis/osteopenia

Question 9

What is the treatment of Raynaud’s?

Answer 9

Nifedipine

Question 10

T scores from Dexa scans and the appropriate management?

Answer 10

> 0: reassure
0 and -1.5: Repeat bone density scan in 1-3 years
<-1.5: Offer bone protection

Question 11

What is the management of reactive arthritis?

Answer 11

NSAIDs

Question 12

What is the treatment of ankylosing spondylitis?

Answer 12

NSAIDs

Question 13

What antibodies are associated with drug-induced lupus?

Answer 13

Antihistone

Question 14

What is the management of PMR?

Answer 14

Prednisolone 15mg OD

Question 15

What are the X-Ray findings in pseudogout?

Answer 15

chondrocalcinosis
- in the knee this can be seen as linear calcifications of the meniscus and articular cartilage

Question 16

What X-Ray findings re associated with rheumatoid arthritis?

Answer 16

peri-articular erosions

Question 17

What are the ankylosing spondylitis associated features?

Answer 17

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

Question 18

What antibody is associated with dermatomyositis?

Answer 18

Anti-Jo-1

Question 19

What are some causes of drug-induced lupus?

Answer 19

Most common causes:
procainamide
hydralazine

Less common causes:
isoniazid
minocycline
phenytoin

Question 20

What are the prominent features of lateral epicondylitis?

Answer 20

• pain and tenderness localised to the lateral epicondyle
• pain worse on wrist extension against resistance with the elbow extended or supination of the forearm with the elbow extended

Question 21

What is the treatment of osteomalacia?

Answer 21

Vitamin D supplementation
Calcium supplementation

Question 22

What is the treatment for Paget’s disease of the bone?

Answer 22

Bisphosphonate