Rheumatology

Question 1

seronegative spondyloarthropathies associated with HLA-B27. Triad of ‘cant see, cant wee and cant climb a tree’

Answer 1

Reactive arthritis

Question 2

What is the most common pathogen which results in the post-dysenteric form of reactive arthritis?

Answer 2

Shigella Flexneri

Question 3

What is the most common sti responsible for reactive arthritis?

Answer 3

Chlamydia trachomatis

Question 4

What antibody may be detected upto 10 years before the development of rheumatoid arthritis and can be used to screen patients eligible for anti-TNF therapy?

Answer 4

Anti-cyclic citrullinated peptide antibody

Question 5

Mutation in what protein causes Marfans syndrome? (Autosomal dominant, tall stature, dilatation of aortic sinuses, mitral valve prolapse, upwards lens discolouration)

Answer 5

Fibrillin-1

Question 6

Mutation in what protein is the cause for Beals syndrome? ( Multiple joint contractures (especially elbow, knee and finger joints), and crumpled ears in the absence of significant aortic root dilatation )

Answer 6

Fibrillin-2

Question 7

What collagen mutation is involved in Cardiac-Valvular Ehlers-Danlos syndrome? (skin hyperextensibility, easy bruising, atrophic scar formation, joint hypermobility and severe, progressive cardiac valvular defects comprising of mitral and/or aortic valve insufficiency)

Answer 7

Polypeptides in type I collagen

Question 8

recurrent DVTs, and learning disability, defect in Cystathionine β-synthase

Answer 8

homocystinuria

Question 9

If the DIP joints are affected is it more likely to be rheumatoid arthritis or psoriatic arthritis?

Answer 9

Psoriatic

Question 10

Female, below the age of 65 is going to be on prednisolone for some time. as a result DEXA scan is performed and T score is between 0 to -1.5. what is the best course of action?

Answer 10

Repeat bone density scan in 1-3 years

Question 11

Drug class of Apremilast which is used in conjunction with other medications for management of psoriatic arthritis?

Answer 11

Phosphodiesterase type-4 inhibitor

Question 12

Mechanism of action of Methotrexate?

Answer 12

dihydrofolate reductase inhibitor

Question 13

X-ray findings characteristic of Ankylosing spondylitis?

Answer 13

Sacro-ilitis on pelvic x-ray, squaring of lumbar vertebrae, bamboo spine, syndesmophytes:, apical fibrosis on cxr

Question 14

Multiple fractures in a child when they begin to walk, blue tinge in the sclera, abnormality in type 1 collagen, autosomal dominant inheritance

Answer 14

Osteogenesis Imperfecta

Question 15

Triad of Behcets syndrome? (HLA B51)

Answer 15

Oral Ulcers + genital ulcers + Anterior Uveitis

Question 16

What part of the coagulation cascade is raised in Antiphospholipid syndrome?

Answer 16

Paradoxical rise in APTT (Ex-vivo reaction of lupus anticoagulant)

Question 17

Primary thromboprophylaxis in Antiphospholipid syndrome?

Answer 17

Low dose Aspirin

Question 18

Secondary thromboprophylaxis in Antiphospholipid syndrome?

Answer 18

Life long warfarin

Question 19

Lesion site: Sensory loss of posterolateral aspect of leg and lateral aspect of foot, weakness in plantar flexion of foot, reduced ankle reflex, positive sciatic nerve stretch test

Answer 19

S1

Question 20

Lesion site: sensory loss over the anterior of the thigh, weakness of knee extension and a reduced patella reflex,

Answer 20

L3

Question 21

Lesion site: ensory loss over the knee, weakness of ankle dorsiflexion and a reduced patella reflex,

Answer 21

L4

Question 22

Lesion site: sensory loss in the dorsum of the foot alongside weakness of big toe extension, not plantar flexion.

Answer 22

L5

Question 23

Lesion site: sensory loss in the posteromedial aspect of the leg, buttocks and genitals and weakness in knee flexion.

Answer 23

S2

Question 24

What is the autoantibody for Mixed connective tissue disorder?

Answer 24

Anti-ribonuclear protein

Question 25

medium vessel vasculitis, is clinched by the presence of mononeuritis multiplex i.e. peripheral neuropathy affecting two or more non-contiguous nerve trunks, as well as hepatitis B infection

Answer 25

Polyarteritis Nodosa

Question 26

large vessel vasculitis which comes with an increased risk of hypertension, aneurysms and hypertension. A textbook examination finding would be absent peripheral pulses

Answer 26

Takayasu Vasculitis

Question 27

Disorder of osteoclasts, older male, isolated rise in ALP, urinary hydroxyproline

Answer 27

Pagets disease

Question 28

Two most specific autoantibodies for SLE?

Answer 28

Anti-SM + Anti-dsDNA

Question 29

Bone pain, tenderness and proximal myopathy, waddling gait?

Answer 29

Osteomalacia

Question 30

Condition + Treatment: characterised by follicular keratin plugs and is thought to be autoimmune in aetiology. Some of the key features, as described in this scenario, are a raised, erythematous rash, most commonly seen on the face and scalp in young women. It may be photosensitive, as alluded to here, with worsening of the lesions without a sunhat. Lesions healing often cause scarring and pigmentation, sometimes causing non-reversible scarring alopecia, as in this case.

Answer 30

Topical Steroids (1st line)
Oral Hydroxychloroquine (2nd Line)

Question 31

Common target of pANCA?

Answer 31

Myeloperioxidase

Question 32

Common target of cANCA?

Answer 32

Serine Protinase 3