Rheumatology

Question 1

Polyarteritis nodosa symptoms

Answer 1

fever, malaise, arthralgia
hepatitis symptoms (scleral jaundice, itchiness)
haematuria, purpura (vasculitic signs)

Question 2

systemic sclerosis with evidence of pulmonary fibrosis (dry cough and SOBOE)

Answer 2

diffuse systemic sclerosis

Question 3

myositis blood marker

Answer 3

Anti-Jo1

Question 4

negative gram stain with elevated WBC (neutrophils)

Answer 4

does not rule out septic arthritis

Question 5

methotrexate toxicity treatment

Answer 5

folinic acid

Question 6

azathioprine and and allopurinol interaction, risk of

Answer 6

bone marrow suppression

Question 7

bone protection if eGFR<30

Answer 7

denosumab

Question 8

Marfans monitoring

Answer 8

echocardiogram- aortic aneurysm and dissection

Question 9

Behcets disease

Answer 9

oral ulcers, genital ulcers, uveitis and systemic vasculitis

Question 10

ank spondylitis second line

Answer 10

anti-TNF-alpha blockers e.g. etanercept and infliximab

Question 11

Tx of renal complications of systemic sclerosis

Answer 11

ACEi- captopril

Question 12

renal complications of systemic sclerosis

Answer 12

HTN, AKI
severe- microangiopathic haemolytic anaemia

Question 13

Hypermobility assessment tool

Answer 13

Beighton score

Question 14

septic arthritis organism in young adults

Answer 14

neisseria gonorrhoea

Question 15

methotrexate drug interaction

Answer 15

trimethoprim or co-trimoxazole
–> BM aplasia

Question 16

osteogenesis imperfects blood test results

Answer 16

normal calcium, phosphate, PTH and ALP

Question 17

What should be corrected before giving bisphosphonates

Answer 17

Hypocalcemia/vitamin D deficiency

Question 18

radial tunnel syndrome

Answer 18

presents similarly to lateral epicondylitis however, pain distal to epicondyle and worse on elbow extension and forearm pronation

Question 19

Drug induced lupus

Answer 19

procainamide
hydralazine
isoniazid
minocycline
phenytoin

Question 20

dermatomyositis association

Answer 20

malignancy (ovarian, breast, lung)

Question 21

Schobers test positive

Answer 21

<5cm–> reduced lumbar flexion

Question 21

ankylosing spondylitis early sign

Answer 21

reduced lateral flexion of lumbar spine
loss of lumbar lordosis, accentuate thoracic kyphosis

Question 22

CKD vs osteomalacia- phosphate

Answer 22

low in osteomalacia
high in CKD (2 HPT)

Question 23

psoriatic arthritis management

Answer 23

mild peripheral/axial disease –> NSAID
moderate/severe –> methotrexate

ustekinumab, secukinumab

Question 24

osteoporosis risk factors (used in FRAX)

Answer 24

history of glucocorticoid use rheumatoid arthritis alcohol excess history of parental hip fracture low body mass index current smoking

Question 25

sulfasazline cautions

Answer 25

G6PD deficiency, allergy to aspirin or sulphonamides

Question 26

acute flare of RA

Answer 26

oral or intramuscular steroids e.g. methylprednisolone

Question 27

ankylosing spondylitis XR spine features

Answer 27

squaring of lumbar vertebrae syndesmophytes subchondral erosions and sclerosis bamboo spine (late and uncommon)

Question 28

osteitis fibrosa cystica

Answer 28

late stage primary hyperparathyroidism causing excessive bone resorption

Question 29

septic arthritis length of Abx treatment

Answer 29

4-6 weeks

Question 30

TNF-alpha s/e

Answer 30

reactivation of TB CXR prior to screen for latent TB

Question 31

polymyalgia rheumatic key investigation

Answer 31

raised inflammatory markers- ESR>40

Question 32

discoid lupus erythematous Tx

Answer 32

topical steroids --> oral hydroxychloroquine

Question 32

Pagets affects what bones

Answer 32

skull, spine/pelvis, long bones of lower extremities

Question 33

CK in PMR

Answer 33

normal

Question 34

Measure uric acid levels in suspected gout (i.e. in the acute setting)

Answer 34

a uric acid level ≥ 360 umol/L is seen as supporting a diagnosis if uric acid level < 360 umol/L during a flare repeat the uric acid level measurement at least 2 weeks after the flare has settled

Question 35

when starting allopurinol

Answer 35

NSAID or colchicine 'cover'

Question 36

Lateral epicondylitis- examination

Answer 36

worse on resisted wrist extension/suppination whilst elbow extended

Question 37

CKD vs osteomalacia

Answer 37

low phosphate= Osteomalacia high phosphate= CKD

Question 38

reactive arthritis joint aspirate

Answer 38

no organism growth on gram stain develops after an infection where the organism cannot be recovered from the joint

Question 39

SLE: most specific vs most sensitive test

Answer 39

most specific= anti-dsDNA most sensitive= ANA