Rheumatology 2

Question 1

dsDNA role in SLE?

Answer 1

assess disease activity

Question 2

What is not a/w increase risk of pseudogout?

Answer 2

Rheumatoid arthritis

Question 3

What reduces serum urate level?

Answer 3

Oestrogen

Question 4

Why Gout tend to occur in distal extremities?

Answer 4

lower Temperature - insoluble urate

Question 5

Suspect amyloidosis - what biopsy?

Answer 5

Fat pad biopsy first - high sensitivity

Renal biopsy next

Question 6

Amyloidosis histology?

Answer 6

Fibrills! - bind to apple congo red turning it into the typical green birefringence amyloid

Question 7

Cardiac amyloidosis imaging sign?

Answer 7

TTE - speckled myocardium

Cardiac MRI - late Gadolinium enchancement

Question 8

What hormone is a/w lupus flare?

Answer 8

Hyper prolactinemia
High osterogen
Low androgen

Question 9

RA has felty syndrome
-part of felty syndrome has anaemia, neutropenia,thrombocytopenia
WHY?

Answer 9

Large granular lymphocyte syndrome

-clonal Lymphocyte proliferation

Question 10

PAN histology shows?

Answer 10

Internal elastic lamina disruption —> aneurysmal dilatation
Fibrinoid necrosis + eosinophilia
Polymorphonuclear + mononuclear cells infiltration
Arterial involvement ONLY!

Question 11

What makes gout -crystal deposition likely?

Answer 11

Lower temperature/pH

Rapid change in urate concentration

Question 12

Tocilizumab adverse effect?

Answer 12

Intestinal perforation

Hyperlipidemia ( not significant to cause CVD)

Question 13

Only arthritic more predominant in males?

Answer 13

Psoriatic arthritis

Question 14

In SLE

CRP/ESR means?

Answer 14

High CRP/ESR = SLE serositis
Normal CRP/ HIGH ESR = Flare
HIGH CRP/Normal ESR = Infection

Question 15

Rheumatoid pleural effusions - presentation?

Answer 15

Low BGL < 2

Moderate WBC < 10,000

Question 16

Most significant poor prognosis factor of Ankylosing spondylitis?

Answer 16

Hip arthritis

Question 17

Colchicine neuro-myopathy - what do you see in muscle biopsy?

Answer 17

Vacuolar myopathy

Question 18

What anti-gout medication increases risk of renal stones?

Answer 18

Probenecid - it alkaline the urine

Question 19

what are 2 pathways in pathogenesis of GCA?

Treatment according to the pathways?

Answer 19

IL-17 axis = steroid responsive

IFgamma = non-steroid responsive —> vessel stenosis and occlusion ( neo-angiogenesis and tunica intima hyperplasia)

IL17 - = Tocilizumab
IFy = Aspirin/Statin

Question 20

How to differentiate cryoglobulinemia and PAN?

Answer 20

Clinical features same but

cryoglobulinemia has deplete C4 and positive RF

Question 21

Nailford capillaroscopy - dilated,enlarged distorted loops vessel indicates?

Answer 21

Connective tissue disorder - MCD, Polymyositis, Dermatomyositis, RA

Question 22

what are RF?

Answer 22

IgM acting against Fc portion of IgG

Question 23

What sign on ultrasound for GCA?

Answer 23

Non-compressible halo sign

Question 24

Why use TNFa with MTX?

Answer 24

synergistic effect

Question 25

What features less likely in drug-induced SLE?

Answer 25

Rash

Question 26

what medications can induce antibodies - dsDNA/ANA in previously negative - seronegative RF

Answer 26

Drug induced - TNFa inhibitors

Question 27

PMR without GCA - what is present?

Answer 27

Reduced IFgamma - protective against GCA

Question 28

Calcium pyrophosphate crystals (pseudo-gout) produced by and move around by?

Answer 28

Chondrocytes

Move by Transmembrane protein ANKH

Question 29

Gout

• proximal tubule reabsorption channel?
• proximal tubule secretion channel?

Answer 29

Reabsortion - URAT1 and GLUT9
RA-Gout

Secretion - OAT3 and ABCG2
OA-BGone

Question 30

Probenecid mechanism of action?

Answer 30

Inhibit OAT channel - so reduce secretion of drug ( B-lactam)