Rheumatology 3

Question 1

Pseudogout
What type of crystals
Age

Answer 1

Calcium pyrophosphate crystals
>60

Question 2

Pseudogout RF (5)

Answer 2

Haemochromatosis
Hyperparathyroidism
Mag and phos low
Acromegaly
Wilson’s disease

Question 3

Pseudogout joint aspiration findings

Answer 3

Positively birefringent rhomboid shaped crystals

Question 4

Pseudogout joints affected
XR finding
Mx (3)

Answer 4

Knee, shoulders, wrist
XR chrondocalcinosis
Mx NSAIDs, IM/intra-articular/ PO steroids

Question 5

Psoriatic arthropathy signs (5)
Skin (1)
Feet (3)
Nails (1)

Answer 5

Psoriatic plaques
Achilles tendonitis
Plantar fascitis
Dactylitis
Onycholysis + pitting of the nails

Question 6

XR typical sign psoriasis

Answer 6

Pencil in cup appearance

Question 7

Mx psoriatic arthropathy (3)

Answer 7

Secondary care
1. NSAIDs +/- DMARDs
2. Monoclonal antibodies

Question 8

Raynauds
Age and gender
Unilat or bilat

Answer 8

Young women e.g 30yo
Bilateral

Question 9

Secondary causes of Raynaud’s (6)

Answer 9

Scleroderma
ReaA
SLE
Leukaemia
OCP
Cervical rib

Question 10

Mx Raynaud

Answer 10

Secondary care referral
1. Calcium channel blocker e.g nifedipine
2. IV prostacyclin

Question 11

Reactive arthritis HLA
Classic triad
Onset
How long do symptoms last?
Another symptom

Answer 11

HLA B27
Conjunctivitis, urethritis, arthritis
Symptoms develop within 4 weeks post an infection
6 months
Dactylitis - inflammation of a digit

Question 12

Skin condition associated with reactive arthritis (2)

Answer 12

Circinate balanitis (painless vesicles on the head of the penis)
Keratoderma blenorrhagica (waxy yellow/brown papules on palms and soles)

Question 13

What is Felty’s syndrome?

Answer 13

RA + splenomegaly + low white cell count

Question 14

Classification criteria for RA (4)
Score needed

Answer 14

6/10
Joint involvement, serology (RhF or anti-CCP), acute phase reactants (CRP or ESR), duration of sx >6/52

Question 15

MTX SE (3)

Answer 15

Myelosuppression
Pneumonitis
Liver cirrhosis

Question 16

Sulfasalazine SE (4)

Answer 16

Heinz body anaemia/ myelosuppresion
ILD
Oligospermia
Rash - Steven Johnson syndrome
Can stain tears/ contact lenses

Question 17

Leflunomide SE (1)

Answer 17

HTN

Question 18

Hydroxychloroquine SE (2)

Answer 18

Retinopathy
Corneal deposits

Question 19

Penicillinamine SE (1)

Answer 19

Exacerbation of myasthenia gravis

Question 20

Etanercept SE (2)

Answer 20

Demyelination
Reactivation of TB

Question 21

RA Mx long term
Acute
Monitoring response to treatment (2)

Answer 21

Long term
1. DMARD (MTX) +/- bridging pred

Acute pred

DAS28/ CRP

Question 22

Examples of DMARDs (4)

Answer 22

MTX
Sulfasalazine
Leflunomide
Hydroxychloroquine

Question 23

2nd line treatment of RA
Examples (3)

Answer 23

If no response to x2 DMARDs
TNF inhibitors
Etanercept, infliximab, adalimumab

Question 24

RA XR (5)

Answer 24

Loss of joint space
Juxta-articular osteoporosis
Soft tissue swelling
Periarticular erosions
Subluxation

Question 25

Name the rotator cuff muscles and function

Answer 25

Supraspinatus abducts arm before deltoid
Infraspinatus rotates arm laterally
Teres minor adducts and rotates arm laterally
Subscapularis adducts and rotates arm medially

Question 26

Sjorgren’s serology (3)

Answer 26

Anti Ro La
ANA 70%
RhF 50%

Question 27

What is Sjojren’s?
Primary and secondary
Gender
Increased risk of?

Answer 27

Autoimmune disorder affecting exocrine glands - resulting in dry mucosal surfaces
Secondary to RA where it develops 10 years after initial onset
F>M
Lymphoid malignancy

Question 28

Features Sjogren’s (6)

Answer 28

Dry eyes - keratoconjunctivitis sicca
Dry mouth
Vaginal dryness
Arthralgia
Raynauds
Recurrent episodes of parotitis

Question 29

Sjogren’s Mx (2)

Answer 29

Artificial saliva and tears
Pilocarpine

Question 30

Sulfasalazine pregnancy and breastfeeding?

Answer 30

Safe in pregnancy and breastfeeding

Question 31

SLE
Gender
Ethnicity

Answer 31

F>M
Afro-Carribean

Question 32

Features SLE (5)

Answer 32

Malar rash
Discoid rash - scaly, well demarcated rash in sun exposed areas
Photosensitivity
Livedo reticularis
Raynauds

Question 33

SLE serology (3)

Answer 33

ANA
anti-dsDNA specific
anti-Smith

Question 34

Monitoring in SLE (3)

Answer 34

ESR
Low C2, C4 during active disease
anti-dsDNA

Question 35

What is systemic sclerosis?
Classification
Gender

Answer 35

Hardened, sclerotic skin
F>M

Limited - face and distal limbs

Diffuse - trunk and proximal limbs

Question 36

Limited systemic sclerosis
First sign
Which areas?
Antibodies
Extra

Answer 36

Raynauds
Distal limbs and face
Anti-centromere
CREST - calcinosis, Raynauds, oesophageal dysmotility, sclerodactyly, telangiectasia

Question 36

What is CREST?
Which disease is it a subtype of?

Answer 36

Limited systemic sclerosis
CREST - calcinosis, Raynauds, oesophageal dysmotility, sclerodactyly, telangiectasia

Question 37

Systemic sclerosis antibodies
General
Limited
Diffuse

Answer 37

ANA 90%
anti-centromere limited
Scl 70 diffuse

Question 38

What is scleroderma?

Answer 38

Tightening of the skin without internal organ involvement

Question 39

Diffuse systemic sclerosis
Location
Antibodies
Most common cause of death
Organ involvement
Prognosis

Answer 39

Trunk and proximal limbs
Scl 70
ILD and pulmonary arterial hypertension
Renal and HTN
Poor

Question 40

Osteoporosis mx
Steroids >65
Steroids <65
Fragility fracture >75
Fragility fracture <75
Women >65
Men >75
>40yo with RF
<40yo RF

Answer 40

• On steroids over 65 - treat
• On steroids under 65 - DEXA
• Fragility fracture + over 75 - treat
• Fragility fracture + under 75 - DEXA
• Frax assessment for: a) all women over 65, b) men over 75, c) >40yo with risk factors
• Younger patients under 40 with major risk factors - DEXA