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MCQ knowledge > Rheumatology > Flashcards

Rheumatology Flashcards

1
Q

True/False: Osteoarthritis (OA) pain is always worse with exercise and alleviated by rest.

A

False.

Where as this is usually the case, severe OA may cause morning stiffness that wears off with movement (as for RA).

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2
Q

What is the triad of Felty’s syndrome?

What genotype is associated with the more aggressive form of the disease?

A

RNS:

  1. RA
  2. Neutropenia
  3. Splenomegaly

HLA-DR4

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3
Q

Spondyloarthopathies have extra-articular manifestations. Which of the following is NOT an extra-articular manifesation of spondyloarthropathries:

  1. Peripheral neuropathy
  2. Uveitis
  3. Aortitis
  4. Upper lobe fibrosis
  5. Urethritis
A

NOT…
1. Peripheral neuropathy

Extra-articular manifestation of spondyloarthropathies:

  1. Uveitis
  2. Aortitis
  3. Upper lobe fibrosis
  4. Urethritis
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4
Q

The Schirmer’s test for dry eyes is no longer used in the diagnosis of Sjogren’s Syndrome. What new techniques are used to measure tear production (3)?

A
  1. Lactoferrin (low if dry)
  2. Lysozyme (low if dry)
  3. Fluorescein (does not flush out if dry, stays longer)
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5
Q

What is p-ANCA?

A
  • Perinuclear staining pattern
  • Usual target is myeloperoxidase (MPO)
  • Hence, p-ANCA / MPO
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6
Q

What is c-ANCA?

A
  • Cytoplasmic (granular) staining pattern
  • Usual target is proteinase 3 (PR3)
  • Hence, c-ANCA / PR3
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7
Q

Which of the following is MPO vs. PR3:

  1. Eosinophilic granulomatosis with polyangitis (Churg-Strauss) - EGPA
  2. Granulomatosis with polyangitis (Wegener granulomatosis) - GPA
A

EGPA = MPO
Remember: Churg-Strauss likes to eat his eggplant (EGPA) with mini potatoes (MPO).

GPA = PR3
Remember: Wegener despite being rich, pressed (PR3) his grandpa (GPA) for pocket money.

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8
Q

T/F: polyarteritis nodosa is ANCA positive.

A

False

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9
Q

T/F: RA is associated typically associated with uveitis.

A

False

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10
Q

Give 6 risk factors for Avascular Necrosis (AVN).

Mnemonic: SASHES

A 
Steroids
Antiphospholipid Syndrome
Sickle Cell Disease
HIV
EtOH
SLE
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11
Q

Patient on pantoprazole gets recurrent attack of pseudogout, what is the reason for this?

A

Pantoprazole-related hypomagnesaemia

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12
Q

Patient with poorly controlled RA with 2 DMARDS and a history of shingles and Hodgkins disease in remission.

Which of the following biologics is most suitable:

A. Etanercept (soluble TNF receptor fusion protein)
B. Adalimumab (TNF mAb)
C. Rituximab (CD20 mAb)
D. Tofacitinib (JAK inhibitor)

A

C. Rituximab (CD20 mAb) - BEST choice as is associated with reduced risk of B-cell lymphomas.

Etanercept and Adalimumab would otherwise be first line BUT are contraindicated due to lymphoma history.

Tofacitinib is contraindicated owing to both lymphoma and shingles history.

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13
Q

What technique of assessment of nail folds is useful in rheumatology?

What diseases is it useful in?

A

Capillarscopy to assess microciruclation in the nail folds is useful in:

  1. Systemic Sclerosis (staging and predicting digital ulcers)
  2. Dermatomyotisitis vs. Polymyositis
  3. Raynaud’s phenomenon (primary vs. secondary)
  4. Screen for ILD in MCTD, scleromyositis and primary biliary cirrhosis.
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14
Q

Patient has digital ischaemia attributed to Reynaud’s phenomena.

What 3 treatments would you consider?

A
  1. Topical nitrates
  2. Oral CCB
  3. Iloprost infusion
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15
Q

Patient has mild symptoms suggestive of systemic sclerosis and presents with fine inspiratory crackles in the bases on auscultation.

All routine Abs are negative. ANA is positive.

Which Ab should be tested?

A

Anti-Ku - associated with ILD that precedes Systemic Sclerosis

ILD may be the forme fruste of connective tissue diseases.

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16
Q

Give the Abs for the following conditions:

SLE (4)
Systemic sclerosis (3)
Sjogren's (2)
RA (2)
Idiopathic inflammatory myopathy (1)
Mixed Connective Tissue Disease (1)
A

SLE (4): Sm / SSA / RiboP / dsDNA

Systemic sclerosis (3): Scl70 / anticentromere / RNA-pol-III

Sjogren’s (2): SSA / SSB

RA (2): CCP / RF

Idiopathic inflammatory myopathy (1): Jo-1

Mixed Connective Tissue Disease (1): U1-RNP

17
Q

Which 4 conditions do idiopathic inflammatory myopathy refer to?

What is the Ab used to identify this group of conditions?

A

Jo-1:

  1. Polymyositis
  2. Dermatomyositis
  3. Inclusion body myositis
  4. Myositis associated with malignancy
18
Q

Which of the idiopathic inflammatory myopathies is associated with ILD?

A

Polymyositis and Dermatomyositis.

19
Q

Patient presents with myositis, non-erosive arthritis, Raynaud’s, appearance of mechanics hands and ILD.

What is the condition?

What Abs would you test for?

A

Anti-synthetase syndrome.

Abs: Jo1 > EJ > PL7 > PL12

20
Q

What is the significance of the following Abs found in Systemic Sclerosis:

  1. Scl70 (topoisomerase 1)
  2. RNA pol III
  3. Anticentromere (CENP)
A
  1. Scl70 (topoisomerase 1) - ILD (Diffuse SS)
  2. RNA pol III - renal crisis (Diffuse SS)
  3. Anticentromere (CENP) - PAH and gut disease (Limited SS)

Remember:
ScL = lung (diffuse)
RNA = renal (diffuse)
Centromere = limited

21
Q

What is the MOA of MTX?

A

Inhibits DHFR (dihydrofolate reductase) thereby impeding the synthesis of DNA, RNA, thymidylates and proteins.

22
Q

In what tissue in the body is COX-2 isoform most strongly expression?

A

Rheumatoid synovium

MCQ knowledge (22 decks)

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