Rheumatology

Question 1

Anti-CCP

Answer 1

RA

Question 2

ANA

Answer 2

SLE, Sjogrens, MCTD, SSc, AIH

Question 3

anti-dsDNA

Answer 3

SLE

Question 4

Anti-Sm

Answer 4

SLE

Question 5

Anti-Ro

Answer 5

SLE, Sjogrens

Question 6

Anti-La

Answer 6

Sjogrens

Question 7

AMA

Answer 7

PBC

Question 8

Anti-centromere

Answer 8

Limited SSc

Question 9

Anti-Scl-70

Answer 9

Diffuse SSc

Question 10

Anti-RNP

Answer 10

SLE, MCTD

Question 11

Anti-Jo-1

Answer 11

Myositis

Question 12

Anti-cardiolipin/anti-lupus anticoagulant

Answer 12

APS

Question 13

ANCA

Answer 13

Small vessel vasculitis
pANCA - Churg Strauss (EGPA)
cANCA - Wegeners (GPA)
MPA

Question 14

How to interpret an xray

Answer 14

Patient name and DOB
When xray was taken
ALIGNMENT: What type of xray it is, e.g bilateral PA hands
BONE: fractures, bone margins, mineralisation, osteopenia (radiolucency), osteophytes, erosions, subluxcation, dislocation, joint spaces, deformities
CARTILAGE: joint spaces, calcification
DISTRIBUTION: where are changes, pattern, symmetry
SOFT TISSUES: swelling, calcification

Question 15

xray findings of RA

Answer 15

Periarticular osteopenia (thinning, lucency)
swan neck, boutonnieres, z shaped thumb, ulnar deviation
soft tissue swelling
periarticular erosions late on

Question 16

xray findings of OA

Answer 16

LOSS
squaring of thumb
heberdens, bouchards nodes

Question 17

Seronegative arthropathies are ___________ positive

Answer 17

HLA-B27

Question 18

xray findings of AS

Answer 18

Sclerosis and fusion of SI joints

Bony spurs on vertebral bodys (syndesmophites) = bamboo spine

Question 19

Arthritis mutilans

Answer 19

Severe form of arthritis in PA

Question 20

Reactive arthritis

Answer 20

In response to infection - GU or GI
Large joints swell 3 weeks after infection
Reiter’s - uveitis, urethritis, arthritis

Question 21

AS is more common in:

Answer 21

males

Question 22

Sjogrens

Answer 22

Autoimmune condition characterised by lymphocytic infiltrates in exocrine organs = sicca symptoms, arthralgia fatigue, parotid swelling, peripheral neuropathy, lymphoma

Question 23

Schirmer’s test

Answer 23

Sjogrens

Question 24

SSc features

Answer 24

Vasomotor disturbance (Raynaud's), fibrosis, skin atrophy
Excess collagen deposition
Pulmonary HT, renal changes

Question 25

3 phases of cutaneous involvement in Sjogrens

Answer 25

Oedematous Indurative Atrophic - skin thickens and tightens, sclerodactyly

Question 26

Limited SSc

Answer 26

Face, hands, forearms, feet | Organ involvement later

Question 27

Diffuse SSc

Answer 27

Trunk, rapid | Organ involvement early

Question 28

Investigations for SSc

Answer 28

Anti-centromere/anti-Scl-70 PFTs Echo Renal function

Question 29

Management of SSc

Answer 29

``` Raynaud's = CCB Renal = ACEI GI = PPI ILD = cyclophosphamide ```

Question 30

APS features

Answer 30

``` Recurrent venous/arterial thrombosis Late foetal loss Stroke/MI/PE Liebman-Sacks endocarditis (sterile) MOF (catastrophic APS) Migraine Livdeo reticularis ```

Question 31

Investigations for APS

Answer 31

Thrombocytopenia (low platelets) Prolonged APTT Lupud anticoagulant/anti-cardiolipin

Question 32

Treatment of APS

Answer 32

Anticoagulate if episode of thrombosis | Recurrent pregnancy loss - LMWH

Question 33

How is uric acid formed?

Answer 33

Product of purine metabolism

Question 34

Podagra

Answer 34

1st MTP gout

Question 35

what causes gout?

Answer 35

Hyperuricaemia (diuretics, CKD) | Alcohol, red meat, sea food

Question 36

Pseudogout

Answer 36

Calcium pyrophosphate

Question 37

PMR

Answer 37

Elderly Proximal myalgia of hip and shoulder girdle, lost lasting morning stiffness Improves with movement

Question 38

GCA

Answer 38

linked with PMR | Transmural vessel inflammation, patchy infiltration, wall thickening, lumen narrowing = ischaemia

Question 39

Treatment of PMR

Answer 39

Lose dose steroids 15mg/day | Reduce over 18 months

Question 40

Symptoms of GCA

Answer 40

Visual disturbance, headache, scalp tenderness, jaw claudication, fatigue, fever Swollen optic disc Raised CRP/PV Biopsy: monoculear infiltration, granulomas, multinucleate giant cells, patchy

Question 41

Treatment of GCA

Answer 41

40mg/day pred | 60mg/day pred if visual symptoms

Question 42

Polymyositis

Answer 42

Idiopathic inflammatory myopathy = symmetrical proximal muscle weakness, dysphagia, ILD Females over 20 CD8 T cells

Question 43

Investigations for polymyositis

Answer 43

``` raised CRP/PV raised CK anti-Jo-1, ANA EMG Biopsy - inflammation, necrosis, regeneration ```

Question 44

Treatment of polymyositis

Answer 44

40mg pred | aza/mtx

Question 45

Dermatomyositis

Answer 45

Polymyositis with cutaneous papules/V shaped chest rash, heliotrope rash (spares nasolabial folds) Risk of malignancy

Question 46

Fibromyalgia

Answer 46

Disorder of pain processing Young women, widespread pain and fatigue Persistent widespread pain, fatigue, cognitive difficulties, anxiety/depression/IBS/migraine

Question 47

Large vessel vasculitis

Answer 47

GCA - older | Takayasu - younger

Question 48

MPA

Answer 48

Small vessel vasculitis, necrotising, GN ANCA No granulomas

Question 49

EGPA

Answer 49

Churg-Strauss Eosinophils, asthma pANCA - MPO Granulomas

Question 50

GPA

Answer 50

Wegeners Epistaxis, sinusitis, nasal crusting, nasal collapse cANCA - PR3 Granulomas

Question 51

Investigations for vasculitis

Answer 51

``` ANCA CRP, PV FBC - anaemia UandEs - renal Urinalysis - GN CXR Biopsy ```