Rheumatology

Question 1

Most common site for referred pain from osteoarthritis of the hip

Answer 1

Groin

Question 2

Most common site for osteoarthritis of the knee

Answer 2

Medial tibiofemoral cartilage

Question 3

Predictors of disease severity in rheumatoid arthritis (RA)

Answer 3

CRP
ESR
Number of swollen joints
Current erosions
Rheumatoid nodules
HLA-DR4
Rheumatoid factor
Anti-CCP

Question 4

Knee joint effusion aspiration location

Answer 4

1cm medial to junction of upper and middle thirds of the patella.

Question 5

Serology - antiphospholipid syndrome (APS)

Answer 5

Anti-cardiolipin Ab
Anti-beta 2 glycoprotein 1 Ab
Lupus anticoagulant

Question 6

Most specific clinical feature for temporal arteritis

Answer 6

Jaw claudication

Question 7

Modified New York Criteria (for ankylosing spondylitis)

Answer 7

Clinical (at least one of):

• inflammatory low back pain and stiffness more than 3 months
• restriction in lumbar forward or lateral flexion
• restriction in chest wall expansion

Radiology (at least one of):

• bilateral grade 2 sacro-iliitis on X-ray
• unilateral grade 3-4 sacro-iliitis on X-ray

Question 8

Treatment of ankylosing spondylitis

Answer 8

Physiotherapy
NSAID - for axial disease and symptom relief
DMARD (sulfasalazine) - for peripheral arthritis
TNF-inhibitor (eg. etanercept) - for symptoms, particularly enthesitis / dactylitis

Question 9

Indications for urate lowering therapy in gout

Answer 9

Frequent attacks
Chronic gouty joint disease
Tophaceous deposits
Renal insufficiency
Recurrent uric acid nephrolithiasis
Urinary uric acid excretion more than 1100mg/day in men under age 25

(Aim serum uric acid less than 0.36 mmol/L)

Question 10

Most common cause of primary hyperuricaemia (can lead to gout)

Answer 10

Reduced uric acid urinary excretion (85-90%)

Inherited defects in regulation of purine nucleotide synthesis (10-15%)

Question 11

Most common joint affected by pseudogout

Answer 11

Knee (more than 50%)

Question 12

Serology - mixed connective tissue disease (MCTD)

Answer 12

Anti-U1 RNP - characteristic
Anti-68 kD and A’ Ab - most associated
ANA - speckled pattern
Anti-dsDNA negative

Question 13

Serology - Sjogren’s syndrome

Answer 13

Anti-Ro (SSA)
Anti-La (SSB)
ANA
RF

Question 14

Serology - systemic lupus erythermatosus (SLE)

Answer 14

ANA
dsDNA
Anti-Ro - neonatal, lymphopenia, photosensitivity
Anti-La - Sjogrens, neonatal
Anti-Sm - renal and CNS disease
U1RNP - myositis, Raynauds, MCTD overlap

Question 15

Serology - polymyositis

Answer 15

Anti-Jo-1
Anti-SRP (signal recognition particle)
CK - over 10x ULN

Question 16

Serology - dermatomyositis

Answer 16

Anti-Jo-1

Anti-Mi-2

Question 17

Serology - scleroderma

Answer 17

Anti-centromere (ACA) - limited
Scl-70 (anti-DNA topoisomerase I) - diffuse
Anti-RNA polymerase III

Question 18

Type I muscle fiber characteristics

Answer 18

Slow twitch
High O2 binding myoglobin content
High oxidative enzyme content
High density mitochondria
High capillary density
Fatigue resistance

Question 19

Type II muscle fiber characteristics

Answer 19

Fast twitch
High glycolytic capacity
High anaerobic capacity
Short term work