Rheumatology

Question 1

What are the criteria for diagnosis for GCA and how many do you need to mail a diagnosis?

Answer 1

Symptoms - jaw claudication, scalp tenderness, headaches

Investigations - positive temporal artery biopsy (skip lesions), raised ESR (with normal Hb)

3 of the 5 are required for positive diagnosis

Question 2

What are the XR findings in osteoarthritis?

Answer 2

Loss of joint space
Osteohpytes
Subchondral cysts
Subchondral sclerosis

Question 3

What are the XR findings in rheumatoid arthritis?

Answer 3

Loss of joint space
Soft tissue swelling
Periarticular osteopenia
Deformity 
Subluxation

Question 4

What are the XR findings in gout?

Answer 4

Soft tissue swelling

Periarticular erosions - “punched out erosions”

Question 5

List the 4 signs of active rheumatological disease (i.e. active inflammation)

Answer 5

Early morning stiffness
Boggy swelling
Red hot joints
Tender to palpation

Question 6

Name some of the deformities found in rheumatoid hands

Answer 6

Swan neck 
Boutonniere's 
Z-thumb
Ulnar deviation of fingers 
Dorsal subluxation

Question 7

List some of the features of rheumatoid arthritis

Answer 7

Arthritis - symmetrical, deforming inflammatory polyarthritis (affects PIPs first)
Nodules - often on elbows
Tenosynovitis
Autoimmune associations 
Pericarditis 
Carpal tunnel syndrome
Reynauld's
Felty's syndrome

Question 8

What is Felty’s syndrome?

Answer 8

Triad of: rheumatoid arthritis, splenomegaly and neutropenia

Question 9

Name some of the deformities found in osteoarthritis hands

Answer 9

Heberden’s nodes (distal)

Bouchard’s nodes (proximal)

Question 10

List some drugs that can cause gout (HINT: think CANT LEAP)

Answer 10

Cyclosporin
Alcohol
Nicotinic acid 
Thiazide diuretics
Loop diuretics
Ethambutol
Aspirin
Pyrazinamide

Question 11

On polarised light microscopy, what is the difference between gout and pseudogout?

Answer 11

Gout - negatively birefringent needle-shaped crystals

Pseudogout - positively birefringenet rhomboid-shaped crystals

Question 12

List the three classical symptoms of Reiter’s disease (reactive arthritis)

Answer 12

Urethritis (can’t pee)
Uveitis (can’t see)
Arthritis (can’t climb a tree)

Question 13

Which CTDs are RF (rheumatoid factor) positive?

Answer 13

Rheumatoid arthritis
Sjogren’s syndrome
Felty’s disease

Question 14

Which CTDs are ANA (antinuclear antigen) positive?

Answer 14

SLE

Sjogren’s

Question 15

Which CTD is dsDNA positive?

Answer 15

SLE

Question 16

Which CTD is centromere positive?

Answer 16

CREST syndrome (limited systemic sclerosis)

Question 17

Which CTDs are Ro positive?

Answer 17

SLE

Sjogren’s

Question 18

Which CTDs are La positive?

Answer 18

SLE

Sjogren’s

Question 19

Which CTD is Sm positive?

Answer 19

SLE

Question 20

Which CTD is RNP positive?

Answer 20

SLE

Question 21

Which CTDs are Jo-1 positive?

Answer 21

Polymyositis

Dermatomyositis

Question 22

Which CTD is Scl70 positive?

Answer 22

Diffuse systemic sclerosis

Question 23

Which CTD is RNA pol positive?

Answer 23

Diffuse systemic scleorisis

Question 24

Which autoantibodies are found in SLE?

Answer 24

dsDNA
ANA
Ro
La
Sm
RNP

Question 25

Which autoantibodies are found in RA?

Answer 25

RF Anti-CCP ANA

Question 26

Which autoantibodies are found in Sjogren's?

Answer 26

RF ANA Ro La

Question 27

Which autoantibodies are found in poly/dermatomyositis?

Answer 27

Jo-1

Question 28

Which autoantibodies are found in diffuse systemic sclerosis?

Answer 28

Scl70 | RNA polymerase

Question 29

Which autoantibodies are found in limited systemic sclerosis (CREST syndrome)?

Answer 29

Centromere

Question 30

List the classical symptoms of Sjogren's

Answer 30

Dryness - dry eyes, dry mouth, vaginal dryness etc.

Question 31

Outline the colour change seen in Raynaud's hands

Answer 31

White --> Blue --> Red (crimson)

Question 32

List the features of limited systemic sclerosis

Answer 32

``` Calcinosis Raynaud's Esophageal dysmotility (GORD) Sclerodactyly Telangiectasia ```

Question 33

What are the signs of active disease in SLE (i.e. which markers are altered in active SLE)?

Answer 33

High ESR (high CRP would mean infection) LOW C3, C4 High dsDNA titre

Question 34

What is the major diagnostic feature of idiopathic inflammatory myopathies (eg: polymyositis and dermatomyositis)?

Answer 34

Progressive, symmetrical proximal muscle weakness

Question 35

Name the three ANCA positive vasculitidies

Answer 35

Granulomatous polyangitis (Wegener's) Churg-Strauss Microscopic polyangitis

Question 36

Which vasculitidies are cANCA positive?

Answer 36

Granulomatous polyangitis (Wegener's)

Question 37

Which vasculitidies are pANCA positive?

Answer 37

Churg-Struass | Microscopic polyangitis

Question 38

Which antibodies are found in Goodpastures syndrome?

Answer 38

Anti-GBM (glomerular basement membrane)