Rheumatology

Question 1

Which type of arthritis are IVDUs particularly at risk of getting?

Answer 1

Septic arthritis

Question 2

What is the most commonly implicated pathogen in septic arthritis?

Answer 2

S aureus

Question 3

What tests are run on joint aspirate in suspected septic arthritis?

Answer 3

Gram stain and culture

WCC

Question 4

What is the first line of management for septic arthritis?

Answer 4

IV Abx

Question 5

What is the surgical management option for septic arthritis?

Answer 5

Joint washout under GA

Question 6

Why can recent infection predispose to gout?

Answer 6

Resulting dehydration increases risk

Question 7

How is synovial fluid imaged to see shape of gout crystals?

Answer 7

Polarised light microscopy

Question 8

Which type of arthritis does chlamydia predispose you to?

Answer 8

Reactive arthritis

Question 9

What is the HLA association of reactive arthrits?

Answer 9

HLA-B27

Question 10

Which disease does “can’t see, pee or climb a tree” refer to?

Answer 10

Reiter’s syndrome

Question 11

Recall 5 signs of reactive arthritis

Answer 11

Conjunctivitis (can't see)
Circinate balantis (can't pee)
Achilles tendonitis (can't climb a tree)
Keratoderma blenorrhagica (can't climb a tree) 
Mouth ulcers

Question 12

What is antalgic gait?

Answer 12

Shortened stance phase in painful limb when walkiing

Question 13

By what mnemonic can the X ray fetures of osteoarthritis be remembered?

Answer 13

LOSS
Loss of joint space
Osteophytes
Sunchondral cysts
Subchondral sclerosis

Question 14

Fixed flexion deformity is seen in what rheumatological disease?

Answer 14

Osteoarthritis

Question 15

Recall a conservative, medical and surgical option for management of osteoarthritis

Answer 15

Conservative: physio
Medical: joint injection
Surgical: joint replacement

Question 16

What is the most specific blood test for rheumatoid arthritis?

Answer 16

Anti-CCP

Question 17

What is ‘z thumb’ a sign of?

Answer 17

Rheumatoid arthritis

Question 18

What is Felty’s syndrome?

Answer 18

Reduced WCC
Splenomegaly
Rheumatoid arthritis

Question 19

Differentiate which type of amyloidosis is primary and seciindary and their aetiologies

Answer 19

Primary = AL
Plasma cell proliferates to produce many clones –> monoclonal Ig –> fibrillar protein deposition
Secondary = AA
Chronic inflammation –> chronically elevated serum AA –> fibrillar protein deposition

Question 20

What are the main risk factors for AL amyloidosis?

Answer 20

Disorders of cell replication in blood: lymphoma, multiple myeloma

Question 21

What are the main risk factors for AA amyloidosis?

Answer 21

Inflammatory polyarthropathies are the main ones, but chronic infection and IBD also predispose

Question 22

What is the definitive way of diagnosing amyloidosis?

Answer 22

Histology shows positive congo-red staining with red-green birefringence under polarised light microscopy

Question 23

Which type of amyloidosis is familial?

Answer 23

ATTR

Question 24

What are the spondyloarthritides?

Answer 24

Inflammatory
Affect spine and peripheral joints
RF negative
HLA-B27 association

Question 25

Recall the 4 diseases that come under the umbrella of 'spondyloarthropathies'?

Answer 25

Ankylosing spondylitis Psoriatic arthritis Reactive arthritis Enteropathic arthropathy

Question 26

Recall 3 examples of enthesitis

Answer 26

Achilles tendonitis Plantar fasciitis Costochondritis

Question 27

Which deformity is typically seen on X ray in psoriatic arthritis?

Answer 27

Pencil-in-cup deformity

Question 28

What is often seen alongside joint pain in psoriatic arthritis?

Answer 28

Nail changes

Question 29

Describe the management of psoriatic arthritis

Answer 29

Similar to rheumatoid

Question 30

What is bamboo spine a sign of on x ray?

Answer 30

Ankylosing spondylitis

Question 31

Recall the management of ankylosing psondylitis

Answer 31

Intense exercise regime NSAIDs TNF alpha blocker