Rheumatology

Question 1

LIMITED SYSTEMIC SCLEROSIS - clinical features + blood tests

Answer 1

1. Skin changes:
   - skin changes up to elbow
   - telangiectasia
2. Face changes
   - beaked nose
   - micostomia
3. Finger changes:
   - Raynaud’s
   - Sclerodactyly
   - Fixed flexion deformity
   - Painful digital ischaemia + ulcers
   - Dilated nail fold capillary loops
4. Oesophageal dysmotility
5. Calcinosis
6. ANA - anti-centromere antibodies

Question 2

DIFFUSE SYSTEMIC SCLEROSIS - clinical features + blood test

Answer 2

1. Skin
   - skin changes proximal to elbow
   - rapid onset
   - oedematous fingers
2. Renal
   - renal failure secondary to diffuse obliterative end arteritis
3. Oesophageal dysmotility
4. Pulmonary fibrosis + pulmonary hypertension
5. Myocardial + pericardial fibrosis

Question 3

Anti-phospholipid syndrome - 10 clinical features

Answer 3

1. DVT
2 Stroke
3. Recurrent miscarriages
4. Renal failure
5. Livedo reticularis
6. Thrombocytopenia
7. Valvular heart disease
9. Chorea/migraine/seizure
10. Positive coombs test

Question 4

Anti-phospholipid syndrome: 3 blood tests

Answer 4

1. Anti-cardiolipin antibody
2. Lupus anti-coagulant
3. Anti beta 2 glycoprotein 1

Question 5

Causes of proximal myopathy

Answer 5

1. Endocrine causes
   - hypothyroidism
   - cushings disease
   - acromegaly
2. Drugs
   - statins
3. Muscular dystrophy
   - Duchenne’s muscular dystrophy
   - Becker’s muscular dystropht
   - Fascio-scapulo-humeral dystrophy
   - myotonic dystrophy (presents with DISTAL weakness)
   - McArdle’s syndrome
4. Auto-immune/ neuromuscular junction
   - myasthenia gravis
   - lambert eaton
5. Electrolyte abnormality
   - hypocalcaemia
   - hypokalaemia
6. Inflammatory
   - polymyositis
   - dermatomyositis
7. Inclusion body myositis

Question 6

SLE 11 diagnostic criteria

Answer 6

1. Malar rash
2. Discoid rash
3. Photosensitivity rash
4. Arthralgia
5. Ulcers
6. Serositis
7. Lupus nephritis
8. Haematological - leucopenia, thrombocytopenia, anaemia
9. Neurological
10. ANA +ve
11. Immuological - decreased C3/C4

Question 7

Spondylarthrophies - 7 features

Answer 7

1. Seronegative
2. HLA B27
3. Axial arthropathy - spine + sacroiliac
4. Asymmetrical large joints oligo + mono
5. Enthesitis
6. Dactylitis
7. Extra-articular manifestations

Question 8

5 types of spondylarthropathy

Answer 8

1. Ank Spond
2. Enteric arthritis
3. Psoriatic arthritis
4. Reactive arthritis
5. Post dysenteric reactive arthritis

Question 9

4 extra-articular features of Ank Spond

Answer 9

1. Apical lung fibrosis
2. Aortic incompetence
3. Anterior uveitis
4. Amyloid

Question 10

Psoriatic arthritis nail changes

Answer 10

1. Pitting
2. Ridging
3. Onycholysis
4. Subungal kerratosis
5. Beau’s lines

Question 11

5 causes of painful feet

Answer 11

1. Inflammatory
   - RA
   - Psoriasis
   - Crystal arthropathy
2. Infection - septic arthritis
3. Peripheral neuropathy
4. Vascular - PVD
5. Plantar fasciitis

Question 12

Pulmonary stages of sarcoidosis

Answer 12

Stage 0 - normal CXR
Stage 1 - BHL
Stage 2 - BHL + pulmonary infiltrates
Stage 3 - pulmonary infiltrates only
Stage 4 - pulmonary fibrosis