Rheumatology

Question 1

What is inflammatory arthritis?

Answer 1

• joint or tendon inflammation and abnormal bloods and imaging
• rapid onset, swelling and symmetrical pain
• women

Question 2

What is calcium hydroxyapatite crystal disease?

Answer 2

• disease in shoulder

- treatment is NSAIDs and steroid injections into joint

Question 3

What is soft tissue rheumatism?

Answer 3

• inflammation of the ligaments, tendons, muscles and nerves outside of joint capsule
• pain in one site
• neck or shoulder

Question 4

What diseases are included in seronegative inflammatory arthropathies?

Answer 4

• ankylosing spondylitis
• psoriatic arthritis
• enteropathic arthritis
• reactive arthritis

Question 5

What are seronegative inflammatory arthropathies?

Answer 5

family of diseases characterised by spine and joint involvement in genetically predisposed individuals

Question 6

What diseases are associated with HLA B27?

Answer 6

• ankylosing spondylitis
• reactive arthritis
• Crohn’s disease
• uveitis

Question 7

What are the characteristics of inflammatory back pain?

Answer 7

• worse with rest
• better with activity
• early morning stiffness for more than 30 minutes

Question 8

What is included in all spondyloarthropathies?

Answer 8

• sacroiliac and spinal involvement
• enthesitis which is inflammation at insertion of tendon to bone
• inflammatory asymmetric lower limb arthritis
• dactylitis which is entire digit inflammation

Question 9

What are some distinguishing features of OA?

Answer 9

• normal bone density
• reduced joint space
• subchondral cysts
• subchondral sclerosis
• osteophytes

Question 10

What are some distinguishing features of AS?

Answer 10

• bone density starts normal but becomes reduced in late disease
• shiny corners
• fusing so Bamboo spine
• flowing syndesmophytes

Question 11

What is the characteristic symptom of inflammatory myopathies?

Answer 11

weakness

Question 12

What is the characteristic symptom of polymyalgia rheumatica?

Answer 12

pain and stiffness

Question 13

What is the characteristic symptom of fibromyalgia?

Answer 13

pain and fatigue

Question 14

Which sides are the golfer’s elbow or tennis elbow?

Answer 14

golfer’s is medial epicondyle

tennis is lateral epicondyle

Question 15

What are the main features of Henoch-Schonlein purpura?

Answer 15

• acute IgA-mediated disorder
• generalised vasculitis with small vessels of skin, GI tract, kidneys, joints and lungs
• kids
• purpuric rash over butt and lower limbs with abdominal pain and vomiting

Question 16

What causes osteomalacia?

Answer 16

• Vit D deficiency
• less renal Ca loss
• more renal excretion of phosphate
• impaired mineralisation so weakened bone

Question 17

What bone disease can hyperparathyroidism cause?

Answer 17

PTH activates osteoclasts so there is osteoporosis

Question 18

What are the definitions of arthropathy, arthritis and arthralgia?

Answer 18

arthropathy- joint disease
arthritis- joint inflammation
arthralgia- joint pain

Question 19

What are the classifications of inflammatory arthropathies?

Answer 19

• seropositive: RA and connective tissue disease
• seronegative: many types
• infectious
• crystal deposition disorder

Question 20

What are the words used to describe how many joints are affected by arthritis?

Answer 20

• monoarthriits is one joint
• oligoarthritis is 2-5 joints
• polyarthritis is 5+ joints

Question 21

What is a common inflammatory oligoarthritis?

Answer 21

psoriatic arthritis

Question 22

What is the DIP involvement in psoriatic and rheumatoid arthritis?

Answer 22

• RA spares the DIP as there is less synovium

- psoriatic has DIP involvement due to enthesis

Question 23

What are the names of the nodes of the finger is OA?

Answer 23

• Heberden’s nodes are distal

- Bouchard’s nodes are proximal

Question 24

What is another name for normocytic anaemia?

Answer 24

anaemia of chronic disease

Question 25

What muscle is commonly first affected by RA in the arm?

Answer 25

extensor carpi ulnaris which is on the ulnar styloid

Question 26

What is the score used for RA severity?

Answer 26

DAS 28
if it is >5.1 then there is serious disease
if it is <2.6 then there is remission

Question 27

How can you tell the difference between SLE and rosacea?

Answer 27

SLE spares the naso-labial folds but rosacea doesn’t

Question 28

What is seen on the bloods of SLE and other autoimmune conditions?

Answer 28

less neutrophils, lymphocytes and platelets

Question 29

What do a high or a low C3+4 tell you?

Answer 29

• high C3+4: infection

- low C3+4: autoimmune disease

Question 30

What is in the triad of systemic sclerosis?

Answer 30

• vascular changes
• fibrosis
• autoimmunity

Question 31

What is the pneumonic for systemic sclerosis?

Answer 31

C alcinosis
R aynaud's
E osophageal dysmotility 
S clerodactyly
T elangiectasia

Question 32

What are the types of systemic sclerosis?

Answer 32

• Diffuse: anti-scl-70 antibody
• Limited: anticentromere antibody
  these are separate so one doesn’t progress into another

Question 33

What should never be given for systemic sclerosis?

Answer 33

steroids as they make the kidney function decrease with malignant hypertension

Question 34

Where are the main affected joints for OA?

Answer 34

• spine
• knee
• hip
• thumb base
• DIP
  these are weight-bearing and active joints

Question 35

What are the main affected joints in RA?

Answer 35

• MCP
• MTP
• PIP
• wrists
• hips
• knees
• shoulders
• C1/2 joint

Question 36

What are the features of seronegative arthritis?

Answer 36

• sacroiliac joints and spine
• ankylosis
• ill-defined and fuzzy periarticular new bone formation

Question 37

What rheumatological disease is associated with recurrent miscarriages?

Answer 37

antiphospholipid syndrome

Question 38

What is the antibody test for antiphospholipid syndrome?

Answer 38

anti-cardiolipin