Rheumatology

Question 1

Which diseases have a nucleolar ENA/ANA pattern?

Answer 1

SS and polymyositis

Question 2

Which diseases have a Centromere ENA/ANA pattern?

Answer 2

Limited SS

Question 3

ENA pattern of SLE

Answer 3

Homogenous dsDNA and speckled anti-smith antigen

Question 4

ENA pattern of DLE

Answer 4

Homogenous anti histone

Question 5

ENA pattern of diffuse systemic sclerosis

Answer 5

Speckled anti-RNA poymerase III and speckled SCL-70

Question 6

ENA pattern of sjorgren’s

Answer 6

Speckled Ro (SSA) and La (SSB)

Question 7

What is Crest syndrome?

Answer 7

Found in limited SS:
Calcinosis
Raynauds
Esophageal motility
Sclerodactyl
Telengectasia
Also get scleroderma of face/neck (as far up as elbow and knees), pulmonary hypertension, Fibrotic lung disease and mild GI disease

Question 8

Stomach complication of SS

Answer 8

GAVE - Gastric Arterial Vascular Ectasia - dilated submucosal vessels that can bleed. Resembles watermelon

Question 9

Treatment progression for raynauds

Answer 9

Ca2+ blockers, then sildenafil, then IV misoprostol

Question 10

Difference between myalgia and myositis

Answer 10

Both can have pain but myositis has raised muscle enzymes and weakness

Question 11

Skin manifestations of dermatosmyositis

Answer 11

Gotrans papules, heliotrope rash, periorbital oedema and shawl sign

Question 12

ANA present in MCTD

Answer 12

Anti-U1 RNP

Question 13

First line management of ankylosing spondylitis

Answer 13

NSAIDs

Question 14

Most common organism causing septic arthritis

Answer 14

Staph aureus esp RA and diabetics

Question 15

ENA in limited systemic sclerosis

Answer 15

Anti-centromere

Question 16

X-ray features of paget’s disease of bone

Answer 16

Coarsened trabeculae, mixed lytic/sclerotic appearance, bone deformities and osteoarthritis, loss of distinction between corticises and medullary bone and bone fractures

Question 17

Lab finding of pagets disease of the bone

Answer 17

Elevated serum ALP and elevated urinary hydroxyproline. Ca2+ levels are usually normal

Question 18

Treatment for pagets disease of the bone

Answer 18

NSAIDs, pain relief and physio if mild. Oral bisphosphonates (and potentially calcitonin) if more severe

Question 19

What type of crystals are found in gout on microscopy

Answer 19

Negatively birefringent needles

Question 20

How long after acute gout flare should allopurinol be initiated?

Answer 20

2 weeks

Question 21

Most common tissue type in which crystals are deposited in pseudogout

Answer 21

Synovium

Question 22

Are rheumatoid nodules more common in patients who are RF positive or negative?

Answer 22

RF positive

Question 23

Complement level changes in SLE

Answer 23

Low C3 and C4

Question 24

Main demographic for SLE

Answer 24

Young women

Question 25

Triad characterising EGPA

Answer 25

Late onset asthma/allergic rhinitis
Systemic vasculitis (constitutional symptoms, arthropathies, GI, rash, mononeutitis multiplex etc)
Peripheral eosinophilia - pANCA suggestive too.

Question 26

Which drugs can unmask vasculitic syndrome in EGPA diagnosed with asthma?

Answer 26

Leukotriene receptor antagonists - e.g. Montelukast

Question 27

Triad characterising GPA

Answer 27

Upper respiratory tract and sinus involvement (chronic sinusitis, rhinitis, nosebleed, septal perforation and saddle nose deformity)
Lung involvement (Haemoptysis and cavitating lesions)
Kidney involvement (necrotising glomerulonephritis or rapidly progressive glomerulonephritis)
Can affect other systems too and often positive for c-ANCA

Question 28

Antibodies for dematomyositis

Answer 28

ANA, anti-JO-1, anti-MI-2

Question 29

Felty’s syndrome

Answer 29

Very active rheumatoid disease, splenic enlargement and neutropenia

Question 30

Which vasculitis is associated with hep B infection?

Answer 30

PAN

Question 31

What is Lofgren syndrome?

Answer 31

Acute arthopathy in sarcoidosis - often associated with erythema nodosum and a fever

Question 32

Which serum enzyme is raised in sarcoidosis?

Answer 32

ACE

Question 33

What bacterial infection can cause acute migratory tenosynovitis in young adults (ep Women)?

Answer 33

Disseminated gonnococcal infection (test for c6-9 complement deficiency)

Question 34

Which antibody is present in Lambert Eaton syndrome?

Answer 34

Anti-VGCC

Question 35

What Ix must be done in RA sufferers prior to surgery?

Answer 35

Cervical spine x-rays - may C1-2 instability which could be subluxed during intubation