Rheumatology / Derm

Question 1

NICE guideline >65 long term steroid therapy

Answer 1

oral alendronate, calcium and vit D

Question 2

<65 Bone density scan

Answer 2

T score
Greater than 0
Reassure

Between 0 and -1.5 Repeat bone density scan in 1-3 years

Less than -1.5
Offer bone protection

Question 3

shingles

Answer 3

dermatomal pattern
painful vesicular rash

Question 4

seborrhoeic keratosis

Answer 4

benign skin lesion
brown/black and light tan

Question 5

ABCDE rule

Answer 5

asymmetry, border irregularity, colour variation, diamete >6mm

Question 6

bowens disease

Answer 6

slow growing red scaly patch -itchy
SCC

Question 7

rheumatoid arthritis

Answer 7

raised CRP
joint swelling /tenderness
symmetric
small joint involved

Question 8

polymyalgia rheumatica

Answer 8

> 60
rapid onset <1 month
ache/morning stiffness proximal limb muscles

ESR >40mm/hr
Creatinine kinase and emg normal

Question 9

still’s disease in adults

Answer 9

15-25 yrs
35-46 yrs

Features:
Arthralgia
Elevated serum ferritin

rash
salmon-pink
maculopapular

pyrexia
lymphadenopathy
RF and anti nuclear antibody

Question 10

methotrexate moa

Answer 10

inhibits dihydrofolate reductase > stops purine and pyrimidines

DNA synthesis enzyme

lowers folate level and impairs blood cell production
> WBC, RBC, platelets

Question 11

ankylosing spondylitis

Answer 11

HLA-B27
ESR / CRP raised

Question 12

Xrya of sacroiliac joints

Answer 12

sacroiliitis : subchondral erosions
sclerosis

squaring fo lumbar vertebrae

bamboo spine
syndesmophytes
apical fibrosis

Question 13

Mx of ankylosing spondylitis

Answer 13

regular exercise
NSAIDs
physio
DMARDS - sulphasalazine
anti-tnf ?

Question 14

reactive arthritis

Answer 14

HLA-B27 seronegative spondyloarthropaties

Question 15

reactive / reiters

triad

Answer 15

pee, see, bone pain

can’t see, can’t pee, can’t climb a tree

Question 16

lichen planus

Answer 16

immune mediated?

itchy / papular rash

> palms, soles, genitalia, flexor

white lines pattern

causes - gold, quinine, thiazineds

Question 17

lotion

Answer 17

thin and feels light

Question 18

cream

Answer 18

thicker than lotion

Question 19

Ointment

Answer 19

thicker than cream

Question 20

Gel

Answer 20

water based and often thinner than ointment

Question 21

emollient

Answer 21

moisturise dry skin and reduce dry skin flakes

used instead od soap

30 minutes before other psoriasis treatments

Question 22

Topical corticosteroid

Answer 22

reduces skin inflammation