Rheumatology Guidelines

Question 1

schobers test and ank spond

Answer 1

<5cm is postiive

Question 2

most useful 1st test for ank spond

gold standard Ix

Answer 2

Xray sacroiliacs

MRI is gold standard

Question 3

ESR and CRP in ank spond

Answer 3

both up

Question 4

1st line ank spond

Answer 4

NSAIDs and exercise

Question 5

DMARD in ank spond

Answer 5

only if peripheral involvemtn (mor ein woman)

Question 6

When do you do biologic in ank spond

Answer 6

if failed 2 NSAIDs

Question 7

antiphospholipid syndrome aPTT

Answer 7

paradoxically up

Question 8

antiphospholipid Mx

Answer 8

warfarin

• first VTE = 6m at 2-3
• recurrent VTE if second one during warfarin = lifelong at 3-4
• arterial thrombosis = lifelong 2-3

Question 9

behcets Ix

Answer 9

pathergy test

Question 10

CFS 1st line

Answer 10

CBT

Question 11

dermatomyositis definitive ix

Answer 11

muscle biopsy

Question 12

CK in dermatomyositis

Answer 12

up

Question 13

EMG in dermatomyositis

Answer 13

fibrillations

Question 14

1st line dermatmyositisi

Answer 14

steroids

Question 15

diagnosis of fibromyalgia

Answer 15

need t be tender at 11+ out of 18 points

Question 16

best evidence Tx for firbomyalgia

Answer 16

aerobic exercise

Question 17

gout acute 1st line

Answer 17

NSAIDs (max dose for 1-2d after Sx stop) or colchicine

Question 18

when can you not use NSAIDs in gout

Answer 18

any CKD

Question 19

when can you not use colchicine in gout and what do you then use

Answer 19

ESKD, use prednisolone

Question 20

serum urate aim for when on allopuronol

Answer 20

less than 300

Question 21

2nd line urate lowering drug

Answer 21

febuxostat

Question 22

diet for gout?

Answer 22

increase vit C

Question 23

diuretics for gout?

Answer 23

stop thiazides. ARB help

Question 24

xray findgins in rickets

Answer 24

cupped ragged metaphysis

Question 25

adults osteomalacia xray finding

Answer 25

pseudofracture/loosers zone

Question 26

skull problem in pagets

Answer 26

``` frontal bossing osteoporosis circumscipta (patches of osteoporosis) ```

Question 27

polyarteritis nodosa association

Answer 27

man with hep B

Question 28

PAN definitive biopsy (2)

Answer 28

renal or mesenteric angiogram | biopsy with microaneursysm

Question 29

PAN Mx

Answer 29

control BP steroids a cyclophosphamide

Question 30

PAN blood test | - crp, esr, wcc, hb

Answer 30

crp esr wcc up | anaemia

Question 31

PMR Ix | - esr, ck, alp, emg

Answer 31

esr up alp up ck and EMG

Question 32

PMR Mx

Answer 32

prednisolone (methylpred if eye involvement)

Question 33

pseudogout Mx

Answer 33

NSAIDs or steroids

Question 34

psoriatic arthroapthy : systemic steroids?

Answer 34

makes rash worse

Question 35

joint aspirate in reactive arthtis

Answer 35

negative

Question 36

Mx for reactive arthtiris

Answer 36

4w to start 4m to leave self limiting so don't have to do anytihgn, can use MTX is lasting more than 6m

Question 37

how do you detect RF

Answer 37

rose waaler test - sheep red cell agglutination | less specific Latex aggluniation test

Question 38

how do you diagnose RA

Answer 38

need 6/10 score of American thingy: | - esr, >6w, joints involved serology

Question 39

1st line RA Tx in flare first time

Answer 39

single DMARD MTX) and pred

Question 40

disease monitoring in RA

Answer 40

DAS28 + CRP

Question 41

TNFa i indication in RA

Answer 41

failed 2 DMARDS including MTX

Question 42

Schirmer test +ve

Answer 42

<15mm in 5min

Question 43

definitive test for sjogrens

Answer 43

biopsy shows lymphocytic infiltration

Question 44

other weird blood test for sjogrens

Answer 44

IgG high and C4 low

Question 45

Mx for sjogrens

Answer 45

articificla tears and saliva | pilocarpine may stimulat esecretions

Question 46

SLE diagnsitic critera

Answer 46

Need 4 or more of: dicoid rash, malar rash, photosensitivity, oral ulcer, arthritis, serositis, renal disorder, CNS disorder, haem disorder, immunological disrde, ANA

Question 47

SLE blood during flare - CRP/ESR - complemenyts?

Answer 47

Crp normal but ESR raised | low C3 and C4

Question 48

disease monitoing for SLE

Answer 48

dsDNA

Question 49

severe flare SLE Mx

Answer 49

IV cyclophosphamide + high dose pred