Rheumatology & MSK

Question 1

What are the characteristic symptoms of OA?

Answer 1

Non-inflammatory unilateral joint pain/stiffness, functional difficulties, bony deformities, limited ROM, tenderness, crepitus, haemarthrosis.

Question 2

How is OA diagnosed?

Answer 2

X-ray (Loss of joint space, Osteophytes, Subchondral sclerosis, Subchondral cysts).

Question 3

What is the primary treatment for OA?

Answer 3

Lifestyle modifications + paracetamol ± NSAID gel (hand or knee).

Question 4

What are ‘The A’s’ associated with Ankylosing Spondylitis?

Answer 4

Apical fibrosis, Anterior uveitis, Achilles tendonitis, AVN block, Amyloidosis, Aortic regurgitation

Question 5

How is Ankylosing Spondylitis diagnosed?

Answer 5

X-ray (Sacroiliitis, Bamboo spine, Syndespositis) + Schober’s test (<5cm lateral flexion) + bloods (high CRP and ESR).

Question 6

How is Psoriatic Arthritis classified?

Answer 6

Symmetrical polyarthritis, asymmetric oligoarthritis, DIP arthritis, psoriatic spondylitis, arthritis mutilans.

Question 7

What imaging is used in the diagnosis of Psoriatic Arthritis?

Answer 7

X-ray (pencil in cup) + bloods (high CRP and ESR).

Question 8

What is the classic triad associated with Reactive Arthritis?

Answer 8

‘Can’t see, can’t pee, can’t climb a tree’ - Conjunctivitis, Urethritis, Inflammatory peripheral arthritis.

Question 9

What is the causative agent often linked to Reactive Arthritis?

Answer 9

Chlamydia trachomatis.

Question 10

What distinguishes RA from OA in terms of joint pain?

Answer 10

Inflammatory symmetrical joint pain/stiffness in RA.

Question 11

How is RA diagnosed?

Answer 11

Bloods (RF, anti-CCP, high CRP and ESR), x-ray (juxta-articular osteopenia, soft tissue swelling, marginal erosion, subluxation), DAS28.

Question 12

What is the first-line treatment for acute RA?

Answer 12

Prednisolone (steroid bridging treatment) + NSAID.

Question 13

What is the chronic treatment approach for RA?

Answer 13

DMARD monotherapy (#1 Methotrexate + folic acid or SSZ or Leflunomide or Hydroxychloroquine), DMARD dual therapy, add biologic if necessary.

Question 14

What is Felty’s syndrome?

Answer 14

RA + Splenomegaly + Leukopenia.

Question 15

What are the common skin manifestations in SLE?

Answer 15

Malar rash associated with photosensitivity, alopecia, livedo reticularis, and Raynaud’s.

Question 16

What is the primary pharmacological treatment for SLE?

Answer 16

Hydroxychloroquine* + lifestyle** ± NSAID ± prednisolone.
*Monitor eyes, **Diet, smoking, sun, exercise.

Question 17

What are the two subtypes of Scleroderma?

Answer 17

Limited cutaneous (RF, ACA/anti-centromere) and Diffuse cutaneous (RF, anti-scl-70/anti-topoisomerase).

Question 18

What diagnostic tests are used for Sjogren’s Syndrome?

Answer 18

Schirmer’s test (<5mm wetting in 5m), bloods (RF, anti-Ro, anti-La).

Question 19

What diagnostic tests are used for Sjogren’s Syndrome?

Answer 19

Schirmer’s test (<5mm wetting in 5m), bloods (RF, anti-Ro, anti-La).

Question 20

What characterizes Behcet’s syndrome?

Answer 20

Oral ulcers + Genital ulcers + Anterior uveitis.

Question 21

What are the characteristic symptoms of gout?

Answer 21

Pain, swelling, and erythema of the first MTP (also ear, wrist, knee, ankle).

Question 22

How is gout diagnosed?

Answer 22

Joint aspiration (negative birefringent needle-shaped crystals), uric acid, x-ray, USS.

Question 23

What is the preferred acute treatment for gout?

Answer 23

NSAID (#1) or Colchicine (#2).

Question 24

What are the characteristic symptoms of pseudogout?

Answer 24

Pain, swelling, and erythema of OA-type joints (wrist, shoulder, hip, knee).

Question 25

How is pseudogout diagnosed?

Answer 25

Joint aspiration (positive birefringent rhomboid-shaped crystals), x-ray (chondrocalcinosis), USS.

Question 26

What distinguishes Polymyalgia Rheumatica from other inflammatory conditions?

Answer 26

Inflammatory pain/stiffness for >1h in the morning (shoulder, hip), acute onset

Question 27

What is the typical treatment for Polymyalgia Rheumatica?

Answer 27

Prednisolone 15mg.

Question 28

What are the classic symptoms of Temporal Arteritis?

Answer 28

Headache, extremity/jaw claudication, tender palpable temporal artery, vision loss.

Question 29

What diagnostic procedure confirms Temporal Arteritis?

Answer 29

Temporal artery biopsy (skip lesions).

Question 30

What is seen on bloods in osteomalacia?

Answer 30

Low calcium, low phosphate, high PTH, raised ALP

Question 31

What do we prescribe for long-term management in moderate / severe psoriatic arhritis?

Answer 31

Methotrexate

Question 32

In bony mets, what do we use for pain control if opiates fail?

Answer 32

IV bisphosphonate infusion or radiotherapy

Question 33

Presentation of NOF fracture

Answer 33

Short leg, externally rotated

Question 34

Why is displaced intra-articular fracture an emergency?

Answer 34

Reduced blood flow to femoral head; risk of avascular necrosis

Question 35

What classification system is used for intra-articular fractures?

Answer 35

Garden

Question 36

Intervention choices in NOF fracture

Answer 36

Total hip replacement if patient could previously walk

Hemiarthroplasty if poor mobility before / significantly co-morbid

Question 37

SE of bisphosphanates

Answer 37

• Reflux / oesophageal erosions
• Atypical fractures
• Osteonecrosis of the jaw
• Osteonecrosis of the external auditory canal

Question 38

How do bisphosphonates work?

Answer 38

Reduce the activity of osteoclasts&raquo_space; prevent bone resorption

Question 39

How do we manage an extracapsular hip fracture (e.g. subtrochanteric fracture)

Answer 39

Intramedullary device