Rheumatology PassMed

Question 1

what is etanercept and what side effect is it associated with?

Answer 1

Anti-TNF drug

Reactivate TB

Question 2

Discuss the mgt of rheumatoid arthritis

Answer 2

1. DMARD monotherapy +/- short course of pred

Question 3

how do you monitor treatment response in RA

Answer 3

Das28 score and CRP levels

Question 4

how are flare ups of RA managed

Answer 4

oral or IM steroids

Question 5

what do you have to regularly monitor in a patient on methotrexate and why

Answer 5

LFTs and FBC

risk of myelosuppression and liver cirrhosis

Question 6

methotrexate and cough

Answer 6

side effect is pneumonitis

Question 7

the current indication for a TNF-inhibitor is an inadequate response to

Answer 7

at least two DMARDs including methotrexate

Question 8

pain worse on wrist extension against resistance with the elbow extended or supination of the forearm with the elbow extended

Answer 8

lateral epicondylitis

Question 9

which one is tennis elbow

Answer 9

lateral epicondylitis

Question 10

how long does lateral epicondylitis last for?

Answer 10

6-12 weeks of acute pain but usually lasts for 6mths to 2 years

Question 11

manage lateral epicondylitis

Answer 11

advice on avoiding muscle overload
simple analgesia
steroid injection
physiotherapy

Question 12

what is ankylosing spondylitis?

Answer 12

HLA-B27 associated spondyloarthropathy - inflammatory disorder which also affects the joints

Question 13

who gets ank spond

Answer 13

It typically presents in males (sex ratio 3:1) aged 20-30 years old.

Question 14

what are the classical features of ank spond?

Answer 14

typically a young man who presents with lower back pain and stiffness of insidious onset
stiffness is usually worse in the morning and improves with exercise
the patient may experience pain at night which improves on getting up

Question 15

what is the main clinical sign seen on examination with people with ank spond

Answer 15

shoebers test <5cm

Question 16

what are the other features of ank spond (all the As)

Answer 16

the 'A's 
Apical fibrosis
Anterior uveitis
Aortic regurgitation
Achilles tendonitis
AV node block
Amyloidosis
and cauda equina syndrome
peripheral arthritis (25%, more common if female)

Question 17

what is the main side effect of colchicine and what do GPs use instead due to this SE

Answer 17

diarrhoea

NSAIDS like naproxen

Question 18

what is gout

Answer 18

form of microcrystal synovitis caused by the deposition of monosodium urate monohydrate in the synovium. It is caused by chronic hyperuricaemia

Question 19

what is classed as chronic hyperuricaemia

Answer 19

uric acid >450 µmol/l

Question 20

what is first line mgt of gout

Answer 20

colchicine or naproxen

if contraindicated can give steroids

Question 21

what is the criteria for offering urate lowering therapy

Answer 21

→ >= 2 attacks in 12 months
→ tophi
→ renal disease
→ uric acid renal stones
→ prophylaxis if on cytotoxics or diuretics

Question 22

what is the first and second line urate lowering therapy

Answer 22

allopurinol

xanthine oxidase inhibitors such as febuxostat

Question 23

what food is high in purines

Answer 23

Liver, kidneys, seafood, oily fish (mackerel, sardines) and yeast products

Question 24

what drugs can precipitate gout

Answer 24

thiazides

Question 25

what is ehlers danlos

Answer 25

genetic collagen disorder, which results in widespread elasticity of tissue. There are many differing subtypes, but most commonly it is an autosomal dominant condition affecting type III collagen

Question 26

what cardiac conditions are associated with ehlers danlos

Answer 26

valvular incompetence

Question 27

what are the main features of ehlers danlos?

Answer 27

elastic, fragile skin
joint hypermobility: recurrent joint dislocation
easy bruising
aortic regurgitation, mitral valve prolapse and aortic dissection
subarachnoid haemorrhage
angioid retinal streaks

Question 28

treat ank spond

Answer 28

nsaids (methotrexate doesn’t work)

second line anti tnf

Question 29

what are blood calcium pth alpphos and phosphate levels like in osteoporosis

Answer 29

all normal

Question 30

Normal calcium, normal phosphate, raised alkaline phosphatase, normal parathyroid hormone

Answer 30

pagets

Question 31

Decreased calcium, decreased phosphate, raised alkaline phosphatase, raised parathyroid hormone

Answer 31

osteomalacia

Question 32

Raised calcium, decreased phosphate, raised alkaline phosphatase, raised parathyroid hormone

Answer 32

primary hyperpapathyroidism (adenoma?)

Question 33

Decreased calcium, raised phosphate, raised alkaline phosphatase, raised parathyroid hormone

Answer 33

secondary hyperparathyrpidism (chronic kidney disease)

Question 34

what is osteoporosis in terms of bone marrow density

Answer 34

bone marrow density <2.5 standard deviations below the mean

Question 35

risk factors for osteoporosis

Answer 35

corticosteroid use
smoking
alcohol
low body mass index
family history
female 
>>age

Question 36

how do you diagnose osteoporosis

Answer 36

DEXA of hip and lumbar spine

Question 37

treat osteoporosis

Answer 37

bisphosphonates (alendronate)

Question 38

what is temporal arteritis associated with

Answer 38

polymyalgia rheumatica

Question 39

what are the typical features of temporal arteritis

Answer 39

typically patient > 60 years old
usually rapid onset (e.g. < 1 month)
headache (found in 85%)
jaw claudication (65%)
visual disturbances secondary to anterior ischemic optic neuropathy
tender, palpable temporal artery
around 50% have features of PMR: aching, morning stiffness in proximal limb muscles (not weakness)
also lethargy, depression, low-grade fever, anorexia, night sweats

Question 40

diagnose temporal arteritis on

Answer 40

biopsy (be aware of skip lesions)

Question 41

what is the treatment of temporal arteritis

Answer 41

should have a fast response to prednisalone

Question 42

SLE is associated with low levels of

Answer 42

C4

Question 43

how can you monitor disease progression in SLE

Answer 43

anti-DsDNA titres
ESR
complement levels