Rheumatology pastest

Question 1

What marker of bone turner is raised in Paget’s disease?

Answer 1

Alkaline Phosphatase

Normal Calcium , phosphate, PTH

Question 2

What is used to treat Pagets?

Answer 2

Bisphosphonates

Question 3

What are the features of reactive arthritis?

Answer 3

“Can’t Pee, Can’t see, Can’t climb a tree”

Urethritis
Arthritis- Pain in knees, ankles or feet
Conjunctivitis

HLA-B27 positive

Other complications:
Circinate balanitis
Keratoderma Blennorrhagicum

Question 4

How is the diagnosis of osteoporosis confirmed?

Answer 4

T score < -2.5 on DEXA Scan
Fragility fracture

Question 5

What is a T score

Answer 5

The number of standard deviations from the mean bone mass of a 30 yr old.

> 1.0 = normal
-1 to -2.5 = osteopenia
<-2.5 = osteoporosis

Treatment for osteoporosis is initiated if T score <-2.5

Question 6

what complication is associated with Anti-Scl-70 antibodies in systemic sclerosis?

Answer 6

Pulmonary Fibrosis

Question 7

what complication is associated with Anti-RNA polymerase III antibodies in systemic sclerosis?

Answer 7

rapidly progressive skin involvement and scleroderma renal crisis

Question 8

what complication is associated with Anti-centromere antibodies in systemic sclerosis?

Answer 8

associated with limited cutaneous systemic sclerosis, pulmonary hypertension and GI involvement

Question 9

What are the features of cryoglobulinaemia?

Answer 9

• purpuric rash
• raynauds
  -polyarthralgia
  -positive RF in 90%
  -low C4

Question 10

What are the features of osteomalacia?

Answer 10

• Vitamin D deficiency leads to hypocalcaemia, lower end of normal phospjate and raised ALP.
• Proximal muscle weakness
• low density bands extending from the cortex

Question 11

What crystals are seen in gout vs pseudogout?

Answer 11

Gout - needle shaped negative birefringence

pseudogout - calcium pyrophosphate crystals appear rhomboidal

Question 12

What is the characteristic finding of ankylosing spondylitis on Xray

Answer 12

Sacroiliitis
Subchondral erosiion
Loss of lumbar lordosis
Bamboo spine

Question 13

What HLA is associated with Ankylosing Spondylitis?

Answer 13

HLA B27

Question 14

How does Ankylosing Spondylitis present?

Answer 14

Age of onset between 15 and 40.
higher incidence in men
Lower back pain and stiffness.
Pain better worse in morning and improves with movement
Associated with anterior uveitis and aortic incompetence.

Question 15

How is ankylosing spondylitis treated?

Answer 15

1. NSAIDs and Physio
2. Anti-TNF-a therapy effective in high disease activity.

Question 16

What are the typical features of dermatomyositis?

Answer 16

• Proximal muscle weakness
• heloptrope rash around eyes
• Gottron’s papules over knuckles
• nail fold dilated capillaries
• shawl sign - upper back and neck redness.

Question 17

What antibodies are specific for dermatomyositis?

Answer 17

Anti-Mi-2 antibodies are found in 30%

Question 18

What are the features of Adult onset juvenile chronic arthritis (JCA)?

Answer 18

• fevers for more than 2 weeks
• Oligoarthritis
• erythematous rash
• pericarditis

First line treatement - NSAIDs and short course systemic corticosteroids

Second line treatment - methotrexate and anti-tnf based therapies.

Question 19

What is the main agent for neutralising the immediate toxic effects of methotrexate?

Answer 19

Calcium Folinate
(Calcium Leucovorin)

Question 20

What is the intial treatment of choice in patients presenting with Gout on background of CKD?

Answer 20

Colchicine

(allopurinol should not be started during an acute attack but at least 4 weeks after the attack has settled)

Question 21

How does Discoid lupus typically present?

Answer 21

• well demarcated macular rash with erythema
• scales, plaques, atrophy,
  -scarring alopecia of scalp
• Photosensitivity
• Afro-caribbean women

Question 22

What is lupus pernio?

Answer 22

Lupus pernio us a cutaneous form of sarcoidosis with dusky-purple infiltration of the nose.

Question 23

What is Buerger’s disease?

Answer 23

• Affects smokers
• disease of small and medium sized vessels leading to inflammation and ulceration
• digital ischaemia / gangrene
• Arteriorgram will show occlusion of distal arteries of hands and feet.

Question 24

What drugs cause lung fibrosis?

Answer 24

Methotrexate
bleomycin
amiodarone
nitrofurantoin
cyclophosphamide

Question 25

What are the features of polymyositis?

Answer 25

• 3-6 mn painful proximal muscle weakness
• elevated CK
• Anti-Jo-1 antibodies are associated with co-existent interstial lung disease
• females are more affect 3:1

Question 26

What is Lofgren syndrome?

Answer 26

Lofgren syndrome is an acute form of sarcoidosis with erythema nodosum, bihilar lymphadenopathy, and polyarthalgia / polyarthritis.

Question 27

What is the first and second line treatment for psoriatic arthritis not responding to NSAIDs?

Answer 27

If not responding to NSAIDs:

1st line is DMARD - methotrexate.

2nd line is TNF antagonist - Etanercept.

Question 28

What conditions are associated with branch retinal vein occlusion?

Answer 28

• Antiphospholid antibody syndrome (has a prolonged APTT)
• diabetes
• sarcoidosis
• lyme disease
• other causes of thrombophilia.

Question 29

What are the occular manifestations of Granulomatosis with polyangiitis (wegeners)?

Answer 29

Scleritis and uveitis

Question 30

What is the occular manifestation of giant cell arteritis?

Answer 30

Sudden loss of vision in one eye due to anterior ischaemic optic neuropathy

Question 31

What antibodies are seen in Sjogrens?

Answer 31

• Anti-ro and anti-la.
• antinuclear antibodies and rheumatoid factor are usually positive but not specific for Sjogrens.

Question 32

What is the difference in symptoms between polymyalgia rheumatica and polymyositis?

Answer 32

PMR is proximal muscle pain and stiffness worse in morning and improves throughout the day.

Polymyositis is proximal myopathy which causes proximal muscle weakness.

Morning stiffness is not a feature of polymyositis.

Question 33

What is the most important test for patients presenting with dermatomyositis?

Answer 33

Malignancy screen