Rhuematology

Question 1

What are some seronegative spondyloarthropathies?

Answer 1

Psoriatic arthritis, ankylosing spondylitis, reactive artheritis, enteropathic arthropathy, juvenile idiopathic arthritis

Question 2

What is scleroderma and what are the types?

Answer 2

Thickening of skin and involvement if visceral organs.
Diffuse cutaneous (systemic sclerosis) - Anti-ScL70
Limited (CREST) - anti-centromere
Localised scleroderma

Question 3

What dies CREST syndrome stand for in limited scleroderma?

Answer 3

Calcinosis, Raynauds, oesophgeal involvement, sclerodactyly, telangiectasia

Question 4

How might cutaneous vasculaitis present?

Answer 4

Petechiae, palpable purpura, macules, haemorrhagic bullae, SC nodules, urticaria

Question 5

What therapies can be used in an acute attack of gout?

Answer 5

1st line - High dose NSAIDs

Colchicine, steroids (IA or IM), analgesia

Question 6

What therapies are used for chronic gout?

Answer 6

Urate lowering therapies:

Allopurinol, Febuxostat

Question 7

What medications can put you at risk of gout?

Answer 7

Aspirin, cyclosporin, diuretics, nicotinic acid

Question 8

What conditions are associated with pseudogout?

Answer 8

Hyperparathyroidism, hypo- or hyperthyroidism, haemochromatosis, renal impairment, OA

Question 9

What condition is associated with PMR?

Answer 9

GCA

Question 10

What condition is associated with myasthenia gravis?

Answer 10

Thymoma

Question 11

What is Myasthenia gravis?

Answer 11

AI condition causing muscle weakness that gets progressively worse with activity and improves with rest
ACh receptor antibodies

Question 12

How might a patient with MG present?

Answer 12

Progressive weakness with repetitive movements:
Worse symptoms at the end of the day
Ptosis, diplopia, facial weakness, slurred speech, jaw fatigue, weak swallow

Question 13

What examinations might you do in suspected MG?

Answer 13

Repeated blinking - ptosis 
Prolonges upward gaze - diplopia
Repeated abduction - weakness
Check for thymectomy scar
Test FVC*

Question 14

What is a Myasthenic crisis?

Answer 14

Life threatening acute worsening of Sx, triggered usually by RTI
May need BiPAP or intubation due to weak respiratory muscles and risk of respiratory failure
IV immunoglobulins or plasma exchange

Question 15

What is Ankylosing spondylitis?

Answer 15

A chronic (>3 months) inflammatory disease of the spine and sacroiliac joints of unknown aetiology

Question 16

How might a patient with ankylosing spondylitis present?

Answer 16

Man < 30, peripheral arthropathy, limited chest expansion,
Reduced lumbar movements, question mark spine (thoracic kyphosis and neck hyperextension),
Gradual onset lower back pain, worse at night with stiffness in the morning >30min relieved by exercise,
Pain radiates from sacroliliac joints to hip/buttocks,
Usually improves towards end of the day

Question 17

What disease tools can be used in Ank spond?

Answer 17

Bath AS disease activity index (BASDAI)
Bath AS functional index (BASFI)
Bath AS metrology index (BASMI)

Question 18

What is reactive arthritis?

Answer 18

An inflammatory, sterile arthritis usually in the lower limbs following an infection elsewhere in the body
?enteric infection - salmonella, shigella, campylobacter
?GU - Chlaymidia, gonorrhoea, mycoplasma genitalium

Question 19

How might a patient with reactive arthritis present?

Answer 19

Systemically unwell
2-6 weeks post-infection
Arthritis, conjunctivitis, urethritis
Dactylitis, anterior uveitis, sacroilitis, keraroderma blenorrhagica

Question 20

What are the different types of psoriatic arthritis?

Answer 20

Oligoarthritis
Asymmetric DIP
Symmetrical polyarthritis
Psoraitic spondyloarthritis
Arthritis mutalins

Question 21

What is sjögrens syndrome?

Answer 21

AI chronic inflammation of exocrine glands

Dry eyes and mouth

Question 22

What antibodies can be seen in sjögrens?

Answer 22

Anti-Ro

Anti-La

Question 23

What is a potential harmful problem associated with Anti-Ro in pregnancy?

Answer 23

It can cross the placenta and cause neonatal lupus and complete heart block

Question 24

What is SLE?

Answer 24

A multisystem AI disease

Remitting and relapsing

Question 25

How might a patient with SLE present?

Answer 25

Photosensitive butterfly rash / malar rash Pain and tender PIP joint Raynauds Fever, fatigue, weight loss, hair loss, lymphadenopathy

Question 26

What ab can be seen in SLE?

Answer 26

>95% have ANA Anti-dsDNA Anti-Ro, Anti-La, Anti-RNP, anti-SM, anti-phospholipid

Question 27

What is RA?

Answer 27

A multisystem inflammatory condition characterised by symmetrical polyarticular arthritis, usually involving the hands, follows a chronic course and results in disability

Question 28

How might you assess disease activity in RA?

Answer 28

DAS-28

Question 29

How might you manage a patient with RA?

Answer 29

1 - NSAIDs (only for inflammation, they do not suppress disease activity) Cox2i - etoricoxib Steroids - PO/IM/IA 2- cDMARDs (slow onset, suppress disease activity) - methotrexate, sulfalazine, leflunomide 3 - bDMARDs (suppress disease activity)- abatercept, infliximab, enteracept

Question 30

What is a important side effect of Methotrexate?

Answer 30

Pulmonary fibrosis

Question 31

What is a important side effect of Leflunomide?

Answer 31

HTN, peripheral neuropathy

Question 32

What is a important side effect of Sulfasalazine?

Answer 32

Male infertility (reduced sperm count)

Question 33

What is a important side effect of Hydroxychloroquine?

Answer 33

Nightmares, reduced VA

Question 34

What is a important side effect of anti-TNF?

Answer 34

Reactivation of TB or hep B

Question 35

What is a important side effect of Rituximab?

Answer 35

Night sweats and thrombocytopenia

Question 36

How would you manage reactive arthritis - mild, mod and severe?

Answer 36

Mild- NSAIDs and simple analgesia + bed rest Moderate - NSAIDs, Joint aspiration, steroids Severe - DMARDs? Its usually self limiting and can take 6months to resolve *

Question 37

What is JIA?

Answer 37

AI inflammation | Diagnosed when a child <16 has arthritis without a known cause/ another cause for >6 weeks

Question 38

What are the different types of Jia?

Answer 38

``` Systemic Polyarticular Oligoarticular Enthesis related arthritis Juvenile psoriatic arthritis ```

Question 39

What would make u think of systemic JIA or stills disease?

Answer 39

Subtle salmon pink rash High swinging fevers Joint pain and inflammation Lymphadenopthay, pericarditis, weight loss, splenomeagly, pleuritis

Question 40

What is a life threatening complication of systemic JIA or stills disease?

Answer 40

Macrophage activation syndrome Severe activation of the immune system with a massive inflammatory response. An acutely unwell child with DIC, anaemia, thrombocytopenia, leukopenia, a non blanching rash ans a LOW ESR

Question 41

What drug can cause drug induced lupus? (clue, tb abx)

Answer 41

Isoniazid methyldopa, enteracept, hydralazine, phenytoin

Question 42

What protein is mutated in marfans?

Answer 42

Fibrillin - AD

Question 43

What is a side effect of hydroxychloroquinine (used in SLE)?

Answer 43

Severe and permanent retinopathy - 'Bulls eye retinopathy' | So need to monitor VA

Question 44

How can CES present?

Answer 44

Cauda equina syndrome classically presents with lower back pain, sciatica, reduced perianal sensation. Late signs include urinary incontinence