RPA Rheum

Question 1

what manifestation of lupus is more likely to cause an elevated CRP

Answer 1

aside from infection, serositis

lupus generally causes elevated ESR without elevated CRP

Question 2

neurolupus antibody

Answer 2

ribosomal P abs

Question 3

what antibody is the most specific for lupus

Answer 3

anti smith

(other specific: dsDNA, SSA, SSB, U1RNP, ribosomal P)

Question 4

what antibody is associated with CHB in neonatal lupus

Answer 4

SSA +/- SSB

Question 5

Non pharmacological lupus tx

Answer 5

UV protection, smoking cessation immunisation

Question 6

screening for hydroxychloroquine retinopathy

Answer 6

at diagnosis then annually after 5 years

Question 7

MOA of belimumab

Answer 7

targeted human monoclonal antibody that binds to soluble BLyS, inhibiting its binding to B-cell receptors

may have effect in MSK and cutaneous SLE

Question 8

Answer 8

livedo reticularis

assos with antiphospholipid syndrome

Question 9

what biochemical marker carries the greatest risk for thrombosis in APLS

Answer 9

lupus anticoagulant

Question 10

management of APLS in pregnancy with

1) prior pregnancy loss
2) prior thrombosis

Answer 10

1) prophylactic LMWH + aspirin
2) therapeutic LMWH + aspirin

Question 11

specific antibodies systemic sclerosis

Answer 11

anticentromere (limited SS; pulmonary hyptension)

anti-topoisomerase (SCL-70; ILD)

anti-RNA polymerase III (severe renal/skin)

Question 12

raynaud’s and subtypes of systemic sclerosis

Answer 12

short history of Raynaud’s - diffuse cutaneous systemic sclerosis

long history of Raynaud’s - long history of Raynaud’s before other manifestations

Question 13

major morality in limited SSc

Answer 13

PulHTN

Question 14

major cause of mortality in diffuse SSc

Answer 14

pulmonary

Question 15

bosentan, macicentan, ambrisentan MOA and SE

Answer 15

endothelium receptor antagonists used in pumlmonary arterial hypertension

SE: LFT abnornality, teratogenic, fluid retention, anaemia

Question 16

what neuralgia is common in SSc

Answer 16

trigeminal neuralgia

Question 17

U1RNP without dsDNA

Answer 17

mixed connective tissue disease

but if they have another antibody highly specific for another disease, it would be another disease

Question 18

Answer 18

Lymphocytic interstitial pneumonia

associated with Sjogren’s

Question 19

what is one of the only drug-induced myopathies that does not cause a raised CK

Answer 19

corticosteroids

(other drug causes - statins, antimalarials, colchicine, penicillamine, anti-retrovirals, alcohol)

Question 20

rimmed vacuoles on histology (myositis) diagnosis

Answer 20

inclusion body myositis

Question 21

which antibotic should be avoided in a patient on methotrexate

Answer 21

trimethoprim due to lunng

Question 22

main benefit of febuxostat 80mg over allopurinol 300mg

Answer 22

lowers uric acid level

(but of note, a better trial would be to assess the clinical benefit after the therapeutic level of uric acid is achieved)

Question 23

polyarteritis nodosa diagnosis

Answer 23

small and medium vessel without GN or arteriole/distal involvement.

ANCA negative

often involves mesenteric/renal arteries

epididymoorchitis is a wellrecognised manifestation

Question 24

pml radiological findings

Answer 24

T1: involved regions are usually hypointense

T2:​ involved regions are hyperintense

multifocal, asymmetric periventricular and subcortical involvement. There is little, or no mass effect or enhancement and the subcortical U-fibers are commonly involved with a predilection for the parieto-occipital regions. Corpus callosum may be involved.

Question 25

lumbar flexion relieving of pain, exacerbated by movement

Answer 25

spinal canalstenosis

Question 26

various mutations to the fibrillin-1 gene located on chromosome 15

Answer 26

Marfan’s

Question 27

why do bisphosphonates have to be taken 30min before the first food

Answer 27

food decreases the absorption of alendronate

Question 28

old person with weakness and raised ALP

Answer 28

osteomalacia

clinical features:

• Bone pain and muscle weakness in 16 (94 percent)
• Bone tenderness in 15 (88 percent)
• Fracture in 13 (76 percent)
• Difficulty walking and waddling gait in four (24 percent)
• Muscle spasms, cramps, a positive Chvostek’s sign, tingling/numbness, and inability to ambulate in one to two (6 to 12 percent)

Laboratory findings:

• Alkaline phosphatase elevated in 95 to 100 percent
• Serum calcium and phosphorus reduced in 27 to 38 percent
• Urinary calcium low in 87 percent
• 25-hydroxyvitamin D (25[OH]D, calcidiol) <15 ng/mL in 100 percent
• PTH elevated in 100 percent

Question 29

lumber radiculopathy vs peroneal radiculopathy - causes of foot drop differentiating options

Answer 29

In L5 radiculopathy both ankle dosrsiflexion and inversion/eversion will be affected while in a pure common peroneal neuropathy inversion will be spared. There is a slight caveat however. If the foot is tested in the dropped position inversion may appear to be weak so inversion should be tested in a passively dorsiflexed position. In an isolated superficial peroneal neuropathy eversion will be weak and dorsiflexion spared while in an isolated deep peroneal neuropathy there will be weakness of dorsiflexion with sparing of eversion. In a common peroneal neuropathy sensation over the lateral foot (sural territory), sole of foot (plantar nerves) and medial calf and foot will be spared. Finally ankle jerks will be spared in a pure common peroneal neuropathy.

Question 30

MOA of corticosteroid induced osteoporosis

Answer 30

increased osteoclast-mediated one resorption

Question 31

rash that comes and goes - rheumatological condition

Answer 31

still’s disease rash

Question 32

homogenous pattern ANA

Answer 32

ENA negative

Question 33

what are rheumatoid factor antibodies directde against

Answer 33

Fc portion of IgG

Question 34

what troponin is more specific for cardiac involvement

Answer 34

troponin I > T

troponin T is produced by regenerating skeletal markers