SBAs: Rheumatology

Question 1

Why does gout so often present in the big toe?

Answer 1

Last place blood reaches from aorta, poor venous return, uric acid able to accumulate

Question 2

Describe the symptoms of gout

Answer 2

Erosive arthritis: warm, swollen, tender and very painful

Question 3

Recall a sign of gout away from the monoarthropathy

Answer 3

Tophi (lumps of uric acid) in ears and on elbows

Question 4

What is the dietary component that causes gout in excess, and in what sort of foods is it found?

Answer 4

Purines: port, red wine, cheese

Question 5

Recall 3 causes of gout

Answer 5

1. Purine-rich diet
2. Kidney failure
3. Leukaemia/ lymphoma

Question 6

How does leukaemia lead to gout?

Answer 6

Tumour lysis syndrome

Very high levels of urate released following chemotherapy

Question 7

What urate level is diagnostic of gout?

Answer 7

> 450

Question 8

Describe the shape of the crystals in gout

Answer 8

Negative birefringent needle-shaped crystals

Question 9

How can you examine crystal shape in gout?

Answer 9

Do a needle biopsy

Question 10

Describe the shape of the crystals in pseudogout

Answer 10

Positive birefringent rhomboid-shaped crystals

Question 11

What tests must be done when gout is suspected?

Answer 11

Needle biopsy

X ray of joint

Question 12

What is the management of acute gout, and what must you be particularly careful about?

Answer 12

NSAIDs and steroids

Cannot give NSAIDs to renal failure patients

Question 13

What is the management of chronic gout?

Answer 13

Allopurinol

Question 14

What is the mechanism of action of allopurinol?

Answer 14

Xanthine oxidase inhibitor

Question 15

How can patients with tumour lysis syndrome be protected from gout?

Answer 15

Giving prophylacted IV rasburicase: it is a recombinant urate oxidase

Question 16

What sort of nodes do you see in osteoarthritis?

Answer 16

Heberden’s (distal)

Bouchard’s (proximal)

Question 17

Recall the mnemonic for and the X ray features of osteoarthritis

Answer 17

LOSS
Loss of joint space
Osteophytes
Subchondral sclerosis
Subchondral cysts

Question 18

When is rheumatoid arthritis pain worst?

Answer 18

Morning

Question 19

Which joints are most commonly affected by rheumatoid arthritis?

Answer 19

MCP and PIP

Question 20

Recall 3 features of rheumatoid arthritis on the hands

Answer 20

Swan-necking
Boutoniere
Ulnar deviation

Question 21

Which is the most specific immunoglobulin to rheumatoid arthritis?

Answer 21

Anti-CCP

Question 22

What score is used to grade the severity of rheumatoid arthritis?

Answer 22

DAS28

Question 23

Recall the medical management of rheumatoid arthritis

Answer 23

DMARDs

Question 24

Recall an example of a DMARD drug

Answer 24

Methotrexate

Question 25

What is the mechanism of action of methotrexate?

Answer 25

Anti-folate - interferes with DNA replication

Question 26

Describe the appearance of psoriatic arthritis on the hands

Answer 26

Brown mail discolouration

Oncholysis

Question 27

Which joints tend to be affected by psoriatic arthritis?

Answer 27

DIPs

Question 28

How is psoriatic arthritis treated?

Answer 28

Similarly to rheumatoid arthritis with DMARDs