Summary Book Rheumatology

Question 1

Movements initiated by radial nerve. Associate with C6 and 7.

Answer 1

C6 - elbow flexion and brachioradialis. C6/7 - wrist extension. C7 - triceps, elbow extension and finger extension.

Question 2

Movements initiated by median nerve. Associate with C8 and T1.

Answer 2

C8 - 1st and 2nd DIP flexion, and thumb flexion. T1 - thumb abduction.

Question 3

Movements initiated by ulnar nerve. Associate with C8 and T1.

Answer 3

C8 - 3rd and 4th finger flexion. C8 and T1 - finger 4 abduction. T1 - 1st finger abduction and finger adduction.

Question 4

Compare crystals of gout and pseudogout

Answer 4

Gout - monosodium urate, needle shaped, negative birefringence. Pseudogout - calcium pyrophosphate, rhomboid shaped, positive birefringence.

Question 5

Compare xray findings of gout and pseudogout

Answer 5

Gout - erosive arthritis with soft tissue swelling. Pseudogout - chondrocalcinosis. Both are asymmetrical deforming peripheral oligoarthritis

Question 6

Management of gout. Acute, prophylaxis and urate lowering.

Answer 6

Acute: 1. NSAID or colchicine. 2. Prednisolone - aim uric acid level <0.4. Prophylaxis: colchicine, weight loss, diet modification. Urate Lowering: allopurinol (xanthine oxidase inhibitor) or IL-1 blocker for refractory gout (anakinm).

Question 7

Systems involved in rheumatoid arthritis

Answer 7

Cushingoid, joints, eyes, cardio, resp, splenomegaly, vasculitis

Question 8

Describe key features of rheumatoid arthritis

Answer 8

Symmetrical deforming, small joint predominant peripheral arthropathy; with morning stiffness, joint pain/swelling, fatigue and possible paraesthesia.

Question 9

Signs of rheumatoid arthritis

Answer 9

elbow subcutaneous nodules, sicca, ILD, pleural effusion, possible anaemia, peripheral neuropathy, splenomegaly, pericarditis, raynauds

Question 10

Risk factors for rheumatoid arthritis

Answer 10

smoking, FHx (HLA-DR4)

Question 11

Poor prognostic factors for rheumatoid arthritis

Answer 11

increased number of joints, extra-articular involvement, high rheumatoid factor and anti-ccp, erosions on xray, HLA-DR4 positive

Question 12

Serum findings for rheumatoid arthritis

Answer 12

rheumatoid factor sensitive, anti-ccp specific and bad prognosis, FBC - anaemia, CRP

Question 13

5 xray findings for rheumatoid arthritis

Answer 13

1. marginal subchondral erosions. 2. symmetrical narrowing of joint space. 3. juxta-articular osteopenia. 4. periarticular soft tissue swelling. 5. deformities.

Question 14

MRI findings for rheumatoid arthritis

Answer 14

synovitis, effusions, oedema

Question 15

Management of rheumatoid arthritis

Answer 15

Non-pharmacological: exercise, braces, smoking cessation, OT/PT. Pharmacological: NSAID, steroids to bridge, DMARD (start early = 1. methotrexate, 2. leflunomide / sulfasalazine / hydroxychloroquine), biologic - anti TNF alpha (if methotrexate and DMARD fail after 6 months). Also manage cardiovascular and osteoporosis risk factors.

Question 16

Risk factors of osteoarthritis

Answer 16

obesity, family history, joint trauma

Question 17

Describe osteoarthritis

Answer 17

asymmetrical deforming peripheral oligoarthritis (knees, DIP (heberden), PIP (bouchard) and 1st CMC). With joint effusions, bony swelling, not warm, tender, crepitations and decreased ROM. Involves progressive loss of synovial cartilage.

Question 18

Serum findings of osteoarthritis

Answer 18

normal inflammatory markers, negative RF/anti-ccp to exclude RA

Question 19

Synovial findings of osteoarthritis

Answer 19

yellow, increased viscous, decreased cell count

Question 20

4 xray findings of osteoarthritis

Answer 20

1. joint space narrowing. 2. osteophytes. 3. subchondral sclerosis. 4. subchondral cysts

Question 21

Management of osteoarthritis

Answer 21

exercise, weight loss, NSAIDs, intra-articular corticosteroids, surgery

Question 22

Examination of psoriatic arthritis (HLA B27)

Answer 22

hands and cardio

Question 23

Signs of psoriatic arthritis

Answer 23

Dactylitis, enthesitis, nail changes (pitting, onycholysis, ridging), functional limitation, anterior uveitis, aortic regurgitation, apical lung fibrosis, psoriatic skin disease (limb extensor, behind the ears, scalp line)

Question 24

Serum findings for psoriatic arthritis

Answer 24

CRP, negative autoantibody

Question 25

4 xray findings of psoriatic arthritis

Answer 25

1. erosive arthropathy. 2. pencil in cup. 3. rays not rows. 4. juxta-articular new bone

Question 26

Management of psoriatic arthritis

Answer 26

exercise, UV for skin, NSAIDs and intra-articular steroids, methotrexate, anti-TNF alpha (infliximab)

Question 27

Presentation and management of giant cell arteritis

Answer 27

Headache, loss of vision, jaw claudication. Steroids.

Question 28

Associations of polyarteritis nodosa

Answer 28

peripheral neuropathy, mononeuritis multiplex and clots (chest or abdo pain)

Question 29

Organ involvement and management of microscopic polyangiitis

Answer 29

Lung and cyclophosphamide

Question 30

Organ involvement and management of granulomatosis with polyangiitis

Answer 30

Lung (dyspnoea, haemoptysis, cough, congestion) and renal. Rituximab, possibly cyclophosphamide or MMF.

Question 31

Organ involvement and management of eosinophilic granulomatosis with polyangiitis.

Answer 31

Renal, atopic conditions, mononeuritis multiplex and peripheral neuropathy. Cyclophosphamide vs mycophenolate.

Question 32

For management of renal and / or respiratory involvement of vasculitis which agents should be considered

Answer 32

Cyclophosphamide for lung or renal. MMF for renal.

Question 33

Investigations for vasculitis

Answer 33

ANCA, ESR, UEC, LFT, renal biopsy, imaging

Question 34

Risk factors for vasculitis

Answer 34

Other autoimmune conditions, drug reaction (hydralazine, allopurinol, propylthiouracil), leukaemia / lymphoma, hep B/C

Question 35

Presentation for mixed cryoglobulinemia

Answer 35

raynauds, arthrtis, Hep C

Question 36

Which organ is associated with microscopic polyangiitis

Answer 36

lung

Question 37

General presentation symptoms for vasculitis

Answer 37

fatigue, myalgia, arthralgia, rash

Question 38

Good questions for steroid and opioid use

Answer 38

Exposure over time, changes in dose, complications, weaning

Question 39

What to examine when determining activity of disease for a rheumatological condition

Answer 39

Nodules, eyes, anaemia, fibrosis, skin

Question 40

Administration of methotrexate

Answer 40

Weekly, monitor for toxicity, give folic acid

Question 41

Potential risk factors of methotrexate

Answer 41

Lung fibrosis, liver cirrhosis, skin malignancy, teratogenicity, infection, mouth ulcers, alopecia, pneumonitis

Question 42

Potential risk factors of leflunomide

Answer 42

Lung fibrosis, liver cirrhosis, skin malignancy, teratogenicity, infection, mouth ulcers, alopecia, pneumonitis, neuropathy

Question 43

What should be monitored for plaquenil (hydroxychloroquine)

Answer 43

Eyes and skin pigmentation

Question 44

Risk factors of sulfasalazine

Answer 44

Neutropenia and rash

Question 45

Risk factors of TNF inhibitors

Answer 45

TB, infection, skin malignancy, drug induced lupus, MS

Question 46

Give two examples of a JAK Kinase Inhibitor

Answer 46

Tofacitinib and Ruxolitinib

Question 47

Risk factors of JAK kinase inhibitors

Answer 47

Lipid dysfunction, CVS event, bowel perforation, diverticulitis, clots, shingles, skin malignancy

Question 48

Name a IL 6 drug

Answer 48

Tocilizumab

Question 49

Risk factors of IL 6 drugs

Answer 49

Bowel perforation, diverticulitis, lipid dysfunction, cytoplasm

Question 50

Important management when taking Rituximab

Answer 50

Vaccination against COVID and strep.