MRCP Part 2 (Rheumatology)

Most common ocular manifestation of RA? - answer-Keratoconjunctivitis sicca Treatment of discoid lupus - answer-Topical steroids and if they fail, PO HCQ Erythema ab igne increases the risk of what malignancy? - answer-SCC When is skin prick and patch testing needed? - answer-Skin prick- food allergies and pollen Skin patch- contact dermatitis Renal failure, haemoptysis and a normal ESR - answer-Goodpasture's syndrome What drug can exacerbate Churg-strauss? - answer-Leukotriene receptor antagonists e.g montelukast At what stage do you treat vitamin D deficiency? - answer-30 50 if high risk, e.g fragility fracture, osteoporosis, high PTH, malabsorption Symptoms of Cryoglobulinemia? (4) - answer-Disease? Raynauds (type I), vascular purpura, arthralgia, diffuse glomerulonephritis Cryoglobulinemia type II associated with which infectious disease? - answer-Hepatitis C SLE associated with which HLA? - answer-HLA B8, DR2, DR3 Symptoms most commonly seen in drug induced lupus? (4) - answer-Arthralgia myalgia Malar rash Pulmonary involvement eg pleurisy Safe drugs to treat RA in pregnancy - answer-HCQ Sulfasalazine NSAIDs up to 32 weeks Low dose prednisolone Mechanism of action of Raloxifene - answer-Selective oestrogen receptor modulator in osteoporosis Increases VTE risk MOA of Strontium ranelate - answer-Increases deposition of new bone by osteoblasts and reduces the resorption of bone by inhibiting osteoclasts MOA of Denosumab - answer-Inhibits RANK ligand to inhibit maturation of osteoclasts MOA of bisphosphonates - answer-Inhibits osteoclast-mediated bone-resorption Name the disease Multiple genital ulcers, thrombophlebitis, arthritis, erythema nodosum, aseptic meningitis, DVT - answer-Bechet's disease Recommended treatments in Fibromyalgia (4) - answer-Explanation Aerobic exercise (strongest evidence) CBT Pregabalin, duloxetine, amitriptyline Most common ocular manifestation of RA - answer-Keratoconjunctivitis sicca High/low/normal in Pagets: ALP, Ca, PO4 - answer-High ALP, normal calcium and phosphate Treatment of Paget's - answer-IV Bisphosphonates Hyper or hypothyroid in pseudogout? - answer-Hypothyroid 1st line management in Ank Spond? - answer-Exercise and NSAIDS (sulphasalazine only if peripheral joint involvement) Mixed CTD features? - answer-Features of SLE, Systemic sclerosis and polymyositis Anastrozole can have what effect on bones? - answer-Breast cancer drug. Causes osteoporosis What is the disease: low calcium, low phosphate, high alk phosphate - answer-Osteomalacia Risk of what cardiovascular pathology is increased in RA? - answer-IHD What stage of Sarcoid do you treat and with what? - answer-Treat stage IIIA-III if symptomatic PO pred 4 weeks What is bisphosphonate failure and how do you treat? - answer-2 or more # on tx or 1 or more # with decrease in BD Which 2 aren't features of PAN? 1. fever, malaise, arthralgia 2. weight gain 3. hypertension 4. mononeuritis multiplex, 5. sensorimotor polyneuropathy 6. testicular pain 7. livedo reticularis 8. haematuria, renal failure 9. C-ANCA 10. hepatitis B serology positive in 30% of patients - answer-Weight loss not gain P-ANCA not C-ANCA (Ix- renal angiogram to confirm) Treatment GCA? - answer-PO pred 60mg for uncomplicated GCA or established visual loss IVMP if transient visual loss Diagnosis? 6 months recurrent pains in both feet. - answer-Gout Treatment for PMR? - answer-Pred 15mg with tapering dose for 2 years What systemic can be used in Ank *S*pond? - answer-*S*ulphasalazine can only be used in peripheral arthritis Dagger sign on spinal XR is seen in...? - answer-Ank Spond What do anti RNA polymerase III, anti-PM-Scl and anti-U3-RNP antibodies mean in sceroderma? - answer-anti RNA polymerase III- higher risk scleroderma renal crisis anti-PM-Scl- higher risk myositis anti-U3-RNP- higher risk pulmonary HTN On XRay you see ossification of tendinous and ligamentous insertions of spine of 80 yr old F. Diagnosis? - answer-DISH DMARD of choice in psoriatic arthritis? - answer-Methotrexate. Effective on arthritis but also dramatic improvement in skin. (second line leflu and if predominant axial then infliximab) Guidelines for starting biologics in RA? - answer-Two DMARDs (including methotrexate), with two DAS 28 scores 5.1 at least one month apart Diagnosis? Acute attack of abdominal pain, chest pain, synovitis and pyrexia with similar episodes before? - answer-Familial mediterranean fever Mx- Colchicine Diagnosis? Man with a headache, high ALP - answer-Paget's Diagnosis? 6-year history of increasing deformity in her hands. She had no joint pain but complained of fatigue, dry eyes and intermittent pleuritic chest pain. On examination, she had no joint tenderness. The appearance of her hands is shown. The deformity of her hands was passively reducible. - answer-Jaccoud's arthropathy of SLE (cannot be corrected if true deformity) CK in PMR? - answer-Normal Management of 22 year old, painful swollen R knee, no PMH. Aspiration shows calcium pyrophosphate crystals - answer-IV Abx- Although calcium pyrophosphate crystals are most associated with pseudo gout they do not rule out septic arthritis. Diagnosis? Numb, weak hands, purpuric rash. P-ANCA positive, ANA positive, anti DS-DNA negative - answer-Microscopic polyangiitis (purpura rules out PAN)