Indian Journal of Rheumatology 2008 December Volume 3, Number 4; p.

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PG Forum

Rheumatology Quiz
V Arya1, V Dhir2

1. Oesophageal involvement in all of the following disorders is predominantly of the lower oesophageal sphincter (LES) except (a) Inflammatory myopathy (b) Rheumatoid arthritis (c) Systemic lupus erythematous (d) Mixed connective tissue disease 2. Vasculitic and atherosclerotic lesions on 18 FDG PET are distinguished by all the following except (a) Atherosclerotic lesions appear as hot spots (b) Vasculitic lesions appear smooth and linear (c) Uptake of 18 FDG is more intense in vasculitic lesions (d) Luminal flow is less in areas of vasculitic lesions 3. Which of the following is false for patellofemoral osteoarthritis (OA)? (a) Osteophytes do not correlate with pain (b) Lateral patellofemoral OA progression is more frequent than medial (c) Patellar subluxation predisposes to the condition (d) Valgus malalignment associates more strongly with patellofemoral OA than tibiofemoral OA 4. Which of the following is false about Fractalkine, a new inflammatory marker (a) It is a chemokine of the CX3CL1 family (b) Exists as both soluble and membrane bound forms (c) Mostly implicated in the pathogenesis of RA (d) Requires glycosaminoglycans for adhesion 5. All the following are true regarding Pegloticase except (a) Potent uric acid lowering drug (b) Given orally (c) Works by converting uric acid to allantoin

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(d) Anti-pegloticase antibodies develop in 75% of patients Ferris major classification criteria for mixed cryoglobulinemia include all except (a) Low C4 levels (b) Leukocytoclastic vasculitis (c) Hepatitis C virus positivity (d) Purpura The arthritis associated with Hepatitis C virus infection can be distinguished from rheumatoid arthritis by all except (a) Pattern of joint involvement (b) Non-erosive character (c) Lack of anti-CCP positivity (d) Response to anti-viral therapy Which of the following is false about carcinomatous polyarthritis (a) Not associated with metastases/tumour extension (b) Has an insidious onset (c) Lower limb predominance with sparing of wrists (d) Commoner in older patients Erythromelalgia has the following characteristics except (a) Predominantly involves the feet (b) Often associated with thrombocythemia (c) Exacerbated by cold (d) Best treated with aspirin Which of the following is not a feature of EhlersDanlos syndrome type IV (a) Hyperextensibility of large joints (b) Repeated arterial ruptures (c) Mitral valve prolapse (d) Spontaneous hemopneumothorax For answers refer to page 173

Department of Medicine, JIPMER, Puduchery and 2Department of Immunology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India. Correspondence: Dr. V Arya, email: linuxphoenix@gmail.com

What is your diagnosis?

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ACKNOWLEDGEMENT
Source of funding: Nil. Disclosure statement: Authors have declared no conflict of interest.

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REFERENCES
1. Davis MD, Daoud MS, Kirby B, Gibson LE, Rogers RS, 3rd. Clincopathologic correlation of hypocomplementemic and normocomplementemic urticarial vasculitis. J Am Acad Dermatol 1998; 38: 899905.

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Wisnieski JJ, Baer AN, Christensen J, Cupps TR, Flagg DN, Jones JV , et al. Hypocomplementemic urticarial vasculitis syndrome. Clinical and serological findings in 18 patients. Medicine (Baltimore) 1995; 74: 2441. Trendelenburg M, Courvoisier S, Spath PJ, Moll S, Mihatsch M, Itin P, et al. Hypocomplementemic urticarial vasculitis or systemic lupus erythematosus? Am J Kidney Dis 1999; 34: 74551. Chen HJ, Bloch KJ. Hypocomplementemic urticarial vasculitis, Jaccouds arthropathy, valvular heart disease, and reversible tracheal stenosis; a surfeit of syndromes. J Rheumatol 2001; 28: 3836.

ANSWERS TO THE RHEUMATOLOGY QUIZ (page 171)

1c*, 2d**, 3a, 4d, 5b***, 6c, 7a, 8b, 9c, 10a *MCTDlower oesophageal sphincter, RA and inflammatory myopathyboth upper and lower oesophageal sphincters affected. **18 FDG PET does not provide information about luminal flow or wall structure.

***Given by intravenous infusion. This is a minor criterion. Pattern of joint involvement mimics RA. Paraneoplastic syndrome which usually has an explosive onset. Worsened by heat. Hyperelastic skin and hyperextensible large joints are not seen in this type, also known as the vascular type.