- Email: [email protected]
Rheumatology quiz
Indian Journal of Rheumatology 2006 December Volume 1, Number 3; p. 129
PG Forum
Rheumatology quiz V Arya1, V Dhir2
1. Scleredema adultorum of Buschke differs from Systemic sclerosis in: (a) Slower evolution of skin changes (b) Sparing of hands and feet (c) Sparing of facial skin (d) Obliteration of dermal appendages on skin biopsy 2. Which of the following is a form of lobular panniculitis? (a) Weber–Christian disease (b) Erythema nodosum (c) Erythema induratum (d) Lupus profundus 3. Patients with antibodies to signal recognition protein (anti-SRP) have all the following except: (a) Pure polymyositis (b) Good response to treatment (c) Progressive disease (d) Higher frequency of cardiomyopathy 4. Which of the following drugs does not require a dosage adjustment in renal insufficiency? (a) Methotrexate (b) Sulphasalazine (c) d-Penicillamine (d) Colchicine 5. Which of the following drugs is not removed by hemodialysis? (a) Azathioprine (b) Prednisolone (c) Methotrexate (d) Cyclophosphamide
6. Which of these is not a feature of Lofgren’s syndrome? (a) Erythema nodosum (b) Arthritis (c) Hilar adenopathy (d) Uveitis 7. Which of these antihypertensive agents lowers serum uric acid? (a) Atenolol (b) Amlodipine (c) Losartan (d) Clonidine 8. All the following are features of septic arthritis in intravenous drug abusers except: (a) High mortality (b) S. aureus is the most common causative organism (c) Increased involvement of the axial skeleton (d) Insidious course 9. Following are true about HIV-associated arthritis except: (a) Mucocutaneous involvement is common (b) Usually involves knees and ankles (c) Symptoms usually do not recur (d) Enthesopathy is not seen 10. ‘Prayer sign’ is seen in: (a) Amyloidosis (b) Psoriatic arthritis (c) Diabetic cheiroarthopathy (d) Primary generalized osteoarthritis For answer refer to page 134
1
Clinical Immunology and Rheumatology Service, Department of Medicine, All India Institute of Medical Sciences, New Delhi, India, Department of Immunology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow. Correspondence: Dr. V Arya, email: [email protected]
2
Indian Journal of Rheumatology 2006 December Volume 1, Number 3; p. 134
Correspondence
Correspondence Dear Editor, Read Professor Misra’s Perspective with great interest.1 It gave me a sense of de ja vu. In the years gone-by, with mighty (physically as well as politically) orthopaedic surgeons of the past (and some of them of present as well) holding most of the top administrative posts related to health care (President, Medical Council of India; Director General Health Services and others) tiny little young physicians just returning from abroad trained in clinical and laboratory aspects of rheumatology had no chance of claiming rheumatology as a separate subspecialty of Internal Medicine. I still remember when I was told “What rheumatology—it is just a small chapter in the textbook of Orthopaedic surgery.” I also remember being the butt of jokes in Orthopaedics department (residents used to convey these gossipy things) ‘What is that new name he uses ‘Seronegative’ (he is ‘zeronegative’!) spondo…do…do…\!!?’ And finally conveying, ‘What rheumatoid? Once joints are replaced no disease is left for him to treat!’ Hopefully, those days are gone and rheumatology as a super-(not sub-) specialty of Internal Medicine has been recognised the world over as well as in most hospitals and several medical schools (Chennai, Hyderabad, KGMU Lucknow) in India. I would strongly recommend to those at the helm of affairs to recognise this superspecialty and appoint formally trained rheumatologists to head these departments so that post-doctoral (DM/DNB) degree courses are started to fill the chiasm between demand and supply of specialists in this field. What about ‘clinical immunology’? Well, clinical immunology is the backbone of research, investigations and day-to-day care of patients with systemic rheumatic autoimmune diseases.
A thorough grounding in immunological concepts and handson experience in conducting the routine and not-so-routine investigations is essential for modern-day rheumatologists. Thus, ‘clinical immunology’ would remain the ‘backbone’ of investigations for clinical and research work of rheumatologists. However, I wish to point out that clinical immunology is not in lieu to rheumatology practice. The reason is simple. Ninety percent of musculoskeletal problems are life-style or trauma related, or developmental mechanical, structural non-inflammatory problems, nothing to do with systemic autoimmunity! Field of rheumatology is, therefore, much wider than autoimmune diseases. My colleagues should now take courage, without being self-conscious and without any feeling of guilt or embarrassment, to forcefully promote rheumatology and get departments of rheumatology going in most medical institutions in the country. Yours sincerely AN Malaviya Consultant Rheumatologist ‘A&R Clinic for Arthritis and Rheumatism’ and ISIC Superspeciality Hospital Vasant Kunj, New Delhi email: [email protected]
REFERENCE 1.
Misra R. What should we foster in India: Clinical immunology or rheumatology? Ind J Rheumatol 2006; 1: 26–8.
ANSWERS TO RHEUMATOLOGY QUIZ (page 129) 1b*, 2a, 3b**, 4b, 5c, 6d, 7c***, 8a†, 9a††, 10c††† Hands and feet are characteristically spared in scleredema. ** Anti-SRP + disease responds very poorly to treatment. *** This makes losartan a very useful drug in gout with hypertension.
*
With appropriate treatment, septic arthritis in HIV patient has a very good outcome. †† Mucocutaneous involvement is characteristically absent. ††† This sign results from inability to extend the fingers due to skin tightening. †
PG Forum
Rheumatology quiz V Arya1, V Dhir2
1. Scleredema adultorum of Buschke differs from Systemic sclerosis in: (a) Slower evolution of skin changes (b) Sparing of hands and feet (c) Sparing of facial skin (d) Obliteration of dermal appendages on skin biopsy 2. Which of the following is a form of lobular panniculitis? (a) Weber–Christian disease (b) Erythema nodosum (c) Erythema induratum (d) Lupus profundus 3. Patients with antibodies to signal recognition protein (anti-SRP) have all the following except: (a) Pure polymyositis (b) Good response to treatment (c) Progressive disease (d) Higher frequency of cardiomyopathy 4. Which of the following drugs does not require a dosage adjustment in renal insufficiency? (a) Methotrexate (b) Sulphasalazine (c) d-Penicillamine (d) Colchicine 5. Which of the following drugs is not removed by hemodialysis? (a) Azathioprine (b) Prednisolone (c) Methotrexate (d) Cyclophosphamide
6. Which of these is not a feature of Lofgren’s syndrome? (a) Erythema nodosum (b) Arthritis (c) Hilar adenopathy (d) Uveitis 7. Which of these antihypertensive agents lowers serum uric acid? (a) Atenolol (b) Amlodipine (c) Losartan (d) Clonidine 8. All the following are features of septic arthritis in intravenous drug abusers except: (a) High mortality (b) S. aureus is the most common causative organism (c) Increased involvement of the axial skeleton (d) Insidious course 9. Following are true about HIV-associated arthritis except: (a) Mucocutaneous involvement is common (b) Usually involves knees and ankles (c) Symptoms usually do not recur (d) Enthesopathy is not seen 10. ‘Prayer sign’ is seen in: (a) Amyloidosis (b) Psoriatic arthritis (c) Diabetic cheiroarthopathy (d) Primary generalized osteoarthritis For answer refer to page 134
1
Clinical Immunology and Rheumatology Service, Department of Medicine, All India Institute of Medical Sciences, New Delhi, India, Department of Immunology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow. Correspondence: Dr. V Arya, email: [email protected]
2
Indian Journal of Rheumatology 2006 December Volume 1, Number 3; p. 134
Correspondence
Correspondence Dear Editor, Read Professor Misra’s Perspective with great interest.1 It gave me a sense of de ja vu. In the years gone-by, with mighty (physically as well as politically) orthopaedic surgeons of the past (and some of them of present as well) holding most of the top administrative posts related to health care (President, Medical Council of India; Director General Health Services and others) tiny little young physicians just returning from abroad trained in clinical and laboratory aspects of rheumatology had no chance of claiming rheumatology as a separate subspecialty of Internal Medicine. I still remember when I was told “What rheumatology—it is just a small chapter in the textbook of Orthopaedic surgery.” I also remember being the butt of jokes in Orthopaedics department (residents used to convey these gossipy things) ‘What is that new name he uses ‘Seronegative’ (he is ‘zeronegative’!) spondo…do…do…\!!?’ And finally conveying, ‘What rheumatoid? Once joints are replaced no disease is left for him to treat!’ Hopefully, those days are gone and rheumatology as a super-(not sub-) specialty of Internal Medicine has been recognised the world over as well as in most hospitals and several medical schools (Chennai, Hyderabad, KGMU Lucknow) in India. I would strongly recommend to those at the helm of affairs to recognise this superspecialty and appoint formally trained rheumatologists to head these departments so that post-doctoral (DM/DNB) degree courses are started to fill the chiasm between demand and supply of specialists in this field. What about ‘clinical immunology’? Well, clinical immunology is the backbone of research, investigations and day-to-day care of patients with systemic rheumatic autoimmune diseases.
A thorough grounding in immunological concepts and handson experience in conducting the routine and not-so-routine investigations is essential for modern-day rheumatologists. Thus, ‘clinical immunology’ would remain the ‘backbone’ of investigations for clinical and research work of rheumatologists. However, I wish to point out that clinical immunology is not in lieu to rheumatology practice. The reason is simple. Ninety percent of musculoskeletal problems are life-style or trauma related, or developmental mechanical, structural non-inflammatory problems, nothing to do with systemic autoimmunity! Field of rheumatology is, therefore, much wider than autoimmune diseases. My colleagues should now take courage, without being self-conscious and without any feeling of guilt or embarrassment, to forcefully promote rheumatology and get departments of rheumatology going in most medical institutions in the country. Yours sincerely AN Malaviya Consultant Rheumatologist ‘A&R Clinic for Arthritis and Rheumatism’ and ISIC Superspeciality Hospital Vasant Kunj, New Delhi email: [email protected]
REFERENCE 1.
Misra R. What should we foster in India: Clinical immunology or rheumatology? Ind J Rheumatol 2006; 1: 26–8.
ANSWERS TO RHEUMATOLOGY QUIZ (page 129) 1b*, 2a, 3b**, 4b, 5c, 6d, 7c***, 8a†, 9a††, 10c††† Hands and feet are characteristically spared in scleredema. ** Anti-SRP + disease responds very poorly to treatment. *** This makes losartan a very useful drug in gout with hypertension.
*
With appropriate treatment, septic arthritis in HIV patient has a very good outcome. †† Mucocutaneous involvement is characteristically absent. ††† This sign results from inability to extend the fingers due to skin tightening. †