Indian Journal of Rheumatology 2010 June

PG Forum
Volume 5, Number 2; pp. 89–90

Rheumatology quiz
Downloaded from http://journals.lww.com/ijru by BhDMf5ePHKav1zEoum1tQfN4a+kJLhEZgbsIHo4XMi0hCywCX1AW

V Dhir1, V Arya2
nYQp/IlQrHD3i3D0OdRyi7TvSFl4Cf3VC1y0abggQZXdtwnfKZBYtws= on 03/17/2023

1. Which of the following is true for ILD in systemic 5. Which of the following is false for Takayasu arteritis?
sclerosis? (a) systemic features, new onset claudication, raised
(a) autopsy and HRCT show 70% of lungs have ILD ESR are all features of disease activity
(b) FVC < 80% is found in 80% (b) hypertension is usually due to renal artery stenosis
(c) majority of involved lungs show rapid progression (c) light headedness signifies carotid involvement
(d) reduction in DLCO is a sensitive measure of early (d) systemic symptoms occur in about half the patient
ILD population
2. Which of the following is seen in anemia of chronic 6. Which of the following is false for Paget’s disease?
disease? (a) polyostotic is more common than single site
(a) Hepcidin is increased involvement
(b) Soluble transferrin receptor is increased (b) axial skeleton is the commonest site
(c) Reticulocyte index can help to differentiate it from (c) pelvic involvement is symmetric and can resemble
iron deficiency anemia fluorosis
(d) Serum ferritin is reduced (d) osteoporosis circumscripta is characteristic
3. Which of the following is true for GI involvement in 7. Which of the following is not true for AA amyloidosis?
systemic sclerosis? (a) commonest associated rheumatic disease is RA
(a) severity of cutaneous and GI manifestations correlate (b) biopsy of subcutaneous tissue, duodenum or labial
(b) small intestine is the commonest involvement salivary gland has high sensitivity (> 90%)
(c) oesophagus shows decreased lower oesophageal (c) Congo red stain is not decolourized by KMnO4
sphincter pressure (d) serum amyloid P nuclear scan is useful for assess-
(d) about two third of patients have constipation, diar- ing disease extent
rhea and/or fecal incontinence
8. Which of the following statement is true regarding IFN
4. Which of the following is true for lymphoma in autoim- gamma release assays for the diagnosis of tuberculosis?
mune diseases? (a) the first generation Quantiferon TB test used
(a) EBV-related diffuse large cell lymphoma is com- ESAT-6
monest in RA (b) the second generation Quantiferon TB test (Gold)
(b) risk factors in Sjogren’s syndrome include low used ESAT-6 and CFP-10
complement levels and RF positivity (c) these assays can differentiate M. tuberculosis vs.
(c) incidence of lymphomas is not increased in SLE M. bovis
(d) DMARD treatment is significantly associated with (d) none of the non-tubercular mycobacteria give a
lymphoma in RA positive result with this test (unlike Mantoux test)

1
Department of Medicine, PGIMER and Dr R.M.L. Hospital, New Delhi and 2Department of Medicine, All India Institute of Medical Sciences,
New Delhi 110 029, India.
Correspondence: Dr. V Arya, email: [email protected]
 90 Indian Journal of Rheumatology 2010 June; Vol. 5, No. 2 Dhir and Arya

9. Which of the following is true of renal failure with 10. Which of the following is not true of diffuse alveolar
arthritis? haemorrhage?
Downloaded from http://journals.lww.com/ijru by BhDMf5ePHKav1zEoum1tQfN4a+kJLhEZgbsIHo4XMi0hCywCX1AW

(a) in case of infective arthritis—it may be polyarticu- (a) infiltrates are usually bilateral and symmetric
lar and fever may not be present (b) usually perihilar and basal infiltrates
(b) ESR and CRP are elevated (c) air bronchograms are common
(c) basic calcium phosphate deposition presents as (d) CT in Wegener’s granulomatosis may show nodules
chronic polyarthritis and ground glassing
nYQp/IlQrHD3i3D0OdRyi7TvSFl4Cf3VC1y0abggQZXdtwnfKZBYtws= on 03/17/2023

(d) amyloid arthropathy is unrelated to the duration of

CRF/dialysis For answers refer to page 94

IAP-Rheumatology Chapter Mid Term CME

IAP Goa invites you for the 2nd National Mid Term CME
of the Rheumatology Chapter of IAP on 18th July 2010
at Goa Medical College Auditorium.
Faculty: Dr. Sujata Sawhney, Delhi; Dr. Raju Khubchandani, Mumbai
Case based format for common pediatric rheumatological problems.
Registration Fee: Rs. 400/ Cheque/Demand Draft in favour of
“Goa Association of Pediatricians” payable at Panaji Goa.
Please add Rs. 50/for outstation cheques.
Contact: Dr. Chetna Khemani C/o Criticare Hospital,
Organising Secretary Opp. Parade Ground,
9920113678, 9850969822 Campal, Panaji, Goa – 403001
[email protected]
 94 Indian Journal of Rheumatology 2010 June; Vol. 5, No. 2 Rao et al

The patient had oncogenic osteomalacia due to malig- computerized tomogram of the paranasal sinuses and 3-
nant haemangiopericytoma. Oncogenic osteomalacia is pri- dimensional treatment planning system with wedge and
Downloaded from http://journals.lww.com/ijru by BhDMf5ePHKav1zEoum1tQfN4a+kJLhEZgbsIHo4XMi0hCywCX1AW

marily described in adults, but can also occur in children and appropriate shielding to the contralateral lens with cobalt
adolescents. It is characterized by proximal muscle weak- 60 machine. At follow-up after 3 months, the patient
ness, bone pains and fractures. The characteristic laboratory showed good symptomatic relief in pain and CT scan of
parameters are hypophosphataemia, hyperphosphaturia and PNS showed good regression of the lesion.
inappropriately normal/low plasma 1,25(OH)2D3 concen-
nYQp/IlQrHD3i3D0OdRyi7TvSFl4Cf3VC1y0abggQZXdtwnfKZBYtws= on 03/17/2023

tration.1 Haemangiopericytoma is the most dominant histo-

logic diagnosis noted.
The tumours secrete phosphatonins, factors involved in REFERENCES
the regulation of phosphate homeostasis such as the
secreted frizzle-related protein 4 (sFRP-4), the fibroblast 1. Clunie GP, Fox PE, Stamp TC. Four cases of acquired
growth factors 7 and 23 (FGF-7/-23) or the matrix extracel- hypophosphataemic (‘oncogenic’) osteomalacia. Problems of
lular phosphoglycoprotein (MEPE).2 These factors upregu- diagnosis, treatment and long-term management. Rheumatology
late the renal sodium phosphate co-transporter, resulting in (Oxford) 2000; 39: 1415–21.
renal phosphate wasting. 2. Woznowski M, et al. Oncogenic osteomalacia, a rare paraneo-
Locating an occult tumour is best done by Octreotide- plastic syndrome due to phosphate wasting—a case report and
labelled In-111 nuclear scintigraphy scan as the tumour review of the literature. Clin Nephrol 2008; 70: 431–8.
expresses somatostatin receptors.3 This should be followed 3. Rhee Y, et al. Oncogenic osteomalacia associated with mesen-
by CT or MRI of the specific site. One report recommends chymal tumour detected by indium-111 octreotide scintigraphy.
careful imaging of the nasal sinuses as a part of the work-up Clin Endocrinol (Ox) 2001; 54: 551–4.
of cases of oncogenic osteomalacia.4 4. Kenealy H, Holdaway I Grey A. Occult nasal sinus tumours
Surgical removal of the primary tumour to prompt reversal causing oncogenic osteomalacia. Eur J Intern Med 2008; 19:
of the symptoms, biochemical abnormalities and healing of 516–9.
the bone disease.5 Malignant varieties require postoperative 5. Folpe AL, et al. Most osteomalacia-associated mesenchymal
irradiation. In inoperable tumours, phosphate wasting may tumors are a single histopathologic entity: an analysis of 32
be relieved by treatment with somatostatin analogues.6 cases and a comprehensive review of the literature. Am J Surg
Our patient received external radiation treatment for the Pathol 2004; 28: 1–30.
lesion at a dose of 63 Gy/35#, 5# a week for seven weeks. The 6. Seufert J, et al. Octreotide therapy for tumor-induced osteo-
treatment planning was done by using contrast-enhanced malacia. N Engl J Med 2001; 45: 1883–8.

ANSWERS TO THE RHEUMATOLOGY QUIZ †

DLBCL in RA is usually unrelated to EBV
††
(page 90) Light headedness is usually due to vertebral artery
involvement
†††
1d*, 2a, 3c**, 4b†, 5c††, 6c†††, 7c, 8b§, 9a§§, 10a§§§ Pelvic involvement is usually asymmetric
§
*More than 90% on HRCT and autopsy, FVC < 80% in First generation use PPD, most but not all non-tubercular
25–40% mycobacteria are excluded by second generation tests
§§
**Oesophagus is the commonest site, one third have BCP presents as tendonitis, usually acute
§§§
constipation Infiltrates are usually asymmetric, although bilateral