Indian Journal of Rheumatology 2010 June
PG Forum
Volume 5, Number 2; pp. 89–90
Rheumatology quiz
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V Dhir1, V Arya2
nYQp/IlQrHD3i3D0OdRyi7TvSFl4Cf3VC1y0abggQZXdtwnfKZBYtws= on 03/17/2023
1. Which of the following is true for ILD in systemic
sclerosis?
(a) autopsy and HRCT show 70% of lungs have ILD
(b) FVC < 80% is found in 80%
(c) majority of involved lungs show rapid progression
(d) reduction in DLCO is a sensitive measure of early
ILD
2. Which of the following is seen in anemia of chronic
disease?
(a) Hepcidin is increased
(b) Soluble transferrin receptor is increased
(c) Reticulocyte index can help to differentiate it from
iron deficiency anemia
(d) Serum ferritin is reduced
3. Which of the following is true for GI involvement in
systemic sclerosis?
(a) severity of cutaneous and GI manifestations correlate
(b) small intestine is the commonest involvement
(c) oesophagus shows decreased lower oesophageal
sphincter pressure
(d) about two third of patients have constipation, diar-
rhea and/or fecal incontinence
4. Which of the following is true for lymphoma in autoim-
mune diseases?
(a) EBV-related diffuse large cell lymphoma is com-
monest in RA
(b) risk factors in Sjogren’s syndrome include low
complement levels and RF positivity
(c) incidence of lymphomas is not increased in SLE
(d) DMARD treatment is significantly associated with
lymphoma in RA
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: linuxphoenix@gmail.com
5. Which of the following is false for Takayasu arteritis?
(a) systemic features, new onset claudication, raised
ESR are all features of disease activity
(b) hypertension is usually due to renal artery stenosis
(c) light headedness signifies carotid involvement
(d) systemic symptoms occur in about half the patient
population
6. Which of the following is false for Paget’s disease?
(a) polyostotic is more common than single site
involvement
(b) axial skeleton is the commonest site
(c) pelvic involvement is symmetric and can resemble
fluorosis
(d) osteoporosis circumscripta is characteristic
7. Which of the following is not true for AA amyloidosis?
(a) commonest associated rheumatic disease is RA
(b) biopsy of subcutaneous tissue, duodenum or labial
salivary gland has high sensitivity (> 90%)
(c) Congo red stain is not decolourized by KMnO4
(d) serum amyloid P nuclear scan is useful for assess-
ing disease extent
8. Which of the following statement is true regarding IFN
gamma release assays for the diagnosis of tuberculosis?
(a) the first generation Quantiferon TB test used
ESAT-6
(b) the second generation Quantiferon TB test (Gold)
used ESAT-6 and CFP-10
(c) these assays can differentiate M. tuberculosis vs.
M. bovis
(d) none of the non-tubercular mycobacteria give a
positive result with this test (unlike Mantoux test)
 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?
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(a) in case of infective arthritis—it may be polyarticu-
lar and fever may not be present
(b) ESR and CRP are elevated
(c) basic calcium phosphate deposition presents as
chronic polyarthritis
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(a) infiltrates are usually bilateral and symmetric
(b) usually perihilar and basal infiltrates
(c) air bronchograms are common
(d) CT in Wegener’s granulomatosis may show nodules
and ground glassing

(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
chetnakhemani@yahoo.com
 94 Indian Journal of Rheumatology 2010 June; Vol. 5, No. 2
The patient had oncogenic osteomalacia due to malig-
nant haemangiopericytoma. Oncogenic osteomalacia is pri-
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marily described in adults, but can also occur in children and
adolescents. It is characterized by proximal muscle weak-
ness, bone pains and fractures. The characteristic laboratory
parameters are hypophosphataemia, hyperphosphaturia and
inappropriately normal/low plasma 1,25(OH)2D3 concen-
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tration.1 Haemangiopericytoma is the most dominant histo-
logic diagnosis noted.
The tumours secrete phosphatonins, factors involved in
the regulation of phosphate homeostasis such as the
secreted frizzle-related protein 4 (sFRP-4), the fibroblast
growth factors 7 and 23 (FGF-7/-23) or the matrix extracel-
lular phosphoglycoprotein (MEPE).2 These factors upregu-
late the renal sodium phosphate co-transporter, resulting in
renal phosphate wasting.
Locating an occult tumour is best done by Octreotide-
labelled In-111 nuclear scintigraphy scan as the tumour
expresses somatostatin receptors.3 This should be followed
by CT or MRI of the specific site. One report recommends
careful imaging of the nasal sinuses as a part of the work-up
of cases of oncogenic osteomalacia.4
Surgical removal of the primary tumour to prompt reversal
of the symptoms, biochemical abnormalities and healing of
the bone disease.5 Malignant varieties require postoperative
irradiation. In inoperable tumours, phosphate wasting may
be relieved by treatment with somatostatin analogues.6
Our patient received external radiation treatment for the
lesion at a dose of 63 Gy/35#, 5# a week for seven weeks. The
treatment planning was done by using contrast-enhanced
ANSWERS TO THE RHEUMATOLOGY QUIZ
(page 90)
1d*, 2a, 3c**, 4b†, 5c††, 6c†††, 7c, 8b§, 9a§§, 10a§§§
*More than 90% on HRCT and autopsy, FVC < 80% in
25–40%
**Oesophagus is the commonest site, one third have
constipation
Rao et al
computerized tomogram of the paranasal sinuses and 3-
dimensional treatment planning system with wedge and
appropriate shielding to the contralateral lens with cobalt
60 machine. At follow-up after 3 months, the patient
showed good symptomatic relief in pain and CT scan of
PNS showed good regression of the lesion.
REFERENCES
1. Clunie GP, Fox PE, Stamp TC. Four cases of acquired
hypophosphataemic (‘oncogenic’) osteomalacia. Problems of
diagnosis, treatment and long-term management. Rheumatology
(Oxford) 2000; 39: 1415–21.
2. Woznowski M, et al. Oncogenic osteomalacia, a rare paraneo-
plastic syndrome due to phosphate wasting—a case report and
review of the literature. Clin Nephrol 2008; 70: 431–8.
3. Rhee Y, et al. Oncogenic osteomalacia associated with mesen-
chymal tumour detected by indium-111 octreotide scintigraphy.
Clin Endocrinol (Ox) 2001; 54: 551–4.
4. Kenealy H, Holdaway I Grey A. Occult nasal sinus tumours
causing oncogenic osteomalacia. Eur J Intern Med 2008; 19:
516–9.
5. Folpe AL, et al. Most osteomalacia-associated mesenchymal
tumors are a single histopathologic entity: an analysis of 32
cases and a comprehensive review of the literature. Am J Surg
Pathol 2004; 28: 1–30.
6. Seufert J, et al. Octreotide therapy for tumor-induced osteo-
malacia. N Engl J Med 2001; 45: 1883–8.
†
DLBCL in RA is usually unrelated to EBV
††
Light headedness is usually due to vertebral artery
involvement
†††
Pelvic involvement is usually asymmetric
§
First generation use PPD, most but not all non-tubercular
mycobacteria are excluded by second generation tests
§§
BCP presents as tendonitis, usually acute
§§§
Infiltrates are usually asymmetric, although bilateral