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MSK > Disease > Flashcards

Disease Flashcards

1
Q

What are the presenting symptoms of dermamyositis?

A

tired muscles, functional difficulty, muscle pain, distinctive rash

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2
Q

Why is the use of steroids and statins significant in dermamyositis?

A

Steroids and statins can cause muscle pain

Statins can cause inflammatory reaction too

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3
Q

What examinations for dermamyositis?

A 
Confrontational test (your power against theirs)
Isotonic tests (30 sec to stand and sit)
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4
Q

Inclusion body myositis affects proximal muscles

A

F

DISTAL muscles i.e. weakness in hands

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5
Q

CK levels are - in Inclusion body myositis than poly/dermamyositis

A

LOWER

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6
Q

poly/dermamyositis patients respond - to treatment than inclusion body myositis patients

A

BETTER

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7
Q

What is the most definitive test for polymyositis?

A

Muscle biopsy

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8
Q

What are the key symptoms of giant cell arteritis?

A 
Jaw claudication
Amaurosis fugax
Temporal artery - tender, enlarges and non pulsatile
Scalp tenderness
Headache
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9
Q

Giant cell arteritis shows rapid and dramatic response to low dose steroids

A

T

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10
Q

FIbromyalgia is an inflammatory condition

A

F

NOT associated with inflammation

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11
Q

WHen should DMARDs be started in rheumatoid arthritis?

A

Within 3 months of symptoms starting

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12
Q

What is the first line treatment for rheumatoid arthritis?

A

Methotrexate (dmard) unless there are contraindications

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13
Q

What are the top 5 side effects of NSAIDs?

A
  1. Heart failure
  2. GI problems, peptic ulcers
  3. Renal failure
  4. Allergic reaction
  5. asthma
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14
Q

DMARDs are - actg, they act within - to -. bECAUSE OF THIS THEY ARE OFTEN STARTED WITH -

A

slow weeks months

STEROIDS

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15
Q

DMARDs side effects?

A

Nausea
hepatitis
low white cell counts
REGULAR BLOOD TESTS NECESSARY

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16
Q

It’s important to slowly wean patients off steroids

A

T

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17
Q

If window of opportunity for therapy missed in RA can cause irreversible loss of fucntion

A

T

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18
Q

Methotraxate is safe to use in pregnancy

A

F

tetragenic and must be stopped in both MEN AND WOMEN if having babies

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19
Q

Methotrexate side effects?

A 
Nausea
Mouth ulcers
Leucopenia (low neutrophil levels)
Hepatitis
Pneumonitis (acute inflammatory lung problem - comes on quickly after starting)
Teratogenic
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20
Q

What is leflunomide?

A

Oral DMARD
used if methotrexate presents with side effects
Long half life

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21
Q

Sulfasalazine can cause steven johnson syndrome - what this?

A

cell death causes seperation of the epidermis and dermis, resulting in huge ulceration

22
Q

Sulfasalizine causes an irreversible reduction in sperm count

A

F

reversible

23
Q

Irreversible retinopathy is a rare sideeffect of hydroxychloroquine

A

T

24
Q

Common targets for biologics?

A

TNF alpha
B cells
Interleukins

25
Q

Biologics are cheap

A

F

expensive!

26
Q

Biologics are less effective than DMARDs

A

F

more effective

27
Q

What is anti TNF licensised for

A

Ank spons, psoriatic arthritis and RA

28
Q

Infliximab, golimumab and etancercept are examples of what?

A

Anti TNF drugs

29
Q

What is the criteria for using biologic therapy over DMARDs?

A

DAS28 score - higher score more active disease

>5.1 high disease activity range plus standard treatment with at least 2 DMARDs

30
Q

Risks of taking anti TNF

A

Reactivate latent TB as well as standard immunosuppressive stuuf (infection, skin cancer), exacerbation of heart failure

TB CAN DO A TEST FOR LATENT - TAKE THOROUGH HIST

31
Q

Anti TNF therapy can cause fetal abnormalities

A

F

32
Q

Rituximab targets?

A

B cells, can be used for connective tissue diseases where there r naughty antibodies

33
Q

Abatacept blocks?

A

full activation of T cells

34
Q

Ustekinumab, Secukinimab are used for what condition? What do they target?

A

Psoriatic arthritis and psoriasis, interleukins

35
Q

Two aspects of treating gout?

A
  1. Acute flare

2. Prophylaxis

36
Q

Allopurinol is used to treat gout in the - term. Why?

A

Long, supresses uric acid production.

Can make flare worse

37
Q

ACute flare treatment in gout?

A

Colchicine
Intramuscular steroid
prednisolone

38
Q

Urate lowering therapy?

A

Xanthine oxidase inhibitors - allopurinol, febuxostat

Uricosurics - not 1st line

39
Q

Why would you use febuxostat instead of allopurinol? Which drug should you NOT coprescribe it with?

A 
skin rash (vasculitis) 
common in elderly and those with renal impairments
interacts with azathioprine and causes bone marrow supression
40
Q

How long after acute flare start urate Lowering therapy?

A

2 weeks

41
Q

Major risk group for gout?

A

renal impairment ppl

42
Q

RA improves during preganancy

A

T

43
Q

In OA what happens to the joint after activity?

A

stiffness is reduced and pain increased (reduction mobility)

44
Q

Joint injury more commonly occurs in the lower limb

A

T

45
Q

Any joint injury may produce secondary OA

A

T

46
Q

60 yr old woman bilateral pain in shoulders neck and pelvic girdle
power of muscles normal
CPK levels normal ESR raised

A

Polymyalgia rheumatic

-patient usualy >50
idiopathic inflammatory condition

47
Q

What is polymyalgia rheumatic strongly associated with?

A

giant cell arteriti

48
Q

Weakness increases on activity

no pain no stiffness

A

Myasthenia gravis

  • autoantibodies neuromuscular junction
49
Q

Female w depression
Poorly localised pain all over body, severe
tender points

A

fibromyalgia rheumatica

50
Q

Symmetrical muscle weakness
difficulty combing hair and buttoning shirt
NO pain or tenderness
elevated CK 50x

A

Polymyositis

51
Q

Morning stiffness >1hr

symmetrical stiffness in wrist and finger joints

A

RA

MSK (8 decks)

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