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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

24
Q

Common targets for biologics?

A

TNF alpha
B cells
Interleukins

25
Biologics are cheap
F | expensive!
26
Biologics are less effective than DMARDs
F | more effective
27
What is anti TNF licensised for
Ank spons, psoriatic arthritis and RA
28
Infliximab, golimumab and etancercept are examples of what?
Anti TNF drugs
29
What is the criteria for using biologic therapy over DMARDs?
DAS28 score - higher score more active disease | >5.1 high disease activity range plus standard treatment with at least 2 DMARDs
30
Risks of taking anti TNF
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
Anti TNF therapy can cause fetal abnormalities
F
32
Rituximab targets?
B cells, can be used for connective tissue diseases where there r naughty antibodies
33
Abatacept blocks?
full activation of T cells
34
Ustekinumab, Secukinimab are used for what condition? What do they target?
Psoriatic arthritis and psoriasis, interleukins
35
Two aspects of treating gout?
1. Acute flare | 2. Prophylaxis
36
Allopurinol is used to treat gout in the - term. Why?
Long, supresses uric acid production. | Can make flare worse
37
ACute flare treatment in gout?
Colchicine Intramuscular steroid prednisolone
38
Urate lowering therapy?
Xanthine oxidase inhibitors - allopurinol, febuxostat | Uricosurics - not 1st line
39
Why would you use febuxostat instead of allopurinol? Which drug should you NOT coprescribe it with?
``` skin rash (vasculitis) common in elderly and those with renal impairments interacts with azathioprine and causes bone marrow supression ```
40
How long after acute flare start urate Lowering therapy?
2 weeks
41
Major risk group for gout?
renal impairment ppl
42
RA improves during preganancy
T
43
In OA what happens to the joint after activity?
stiffness is reduced and pain increased (reduction mobility)
44
Joint injury more commonly occurs in the lower limb
T
45
Any joint injury may produce secondary OA
T
46
60 yr old woman bilateral pain in shoulders neck and pelvic girdle power of muscles normal CPK levels normal ESR raised
Polymyalgia rheumatic -patient usualy >50 idiopathic inflammatory condition
47
What is polymyalgia rheumatic strongly associated with?
giant cell arteriti
48
Weakness increases on activity | no pain no stiffness
Myasthenia gravis - autoantibodies neuromuscular junction
49
Female w depression Poorly localised pain all over body, severe tender points
fibromyalgia rheumatica
50
Symmetrical muscle weakness difficulty combing hair and buttoning shirt NO pain or tenderness elevated CK 50x
Polymyositis
51
Morning stiffness >1hr | symmetrical stiffness in wrist and finger joints
RA

MSK (8 decks)

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