Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Rheumatology > General > Flashcards

General Flashcards

1
Q

Rx non-renal SLE

A

Mild/moderate
Hydroxychloroquine +/- pred

Moderate
Azathioprine or MTX
- Azathioprine in childbearing age/pregnancy. Otherwise MTX is probably a bit better.

Severe
Mycophenolate (more for renal SLE) - very potent
Rituximab
Cyclophophsmiade

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Anti-dsDNA in SLE

A

very specific, can correlate with disease activity, high result suggests renal disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Anti-SM positive in SLE

A

Very specific

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Main differences between SpA and DISH

A

SpA

  • Younger people before age 45
  • History of psoriasis, IBD, uveitis, dactylitis
  • FHx
  • Inflammatory back pain or stiffness
  • Postural abnormalities
  • Response to NSAIDs
  • Xray:

DISH

  • Asymptomatic
  • Found on xray - continuous bulky calcificat of the anterior longitudinal ligaments
  • Cervical and thoracic spine
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What is Livedo racemosa?

A

Similar to livedo reticularis

Lace is contained in livedo racemosa but broken in reticularis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What is polyarteritis nodosa?

A

Raised inflammatory markers
Renal impairment
CT small vessel aneurysms
Livedo racemosa

No available autoantibody screening test

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Febuxostat vs allopurinol

A

Both xanthine oxidase inhibitors

Febuxostat

  • Can cause LFT derangement
  • Drops uric acid very quickly (more likely to have flares) so important to have people on prophylaxis colchicine 500microg BD (eGFR >60). If renal function is bad, may need pred.
  • ?Higher CV events
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Uric acid targets for tophi and non-tophi gout

A

Tophi: <300micromol/L

Non-tophi: <360micromol/L

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

When to start febuxostat?

A

Better for renal impairment
Not tolerating uptitration of allopurinol
Allopurinol hypersensitivity syndrome

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

How to start allopurinol?

A

Uptitrate allopurinol up to 900mg first - increase 100mg each month if renal function normal until uric acid level is at target

Start prophylaxis (colchicine) at the same time. Continue until you reach target for 6 months.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

When to avoid colchicine?

A

eGFR <30: don’t use colchicine. Use pred instead.

eGFR 30-60: daily dosing instead of BD

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

When can you start allopurinol after a flare?

A

Can start during the acute attack

Bad flare and on prednisolone/NSAIDs - wait for flare to turn around and start allopurinol after 3-4 days (100mg if no renal impairment; dose reduce if renal impairment)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Rx acute gout flare

A

Prednisolone and NSAIDs work equally well

Can hit them harder with prednisolone (up to 50mg for polyarticular gout)
Need to be careful with NSAIDs in kidney impairment

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Can you get total resolution of tophi with good serum uric acid control?

A

Yes
Can take several years

Can also have surgical management but this must be done after good serum uric acid control. If not it will come back quickly.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Dual energy CT for gout

When is it used?

A

Not that helpful
Can’t rely on it diagnostically
Poor sensitivity, specificity

Can quantify the amount of uric acid in a joint e.g. 20ml

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

GCA is pretty rare under age …

A

50

Few case reports around the world!

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What’s a specific sign of GCA?

A

Jaw claudication

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Why should we do bilateral temporal artery biopsies for GCA?

A

Biopsy of the contralateral temporal artery can increase the yield by 15%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What might you see on ultrasound of temporal artery suggesting GCA?

A

Halo sign

But US is generally not useful cause its not done often

20
Q

Does steroids influence temporal artery biopsy outcome?

A

TAB should be performed ASAP after steroid treatment (Within 14 days)
But it can be positive even after weeks of steroids

21
Q

How big should the temporal artery biopsy be?

A

2.5cm or more

22
Q

High suspicion for GCA but negative temporal artery biopsy

What do you do?

A

Start

PET - large vessel vasculitis but no cranial nerve involvement

23
Q

Should we screen GCA patients with aortic aneurysm?

A

No

This is controversial some rheumatologists do

24
Q

Why do we use aspirin in GCA?

A

Secondary prevention
Pred increases hypertension, cholesterol, BSLs

Continue until pred is finished (or continue if there are risk factors)

25
Q

Tozolizumab in GCA

When is it indicated?

A

Subcut weekly injections
Not PBS covered

But can be used in patients with brittle diabetes and you’re worried about using prednisolone

26
Q

Describe lefluonamide induced neuropathy

A

Symmetrical
Hands and feet
Motor and sensory neuropathy

27
Q

Anti-MDA5 antibody in polymyositis

A

Rapidly progressively lung disease

28
Q

What disease?

1) AntiCCP
2) AntiSM
3) AntiScl70
4) AntiDNA
5) RF
6) Anti-centromere
7) Anti-Jo
8) Anti-RNP
9) Ro and La

A

RA - specific

SLE - specific

Diffuse scleroderma

SLE - particularly worsening disease or renal

RA - not very specific

limited scleroderma (more benign than diffuse)

Anti synthetase syndrome (muscle, lung, joint problem)

Mixed CT disease

Sjogren’s but not very specific

29
Q

Which feature has the worst prognosis in anti synthetase syndrome?

A

Dysphagia

30
Q

How do you differentiate SpA from mechanical back pain?

A

morning stiffness*** most useful
younger men
Buttock pain

31
Q

HLAB27 is present in ….% of SpA

A

90%

But also present in 10% of normal people without SpA

32
Q

Which investigation is best to support a diagnosis of SpA?

A

Xray sacroiliac joints

33
Q

What 3 tests rule out SpA?

A

Normal sacroiliac xray
Normal MRI
Negative HLAB27

34
Q

Is colchicine good for acute flare of gout?

A

No
Better as a prophylaxis
May use colchicine for 24hrs if worried about infection until joint MCS comes back

Use NSAIDs or prednisolone if renal impairment instead

35
Q

Radiological pattern of ILD in the following

1) RA
2) MCTD
3) SSc
4) Ankylosing spondylitis
5) Sjogren’s

A

1) UIP >NSIP >OP
2) NSIP/OP >UIP
3) NSIP >UIP
4) Upper lobe fibrosis
5) NSIP >LIP (lymphocytic interstitial pneumonitis - seen exclusively in Sjogren’s)

36
Q

4As in anklylosing spondylitis

A

Apical fibrosis
Aorta incompetence
A

37
Q 
Lupus pernio (rash on face)
What's the dx?
A

Sarcoidosis

38
Q

Livedo reticularis vs livedo racemosa

A

Livedo reticularis - closed rings - venous problem

Livedo racemosa - open rings - arteritis problem

Retiform purpura - tissue ischaemia, death

39
Q

Polyarteritis nodosa associated with

A

HBV

40
Q

Which rheum drugs are safe in pregnancy?

A

PASH

Pred
Azathioprine
Sulfasalazine
HCQ

41
Q

Glucocorticoid-induced OP

What’s the only available therapy?

A

Bisphosphonates

Blocks osteoclast-mediated bone resorption

42
Q

Clinical features of PMR

A

Shoulder, neck, lumbar, hip pain/reduced ROM
Prolonged morning stiffness
Muscle strength normal but testing limited by pain
Associated with depression, fatigue, weight loss

43
Q

Age of people with PMR

A

> 50 years old

44
Q

Investigations in PMR

A

Elevated CRP, ESR
Negative RF, CCP to exclude sero+ RA
SPEP to exclude myeloma
CK to exclude myositis

45
Q

Immunology of PMR

A

IL6 is important

Increased Th17, and reduced Th1 and Treg cells

46
Q

What assessment tools can you use to assess severity of PMR?

A

PMR activity score

Can be used to define a flare and to guide treatment

47
Q

Treatment of isolated PMR

A

Prednisolone 15mg/day then slow wean after 4 weeks
Respond within 48-72hr
May get relapses during wean

Rheumatology (5 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions