LOCO EOYS3 Flashcards by patrick ellis

Gottron sign is an indication of which disease? [1]

Dermatomyositis

How well did you know this?

Not at all

Perfectly

Ankylosing spondylitis is most associated with which of the following?

Aortic stenosis
Aortic regurgitation
Mitral stenosis
Mitral regurgitation

Aortic regurgitation

How well did you know this?

Not at all

Perfectly

State an autoimmune disease that can cause AVN block [1]

Ankylosing spondylitis

How well did you know this?

Not at all

Perfectly

What is the name for this sign of dermatomyositis? [1]

Gottron sign: red, thickened, scaly skin over the knuckles

How well did you know this?

Not at all

Perfectly

This rash is likely to be sign of:

Scleroderma
Ankylosing spondylitis
Dermatomyositis
SLE

Dermatomyositis: purple rash around eye lids and face

How well did you know this?

Not at all

Perfectly

Describe the difference in pathology of calcinosis between scleroderma and dermatomyositis [1]

systemic sclerosis: vascular hypoxia
dermatomyositis: release of calcium from mitochondria in muscle cells damaged by myopathy

How well did you know this?

Not at all

Perfectly

Inflammation of the middle layer of the eye is a complication of:

Scleroderma
Ankylosing spondylitis
Dermatomyositis
SLE

Ankylosing spondylitis: anterior uveitis

How well did you know this?

Not at all

Perfectly

Why is AS referred to as a seronegative spondyloarthropathy? [2]

Lack of rheumatoid factor positivity
Abscence of specific antibodies

How well did you know this?

Not at all

Perfectly

Describe the pathophysiology of Scleroderma [1]

Autoimmune inflammatory and fibrotic connective tissue disease: immune mediated damage to vascular stuctures and excessive synthesis and depostion of extracellular martrix like collagen.

Cause chronic fibrosis, scarring and damage to organs

Cause of condition unknown

How well did you know this?

Not at all

Perfectly

What are the two main patterns of disease in scleroderma? [2]

Limited cutaneous systemic sclerosis / scleroderma: aka CREST syndrome
Diffuse cutaneous systemic sclerosis / scleroderma: progressive organ dysfunction due to fibrosis

How well did you know this?

Not at all

Perfectly

Describe skin changes seen in scleroderma [8]

Pruritus (usually early)
‘Puffy’ appearance due to oedema (often seen in digits)
‘Salt and pepper’ appearance: due to hyperpigmentation and hypopigmentation
Loss of hair
Dryness
Changes to capillaries in nail bed: may only be seen with special dermatoscope (Capillaroscopy)
Atrophy of subcutaneous tissue
Ulcerations: may be seen over joints due to tight skin or on finger tips
Telangiectasia: abnormal dilation of capillary
Calcinosis: calcium deposits in the skin
Perioral skin tightening with decreased oral opening: gives rise to a ‘pursed-string’ appearance

How well did you know this?

Not at all

Perfectly

Describe a phenomenon associated with scleroderma [1]

Raynaud phenomenon: skin colour changes that occur in the fingers and toes from vasospasm.

How well did you know this?

Not at all

Perfectly

Desribe the characteristic features of CREST syndrome [5]

C - calcinosis: calcium deposits in the skin
R - Raynaud phenomenon
E - oEsophageal dysmotility: swallowing difficulty
S - sclerodactyly: skin thickening and hardening affecting the fingers and toes
T - telangiectasia: dilated capillaries. Usually appear on face, palms and mucous membranes

How well did you know this?

Not at all

Perfectly

What is the key investigation for diagnosing dermatomyositis? [1]

Creatine kinase blood test: inflammation in the muscle cells (myositis) leads to release of creatine kinase.

Normal creatine kinase levels are 300 U/L; in dermatomyositis is usually over 1000 U/L

How well did you know this?

Not at all

Perfectly

What are skin features of dermatoymyositis? [5]

Gottron lesions (scaly erythematous patches) on the knuckles, elbows and knees
Photosensitive erythematous rash on the back, shoulders and neck
Purple rash on the face and eyelids
Periorbital oedema (swelling around the eyes)
Subcutaneous calcinosis (calcium deposits in the subcutaneous tissue)

How well did you know this?

Not at all

Perfectly

How do you treat AS?

Conventional analgesia / NSAIDs:
* Naproxen
* Ibuprofen
* Celecoxib

Convetional DMARDs: although not much evidence for
Sulphasalazine, methotrexate

Biological DMARDs

How well did you know this?

Not at all

Perfectly

Describe extra-articular manifestations of AS [3]

Anterior uveitis: inflammation of the middle layer of the eye. Typically causes unilateral eye pain and redness
Aortitis: can lead to aortic regurg
Atrioventricular block

How well did you know this?

Not at all

Perfectly

Articular features of reactive arthritis? [3]
Extra-articular associations of reactive arthritis? [3]

Articular features:
* Peripheral arthritis
* Axial arthritis: inflammatory back pain
* Enthesitis and/or dactylitis

Extra-articular associations
* Bilateral conjunctivitis (non-infective)
* Anterior uveitis
* Circinate balanitis is dermatitis of the head of the penis
* Triad: arthritis, urethritis and, conjunctivitis

How well did you know this?

Not at all

Perfectly

Reactive arthritis has a triad of which 3 symptoms? [3]

Classic triad of urethritis, conjunctivitis and arthritis

‘Can’t see, pee or climb a tree’

How well did you know this?

Not at all

Perfectly

Which disease is depicted?

Systemic lupus erythematosus
Dermatomyositis
Scleroderma
Tendinitis

Scleroderma: Perioral skin tightening with decreased oral opening: gives rise to a ‘pursed-string’ appearance

How well did you know this?

Not at all

Perfectly

Name this sign of scleroderma [1]

Telangiectasia: abnormal dilation of capillary

How well did you know this?

Not at all

Perfectly

This lady presents with puffy eyes. What disease is she most likely to have?

Systemic lupus erythematosus
Dermatomyositis
Scleroderma
Tendinitis

Dermatomyositis: Periorbital oedema (swelling around the eyes)

Name this sign [1]

What is it a complication of? [1]

Circinate balanitis: due to reactive arthritis

A 54-year-old woman, who is known to have systemic sclerosis, complains that her hands change colour in the cold. This is associated with severe pain. She asks if there is any medication you can prescribe.

Which of the following is a suitable first line option?

Amlodipine

Atenolol

Amitriptyline

Bisoprolol

Nifedipine

Nifedipine is a pharmacological option for Raynaud’s phenomenon

Explain the peripheral mechanism of inflammation during tissue injury [4]

**Release of inflammatory mediators** (K+ H+ bradykinin, histamine, 5HT, nitric oxide): make membranes more unstable **Activation of arachidonic acid pathway**: production of leukotrienes and prostanoids **Activation of peripheral nociception** (pain enhanced in inflammation) **Modulation of primary afferents to subsequent stimulus**

Describe the pain pathways in neuropathic [4]

Pain is felt somewhere else, but pathology could be more proximal Inflamamtion / mech. pressure **causes the nerve to change behaviour**: cell membrane becomes unstable and **fires ectopic signals.**: * **Alteration** in **ion channel expression** * **Ectopic** and **spontaneous** **discharge** * **Ephaptic** **conduction** * **Collateral** **sprouting** at **primary** afferents * **Sprouting** of **sympathetic** **neurones** at **DRG**

Saw tooth erosion is associated with which type of OA? [1]

**Erosive OA**

Question 28 of 152 A 23-year-old woman suffers from recurrent anterior dislocations of her left shoulder. A CT scan reveals a Bankart lesion. This is a lesion of the anterior glenoid labrum. Which rotator cuff muscle tendon is found at the anterior aspect of the shoulder capsule? Teres minor Supraspinatus tendon Teres major Subscapularis tendon Infraspinatus tendon

**Subscapularis tendon**

A 34-year-old man presents to the emergency department complaining of pain in his right hand after a fall 5 days ago. The pain is on the dorsum of the hand, at the base of his thumb. He explains that he fell forwards whilst playing football but managed to catch himself with his right hand before his head hit the floor. On examination, there is marked tenderness on palpation of the base of the first metacarpal on the dorsum of his hand. There is also swelling in this area. What type of fracture is the patient most likely to have sustained? Boxer's fracture Colles' fracture Galeazzi fracture Scaphoid fracture Smith's fracture

Falling onto an outstretched hand (FOOSH) is the most common mechanism causing a **scaphoid fracture**

A 61-year-old female presents to the rheumatology clinic with a new diagnosis of rheumatoid arthritis. She is started on a short course of steroids and a disease modifying anti-rheumatic drug. What type of joint is primarily affected in rheumatoid arthritis? Synovial Fibrous Cartilaginous Synostosis Hyaline

**Synovial**

A 52-year-old woman with muscle aches presents to the general practice. She has been experiencing this for well over a year and it affects her chest and back more so than her limbs. On questioning, she alludes to having bouts on average every 3 months of becoming short of breath. She lives a very healthy lifestyle remaining abstinent from drinking and smoking. On examination, she has a flat erythematous rash on her torso and purple discolouration bilaterally around the eyelids which she explains she has had for a long time. Which antibody is associated with the patient’s condition? Anti-Jo-1 Anti-Scl-70 Anti-smooth muscle Anti-histone C-ANCA

**Anti-Jo-1** Dermatomyositis is associated with the anti-Jo-1 antibody

A 27-year-old male attends his general practitioner with lower back pain. He reports that the back pain has been present for the past year and has minimal improvement with oral ibuprofen and paracetamol. He has found that it is worse in the morning and swimming helps alleviate his symptoms. He has no history of trauma and works as a tax analyst, preferring to run for exercise than perform heavy lifting routines. He has no past medical history of note and no drug allergies. What is the most likely radiological finding in this patient? 'Pencil in cup' deformity Bamboo spine Osteophytes Sacroiliitis Vertebral collapse

**Sacroiliitis** (Bamboo spine is a sign of late stage AS)

# RA Methotrexate and Rituximab would be First line treatment Second line treatment Third line treatment Fourth line treatment

**Third line treatment**

# RA Methotrexate & a TNF-inhibitor would be First line treatment Second line treatment Third line treatment Fourth line treatment

**Second line treatment**

Methotrexate inhibits which enzyme? [1]

**dihydrofolate reductase**

RA Treatment: Hydroxychloroquine blocks: TLR7 TLR8 TLR9 TLR10 TLR11

**TLR9**

# RA Leflunomide inhibits which enzyme? [1] What is the effect of this? [2]

**Dihydroorotate dehydrogenase (DHODH)**: **stops** **pyrimidine** **synthesis** & therefore reduces pro-inflammatory cytokines: IL-1, TNF-A and IL-6; Blocks T cell proliferation

Which treatment for RA reduces pyrimidine synthesis? Methotrexate Sulfasalazine Hydroxychloroquine Leflunomide Infliximab

**Leflunomide**

Which treatment for RA that targets TLR-9? Methotrexate Sulfasalazine Hydroxychloroquine Leflunomide Infliximab

**Hydroxychloroquine**

Which treatment for RA that reduces dendritic cell activation? Methotrexate Sulfasalazine Hydroxychloroquine Leflunomide Infliximab

**Hydroxychloroquine**

Which is a treatment for RA that inhibits dihydro-orotate dehydrogenase? Methotrexate Sulfasalazine Hydroxychloroquine Leflunomide Infliximab

**Leflunomide**

Which treatment for RA is a tumor necrosis factor-alpha (TNF-alpha) inhibitor? Methotrexate Sulfasalazine Hydroxychloroquine Leflunomide Infliximab

**Infliximab**

Which treatment for RA leads to decreased T-cell proliferation and cytokine production? Etanercept Adalimumab Anakinra Rituximab Abatacept Tolizumab

**Abatacept**

Which treatment for RA is an IL-1 antagonist? Etanercept Adalimumab Anakinra Rituximab Abatacept Tolizumab

**Anakinra**

Which treatment for RA targets IL-6? Etanercept Adalimumab Anakinra Rituximab Abatacept Tolizumab

**Tolizumab**

Which treatment for RA targets upregulates CTLA-4, which switches T cell off? Etanercept Adalimumab Anakinra Rituximab Abatacept Tolizumab

**Tolizumab**

A garden spade deformity arises from a Hangman fracture Colles fracture Smith fracture Wedge fracture

**Smith fracture**

This shows what type of deformity? [1] What type of fracture would this have arisen from? [1]

**Garden spade**; due to **Smith** fracture

This shows a Hangman fracture Colles fracture Smith fracture Wedge fracture

**Wedge fracture**

*hyperflexion injuries to the vertebral body resulting from axial loading* This best describes a Hangman fracture Colles fracture Smith fracture Wedge fracture

**Wedge fracture**

Dinner fork deformity arises from improper healing of a Hangman fracture Colles fracture Smith fracture Wedge fracture

**Colles fracture**

What is the name for this type of fracture? [1]

**Jefferson fracture**

What is impingement syndrome Compression of the musculocutaneous nerve Compression of the long thoracic nerve Inflammation of the long head of the biceps brachii Inflammation of the supraspinatus tendon Compression of the axillary artery

**Inflammation of the supraspinatus tendon**