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MRCP Part 1 > MRCP Rheum > Flashcards

MRCP Rheum Flashcards

1
Q

What is the commonest cause of gout?

A

impaired renal excretion of uric acid

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2
Q

What are the main symptoms of PMR

A

early morning stiffness in proximal muscles and aching
constitutional symptoms (FLAWS)

NOT WEAKNESS

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3
Q

What is the autoantibody for Still’s disease?

A

autoantibody negative

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4
Q

Where does tibial nerve compression occur?

A

medial malleolus

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5
Q

Which nerve injury do you see foot drop and eversion deficit?

A

common peroneal nerve

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6
Q

Which 3 medications are commonly known to be folate antagonists?

A

Trimethoprim
Methotrexate
Co-trimoxazole

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7
Q

What is the treatment for Paget’s?

A

Bisphosphanate

Can give IV zolendronate if GORD

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8
Q

HLA for ankylosing spondylitis?

A

HLA B27

NOTE: seronegative

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9
Q

What eye symptom do you get in GCA?

A

altitude defect (bottom up or top down)
ischaemic optic neuropathy

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10
Q

What age group does PMR occur?

A

60-70

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11
Q

Which body parts does PMR affect?

A

shoulder girle, spreading both shoulders
pelvic girdle

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12
Q

What condition has small joint polyarthritis?

A

Rheumatoid arthritis

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13
Q

What are the main symptoms of sjogrens?

A

dry gritty eyes
dry mouth

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14
Q

What condition presents with discoid/malar rash and joint pains?

A

SLE

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15
Q

What condition has normal CRP but raised ESR?

A

SLE

ESR used to monitor disease

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16
Q

What is felty’s syndrome?

A

rheumatoid arthritis
splenomegaly
neutropenia

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17
Q

Why is there hypersplenism in felty syndrome?

A

reticuloendothelial stimulation

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18
Q

What drug class is given for ankylosing spondylitis after failure of 2 NSAIDs?

A

anti-TNF agent

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19
Q

What drug is given for Wilsons?

A

penicillamine

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20
Q

What drug should be given in ankylosing spondylitis with peripheral arthritis?

A

DMARD: sulfasalazine/methotrexate

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21
Q

Which antibody is associated with CREST - limited cutaneous scleroderma?

A

anti-centromere

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22
Q

Which antibody is associated with diffuse systemic sclerosis (scleroderma)

A

anti- scl70

Anti-Topoisomerase II

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23
Q

What is the differential for heaviness in both legs and worse back pain with extending back?

A

spinal stenosis

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24
Q

Which vasculitis is most commonly associated with pulmonary renal syndrome

A

microscopic polyangitis

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25
Q

Which antibody is associated with microscopic polyangitis?

A

anti-MPO
PANCA

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26
Q

SLE multisystem manifestation mneumonic

A

Multisystem autoimmune disorder characterised by the presence of an array of the following features (SOAP BRAIN MD)

Serositis

Oral Ulcers

Arthritis

Photosensitivity

Bloods (cytopaenias)

Renal Disease

ANA

Immunological Factors (anti-dsDNA, anti-Sm)

Neurological Factors (psychosis, seizures)

Malar Rash

Discoid Rash

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27
Q

What is the earliest sign of RA on XR?

A

EFFUSION

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28
Q

Which type of urate is gout and polarisation?

A

monosodium urate monohydrate arthropathy
needle shaped
negatively bifringent

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29
Q

What is the management of gout?

A

NSAID (not in CKD)
Colchicine
Prednisolone (not in DM)

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30
Q

What condition is associated with looser zones on XR?

A

osteomalacia

low vit D- low calcium, low phosphate, high ALP

linear areas of low density

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31
Q

What is the management of SLE with simple arthralgia?

A

hydroxychloroquine

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32
Q

What is the management of SLE with arthritis and treatment resistant/severe?

A

methotrexate

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33
Q

What is the management of SLE with internal organ involvement?

A

prednisolone

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34
Q

What is AIN
acute interstitial nephritis

A

drug hypersensitivity
AKI, fever, arthralgia, eosinophilia

autoimmune
infection
NSAID abx

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35
Q

When is minimal change nephropathy seen?

A

children with nephrotic syndrome

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36
Q

What is renal tubular acidosis type 4

A

NSAID induced

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37
Q

Why do you get calcific tendonitis?

A

Deposits of hydroxyapatite crystal in injured rotator cuff muscles

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38
Q

Which AZA is safe in pregnancy

A

Azathioprine

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39
Q

Which haem condition causes avascular necrosis of femoral head

A

Sickle cell disease

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40
Q

What is the first line therapy for gonococcal arthritis?

A

Ceftriaxone

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41
Q

What is the first line treatment for early RA?

A

METHOTREXATE

Initial Management
First-Line: DMARD Monotherapy

Options: methotrexate, leflunomide and sulfasalazine

Alternative: hydroxychloroquine

Consider DMARDs in combination if monotherapy is ineffective

Steroids
Offer short-course glucocorticoids for managing flares

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42
Q

What is reactive arthritis

A

sexually transmitted disease/gastroenteritis

can’t see
cant pee
cant climb trees

Mx: NSAID

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43
Q

What does early morning stiffness lasting more than 1 hr suggest?

A

inflammatory arthritis

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44
Q

Fibromyalgia diagnostic criteria

A

widespread pain for at least 3 months in addition to tenderness of at least 11 out of 18 designated tender point sites.

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45
Q

What is lateral epicondylitis?

A

tennis elbow

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46
Q

What is medial epicondylitis?

A

golfer’s elbow

pain on pronation and flexion of wrist

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47
Q

Give an example of COX1 inhibitor

A

Naproxen
piroxicam

reduces prostaglandin in stomach

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48
Q

Which complement is associated with SLE?

A

C4

note C3 is low in active disease

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49
Q

What is z score and T score

A

Z = 0 (normal BMD for age)

T (>-1 = normal) - compared to normal individual age adjusted

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50
Q

What is T score of osteopenia and osteoporosis

A

Osteopenia:
-1 and -2.5

Osteoporosis:
-2.5 and below

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51
Q

What are the features of polyartertis nodosa?

A

Hep B

Form aneurysms
- rosary sign on renal angio

Constitutional upset

Skin rash

Peripheral neuropathy

Renal impairment

NOTE: associated with hepatitis B

-hypertension
-mononeuritis multiplex,
-sensorimotor polyneuropathy
-p (ANCA) are found in around 20% of patients with ‘classic’ PAN
-hepatitis B serology positive in 30% of patients

systemic necrotising vasculitis -> aneurysm forms

Rosary string of bead sign due to microaneurysm

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52
Q

How does dermatomyositis present?

A

symmetrical promixal myopathy
heliotrope purple rash on cheek/eyelid
photosensitive
gottron papule (rough red extensor surface)
CK elevated

note: polymyositis has no heliotrope rash

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53
Q

What eye symptoms does MS present?

A

Unilateral optic neuritis

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54
Q

What is the diagnostic criteria for RA?

A

J-SAD

Joint involvement (large and small)
Serology (RA factor, anti-CCP)
Acute phase reactant (ESR/CRP)
Duration of symptoms (6 weeks or longer)

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55
Q

RA x-ray changes

A

S: oft tissue swelling
P: eri-articular osteoporosis
A: bsent osteophytes
D: eformity
E: rosions (late feature)
S: ubluxation (late feature)

SPADES

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56
Q

What is enteropathic arthritis?

A

Athritis associated with IBD (crohn’s)

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57
Q

What is the first line management for Behcet syndrome?

A

Colchicine

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58
Q

What is Behcet syndrome?

A

vasculitis affecting mucocutaneous , vascular, GI, eye, CNS

triad of symptoms:
- oral ulcers
- genital ulcers
- anterior uveitis

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59
Q

What HLA is associated with behcet syndrome?

A

HLA B51

ANA and ANCA negative!

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60
Q

What is the classical presentation of Still’s

A

polyarthritis
maculopapular salmon pink rash
intermittent fever

Mx: NSAID, steroid, methotrexate, tocilizumab

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61
Q

What is pseudogout crystal and polarisation?

A

calcium pyrophosphate dihydrate
Rhomboid crystals
POSITIVELY bifrengence

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62
Q

What is pseudogout associated with

A

metabolic disorders

Haemochromatosis
Hyperparathyroidism
Diabetes

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63
Q

What is Sheuermann disease?

A

Deforming thoracic kyphosis

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64
Q

What are the 3 types of cryoglobulinaemia?

(precipitating from temperature diff)

A

arthralgia, pupura, glomerulonephritis

T1: monoclonal (raynaud/MM/waldenstrom)
T2: mixed (hep C/RA/Sjogrens/lymphoma)
T3: polyclonal (RA/sjogrens)

Rheumatic factor!

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65
Q

Which antibody is associated with SLE?

A

ds-DNA (specific)

ANA (sensitive)

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66
Q

Which antibody is associated with sjogrens?

A

anti Ro and La

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67
Q

What is straight leg raise negative?

A

spinal stenosis

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68
Q

Which 3 antibodies are associated with antiphospholipid syndrome?

A

Anti cardiolipin
lupus anticoagulant
anti beta2 glycoprotein 1

recurrent miscarriage, livedo rahs, prolonged APTT/INR

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69
Q

What side effect is rarely seen with hydroxychloroquine?

A

retinopathy
hair loss

bald blind man swimming

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70
Q

What side effect is seen with sulfasalazine?

A

pancytopenia

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71
Q

What is a consequence of atlanto-axial subluxation in RA?

A

Cervical myelopathy => spinal cord compression

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72
Q

Which antibodies are non specific?

A

RF
ANA

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73
Q

What is dermatomyositis associated with?

A

malignancy (paraneoplastic)

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74
Q

Which maternal autoantibody causes neonatal lupus?

A

Anti-Ro (crosses placenta)

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75
Q

Which arthritis is associated with keratoderma blenorrhagica?

A

Reactive arthritis

brown macule/vesicle/pustule on palms and soles

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76
Q

How does arthritis present in gonococcal arthritis?

A

migratory (not fixed)
tenosynovitis

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76
Q

What is the difference between gonococcal arthritis and reactive arthritis?

A

Both STI

Reactive- oligoarthritis (2-4 joints) no tenosynovitis
Gonococcal- periarthritis dermatitis tenosynovitis

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77
Q

What is the blood test like in osteoporosis?

A

Normal bone profile
Normal PTH
ALP can be elevated following fracture

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78
Q

Why are patients with nephrotic syndrome at risk of avascular necrosis?

A

Loss of protein S and antithrombin 3 in urine

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79
Q

What are the two signs for carpel tunnel?

A

Tinel-tapping median nerve in carpal tunnel

Phalen-inverse prayer

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80
Q

Which diuretic cause gout?

A

thiazide

indapamide

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81
Q

Which antibody is more specific to RA?

A

anti-CCP

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82
Q

What is the difference between spondylosis and spondylolisthesis?

A

Spondylosis= degenerative, narrow space

Spondylolisthesis=on verterae slips forward or backward over the bone below it (likely due to OA)

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83
Q

Which DMARD used in RA is safe in pregnancy?

A

hydroxychloroquine

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84
Q

What is bilateral sacroiliac erosion suggestive of?

A

Ank Spond (more specific than HLA type)

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85
Q

SLE manifestation percentage:

A

Joint (>80%)
Skin (75%)
Lung (60%)
Kidney (30%)
Heart and vessel (25%)

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86
Q

Epidemiology of SLE

A

9 times more common in women
more common in Afro-Caribbeans* and Asian
onset is usually 20-40 years
First degree relatives 3% dwveloping
Associated with HLADR2 and HLADR3 in white people

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87
Q

What lung condition is RA associated with?

A

Bronchiolitis obliterans

diffuse wheeze

Mx: steroids

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88
Q

Which bone is most susceptible to Paget’s

A

Lumbar spine

lytic and sclerosis

89
Q

Which nodes are present in OA?

A

PIP
- Bouchard

DIP
- Heberden

90
Q

What is the management of chronic fatigue syndrome?

91
Q

What is arthritis mutilans

A

psoriatic arthropathy

telescoping fingers, nail pitting, horizontal ridge

92
Q

What is the XR lumbar appearance of ank spond?

A

Tramline Bamboo spine

XR pelvis- fusion of sacroiliac joint

93
Q

Why does Paget’s present with deafness

A

foraminal narrowing causing compression of 8th cranial nerve

94
Q

What eGFR is alendronate contraindicated?

95
Q

Which medication is used for secondary prevention of fractures in osteoporosis with CKD ?

A

Denosumab (RANK ligand)

96
Q

How does RA affect joints?

A

Symmetrical

small joints

97
Q

How does Takayasu present?

A

upper limb claudication
constitutional upset
weak puse
BP diff both arms

idiopathic arteritis, women 20-40

98
Q

Which anti TB medication is associated with gout?

A

Pyrazinamide

99
Q

What should be ruled out in MONOARTHRITIS

A

SEPTIC JOINT

100
Q

What are the hallmarks of primary raynaud

A
  • 30 year old female
  • symmetrical attack
  • seronegative antibody
101
Q

What are the hallmarks of secondary raynaud?

A
  • 50+ male
  • digital ulcer/gangrene
  • asymmetrical attack
  • positive autoantibodies

a/w CREST, SLE

102
Q

what type of anaemia

What is anaemia of chronic disease

A

normocytic anaemia

secondary to chronic inflammatory disease/CKD

103
Q

What is diagnostic of ank spond?

A

XR of sacroiliac joint

104
Q

What is the first line treatment for ank spond back pain?

A

NSAID - naproxen

105
Q

Rim of calcification on lateral meniscus?

A

Pseudogout

chondrocalcinosis - deposition of calcium pyrophosphate along the margins of the cartilage

106
Q

What is the renal complication seen in eGPA?

A

necrotizing crescent glomerulonephritis

(rapid progressive)

107
Q

What renal complication is seen in SLE

A

membranous glomerulonephritis

108
Q

Which part of IgG does rheumatoid factor target?

A

Fc portion of IgG1

109
Q

Which HLA is associated with Felty syndrome?

110
Q

Outline management of Psoriatic arthritis

A
  1. NSAID for sx relief
  2. DMARD - if both skin and arthritis
    - leflunomide
    - sulfasalazine - not for skin
    - methotrexate - joint and skin
    - ciclosporin
  3. anti-TNF alfa (refractory to above)

note- stop sulfasalazine if adding anti TNF

111
Q

What 4 triggers gout

A

Surgery
Starvation
Diet/Alcohol
Drugs- diuretics

112
Q

What is Pott’s disease

A

SPINAL TB

Mx: 12 month therapy

113
Q

What are the causes of ATN?

A

HYPOTENSION
NEPHROTOXINS
PRE-RENAL (HYPOVOLAEMIA)

114
Q

How do you classify between limited and diffuse scleroderma?

A

Area of skin distribution
- limited to below elbow and knee in limited sclerosis
- trunk in diffuse
- both can affect face

115
Q

Which 2 conditions is ischaemic optic neuropathy associated with?

116
Q

What are the complications of PAN

A

MI
Stroke
Bowel perforation
Pulmonary haemorrhage

117
Q

Management of frozen shoulder

A

Acute: pain
- steroid injection

Chronic: stiffness
- physio

118
Q

What neurological involvement is APL syndrome associated with?

A

epilepsy
chorea
migraine

119
Q

APL syndrome management

A

Secondary thromboprophylaxis:
- previous clot -> warfarin lifelong (INR 2-3)
- recurrent clot-> warfarin lifelong + aspirin (INR 3-4)

Primary Thrmbophrophylaxis:
- aspirin

Pregnant:
aspirin as soon as pregnant->LMWH when fetal HB seen -> until 34 weeks

120
Q

What is meralgia paraesthetica?

A

entrapped lateral cutaneous nerve of thigh

triggered by tight clothing

121
Q

Which autoantibody is associated with dermatomyositis?

A

ANA

Polymyositis: Anti-Jo1

Dermatomyositis: Anti-Mi2

122
Q

Outline management for dermatomyositis

A
  1. steroid
  2. azathioprine/ciclosporin/methotrexate

check TPMT level before azathioprine

123
Q

What are the signs of patellar bursitis

A

tender
fluctuant oedema
erythema
crepitus of knee

123
Q

What is henoch schonlein purpura

A

rash on buttock and lower limb
raised IgA- nephropathy
(recent URTI)

124
Q

What is the significance of presence of anti- Jo 1 antibody

A

POLYmyositis and interstitial lung disease

125
Q

What is the diagnostic test for myositis

A

muscle biopsy

126
Q

What condition presents with bilateral idiopathic avascular necrosis of scaphoid?

A

preiser disease

127
Q

What is the medication to reduce further risk of gout attack?

A

Allopurinol

128
Q

What is the first line investigation for monoarthritis (even in those with known inflammatory arthritis?)

A

Joint aspiration
Start abx immediately

129
Q

What is the most common organism causing septic arthritis?

A

Staph aureus

130
Q

What the most common organisms causing childhood septic arthritis?

A

Gonorrhoea
Haemophilus influenza

131
Q

What is the most common bug associated with septic arthritis in sickle cell?

A

Salmonella

132
Q

Why is the ESR high in primary sjogren?

A

High gammaglobulinaemia
(immunoglobulin)

133
Q

What is the most common form of progression of RA?

A

chronic
persistent

134
Q

What is osteochondritis dissecans

A

subchondral crescent sign or loose bodies due to local necrosis and underlying bone

135
Q

What are the 2 most common causes of death in systemic sclerosis?

A
  1. pulmonary fibrosis
  2. Kidney disease
136
Q

What are the colonoscopy findings of Crohns?

A

Rose thorn ulcer
Discrete ulcers
Cobble stone mucosa
Strictures

Note: associated with enteropathic arthritis

137
Q

What are the 4 invetigation to aid diagnosing sjogrens?

A

oral labial biopsy
MRI of parotid gland
schirmer’s test
anti Ro

138
Q

What are the findings on colonoscopy of UC?

A

pseudopolyps
crypt abscess
dilatation

Note: associated with enteropathic arthritis

139
Q

What is the bone profile like in Paget’s

A

isolated ALP rise

indicating high bone turnover

140
Q

Why does negative temporal biopsy not rule out GCA?

A

Skip lesions

141
Q

What should women of child bearing age be told before starting methotrexate?

A

Birth control measures must be in use before (teratogenic)

if planning conception- stop meds 3-6 months

142
Q

What is the joint aspirate result in reactive arthritis?

A

sterile
no growth

143
Q

What triggers reactive arthritis?

A

Enteric infection:
- shigella
- salmonella
- yersinia
- campylobacter

Genital infection:
- chlamydia

arthritis, uveitis, urethritis, keratoderma

144
Q

Which HLA is reactive arthritis associated with?

145
Q

What triggers gonococcal arthritis (type of septic arthritis)

A

Neisseria gonorrhoea

tenosynovitis, migratory polyarthritis, dermatitis,

146
Q

What is the most common GI manifestation of SLE?

A

mouth ulcer

147
Q

What is mononeuritis vs multiplex

A

Mononeuritis is inflammation of a single nerve

mononeuritis multiplex is inflammation of two or more nerves.

148
Q

What are the symptoms of EDS?

A

recurrent dislocation
skin laxity
bruising

149
Q

Outline management of Takayasu arteritis

A

First: steroid

Second: steroid sparing
- methotrexate
- azathioprine
- cyclophosphamide

150
Q

What is the most common hand presentation of psoriatic arthritis?

A

nail dystrophy

151
Q

What is the investigation of choice to confirm diagnosis of gout/pseudogout

A

joint aspiration and microscopy

152
Q

Which HLA is associated with RA?

A

HLA DR4

and DR1

153
Q

How does Behcet manifest the skin?

A

thrombophlebitis
erythema nodosum

154
Q

What is mixed connective tissue disease?

A

Systemic sclerosis
SLE
Polymyositis

155
Q

What are the side effects of GOLD in RA treatment?

A

pancytopenia
pulmonary fibrosis

156
Q

Why does SLE present with normocytic anaemia with low WCC or platelet?

A

body’s immune system mistakenly attacks and destroys healthy blood cells, including platelets and certain types of white blood cells, due to the autoimmune nature of the disease

157
Q

Which DMARD is not used in spinal disease in ank spond

A

Methotrexate

158
Q

What is rheumatoid factor

A

IgM that target Fc portion of IgG

159
Q

What is microscopic polyangitis?

A

small-vessel ANCA vasculitis.

fever, fatigue, weight loss
arthalgia
cough, SOB- pulmonary
haematuria

160
Q

Which autoantibody is microscopic polyangitis associated with?

A

pANCA (70%)
against MPO

MPO
MicroPoly

161
Q

What type of immunoglobulin is anti GBM

A

IgG

Good pastures (IgGood)

162
Q

What are the 3 diagnostic methods for polymyositis?

A

CK
EMG
Muscle biopsy

163
Q

What is the diagnostic imaging for avascular necrosis?

164
Q

What arthroscopic findings are seen in RA of synovial joint?

A

vascular proliferation-> permeable
(Inflammation)

165
Q

Which patients are offered DEXA scan?

A

> 50 with fragility fracture
<40 with major fragility fracture

Note if on long term steroid-no need for DEXA

and start alendronate, calcium, vit D

166
Q

What happens to the complement levels in active SLE?

167
Q

What are seronegative arthritis?

A

Psoriasis
Enterpathic arthritis
Ankylosing spondylitis
Reactive arthritis

PEAR

168
Q

What antibody is associated with mixed connective tissue disease?

169
Q

Which vasculitis cause nasal bridge dipping, sinusitis, epistaxis, haemoptysis?

170
Q

What is the pleural tap result of RA effusion?

A

low glucose
high LDH
exudative
low pH

171
Q

What does normal CXR tell you about latent TB whilst on anti-TNF?

A

cannot rule out reactivation

172
Q

Which chromosome is haemochromatosis defective HFE gene on?

173
Q

What is de quervain synovitis?

A

base of thumb pain

174
Q

Why is allopurinol not given in acute gout?

A

can worsen the acute phase including worsening joint pain and fever

give 4-6 weeks after acute management

175
Q

What test is performed for assessing stiffness of the back for ank spond?

A

schober test

176
Q

What spinal movements are limited in ank spond?

A

forward flexion
lateral lumbar flexion

177
Q

What should you do with the steroid dose with SLE flare secondary to infection?

A

double dose for adrenal support

178
Q

Should you continue hydroxychloroquine in acute illness?

179
Q

what do you call a chronic osteomyelitis with abscess near site of metaphysis?

A

Brodie’s abscess

180
Q

What is the radiological feature of Ewing sarcoma?

A

onion peel

181
Q

What is myasethenia gravis auto antibody?

A

anti-acetylcholinesterase receptor antibody

182
Q

Outline symptoms of radial, ulnar and median neuropathy

A

Radial= wrist drop
Ulnar= weak hypothenar
Median= weak thenar

183
Q

What are the 3 nephropathies associated with ank spond?

A

AA amyloidosis:
- enlarged kidney (deposit)
- apple green bifringence

NSAID nephropathy

IgA nephropathy
- haematuria
- hypertension

184
Q

Which features indicate worse prognosis in RA?

A
  1. female
  2. gradual onset over few months
  3. postivie IgM RF
  4. anaemia within 3 months
  5. Anti-CCP positivity
185
Q

What are the risk factors for AVN?

A

Chemotherapy
Alcohol
Steroid/sickle cell
Trauma

CAST

186
Q

What is the first line management for pain in ank spond?

187
Q

What is the most appropriate management for early ank spond without syndesmophytes?

A

physiotherapy

Paramount to prevent stiffness early ,!!!

188
Q

What is the prevalence of RA?

A

1% in western world
0.2% in china japan

189
Q

Outline sequence of spinal changes in ank spond

A

blurring upper and lower vertebral rims => enthesitis causing bony spurs (syndesmophytes) => fusion and sclerosis => calcification of intervertebral ligament

190
Q

Outline the sequence of bony changes in OA

A

limited ROM => joint crepitus and instability

LOSS on XR
Loss of Joint Space
Osteophytes
Subchondral Cysts
Subchondral Sclerosis

190
Q

Why is there anaemia in chronic inflammation?

A

Suppression of EPO

191
Q

Outline the vitamin D activation pathway

A

Vit D in skin photoactivated forming cholecalciferol-> liver converts to 25 hydrocycholecalciferol -> kidney 1 alfa hydroxylase converts to 1,25 dihydrocycholecalciferol

192
Q

What is mononeuritis multiplex?

A

neuropathy of 2 or more peripheral nerves not related anatomically

193
Q

What is the mechanism of action of colchicine?

A

xanthine oxidase inhibitor

194
Q

How does thoracic outlet obstruction present?

A

disappearance of pulse on raising arm

195
Q

When is anti-TNF contraindicated?

A

comorbid MS
active Hep B/C

196
Q

What renal manifestation occurs with SLE?

A

lupus nephritis

197
Q

What does TNF alfa do to insulin resistance?

A

increases insulin resistance

198
Q

Which hand joints are most affected in RA?

199
Q

What does low volume voltage QRS indicate ?

A

cardiac tamponade

200
Q

What is the action of tocolizumab for RA?

A

IL-6 inhibitor

note TNF alfa also reduced IL 6

201
Q

What is the most common pulmonary manifestation of SLE?

A

Pleural effusion

202
Q

What is the problem with serum urate levels for gout?

A

40% can be normal

in those on diuretics can have asymptomatic hyperuricaemia without gout

203
Q

What is the significance of weakly positive RF?

A

negligible in elderly

204
Q

What does polyarthritis in peripheral joints, red painful swollen suggest?

205
Q

What is a risk factor of raloxifene (serm)

A

endometrial ca
increased clotting risk

206
Q

What complication can occur in chronic RA of knee?

A

baker cyst from persistent effusion

207
Q

What is IgA nephropathy also known as?

A

Berger disease

208
Q

Differentiate between IgA nephropathy and post strep glomerulonephritis?

A

IgA nephropathy:
- 2 days post URTI
- Associated with HSP (abdo pain, buttock petechiae)

Post strep glomerulonephritis:
- 2 weeks post URTI

209
Q

On rituximab and presents with deranged LFT- what reactivation risk is there?

A

?reactivation of hep B

210
Q

What is an investigation of choice for Behcet?

A

pathergy test

shows hypersensitivity reaction at venepuncture site i.e pustule forms

211
Q

Which drug classes can cause drug induced lupus?

A

AED (carba/valproate)
Abx (linezolid)
Anti-inflammatory (sulfasala/penicillamine)

212
Q

What does gritty red eye with normal vision suggest?

A

episcleritis

213
Q

Outline management for RA?

A

DMARD monotherapy +/- a short-course of bridging prednisolone.

-methotrexate
-sulfasalazine
-leflunomide
-hydroxychloroquine

flares of RA are often managed with corticosteroids - oral or intramuscular

TNF-inhibitor is an inadequate response to at least two DMARDs including methotrexate.
- AEI (adalimumab, etanacept, infliximab)

Anti-CD20
- rituximab

214
Q

Outline management of SLE

A

First-line options include: (NHS)

  • NSAIDs
  • Hydroxychloroquine
  • Steroids (e.g., prednisolone)

Treatment options for resistant or more severe SLE include:

  • DMARDs
  • (e.g., methotrexate, mycophenolate mofetil or cyclophosphamide)
  • Biologic therapies
215
Q

Axial ank spond management

216
Q

Psoriasis with skin involvement management

A

methotrexate

217
Q

Psoriasis without skin involvement

A

sulfasalazine

MRCP Part 1 (17 decks)

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