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musc Flashcards

1
Q

X-ray findings in osteoarthritis

A

Loss of joint space
Osteophytes
Subchondral cysts
Subchondral sclerosis

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2
Q

X-ray findings in RhA

A

Loss of joint space
Soft tissue swelling
Peri-articular osteopenia

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3
Q

Swan-neck deformity in RhA results from

A

PIP extension
DIP/MCP flexion

n.b. Boutonnier’s deformity is the opposite

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4
Q

Malignant melanoma staging

A

Breslow thickness

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5
Q

Treatment of hypercalcaemia (i.e. due to mets/multiple myeloma)

A 
IV saline (first-line for dehydration)
Then afterwards give IV bisphosphonates
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6
Q

Decubitus ulcers

A

Pressure ulcers

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7
Q

Patient becomes pyrexic and creps at R lung base while on a course of chemotherapy

A

Neutropenic sepsis

  1. blood tests (FBC)
  2. blood cultures
  3. give Abx depending on results
  4. urine MC+S, CXR
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8
Q

Sjogren’s syndrome definition

A

Autoimmune destruction of exocrine glands, especially lacrimal and salivary glands

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9
Q

Primary AL amyloidosis

A

Ig light chain

Associated with multiple myeloma

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10
Q

Secondary AA amyloidosis

A

Serum amyloid A

Associated with chronic inflammation and infection (IBD)

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11
Q

Kawasaki’s disease (vasculitis) diagnosis

A

Echocardiogram

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12
Q

Rheumatoid arthritis serum markers include

A

RhF
anti-CCP (MOST SPECIFIC)
ESR
CRP

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13
Q

RhA (chronic inflammatory systemic disease, HLADR1 and DR4).

Presentations and Rx

A

Worse in the morning.
PIPs, MCPs, wrists, MTPs. Defomities.
Rx: 1. NSAIDs, 2. methotrexate, 3. DMARDs, 4. anti-TNF.
Complications: pulmonary fibrosis.

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14
Q

A 65 year old male undergoing chemotherapy for acute myeloid leukaemia starts to deteriorate on the ward. He complains of a tingling sensation in his fingers and around his lips. He also complains of muscle weakness and appears confused. His biochemistry reveals that he is hyperkalaemic, hyperphosphataemic, hyperuricaemic and hypocalcaemic. His creatinine is elevated to 300umol/L. What is the diagnosis?

A

Tumour lysis syndrome occurs in patients undergoing chemotherapy for lymphoproliferative malignancies. Lysis of tumour cells leads to the release of large amounts of potassium, phosphate and uric acid into the circulation. Excess phosphate binds to calcium, leading to hypocalcaemia and its clinical features. Patients are also at risk of developing AKI due to the deposition of uric acid and calcium phosphate crystals in renal tubules.

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15
Q

Types of large vessel vasculitis

A

Giant cell/temporal arteritis
Polymyalgia rheumatica
Takayasu’s arteritis

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16
Q

Types of medium vessel vasculitis

A

Kawasaki’s disease

Polyarteritis nodosa

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17
Q

Types of small vessel vasculitis with ANCA antibodies

A

CS disease (eosinophilic granulomatosis with polyangiitis)
WG (granulomatosis with polyangiitis)
Microscopic polyangiitis

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18
Q

Types of small vessel vasculitis (autoimmune but not ANCA)

A

Henoch-Schnolein purpura
Anti-GBM disease
Behcet’s disease

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19
Q

Felty’s syndrome

SANTA mnemonic

A 
Splenomegaly
Arthritis (rheumatoid)
Neutropenia
Thrombocytopenia
Anaemia
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20
Q

Septic (infective) arthritis causative organisms

A

<30years - N gonorrhoea

>30years - Staph aureus

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21
Q

Spondyloarthropathies are seronegative. Present in M>F. They are associated with HLA-B27 and axial arthritis. Examples of these follow the PEAR mnemonic i.e…..

A

Psoriatic
Enteropathic
Ankylosing spondylitis
Reactive arthritis

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22
Q

Extra-articular manifestations of spondyloarthropathies

A 
Uveitis
Psoriatic rash
IBD
Aortic valve problems
Ulcers

(see pg 553 OHCM)

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23
Q

A 30 year old male has lower back pain that is worse at night and at rest. It is relieved with exercise slightly and he has spinal stiffness. Pain spreads to hip and buttocks. O/E: spinal kyphosis. What is the likely diagnosis?

A

Ankylosing spondylitis

Bone fusion with abnormal joint stiffening and immobility. There is inflammation of vertebrae

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24
Q

SLE signs and symptoms

SOAP BRAIN MD mnemonic

A 
Serositis
Oral ulcers
Arthritis
Photosensitivity
Blood cell def (low Hb, WCC, plts)
Renal disorders
ANA +ve
Immunological disorders (anti-dsDNA, anti-Sm, anti-phospholipid)
Neuro disorders
Malar rash
Discoid rash
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25
Q

SLE antibodies

A

ANA - most sensitive
dsDNA - most specific

others: anti-Ro
anti-La
anti-Sm

26
Q

Schirmer’s test (filter paper under lower eyelid measures tear production) is used in which condition

A

Sjögren’s syndrome (autoimmune destruction of exocrine glands, esp. lacrimal and salivary glands)

27
Q

Dermatomyositis is an idiopathic inflammatory myopathy. Skin presentations on examination include

A

Gottren’s papules: discrete erythematous papules over MCP and IP joints
Heliotrope/lilac rash: violet rash on upper eyelids
Shawl sign: diffuse rash over back and shoulders
Periungual telangiectasia: around the nails

28
Q

Limited systemic sclerosis

A

CREST features
Skin involvement does not progress beyond forearms ± peri-oral skin

Anti-centromere antibodies

29
Q

Diffuse systemic sclerosis

A 
CREST features
GI disease
Interstitial pulmonary disease
Renal disease 
Beaked nose
Radial furrowing (puckered mouth)
Microstomia (small mouth)

Anti-topoisomerase (Scl70) antibodies

30
Q

CREST features in systemic sclerosis

A 
Calcinosis
Raynaud's
Oesophageal dysmotility
Sclerodactyl
Telangectasia
31
Q

Chronic tophaceous gout follows repeated attacks of acute gout. Presentations include

A

Persistent low grade fever
Polyarticular pain
Painful tophi (urate deposits)

Best seen on tendons and pinna of the ear. High serum urate.

32
Q

Acute attack of gout may be triggered by trauma, infection, alcohol, starvation, or withdrawal of hypouricaemic agents. Signs and symptoms include

A

Sudden excruciating monoarticular pain in MTP joint of big toe
Symptoms peak around 12hrs and resolve in 7-10days

±cellulitis, polyarthritis, serum urate levels can be normal.

33
Q

Osteoarthritis synovial fluid analysis

A

Clear
Viscous
Low cell count
Cartilage fragments

34
Q

Arthritis associated with deposition of calcium pyrophosphate dihydrate (CPPD) crystals in joint cartilage.

A

Pseudogout

35
Q

Reactive arthritis typically follow GI or GU infections. What are causative organisms?

A

GI - Salmonella, Yersinia, Campylobacter

GU - Chlamydia

36
Q

Keratoderma blenorrhagica (brownish red yellow scales on soles of feet or palms) occurs in

A

10% reactive arthritis patients.

37
Q

Reactive arthritis Rx

A
  1. NSAIDs
  2. Intra-articular steroid injection
  3. Sulfasalazine
38
Q

Is rheumatoid arthritis (HLA-DR1 and HLA-DR4) asymmetrical or symmetrical?

A

Symmetrical

deforming polyarthritis

39
Q

Polyarteritis nodosa (PAN) is a medium vessel vasculitis. It is associated with which other condition?

A

Hep B

40
Q

Mixed essential cryoglobulinaemia (MEC) is a small vessel vasculitis. It is associated with which other condition?

A

Hep C

41
Q

Microscopic polyangiitis is a small vessel vasculitis. What autoantibody is it associated with?

A

pANCA

42
Q

Wegner’s polyangiitis (granulomatosis with polyangiitis) is a small vessel vasculitis. What autoantibody is it associated with?

A

cANCA

43
Q

Behcet’s disease is an inflammatory multisystem disease with HLA-B51. Clinical triad is

A

Orogenital (both) ulcers

Uveitis

44
Q

Diagnostic test for Behcet’s disease

A

Pathergy test

±complement levels, FHx

45
Q

Polymyositis is associated with which type of diseases

A

Autoimmune connective tissue disorders e.g. scleroderma

46
Q

Dermatomyositis is associated with which type of diseases

A

Bronchial, stomach, testicular, breast and ovarian malignancy
Auto-antibodies (anti-Jo-1, anti-Scl, anti-Mi2, HLA-DRW52)

47
Q

Polymyositis and dermatomyositis both have

A

Proximal muscle weakness and atrophy affecting both upper and lower limbs

48
Q

Definitive diagnosis of polymyositis/ dermatomyositis is by

A

Muscle biopsy

inflammation, vascuolated fibres, amyloid fibrils

49
Q

Polymyositis and PMR present similarly. Ways to distinguish

A

PMR has elevated ESR and pain

50
Q

Myelofibrosis bone marrow aspirate or biopsy results

A

Aspiration = unsuccessful (‘dry tap’)

Trephine biopsy = fibrotic hypercellular marrow with dense reticulin fibres on silver staining

51
Q

Criteria for severe aplastic anaemia

A

<25% normal cells

or <50% normal cells + <30% haemopoietic cells and two of the following:
low neutrophils
low platelets
low reticulocytes

52
Q

Gout and pseudogout x-ray findings

A

Gout - none. Uric acid renal stones -> CT KUB

Pseudogout - chondrocalcinosis = linear calcification of cartilage. Signs of osteoarthritis (LOSS)

53
Q

Stages of sarcoidosis

A

Stage 1 - BHL
Stage 2 - BHL + pulmonary infiltration + node enlargement
Stage 3 - pulmonary infiltration + fibrosis

54
Q

Conditions that present with keratoconjunctivitis sicca (dry eyes)

A

Sarcoidosis

Sjogren’s syndrome

55
Q

Fluorescein/rose bengal stains in Sjogren’s syndrome may show…

A

Punctate or filamentary keratitis (clumps of mucus

on cornea)

56
Q

Sjogren’s syndrome increases the risk of Non-Hodgkin B-cell lymphoma by how many times

A

40

Other complications: oral candida, conjunctivitis, keratitis, vasculitis, kidney interstitial nephritis, pregnancy congenital heart block.

57
Q

Anti-cardiolipin antibodies are present in which condition?

A

Anti-phospholipid syndrome

APL, anti-b2-GPl. demonstrated by ELISA assays

58
Q

:hermitte’s sign in cervical spondylosis

A

Neck flexion causes crepitus ±parasthesia down the spine

59
Q

Cervical spondylosis involves osteoarthritic degeneration of vertebral bodies to produce osteophytes. These compress on nerve roots or anterior spinal cord to cause…

A

nerve roots - radiculopathy

anterior spinal cord - myelopathy

60
Q

Macroglossia and purpura around the eyes are both characteristic of which type of amyloidosis?

A

AL amyloidosis

light chain

61
Q

Amyloidosis immunochemistry stains

A

Congo red +ve (only really reliable in AA, poor for AL)

Apple-green bifringence

62
Q

A 60yr old woman complains of bilateral proximal muscle weakness in the legs and dysphagia. O/E: purple rash on her cheeks. What is the likely diagnosis?

A

Dermatositis

Autoimmune disease which can have resp and cardio involvement when severe. CK is usually elevated in dermatositis and polymyositis, and EMG shows fibrillation potentials. Rash = heliotropic lilac rash and dysphagia occur.

yr3 (19 decks)

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