Questions Flashcards
Describe what is meant by drug-induced lupus erythematosus [4] - include which antibodies are commonly found [2]
Which drugs most commonly cause this? [2]
Most common causes
* procainamide (antiarrhythmic)
* hydralazine (antihypertensive agent)
Features:
* arthralgia
* myalgia
* skin (e.g. malar rash) and pulmonary involvement (e.g. pleurisy) are common
* ANA positive in 100%, dsDNA negative
* anti-histone antibodies are found in 80-90%
* anti-Ro, anti-Smith positive in around 5%
Describe how you manage long term bisphosphinate treatment [1]
After a five year period for oral bisphosphonates (three years for IV zoledronate), treatment should be re-assessed for ongoing treatment, with an updated FRAX score and DEXA scan.
This guidance separates patients into high and low risk groups. To fall into the high risk group, one of the following must be true:
* Age >75
* Glucocorticoid therapy
* Previous hip/vertebral fractures
* Further fractures on treatment
* High risk on FRAX scoring
* T score <-2.5 after treatment
This guidance separates patients into high and low risk groups. To fall into the high risk group, one of the following must be true [6]
- Age >75
- Glucocorticoid therapy
- Previous hip/vertebral fractures
- Further fractures on treatment
- High risk on FRAX scoring
- T score <-2.5 after treatment
Alendronate can cause atypical stress fractures of which bone? [1]
atypical stress fractures of the proximal femoral shaft
- they reduce bone remodelling since they inhibit osteoclasts, which means micro fractures can’t be healed as well.
Describe the acute phase response of bisphosphinate initiation [3]
acute phase response: fever, myalgia and arthralgia may occur following administration
What change in Ca levels would occur with bisphosphinate tx? [1]
hypocalcaemia: due to reduced calcium efflux from bone. Usually clinically unimportant
What are RA x-ray changes? [5]
loss of joint space
juxta-articular osteoporosis
soft-tissue swelling
periarticular erosions
subluxation
How do you differentiate gout from pseudogout on x-ray? [1]
Chondrocalcinosis helps to distinguish pseudogout from gout
Name two drug classes that cause erythema nodosum [2]
penicillins; sulphonamides
Felty’s syndrome is a triad of []
Felty’s syndrome is a triad of rheumatoid arthritis, splenomegaly and neutropenia (low white cell count).
Pneumonic for remembering causes of erythema nodosum? [+]
NO : idiopathic
D : drugs → penicillin sulphonamides
O : oral contraceptives / pregnancy
S : sarcoidosis / TB
U : ulcerative colitis / Crohn’s disease / Behçet’s disease
M : micro → strep, mycoplasma, EBV and more
The concurrent use of [] and [] containing antibiotics may cause bone marrow suppression and severe or fatal pancytopaenia
The concurrent use of methotrexate and trimethoprim containing antibiotics may cause bone marrow suppression and severe or fatal pancytopaenia
What would indicate that Raynaud’s is primary and not a secondary cause? [1]
Raynaud’s disease typically presents in young women (e.g. 30 years old) with bilateral symptoms.
What is the difference in treatment betwen mild and moderate fungal nail infections in terms of:
- presenting features [1]
- treatment [1]
Mild:
- < 2 nails impacted
- Topical amorolfine
Moderate:
- > 2 nails impacted
- Oral itraconazole
[] score is a useful tool to assess hypermobility.
Beighton score is a useful tool to assess hypermobility.
A patient has gout, which they are given long term treatment for.
He comes in with an acute exercabation of another illness he has.
A FBC reveals pancytopenia.
The interaction of which medications is likely to have caused this? [2]
Azathioprine and allopurinol have a severe in teraction causing bone marrow suppression
What is the difference in underlying pathologies causing:
Low calcium, raised phosphate, raised ALP, raised PTH
versus
Low calcium, low phosphate, raised ALP, raised PTH
Low calcium, raised phosphate, raised ALP, raised PTH = kidney failure
Low calcium, low phosphate, raised ALP, raised PTH = osteomalacia
What is the immediate plan for a patient who has a fragility fracture and is over 75? [1]
Start alendronate in patients >= 75 years following a fragility fracture, without waiting for a DEXA scan
- the most likely diagnosis is osteoporosis
Which two key parts of a question indicate a patient is suffering from polymalgia rheumatica? [2]
Shoulder Girdle pain x raised ESR
A 57-year-old female has noticed that the skin on her hands has become very tight and that her fingers sometimes turn blue. She has also had difficulty swallowing both solids and liquids. What autoantibody is most associated with these symptoms?
Anti-centromere
Anti-topoisomerase (anti-Scl-70)
Anti-double-stranded DNA (anti-dsDNA)
Anti-cyclic citrullinated peptide (anti-CCP)
Anti-mitochondrial (AMA)
A 57-year-old female has noticed that the skin on her hands has become very tight and that her fingers sometimes turn blue. She has also had difficulty swallowing both solids and liquids. What autoantibody is most associated with these symptoms?
Anti-centromere - patient has limited cutaneous systemic sclerosis
Anti-topoisomerase (anti-Scl-70) - for diffuse systemic sclerosis
anti-centromere –>’mere’ and ‘limited’ are synonyms
[RA drug] - may result in a severe and permanent retinopathy
Hydroxychloroquine - may result in a severe and permanent retinopathy
Donald trump loves hydroxychloroquine- wouldn’t stop going on about it
He is orange (skin pigmentation), he is nightmarish (nightmares), always looks like he’s squinting (reduced visual acuity- bullseye retinopathy), and his brother died from alcoholism (liver toxicity)
Schober’s test < [] cm is suggestive of ankylosing spondylitis.
Schober’s test < 5 cm is suggestive of ankylosing spondylitis.
Inflammatory arthritis involving DIP swelling and dactylitis points to a diagnosis of []
Name another common symptom associated with this condition [1]
Inflammatory arthritis involving DIP swelling and dactylitis points to a diagnosis of psoriatic arthritis
Commonly presents with Onycholysis
A patient has RA.
Which medication is causing this condition? [1]
Hydroxychloroquine:
- ‘bull’s eye maculopathy’
Fibromyalgia typically presents in which patient aged population? [1]
Polymyalgia rheumatica (PMR) typically presents in which patient aged population? [1]
Describe the difference in presentation between them [2]
Polymyalgia rheumatica (PMR) typically presents in older adults with bilateral aching and stiffness in the shoulder and hip girdle muscles, often with morning stiffness lasting more than an hour.
Fibromyalgia typically affects younger individuals and presents with chronic widespread pain, tenderness at specific points, fatigue, and sleep disturbances.
TOM TIP: The key feature that often appears in exams that should make you think about osteogenesis imperfecta is the []
This is a unique feature that examiners love to drop in. The exam patient may be a young child with unusual and recurrent fractures that would normally make you consider safeguarding, however “you notice a blue discolouration to the sclera”.
TOM TIP: The key feature that often appears in exams that should make you think about osteogenesis imperfecta is the blue sclera.
This is a unique feature that examiners love to drop in.
The exam patient may be a young child with unusual and recurrent fractures that would normally make you consider safeguarding, however “you notice a blue discolouration to the sclera”.
A patient has anterior ischaemic optic neuropathy (AION) secondary to temporal arteritis.
What is the most likely finding on fundoscopy? [1]
swollen pale disc and blurred margins
AS presents with reduction of which movements in clinical examination? [3]
- reduced lateral flexion
- reduced forward flexion - Schober’s test - a line is drawn 10 cm above and 5 cm below the back dimples (dimples of Venus). The distance between the two lines should increase by more than 5 cm when the patient bends as far forward as possible
- reduced chest expansion
