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1
Q

Cutaneous manifestations of dermatomyositis

A
  • Gottrons papuls
  • Red, violacious erythemas (V-sign, Shawl sign, Holster sign)
  • Mechanic’s hands
  • cutanous calcinosis
  • heliotrope rash
  • erythroderma
  • nailfold abnormalities
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2
Q

Causes of subcutaneous nodules

A
  • RA
  • Gout
  • Rheumatic fever
  • sarcoidosis
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3
Q

Causes of dactylitis

A
  • Ank spond
  • Psoriatic arthritis
  • IBD-related arthritis
  • reactive arthritis
  • undiff. spondyloarthrits
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4
Q

Hand deformities in RA

A
  • Ulnar deviation
  • subcutaneous nodules
  • Z deformity of thumb
  • Boutonniere’s deformity
  • Swan-neck deformity
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5
Q

Biological agents to treat RA

A
  • TNF inhibitors
  • IL-6 inhibitor
  • B-cell depletion
  • Co-stimulation modulation
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6
Q

DMARDS

A
  • methotrexate
  • sulfasalazine
  • chloroquine
  • lefluonomide
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7
Q

X-ray findings in RA

A
  • uniform joint space narrowing
  • periarticular osteopenia
  • juxta-articular bony erosions
  • sub-luxation and gross deformities
  • peri-articular soft tissue swelling
  • capsular erosions
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8
Q

X-ray findings in OA

A
  • joint space narrowing
  • osteophytes
  • subchondral cysts
  • subchondral sclerosis
  • fibrillated cartilage
  • early cartilage loss
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9
Q

Nail manifestations in psoriatsis

A
  • pitting
  • onycholysis
  • subungual hyperkeratosis
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10
Q

Differentials of OA

A
  • ank spond
  • avascular necrosis
  • RA
  • psoriatic arthritis
  • gout
  • psuedogout
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11
Q

Clinical features of diffuse systemic sclerosis

A
  • severe ILD
  • renal involvement
  • diffuse skin involvement
  • anti-topoisomerase Ab
  • short duration of Raynauds
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12
Q

Clinical features of limited systemic sclerosis

A
  • isolated pumonary hypertension
  • no renal involvement
  • limited skin involvement
  • anti-centromere Ab
  • long duration of Raynauds
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13
Q

Drug used for renal involvement of systemic sclerosis

A

ACE-inhibitor

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14
Q

Autoantibodies specific to systemic sclerosis

A
  • anti-centromere antibody SCL70

- anti-topoisomerase

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15
Q

6 types of systemic involvement of systemic sclerosis

A
  • GIT (oesoph dysmotility, microstomia)
  • Pulm (ILD, PHPT)
  • Cardiac (pericarditis)
  • renal (scleroderma renal crisis)
  • musculoskeletal (arthralgia)
  • vascular (Raynauds)
  • cutaneous (progressive skin fibrosis)
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16
Q

6 systemic manifestations of idiopathic inflammatory myositis

A
  • Constitutional
  • Skeletal (prox muscle weakness, pharyngeal weakness, weak neck flexors)
  • skin (DM)
  • lungs (ILD)
  • cardiac (carditis, CMO)
  • joints (arthritis)
  • GIT (GORD)
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17
Q

Differentials of proximal muscle weakness

A
  • genetic muscle disorders (muscular dystrophies)
  • congenital myopathies
  • neuropathies (SMA, MG, GBS)
  • metabolic (storage disease)
  • endocrine (thyroid)
  • infection
  • drugs (AZT, steroids)
  • granulomatous disease
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18
Q

Causes of Raynaud’s phenomenon

A
  • Idiopathic (primary)
  • scleroderma
  • SLE
  • Sjogrens
  • RA
  • dermatomyositis
  • drugs (Bblock, sulfasalazine)
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19
Q

Differentials for gout

A
  • CPPD
  • BCPC
  • septic arthritis
  • reactive arthritis
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20
Q

Bedside test for renal flare in SLE

A

Dipstix - proteinuria and haematureia

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21
Q

Clinical findings for APS

A
  • tendency to thrombosis, recurrent fetal loss, thrombocytopenia, false positive tests for syphilis
  • Ab: anti-cardiolipin, anti-glycoprotein1, anti glycoprotein B2, anti-lupus coag
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22
Q

Treatment of APS

A

long-term anticoagulation with Warfarin

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23
Q

Definition of osteoporosis

A

Generalised bone disease characerised by decreased bone mass and deterioration of bone micro-architecture, resulting in increased fracture risk

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24
Q

Primary OP

A

bone loss related to decline in gonadal function associated with aging

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25
Q

Secondary OP

A

bone loss that results due to a variety of conditions that adversely impact bone metabolism

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26
Q

Causes of secondary OP

A
  • endocrine - thyrotoxicosis, cushings
  • hypogonadal (anorexia, turners)
  • drugs (glucocorticoids)
  • haematological malignancy (MM, thalassemia)
  • GIT (IMB, malabsorption)
  • Neurological (Parkinsons)
  • other (RA, AS, SLE, CRF)
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27
Q

Radiographic diagnosis of OP

A

Dexa score of -2.5 and below or T-score of -1 and below

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28
Q

Treatment of OP

A

Non-pharm
- prevention of falls

Pharm

  • calcium and vit D supp
  • bisphosphonates
  • calcitonin
  • strontium ranalate
  • HRT
  • selective oestrogen receptor modulator
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29
Q

SLICC immunological criteria

A
  • anti-dsDNA
  • anti-Sm
  • positive Coomb’s test
  • anti-phospholipid antibody
  • ANA
  • low complement
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30
Q

SLICC clinical criteria

A
  • acute lupus rash
  • chronic lupus rash
  • oral ulcers
  • arthritis
  • thrombocytopenia
  • haemolytic anaemia
  • leucopenia
  • serositis
  • lupus nephritis
  • non-scarring alopecia
  • neurological
31
Q

Things to exclude for FMS

A
  • hypothyroidism
  • hyperparathyroidism
  • polymyalgia rheumatica
  • early inflammatory arthritis
  • parkinsonism
  • myositis
  • malignancies
32
Q

Treatment of FMS

A

Non-pharm

  • education
  • aerobics
  • CBT

Pharm

  • TCAs
  • SSRIs
  • alpha 2 delta ligands
  • tramadol and paracetamol
33
Q

Commonest non-articular rheumatism at elbow

A
  • tennis elbow (lateral epicondylitis - pain on wrist flexion)
  • golfer’s elbow (medial epicondylitis - pain on wrist extension)
34
Q

Commonest non-articular rheumatism at knee

A

Pre-patellar bursitis (housemaid’s knee)

35
Q

New classification of JIA

A
  • oligoarticular (persisten, extended)
  • polyarticular (RF pos, neg)
  • systemic
  • enthesitis related
  • psoriatic
  • unclassified
36
Q

Causes of primary large artery vasculitis

A
  • GCU

- Takayasu’s

37
Q

Causes of primary medium artery vasculitis

A
  • classic PAN

- Kawasaki

38
Q

Causes of secondary large artery vasculitis

A
  • aortitis (RA)

- infection (syphilis, TB)

39
Q

Treatment for primary vasculitis

A
  • immunosuppression (steroids, MTX, biologicals)

- revascularisation

40
Q

Acute treatment of gout

A
  • NSAIDs
  • colchicine
  • if CI, steroids
41
Q

Urate lowering therapies

A
  • uricostatic (allopurinol)
  • uricosuric (probenecid)
  • uricolytic (pegloticase)
42
Q

Prophylaxis of acute attacks during ULT

A

colchicine for 3-6 months

NSAIDS for 6-12 weeks

43
Q

6 clinical syndromes of CPPD

A
  • pseudogout
  • OA-like
  • RA-like
  • OA- like with discrete acute attacks
  • neuropathic type
  • asymptomatic chondrocalcinosis
44
Q

Crystals in CPPD joint aspirate

A

Positively bifringemnt

45
Q

Treatment of CPPD

A
  • NSAIDs
  • IAI steroids
  • colchicine (pseudogout)
  • HCQ (chronic arthritis
46
Q

Definition of Sjogrens

A

Chronic inflammatory disorder characterised by lymphocytic infiltrates in exocrine glands

47
Q

Red flags for lower back pain

A
  • age of onset <20 years or >50 years
  • recent history of violent trauma
  • constant progressive, non-mechanical pain
  • thoracic pain
  • past history of malignant tumour
  • prolonged use of corticosteroids
  • drug abuse, immunosuppression, HIV
  • systemically unwell
  • unexplained weight loss, night sweats
  • widespread neurological symptoms
  • structural deformity
  • fever
48
Q

Criteria for Sjogrens

A
  • ocular symptoms
  • oral symptoms
  • ocular signs
  • autoantibodies (ro, La)
  • alivary gland involvement
  • histopathology
49
Q

What malignancy is Sjogrens associated with?

A

Non-Hodgkins lymphoma

50
Q

Triad of Reiter’s syndrome

A
  • urethritis
  • conjunctivitis
  • oligo-arthritis
51
Q

Extra-articular features of reactive arthritis

A
  • mucocutaneous lesions
  • enthesitis
  • conjunctivitis
  • uveitis
  • urethritis
  • dactylitis
  • carditis
52
Q

Treatment of reactive arthritis

A
  • NSAIDS
  • IAI steroid
  • mod/high dose steroids
  • antibiotics if acute phase
  • chronic = sulfasalazine
  • physiotherapy
53
Q

Side effects of long-term steroid use

A
  • proximal myopathy
  • diabetes
  • cushings
  • osteoporosis
  • hypertension
  • glaucoma
  • cataracts
54
Q

Side-effects of NSAIDs

A
  • Reye’s syndrome
  • sodium and water retention
  • PUD
  • interstitial nephritis
  • bronchospasm
  • transaminitis
55
Q

Criteria for hypermobility syndrome

A
  • hyperextension of knees >10
  • thumb passively opposed to forearm
  • little MCP extends >90 degrees
  • elbow extension >10
  • palms on floor
56
Q

Causes of hypermobility syndrome

A
  • hypermobility syndrome (AD)
  • Ehlers Danlos
  • Down’s syndrome
  • osteogenesis imperfecta
  • Marfans
  • Marfanoid hypermobility syndrome
57
Q

Gout X-ray findings

A
  • preserved joint space
  • rat-bitten punched out erosions
  • overhanging sclerotic edges
  • tophi
  • no periarticular osteopenia
58
Q

Spondyloarthritis disorders

A
  • ankylosing spondyitis
  • psoriatic arthritis
  • reactive arthritis
  • IBD-related arthritis
  • undifferentiated spondyloarthritis
59
Q

Axial features of spondyloarthritis

A
  • inflammatory back pain
  • ankylosis of the spine, vertebro-costal and sterno-costal joints
  • abnormal posures
  • risk of fracture
  • sacroilitis
  • arthritis of hip and shoulder
60
Q

Extra-articular features of spondyloarthritidies

A
  • enthesitis
  • dactylitis
  • acute anterior uveitis
  • diarrhoea
  • psoriases
  • keratoderma blenorrhagicum
61
Q

Treatment of axial spondyloarhtitis

A
  • NSAIDs

- biologic DMARDs

62
Q

Treatment of peripheral arthitis of spondyloarthritis

A
  • NSAIDs
  • synthetic DMARD
  • biologic DMARDs
63
Q

CASPAR criteria for psoriatic arthritis

A

An inflammatory articular disease with >3 of:

  • psoriasis (current, present, fam Hx)
  • typical nail dystrophy
  • negative RF
  • dactylitis
  • juxtaarticular new bone formation
64
Q

Ophthalmic manifestations of RA

A
  • keratoconjunctivitis sicca
  • scleritis and episcleritis
  • keratitis
  • retinal vasculitis
  • scleromalacia
65
Q

Pulmonary manifestations of RA

A
  • pulmonary nodules
  • interstitial lung disease
  • pleural effusions
66
Q

Felty’s syndrome

A
  • neutropenia
  • splenomegaly
  • leg ulcers
67
Q

Complications of RA

A
  • accelerated atherosclerosis
  • lymphoma
  • FMS
  • medication-related
68
Q

BCP crystals

A
  • carbonate-substituted hydroxyapetite
  • tricalcium phosphate
  • otacalcium phosphate
69
Q

Associations with BCP deposition disease

A
  • Milwaukee shoulder syndrome
  • OA
  • calcific tenditiis
  • limited SS
  • dermatomyositis
  • mixed crystal deposition disease
  • chronic renal failure
  • hypercalcaemia
70
Q

3 types of idiopathic inflammatory myopathy

A
  • polymyositis
  • dermatomyositis
  • inclusion body myositis
71
Q

Management of IIM

A
  • corticosteroids
  • immunosuppressive agents
  • IVIG
72
Q

Complications of Raynaud’s phenomenon

A
  • fingertip pits and digital ulcers
  • gangrene
  • osteomyelitis
  • digital amputation
73
Q

Treatment of pulmonary arterial hypertension in systemic sclerosis

A
  • calcium channel blockers
  • endothelin receptor antagonist (bosentan)
  • phosphodiesterase 5 inhibitor (sildenafil)
  • prostacyclin analogue inhalers

Rheumatology (6 decks)

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