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Medicine > Rheu > Flashcards

Rheu Flashcards

1
Q

Are Oral corticosteroids Dmards?

A

No they are not. Oral corticosteroids are not DMARDS

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2
Q

Difference between Methylprednisolone and Prednisolone?

A

Essentially the same. Prednisolone is administered Orally. Methylprednisolone is administered IV.

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3
Q

According to NICE guidelines, patient needs a DAS assessment

A

anti TNF therapy

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4
Q

Pneumonitis is well recognized but uncommon complication

A

Methotrexate

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5
Q

Inhibit both COX-1 and COX-II

A

NSAIDS

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6
Q

All brands are parenteral

A

anti TNF therapy

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7
Q

Causes profound B-Cell lymphocyte depletion

A

Rituximab

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8
Q

Better G.I. safety than the older generation of these drugs

A

Cox II selective non-steroidals

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9
Q

Can cause temporary azospermia in young men

A

Sulphasalazine

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10
Q

Azoospermia meaning

A

The complete absence of sperm from the seminal fluid.

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11
Q

Combination therapy may be more effective than monotherapy

A

DMARDs

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12
Q

Increased risk of infection with intra-cellular pathogens

A

Anti TNF therapy

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13
Q

Highly teratogenic and abortifacient

A

Methotrexate

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14
Q

Efficacy is similar to the older generation of these drugs

A

Cox II selective non steroidals

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15
Q

Closely related drugs are used to treat Crohn’s disease

A

Sulphasalazine

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16
Q

Given as adjuvant to other drugs to treat osteoporosis

A

Calcium/Vitamin D

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17
Q

Given early in disease to slow down progression

A

DMARDs

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18
Q

Have cardiovascular risk similar to older generation of these drugs

A

Cox II Selective non steroidals

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19
Q

Helpful for bone metastases induced hypercalcaemia

A

Bisphosphonates

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20
Q

Also referred as ‘pulse’ therapy

A

Methylprednisolone

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21
Q

Do not prescribe if allergic to aspirin

A

Sulphasalazine

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22
Q

Very rapid influence on inflammatory arthritis SLE & vasculitis

A

Oral Corticosteroids

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23
Q

Well recognised to cause infertility

A

Cyclophosphamide

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24
Q

Many brands in chewable formulation

A

Calcium/vitamin d

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25
Q

Narrow therapeutic window

A

Paracetamol

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26
Q

Minimise fracture risk in people taking steroids

A

Bisphosphonates

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27
Q

Titrate dose to reduce serum urate level

A

Allopurinol

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28
Q

More side effects if TPMT enzyme deficient

A

Azathioprine

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29
Q

Most of them need regular blood monitoring

A

DMARDs

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30
Q

Osteoporosis with long term use

A

Oral Corticosteroids

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31
Q

Weight gain very common

A

Oral Corticosteroids

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32
Q

Drug interaction with allopurinol

A

Azathioprine

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33
Q

Risk of haemorrhagic cystitis

A

Cyclophosphamide

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34
Q

Risk of interstitial nephritis and fluid retention

A

NSAIDs

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35
Q

Risk of oesophagitis

A

Bisphosphonates

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36
Q

Risk of peptic ulcer

A

NSAIDs

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37
Q

Should not be stopped during an ‘attack’

A

Allopurinol

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38
Q

Key treatment for temporal arteritis (gca) and PMR

A

MethylPrednisolone

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39
Q

Often used as a ‘steroid sparing’ agent

A

Azathioprine
(I think othere DMARDs too, check…)

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40
Q

reduces hyperuricaemia

A

Allopurinol

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41
Q

Efficacy due to action on bone and muscle

A

Calcium/Vitamin D

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42
Q

Used for intra-articular and intravenous injections

A

Methylprednisolone

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43
Q

Licensed for treatment of lymphoma and rheumatoid arthritis

A

Rituximab

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44
Q

Weekly doses followed by folic acid

A

Methotrexate

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45
Q

Alkylating chemotherapeutic drug

A

Cyclophosphamide

46
Q

Follow up infusions are not needed many months

A

Rituximab

47
Q

Which anti microbial may cause cutaneous hypersensitivity vasculitis?

A

Penicillin

48
Q

Do Diuretics decrease uric acid excretion?

A

Yes. Therefore risk factor for gout.

49
Q

Which Class of antiarrhythmics can exacerbate Raynards symptoms

A

Beta Blockers.

50
Q

The 4 common clinical features of Spondyloarthropathies

A
  1. Sacroiliac/axial disease (back/buttock pain)
  2. Inflammatory arthropathy of peripheral joints
  3. Enthesitis (inflammation at tendon insertions)
  4. Extra-articular features (skin/gut/eye)
51
Q

Common signs and symptoms of SLE

A

S erositis (pleurisy, pericarditis)
O ral ulcers (usually painless; palate most specific)
A rthritis (small joints nonerosive)
P hotosensitivity (or malar or discoid rash)

B lood disorders (low wcc, lymphopenia, thrombocytopenia, hemolytic anemia)
R enal involvement (glomerulonephritis)
A utoantibodies (ANA positive in >90% of cases)
I mmunologic tests (e.g. low complements)
N eurologic disorders (seizures or psychosis)

52
Q

Which conditions can have Raynauds Phenomenon as an extra articular sign?

A

SLE,
Sjorgrens’s,
Systemic Sclerosis (Scleroderma)
Dermatomyositis + Polymyositis

53
Q

Which drugs can induce Raynauds

A

Beta Blockers

54
Q

Risk factors for septic arthritis

A

diabetes mellitus, pre existing joint disease (e.g. RA), recent joint surgery, immunosuppression, chronic renal failure, Alcoholism

55
Q

Septic arthritis pathophysiology

A

Foreign microbe infection of the joint space (capsule) that is associated with rapid joint destruction within days if not adequately treated.

56
Q

Is septic arthritis typically monoarticular or polyarticular?

A

Typically monoarticular. Can be polyarticular = very poor prognosis

57
Q

Most common causative organisms of septic arthritis

A

Staph Aureus and Streptococci

58
Q

IVDU can have septic arthritis in strange sites, where?

A

Axial Sites

59
Q

In which joint is septic arthritis most commonly affected?

A

Knee

60
Q

Gram -ve seen as causative organism for septic arthritis in elderly and IVDU, true or false?

A

True

61
Q

In people under 40, what can be the causative organism for septic arthritis?

A

Gonococcal

62
Q

Complications of septic arthritis

A

Degeneration of joint
Death

63
Q

The 2 specific septic arthritis diagnostic investigations

A

Aspirate synovial fluid
Blood culture

64
Q

Management of Septic Arthritis

A

Antibiotics and surgical washout

65
Q

Features seen in Spondyloarthropathies (but in different degrees depending in the type of Spondyloarthropathy)

A

S ausage digits
P soriasis
I ritis (inflammation of the colored part of your eye)
N SAID response is good
E nthesitis (inflammation of sites of tendon to bone)

A rthritis/ arthralgia
C rohns (+other IBDs)
H LA-B27
E levated inflammatory vessels

66
Q

Dactylitis (sausage digit) is associated with which forms of spondyloarthropathy?

A

Psoriatic arthritis
Ankylosing spondylitis

67
Q

What are spondyloarthropathies?

A

Group of conditions that affect the spine and peripheral joints and are associated with the presence of HLA-B27

68
Q

Name 4 clinical features that all Spondyloarthropathies tend to have:

A

Sacroiliac/axial disease (back/buttock pain)
Inflammatory arthropathy of peripheral joints
Enthesitis (inflammation at tendon insertions)
Extra articular features (skin/gut/eye)

69
Q

Extra-articular manifestations of Ankylosing spondylitis (All the A’s)

A

Anterior uveitis
AV block
Aortic incompetence
Apical lung fibrosis
Amyloidosis

70
Q

I.PAIN (=features of inflammatory back pain) tell me them!

A

Insidious onset
Pain at rest and at night therefore
Age of onset is LESS THAN 40
Improvement with exercise
No improvement with rest

71
Q

Talk Psoriatic Arthritis in terms of patterns of presentation

A

Nails can be affected
Can be seen as symmetrical arthritis (like RA)
Can be seen as monoarthritis
Can be seen as asymmetrical oligoarthritis with dactylitis

72
Q

What xray appearance can be observed in Psoriatic Arthritis

A

Pencil in cup

73
Q

Can you get costochondritis with Ankylosing spondylitis?

A

Yes

74
Q

In Ankylosing Spondylitis name 3 features seen on the xray of the spine and the SI joint

A
  1. Syndesmophytes (seen in ankylosing spondylitis)
  2. Romanus lesion
  3. SI joint erosions
    (The sacroiliac joints are centrally involved in the SpA (spondyloarthropathy ), most clearly and pathognomonic in ankylosing spondylitis)
75
Q

Before giving someone Methotrexate what two tests does the patient need

A

CXR and liver tests

76
Q

Name two characteristic features of blood tests for someone with SLE?

A

low WCC and low platelets

(also raised PV with normal CRP)

77
Q

Lupus urine test would show?

A

Lupus can attack the kidneys (lupus nephritis). Therefore, can have blood and protein in the urine. (Haematuria and Proteinuria)

78
Q

Polymyalgia Rheumatica is associated with which other condition?

A

Giant cell Arteritis

79
Q

Prednisolone is typically given daily in almost all PMR patients initially, at what dose though?

A

15mg
Then taper off slowly.

80
Q

Can PMR patients expect the response to prednisolone to be dramatic or not?

A

Dramatic diagnostic response within 5 days of starting the medication

81
Q

What symptom should patients with PMR be watchful for?

A

Headache (possible GCA)

82
Q

If GCA is diagnosed what drug is given and at what dose?

A

60mg Prednisolone daily.
For at least 2 weeks, then taper off.

83
Q

For acute onset GCA visual symptoms, what drug should be given?

A

Methylprednisolone IV pulse therapy (1-3 days)

84
Q

GCA trumps PMR as it requires higher prednisolone. True or False?

A

True

85
Q

In PMR prednisolone is given and which other drugs?

A

Many adverse effects of long term corticosteroid usage.

Calcium/ vit d (prevention of osteoporosis)
PPI (to reduce glucocorticoid risk of [weakly linked with] peptic ulceration and perforation)

86
Q

Either a biopsy of the temporal artery or …….. can help to diagnose GCA

A

Ultrasound of the temporal artery

87
Q

Which NSAID has least risk for cardiovascular adverse events?

A

Naproxen

88
Q

Are Heberden’s nodes on the PIPJs?

A

No they are on the DIPJs
(herbs sprinkling).
Seen in OA

89
Q

Are Bouchard’s nodes on the PIPJs?

A

Yes
Seen in OA

90
Q

If a patient has really tight skin and as a result can no longer fully stretch their fingers, which condition are you thinking of?

A

Systemic Sclerosis

Sign is called sclerodactyly

91
Q

Person presents with weird looking nails and DIPJs swelling, whats most likely diagnosis?

A

Psoriatic Arthritis

92
Q

Which two tests can be used to diagnose carpal tunnel syndrome?

A

Tinel’s and Phalen’s

93
Q

What condition?

A

Hallux Valgus

94
Q

Which condition can have nail fold infarcts?

A

RA
SLE, Vasculitis

95
Q

Schobers test is used in which Spondyloarthropathy?

A

Ankylosing Spondylitis

96
Q

What is Schobers test?

A

Used to test if theres a decrease in lumbar spine flexion

97
Q

Test yourself with cover and recall of rheumatology booklet

A

Look at written notes too

98
Q

Test yourself with cover and recall of rheumatology booklet

A
99
Q

Test yourself with cover and recall of rheumatology booklet

A

Look at written notes too

100
Q

Test yourself with cover and recall of rheumatology booklet

A

Look at written notes too

101
Q

Test yourself with cover and recall of rheumatology booklet

A

Look at written notes too

102
Q

Test yourself with cover and recall of rheumatology booklet

A
103
Q

Whats Tophi?

A

Urate deposits (seen in e.g. pinna, tendons, joints)

104
Q

A patient has gout. They extract synovial fluid from the affected joint, describe what the urate crystals look like?

A

Needle-shaped monosodium urate crystals, displaying negative birefringence under polarised light

105
Q

What conditions lead to saddle nose?

A

Trauma,
Cocaine abuse,
Relapsing polychondritis,
Vasculitis (e.g. Wegener’s granulomatosis)

106
Q

Name some forms of Vasculitis

A

Blood vessels affected:
Large: GCA
Medium: Kawasaki disease
Small: Wegener’s granulomatosis (granulomatosis with polyangiitis)
Variable vessel vasculitis: Behcet’s

From research PMR is and is not considered to be a true vasculitis

107
Q

Whats arthralgia?

A

Joint pain (check)

108
Q

Some tests required for Vasculitis:

A

ANCA (may be positive),
CRP (raised),
ESR (raised),

Mandated urinalysis: To identify if theres kidney involvement then look for proteinuria and haematuria (sign of glomerulonephritis)

“The presentation of vasculitis will depend on the organs affected”

109
Q

Whats the most common cause of Thoracic kyphosis in men? In women?

A

In men Ankylosing Spondylitis
In women Osteoporosis.

110
Q

Give examples of Hypermobility Spectrum Disorders:

A

Ehlers Danlos syndrome, Marfan syndrome

111
Q

Whats Beighton Score

A

Beighton score is a popular screening technique for hypermobility

112
Q

Dupuytren’s contracture causes

A

Diabetes mellitus, Alcoholic liver disease, trauma, anti epilepsy drugs (e.g. Phenytoin)

Medicine (30 decks)

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