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3B + Finals > Rheum > Flashcards

Rheum Flashcards

1
Q

Important side effects of Rituximab

A

thrombocytopenia

peripheral neuropathy

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2
Q

Maintenance dose of methotrexate in RA

A

7.5-15mg Once weekly

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3
Q

What other drug should be prescribed along methotrexate in RA

A

Folic acid 5mg OD. Omit on meth day

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4
Q

side effects of methotrexate

A 
mucositis 
mouth ulcers
pulmonary fibrosis 
leukopenia 
teratogenic
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5
Q

Extra-articular diseases associated with Ra, or that may present along side

A

Pulmonary fibrosis + nodules
Bronchiolitis obliterates (inflam –> small airway destruction)
Felty’s syndrome - neutropenia + splenomegaly
Anemia
nodular disease
pericarditis/pericardial effusions

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6
Q

systemic symptoms of RA

A

fatigue + weight loss
pericarditis
pleurisity
recurrent soft tissue disease

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7
Q

Genes associated with RA

A

HLA-DR4

hla-dr1

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8
Q

Antibodies associated with RA

A 
Anti-CCP Cyclic citrullinated peptide antibodies
rheumatoid factor (only in 70%)
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9
Q

Inx in suspected RA

A

RBC, U/E - Norm anaemia, CRP and ESR up
Antibodies - ANTI-CCP
gene testing? - HLA-DR4/1

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10
Q

Urgent referral criteria for RA

A

If hands and feet involved
multiple joints
>3 months of symptoms

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11
Q

First line mx of RA (exc NSAIDS)

A

Methotrexate + folic acid, leflunomide, hydroxychloroquine,

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12
Q

2nd line mx of RA

A

2 of Methotrexate + folic acid, leflunomide, hydroxychloroquine

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13
Q

3rd line mx of RA

A

TNF inhibitors - eternacept, adalumimab,

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14
Q

4th line mx of ra

A

methotrexate + rituximab

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15
Q

Side effects of leflumonide

A

peripheral neuropathy

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16
Q

Side effects of hydroxychlorquine

A

visual field defects

retinopathy

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17
Q

Severe complication of RA involving cervical spine

A

Atlanta-axial sublimation
Inflammation and bursitis of the joint can cause spinal cord compression.
Medical emergency

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18
Q

Psoriatic arthritis signs

A

Onychosis - nail splitting from bed
Nail pitting
bone shortening - telescoping fingers

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19
Q

X-ray signs in Psoriatic A

A

periosteum inflammation, ankylosis, osteolysis

pencil in cup deformity

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20
Q

Management of psoriatic a

A

NSAIDs
Methotrexate + ciclosporin
Eternacept

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21
Q

How should steroids be delivered in psoriatic A

A

injection into joint space only - oral steroids may worsen skin lesions

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22
Q

3 other features of reactive arthritis

A

Anterior uveitis
keratoderma blenorrhagia
Circinate balantis
Bilateral aseptic conjuctivitis

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23
Q

Associated diseases with and spond

A 
psoriatic arthritis 
reactive arthritis 
dactylics 
inflammatory bowel disease 
enthuses (archilis)
heart block 
restrictive lung disease 
apical pulmonary fibrosis 
anaemia
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24
Q

Gene associated with ank spond

A

HLA-B27

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25
Q

inx of ank spond

A

FBC, U/E
CRP and ESR raised
MRI - bone marrow oedema in early disease
XRAY - bamboo spine
Schobers test - <20cm increase in distance on back = suggestive of ank spond

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26
Q

Two clinical features of anti-phospholipid syndrome

A

Recurrent miscarriage

VTEs

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27
Q

What other condition has strong links to giant cell arteritis

A

Polymyalgia rheumatica

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28
Q

Temporal arteritis sympoms

A 
jaw claudication 
Unilateral headache (temporal and forehead) and scalp tenderness 
Visual changes
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29
Q

Positive blood results in GCA

A

raised ESR and CRP

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30
Q

How would you approach a patient with suspected GCA

A

Bloods + temporal artery biopsy
Start steroids before results arrive to avoid blindness/stroke.
Mx = 40-60mg of pred. Taper off slowly (over years)
Additional meds = aspirin 75mg (stroke protection). PPI. Bisphosphonates and vit d

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31
Q

Patient presents with bilateral weak arm pulses. Hypertension. Aortic valve regard.
Where are they from and what do they have?

A

Japan
Takayasu’s vasculitis
Affected the aorta and renal artery most commonly

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32
Q

Symptoms of limited cutaneous systemic sclerosis

A 
Calcinosis 
Raynauds 
Eosophogeal dysmotility 
scleroderma 
telangiectasia
33
Q

Symptoms seen in diffuse systemic sclerosis on top of crest symptoms

A

cardiac: hypertension. CVD
Lung: pulmonary fibrosis. Pulmonary hypertension
Kidney: glomerulonephritis and scleroderma renal crisis

34
Q

Auto-antibodies seen in Systemic sclerosis

A

ANA positive in most patients
Anti-centromere in cutaneous disease
Anti-scl70 - diffuse

35
Q

What criteria are used to base diagnose of systemic sclerosis on

A

ACR and the EULAR

36
Q

Symptoms of SLE: Joints, Kidneys and skin

A

Arthralgia with no clinical signs of disease
Butterly erythemous rash on face - photosensitive
Nephritis

37
Q

Symptoms of SLE specific to eyes, GI, heart, lungs, lymphatic system

A 
Conjuctivitis, optic neuritis, retinopathy 
Ulcers, mesenteric vasculitis 
Depression psychosis 
Pericarditis effusions 
Exudative effusions 
Lymphadenopathy, splenomegaly
38
Q

What is discoid lupus erythema

A

raised discoid plaques on the skin

However the autoimmune condition is limited to the skin, no other organs involved

39
Q

Positive bloods in SLE

A

ESR raised but CRP normal
urea and creat raised in renal involvement
Abds - anti-dsDNA, anti-ro, anti-la
normocytic anaemia

40
Q

What blood results would indicate a flare up of SLE

A 
raised ESR
raised antibodies (dsDNA)
Reduces C3
41
Q

Mx of SLE

A 
Skin - topical corticosteroids 
joints - NSAIDs 
Flares - short course of steroids 
Flares involving renal or cerebral - high dose steroids 
Hydroxychloroquine in mild disease
Rituximab and Balumamab
azathioprine
42
Q 
Patient has boney pain and these blood results 
ALP raised
Ca low
PO4 low 
PTH raised
A

osteomalacia

43
Q

Blood results in osteomalacia

A

ALP raised
Ca low
PO4 low
PTH raised

44
Q

Pagets disease blood results

A

ALP raised

Ca and PO4 normal

45
Q

X ray signs in pagets disease

A

woolly skull
v shaping of long bones
osteoporosis circumsscripta

46
Q

gold standard test in osteoporosis

A 
DEXA scan 
0 = better than normal 
-1 > normal 
-2.5 > osteopenia 
-2.5  > osteoporosis
47
Q

Management of osteoporosis (FRAX and DEXA)

A

Those at risk - women >65 men >75 - offer FRAX score.
If risk low: measure and offer lifestyle advice
If risk intermediate - DEXA
If risk high - treat
DEXA scan results: either treat or offer lifestyle advice
Treatment = bisphosphonates (alendrolic acid 10mg OD) and calciferol.

48
Q

What drug should be used to treat vitamin D deficiency in kidney disease

A

Alfacalcidol

49
Q

Pulmonary condition associated with limited cutaneous Systemic sclerosis

A

Pulmonary arterial hypertension

50
Q

Pulmonary condition associated with diffuse Systemic sclerosis

A

Interstitial lung disease

51
Q

Antibodies in both types of systemic sclerosis

A

ANA positive
Anti-centromere in limited cutaneous
Anti-scl70 in diffuse

52
Q

Diagnostic criteria/tool for ss

A

ACR and the EULAR

53
Q

Management of ss

A 
steroids and immunosuppressants 
non-medical management 
stop smoking 
physio
emollients
54
Q

57yo women presents with unilateral headache + scalp tenderness

1) Possible diagnosis
2) inx and results
3) Management and dosages
4) Severe complication
5) Associated rheum condition

A

1) Temporal arteritis
2) Raised ESR and CRP. Temporal artery biopsy would be diagnostic
3) Aspiriin 75mg. Pred 40mg (60mg if jaw claudication or vision changes)
4) Blindness
5) polymyalgia rheumatica

55
Q

Japanese women has weak pulses and malignant hypertension

1) diagnosis
2) cause of hypertension

A

1) Takayasu’s arteritis

2) renal artery stenosis causes RAAS.

56
Q

mx of antiphospholipid syndrome

A

long term warfarin

preggers –> LMWH + aspirin ?75mg

57
Q

Definition of bachets disease

A

inflammatory condition - recurrent oral and genital ulcers

58
Q

1) Skin signs in Bachets
2) MSK signs in bachets
3) GI
4) CNS

A

1) erythema nodosum, papules and pustules, vasculitis.
2) Arthalgia. morning stiffness. Oligoarthritis
3) Inflammation, ulceration
4) Memory decline, headaches, migranes, aseptic meningitis, mengioencephalitis

59
Q

Management of bachets disease

A

topical steroids for mouth.
Systemic prednisolone
anaesthetic cream for genitals
cochicine nsaids

60
Q

Key features of pagets disease

A

Disease of bone turnover

On x-ray areas of osteolysis and areas of high densitiy (sclerosis)

61
Q

X ray signs of pagets

A

osteoporosis circumscripta
cotton wool appearance of skull
v-shaped defects in long bone

62
Q

Management of pagets disease

A

bisphosphonates

63
Q

Key blood results seen in pagets disease

A

Raised ALP.

Normal Ca and Normal Phosphate

64
Q

1) Two possible causes for a patient with bilateral shoulder and pelvic girdle pain.
2) Which of the above is more likely to affect white women over the age of 50.
3) what percentage of these patients will suffer GCA as well?

A

1) Polymyalgia rheumatica and Polymyositis.
2) PR
3) 10%

65
Q

1) Inx in patients with Polymyalgia rheumatica

2) Management of PR

A

1) Raised ESR, Raised CRP. Raised plasma viscosity.
LFTs. U&Es. FBC. Ca, TSH and CK to rule out other possible causes.
2) Prednisolone 2 year dose reducing cause.

66
Q

HLA-B27 associated diseases and symptoms

A

Reactive arthritis
IBD - associated
Psoriatic
Ank Spon

Dactylitis, psoriasis, inflammatory back pain, improves with nsaids, enthesis, anterior uveitis, HLA-B27.

67
Q

Test for spinal mobility in ank spon

A

Schöber test. Lumber sine length increases by 5cm in full flexion at the L5 level.

68
Q

X ray signs in ank spond

A

Ossification of ligaments
Syndesmophytes
erosion and sclerosis
bamboo spine

69
Q

Management of of all seronegative spondyloarthropathies

A

patient education, physiotherapy and stop smoking.

Methotrexate, luflunomide, sulfalazine.

Infliximab
Adalimumab

70
Q

1) Infections that cause reactive arthritis
2) STI that cause septic arthritis
3) 3 associated symptoms with RA
3) Management and inx of reactive arthritis

A

1) Chlamydia. Gastroenteritis
2) Gonococcal septic arthritis
3) Ant uveitis. Circinate balantitis. Bilateral aseptic conjunctivitis.
3) Joint aspiration and cultures to rule out septic arthritis. Manage with NSAIDs

71
Q

1) Patient demographic affected by GCA and related condition
2) 3 presenting symptoms for GCA

A

1) Old people >50 Polymyalgia Rheumatica

2) Jaw claudication. scalp tenderness, frontal headache

72
Q

1) 4 small vessel vasculitis’ - which ones are ANCA positive.
2) Differential for the three ANCA + diseases
3) General management of ANCA + small vessel vascultis

A

1) HSP, Eosinophilic GPA. GPA and microscopic polyangitis
2) EGPA - raised eosinophiles on blood count.
GPA - granulomas present (not seen on mPA)
3) Prednisolone, cyclophosphamide, rituximab.

73
Q

Symptoms common in all anca + small vessel vasculitis

A

ENT - sinusitis. Rinorrhoea.
Pulmonary - fibrosis, effusions
Heart - pericarditis
renal - nephritic picture

74
Q

Pathology of HSP

A

IgA nephropathy.
Affects children mostly
Causes nephritic syndrome

75
Q

Presentation of HSP

A

haematuria
purpuric rash
joint pain and abdo pain may also be present

76
Q

Antibodies in

1) Limited systemic sclerosis
2) Diffuse systemic sclerosis

A

1) Anti-centromere

2) Anti - scl70

77
Q

Antibodies in

1) Polymyositis
2) Dermatomyositis

A

1) Anti-Jo 1

2) Anti-Mi 2 and ANA

78
Q

1) Inx for polymyositis and dermatomyositis
2) Lesions seen on back of hands in dermatomyositis
3) Where is the pain commonly located in the above disease. what other disease shares this presentation
4) Facial symptoms/sign in above disease.

A

1) Creatinine kinase will be raised
2) Gattrons lesions (rash on knuckles)
3) Shoulder and pelvic girdle - polymyalgia rheumatica
4) Peri-orbital oedema

79
Q

X ray signs in AS

A

Subchondral sclerosis
Syndesmophytes
Ossification of ligaments
Fusion of the facet at sciatic/lumbar

3B + Finals (15 decks)

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