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Medicine > Rheum > Flashcards

Rheum Flashcards

1
Q

5-day history of pain behind the left eye
pain across the left forehead and scalp every time she brushes her hair.
more effortful when eating.
DX?

A

Temporal Arteritis aka GCA

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2
Q

clincher for temporal arteritis

A

rapid onset of unilateral headache(<1 month)+jaw claudication+raised esr+vision problem

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3
Q

temporal arteritis have 50% features of which condition?

A

PMR;
aching, morning stiffness in proximal limb muscles (not weakness)

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4
Q

Tx of temporal/GCA?

A

urgent high-dose glucocorticoids should be given (as soon as the diagnosis is suspected and before the temporal artery biopsy)
if there is no visual loss then high-dose prednisolone is used
if there is evolving visual loss IV methylprednisolone is usually given prior to starting high-dose prednisolone
there should be a dramatic response, if not the diagnosis should be reconsidered

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5
Q

swelling of the distal interphalangeal joints.

A

Heberden’s nodes

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6
Q

swelling of proximal interphalangeal joints

A

Bouchard’s nodes

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7
Q

bright red/blood crusted lesion that usually occurs follow trauma. It is more common in children.

A

Pyogenic granuloma

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8
Q

subcutaneous, cystic lesion of the joint or synovial sheath of a tendon. It most commonly occurs at the wrist.

A

ganglion

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9
Q

round, mobile cyst with a characteristic central punctum.

A

sebaceous cyst

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10
Q

old man+
bone pain+
isolated raised ALP (Even highish with in the normal range) normal calcium and phosphate.
DX?

A

PAGETS DIS

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11
Q

tx of paget’s

A

bisphosphonate (ORIS; either oral risedronate or IV zoledronate)

calcitonin is less commonly used now

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12
Q

MAJOR DIFFERENCE BETWEEN ANKYLSOING SPONDYLITIS AND OSTEOARTHRITIS IS?

A

OA;pain increase on exercise

AS; pain improves with exercise, worsens on sitting for a prolonged period of time.

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13
Q

which is the most imp investigation used for the dx of AS?

A

Plain XR of Sacroiliac joints; which can show S= Sacroilitis(subchondral erosions and sclerosis)

S= squaring of lumbar vertebra

bamboo spine

S= Syndesmophytes

CXR;apical fibrosis

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14
Q

If the x-ray is negative for sacroiliac joint involvement in ankylosing spondylitis but suspicion for AS remains high, the next step in the evaluation should be ?

initial management of AS

A

MRI

Swimming
NSAIDS
physio
sulphasalazine for peripheral joint involvement.

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15
Q

XRAY=Chondrocalcinosis OR
linear calcifications of the meniscus and articular cartilage.
DX?

A

Pesudogout

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16
Q

tx of pseudogout?

A

aspiration of joint fluid, to exclude septic arthritis.

NSAIDs
or intra-articular, intra-muscular or oral steroids as for gout

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17
Q

rhomboid crystals in?

A

pseudo gout

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18
Q

X-ray changes of osteoarthritis

A

decrease of joint space
subchondral sclerosis
subchondral cysts
osteophytes forming at joint margins

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19
Q

X-ray changes of rh arthritis

A

Periarticular erosions

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20
Q

bochards and heberden nodes are painful or painless?

A

painless

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21
Q

osler nodes and laneway lesions painful or painless and are present in which condition?

A

Osler;painful
Janeway;painless

both present in inf endocarditis

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22
Q

roughened red papules over the knuckles /
keratotic macules overlying her interphalangeal joints
DX?

A

Gottron’s papules.

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23
Q

proximal muscle weakness/tenderness + skin changes;

  1. gottron’s papules
  2. photosensitive
  3. macular rash over back and shoulder
  4. heliotrope rash in the periorbital region
  5. ‘mechanic’s hands’: extremely dry and scaly hands with linear ‘cracks’ on the palmar and lateral aspects of the fingers

DX?

A

Dermatomyositis

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24
Q

features associated with dermatomyositis

A

raynaud’s
ILD

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25
Q

Foods to avoid in acute attack of gout

A

high in purines e.g. Liver, kidneys, seafood, oily fish (mackerel, sardines) and yeast products.

Alcohol

26
Q

prophylactic tx of gout

tx of acute attack of gout

A

start allopurinol 2 weeks after acute attack is resolved
start at 100 mg OD and
titrateuntil serum uric acid level is <300

consider co prescribing colchicine when initiating

Febuxostat second line if can’t use allopurinol.

NSAIDS for 1-2 days with PPI and Colchicine

if NSAIDS and Colchicine is contraindicated;
oral steroids; prednisolone 15mg/day OR
Intrararticular steroid injection can be used.

27
Q

CI in acute attack of gout

A

L CAP D
Losartan
Ciclosporin
cytotoxic agents
aspirin
alcohol
Pyrazinamide
Diuretics;
thiazides/furosemide

28
Q

HLA B27 associated with?

A

AS
and reactive/reiters arthritis

29
Q

Not only sacroilitis is prominent is AS but also?

A

enthesitis of the Achilles tendon and plantar fascia is also common.

30
Q

systemic sclerosis is more common in?

A

females

31
Q

CREST SYND?

A

Calcinosis
raynauds
oesophageal dysmotility
sys sclerosis
telangeictasia

32
Q

there are 3 patterns of sys sclerosis

A

limited cutaneous SS;
1. Rynaud’s is the first sign.
2.scleroderma affects face and distal limbs

Diffuse cutaneous SS;
1. scleroderma affects trunk and proximal limbs
2. most common cause of death is now responsible;ILD and PAH
3. other complications include Renal dis and HTN
4. poor prognosis

Scleroderma;
without organ involvement

33
Q

Antibodies positive in limited cutaneous SS

A

Anti centromere

34
Q

Antibodies positive in diffuse cutaneous SS

A

anti scl 70

35
Q

Aschoff nodules are pathognomonic of

A

Rheumatic fever

36
Q

Muehrcke’s lines

A

white, transverse lines of the fingernail seen in hypoalbuminaemia

37
Q

azathioprine is safe in pregnancy

A

yes

38
Q

azathioprine should be used in lesser amount with ?

A

Allopurinol

39
Q

side effects of Azathioprine

A

bone marrow suppression
pancreatitis
increased risk of melanoma cancer

40
Q

imp features of AS

A

Presents with lower back pain and stiffness
pain at night that improves on getup up.

41
Q

the A features of AS

A

Apical fibrosis
Anterior uveitis
Aortic regurgitation
Achilles tendonitis
AV node block
Amyloidosis

42
Q

drug induced SLE

A

is caused by hydralazine
and procainamide

43
Q

features of drug induced SLE

A

arthralgia
myalgia
malar rash
pleurisy
ANA positive in 100%, dsDNA negative
anti-histone antibodies are found in 80-90%
anti-Ro, anti-Smith positive in around 5%

44
Q

SE of Colchicine is?

A

Diarrhea

45
Q

butterfly rash+joint pain+ proteinuria
DX?

A

SLE

46
Q

features of SLE

A

fever,
fatigue,
mouth ulcers, lymphadenopathy

47
Q

imp facts about sjogrens syndrome

A

common in females
increased risk of lymphoid malignancy
RF is positive
ANA is positive
Anti Ro antibodies is positive in 70%
Anti la 30%

48
Q

can’t pee,walk and see well
which arthritis?

A

reactive

49
Q

reactive arthritis is caused after?

A

post dysentry(Shigella
Salmonella
Yersinia
Campylobacter)
and post sti (chlamydia trachomatis)

50
Q

tx of reactive arthritis

A

symptomatic:
analgesia, NSAIDS, intra-articular steroids
sulfasalazine and methotrexate are sometimes used for persistent disease
symptoms rarely last more than 12 months

51
Q

antibodies in dermatomyositis

A

ANA positive 80%

30% ;
ANTI JP-1
ANTI MI-2
ANTI SRP

52
Q

In Dermatomyositis which underlying conditions is associated with dermatomyositis and should be considered?

A

internal malignancy

53
Q

three-week history of low-grade fevers and myalgia in the shoulder girdle. He also reports a transient loss of vision in his left eye.
DX?

Anorexia,night sweats an depression could also be the symptoms

A

PMR

54
Q

Diagnostic test for PMR?

Tx of PMR

A

Raised ESR

CK and electromyography would be normal

Steroids;prednisolone 15mg OD

55
Q

nail changes(pitting and onycholysis), skin changes and arthritis
Dx?

A

Psoraitic arthritis

56
Q

dx tets for psoriatic arthritis

A

x ray; pencil in cup appearance

57
Q

tx of psoriatic arthritis

A

similar to rheumatoid arthritis;
mild peripheral arthritis/mild axial disease may be treated with ‘just’ an NSAID, rather than all patients being on disease-modifying therapy as with RA
use of monoclonal antibodies such as ustekinumab

58
Q

livedo reticularis is associated with ?

A

antiphospholipid syndrome

59
Q

lupus vulgaris is associated with?

A

tb

60
Q

features of Antiphospholipid synd?

A

venous/arterial thrombosis
recurrent fetal loss
imp; livedo reticularis
thrombocytopenia
imp; prolonged APTT
other features: pre-eclampsia, pulmonary hypertension

61
Q

tx of Antiphospholipid syndrome

A

primary thromboprophlyaxis;low dose aspirin

secondary thromboprophylaxis;
initial venous thromboembolic events: lifelong warfarin with a target INR of 2-3

recurrent venous thromboembolic events: lifelong warfarin; if occurred whilst taking warfarin then consider adding low-dose aspirin, increase target INR to 3-4

arterial thrombosis should be treated with lifelong warfarin with target INR 2-3

Medicine (18 decks)

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