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MRCP 1 > Rheum > Flashcards

Rheum Flashcards

1
Q

Earliest radiological finding in ank spon?

A

Bone marrow oedema

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2
Q

XR findings in ank spon?

A

Subchondral erosions
Sclerosis
Squaring of vertebrae
Syndesmophytes

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3
Q

Early XR finding in RA?

A

Juxta-articular osteopaenia

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4
Q

DIP swelling and dactylitis?

A

Psoriatic arthritis

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5
Q

XR findings in RA

A

Marginal erosions, soft tissue swelling and periarticular osteoporosis/erosions,
Joint-subluxation is late

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6
Q

Most common secondary cause of Raynaud’s?

A

Systemic sclerosis (scleroderma)

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7
Q

Obstructive picture PFTs in RA?

A

Bronchiolitis Obliterans

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8
Q

Pain on the radial side of the wrist/tenderness over the radial styloid process?

A

De Quervein’s Tensosynovitis

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9
Q

Calcification of the triangular fibrocartilage?

A

Pseudogout (often flares with infection)

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10
Q

Swelling at the DIP joints (Heberden’s nodes)?

A

OA

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11
Q

Can anti-TNF alpha drugs slow radiological progression in ank spon?

A

No (contrary to their effects in RA)

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12
Q

Can’t see/pee/bend the knee?

A

Reactive arthritis

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13
Q

Waxy yellow rash on the feet in an arthritis?

A

Keratoderma blenorrhagica - i.e. reactive arthritis

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14
Q

DMARDs safe in pregnancy

A

Sulfasalazine
Hydrochloroquine

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15
Q

False positive VDRL test?

A

Antiphospholipid syndrome

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16
Q

Paradoxicallly high APTT and low plateletes? (+/- emobuls) Rheum disease assoc?

A

Antiphospholipid, SLE

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17
Q

Homogenous ANA staining?

A

SLE

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18
Q

Speckled ANA staining?

A

MCTD

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19
Q

Nucleolar ANA staining?

A

Scleroderma

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20
Q

Centromere ANA staining?

A

Limited (central) systemic sclerosis, incl. CREST syndrome

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21
Q

RA with +ve ANA?

A

Felty’s or Sjorgrens

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22
Q

ANA against anti-dsDNA?

A

SLE

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23
Q

ANA against anti-ssDNA?

A

Drug-induced lupus

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24
Q

Anti-Ro

A

Sjogrens/congenital lupus/neonatal lupus syndrome

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25
Q

Anti-La

A

Primary sjogrens

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26
Q

Anti-Jo1

A

Polymyositis

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27
Q

Anti-Sm

A

SLE

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28
Q

Anti-RNP

A

MCTD

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29
Q

Anti-Scl70

A

Progressive systemic sclerosis

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30
Q

Treatment in antiphospholipid syndrome?

A

Primary prevention is low dose aspirin
Secondary prevention is life long warfarin INR 2-3 for first venous or arterial thrombus
Warfarin INR 3-4 for second thrombus/recurrence

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31
Q

Most sensitive vs most specific autoantibodies in SLE

A

ANA 99% sensitive
Anti-Sm, Anti-dsDNA 90% specific

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32
Q

Which complement levels low in SLE?

A

C4 (and C3)

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33
Q

3 culprit drugs in drug-induced lupus?

A

Hydralazine
Isoniazid
Procainamide

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34
Q

SLE - which hypersensitivity reaction?

A

Type III

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35
Q

HLA assoc in SLE?

A

HLA B8, DR2, DR3

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36
Q

Mainstay of treatment in SLE?

A

Hydroxychloroquine

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37
Q

Commonest form of lupus nephritis? Treatment?

A

Class IV - diffuse proliferative glomerulonephritis
Treat the HTN
Steroids + MMF OR cyclophosphamide

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38
Q

Skin findings in dermatomyositis?

A

Heliotrope rash around the eyes
Gottron’s papules (scaly papules over MCP/PIP)
Mechanic’s hands

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39
Q

Autoantibodies in dermatomyositis/polymtositis?

A

Anti-Jo1
ANA
Anti-Mi-2

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40
Q

Classes of systemic sclerosis?

A

Limited scleroderma with systemic involvement (includes CREST)
Diffuse scleroderma with limited involvement
Scleroderma without internal organ disease

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41
Q

Worst prognosis of the systemic sclerosis patterns?

A

Diffuse scleroderma with limited involvement

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42
Q

Autoantibody particularly assoc with diffuse scleroderma with limited involvement?

A

Anti-Scl-70

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43
Q

Autoantibody particularly assoc with limited scleroderma with systemic involvement?

A

Anti-centromere

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44
Q

Features of CREST syndrome?

A

Calcinosis
Raynauds
oEsophageal dysmotility
Sclerodactyly
Telangectasia

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45
Q

anti-RNP mnemonic
which condition?

A

R Raynoud
N swollen hands with No synovitis
P Pain in muscle and joints
Mixed connective tissue

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46
Q

Most likely organism in reactive arthritis aspirate?

A

None!

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47
Q

TNF primarily secreted by?

A

Macrophages

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48
Q

Second line for saliva lack in Sjogrens?

A

pilocarpine

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49
Q

Most likely organism in septic arthritis/discitis?

A

S aureus

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50
Q

Reactive arthritis HLA association?

A

HLA-B27

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51
Q

Azathioprine mechanism of action?

A

Inhibits purine synthesis

52
Q

Antibiotic contraindicated with MTX?

A

Trimethoprim (or co-trim)

53
Q

MMF mechanism?

A

Inosine-5’-monophosphate dehydrogenase inhibitor

54
Q

Co-allergy with sulfasalazine?

55
Q

Proximal myopathy in combination with mechanic hands?

A

Anti-synthetase syndrome

56
Q

First and second-line Rx in primary Raynaud’s?

A

1st: CCB - nifedipine
2nd: IV prostacyclin (epoprostenol) infusions:

57
Q

Familial Mediterranean Fever features?

A

Attacks typically last 1-3 days
pyrexia
abdominal pain (due to peritonitis)
pleurisy
pericarditis
arthritis
erysipeloid rash on lower limbs

58
Q

Familial Mediterranean Fever mode of inheritance

59
Q

Familial Mediterranean Fever who does it affect?

A

Turkish and Armenian

60
Q

MTX mechanism?

A

Inhibition of dihydrofolate reductase

61
Q

Dermatomyositis - most common and most specific?

A

Most common - ANA
Most specific - Anti-Mi-2

62
Q

‘Second-wind’ phenomenon distal muscle cramping following exercise?

A

McArdle’s disease

63
Q

Tenderness over the radio-styloid process?

A

De Quervein’s Tensosynovitis

64
Q

Oral ulcers, genital ulcers, anterior uveitis?

65
Q

Bechets HLA association?

66
Q

Marfans - defect in what?

A

Fibrillin-1

67
Q

Alendronate most common side effect?

A

Dyspepsia (numerous oesophageal problems can occur)

68
Q

Percentage of psoriasis patients who develop arthropathy?

69
Q

Large vessel vasculitidies?

A

GCA/temporal arteritis
Takayasus

70
Q

Medium vessel vasculitidies?

A

PAN
Kawasaki

71
Q

ANCA vasculitides?

A

Micro polyang.
Gran. with polyang. (Wegner’s)
Eosin. gran. with polyang. (Churg-Strauss)

72
Q

Drug unmasking Churg-Strauss?

A

Montelukast

73
Q

Most common opthalmic pathology in GCA?

A

Anterior ischaemic optic neuropathy

74
Q

GCA/PMR association?

A

50% GCA patients have PMR
15% PRM patients develop GCA

75
Q

Systemic illness with claudication/absent pulses/bruits?

A

Takayasu (large vessel)

76
Q

cANCA directed against what?

77
Q

pANCA directed against what?

78
Q

Type of ANCA in gran. with polyang?

A

cANCA (c comes first)

79
Q

Type of ANCA in eosin. gran. with polyang?

A

pANCA (p comes second)

80
Q

PAN assoc with?

81
Q

Livedo retiularis and mononeuritis multiplex, gen unwell?

82
Q

As well as ear problems, may present with nasal chondritis, respiratory tract involvement and arthralgia?

A

Relapsing polychondritis - repeated attacks and degradation on/of cartilage

83
Q

Treatment for uncomplicated vs complicated GCA?

A

Uncomplicated - oral pred
Complicated - IV methylpred

84
Q

Marfan mode of inheritance?

85
Q

Cystals in pseudogout?

A

Weakly positively birefringent rhomboid-shaped crystals

86
Q

Cystals in gout?

A

Negatively bifringent needle-shaped crystals

87
Q

CK in PMR?

A

Normal (CRP and ESR raised)

88
Q

Sensory loss of posterolateral aspect of leg and lateral aspect of foot, weakness in plantar flexion of foot, reduced ankle reflex, positive sciatic nerve stretch test?

89
Q

Ottawa rules?

A

bony tenderness at the lateral malleolar zone (from the tip of the lateral malleolus to include the lower 6 cm of posterior border of the fibular)
bony tenderness at the medial malleolar zone (from the tip of the medial malleolus to the lower 6 cm of the posterior border of the tibia)
inability to walk four weight bearing steps immediately after the injury and in the emergency department

90
Q

Bone pain, tenderness and proximal myopathy (→ waddling gait) → ?

A

Osteomalacia

91
Q

Looser’s zones on x-ray?

A

Osteomalacia

92
Q

Osteogenesis imperfecta collagen type?

93
Q

Marfans occular manifestation?

A

Marfan’s syndrome - upwards lens dislocation

94
Q

RA HLA assoc?

A

HLA DR4 - especially BR1

95
Q

Where is the fibrosis in asbestosis ?

96
Q

CXR findings in asbestosis?

A

Reticulonodular shadowing of the lower zones
Hooneycombing

97
Q

PFTs in asbestosis? Why?

A

Restrictive
It’s fibrotic

98
Q

Dust and small rounded upper zone opacities?

A

Coal workers pneumoconiosis

99
Q

Breathlessness, progression and dry cough.
Eggshell calcification?

100
Q

Occupational asthma mnemonic?

A

GIrlfriend works at a PEPSI factory and comes home with asthma symptoms every day

GF Glutaraldehyede. Flour
PEPSi :
Platinum salt
Epoxy resins
Proteiolytic enzymes
Soldering flux resins
Isocynayes

101
Q

What is extrinsic allergic alveolitis?

A

(Hypersensitivity pneumonitis)

Farmers lung - mouldy hay - micropolyspora
Bird fanceris
Bagassosis - sugar cane - sacchari
Malt worker’s - aspergillus clavatus
Mushroom workers lung - thermophilic actinomycetes

102
Q

Acute breathlessness hours after dust exposure/allergen, flu like, resolve within 48 hours?

103
Q

Fibrosis in EAA?

A

Upper zone

104
Q

Diagnosis of EAA?

A

Clinical history
Restrictive PFTs (eventually)
Lung tissue histology - mononuclear cell infiltrate with NON-CASEATING GRANULOMAS
High WCC on BAL
Specific IgG precipitins

105
Q

HRCT findings in EAA?

A

Reticular, nodular and ground-glass opacities

106
Q

Hypersensitivity type in EAA?

107
Q

Pulmonary eosinophilia causes?

A

Churg-Strauss syndrome
allergic bronchopulmonary aspergillosis (ABPA)
Loffler’s syndrome
eosinophilic pneumonia
hypereosinophilic syndrome
tropical pulmonary eosinophilia
drugs: nitrofurantoin, sulphonamides
less common: Wegener’s granulomatosis

NOT EAA!!!

108
Q

Vasculitis sounding question presents with general upset plus acute abdominal pain?

A

PAN - can cause bowel ischaemia

109
Q

Tramline pattern on XR?

110
Q

Rash over buttocks and IgA deposition after recent viral infection?

111
Q

Chronic fatigue treatment?

112
Q

Blood marker in Still’s?

A

Very high ferritin

113
Q

Haemoptysis, saddle nose deformity, deafness?

A

GPA (Wegner’s)

114
Q

Renal disease in Churg strauss?

A

Necrotising crescentic glomerulonephritis

115
Q

Onion peel appearance on paeds XR?

116
Q

Lytic lesion with sclerotic margins in the upper (e.g. tibial) metaphysis on child’s XR?

A

Brodie’s abscess

117
Q

Soap-bubble appearance on bony film?

A

Osteoclastoma

118
Q

Most likely blood abnormality in PAN?

A

Raised creatinine (and urea)

119
Q

HLA for Felty’s?

A

DRW4 (not just DR4 as in RA)

120
Q

XR finding in osteomalacia?

A

Looser zone aka translucent bands aka pseudofractures

121
Q

Swelling and tenderness of the forearms with skin induration/peau d’orange, carpal tunnel and eosinophilia?

A

Eosinophilic fasciitis

122
Q

3 or 4 loose bodies in the knee, young men?

A

Osteochondritis dissecans

123
Q

Burning foot pain/reduced sensation sole, severe pain on pressure applied behind the medial mal?

A

Tarsal tunnel syndrome - tibial nerve compression

124
Q

First line for polymyositis?

125
Q

Most definitive diagnostic test for Sjogrens?

A

Labial gland biopsy

126
Q

HIV positive and mentions on didanosine, gouty question. What can’t you give?

A

Allopurinol

127
Q

Pneumonia in an alcoholic? Previous aspiration?

A

Klebsiella

MRCP 1 (24 decks)

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