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M R C P > RHEUM > Flashcards

RHEUM Flashcards

1
Q

pANCA main target

A

myleoperoxidase

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2
Q

anti nuclear antibodies (ANA)- what condition

A

dermatomyositis

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3
Q

Dermatomyositis treatment

A

predisolone

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4
Q

pANCA and cANCA

A

(p)ANCA - (C)hurg-Strauss.
(c)ANCA - G(P)A.

wrong way round

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5
Q

Treatment termporal arteritis

A

ASAP prednisolone glucocorticoid
- even before temporal aa biopsy

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6
Q

SLE affects fetus in pregnancy?

A

causes fetal bradycardia

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7
Q

how to take bisphosphonates

A

take 30 mins before food and sit up for 30 mins after

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8
Q

old man, bone pain, raised ALP=== what condition?

A

pagets disease

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9
Q

anti ro- which condition

A

SLE

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10
Q

Marfan syndrome affected gene

A

fibrillin

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11
Q

low calcium
low phosphate
raised ALP and raised PTH

A

osteomalacia

CFs
widespread bone pain, proximal myopathy

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12
Q

golimumab=?MOA

A

TNF ALPHA antagonist

tumour necrosis factor alpha

MABS= type of TNF inhibitor

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13
Q

anti tnf meds= (4)

A

I AGE

infliximab, adalimumab, golimumab, etaercept

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14
Q

bulls eye retinopathy with which type of DMARD ?

A

hydroxychloriquine

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15
Q

most common cause of gout ?

A

decreased renal excretion of uric acid

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16
Q

Lesch-Nyhan syndrome

A

Lesch-Nyhan syndrome
hypoxanthine-guanine phosphoribosyl transferase (HGPRTase) deficiency
x-linked recessive therefore only seen in boys
features: gout, renal failure, neurological deficits, learning difficulties, self-mutilation

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17
Q

drug induced lupus– HOW is it different to normal SLE

A

renal and neuro symptoms unlikely

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18
Q

DEXA SCAN INTERP:
t and z sore

A

T score: based on bone mass of young reference population – GENERAL
T score of -1.0 means bone mass of one standard deviation below that of young reference population
Z score is adjusted for age, gender and ethnic factors

T score
> -1.0 = normal
-1.0 to -2.5 = osteopaenia
< -2.5 = osteoporosis

T-score of - 2.5 SD or below
BUT GIVE oral bisphosphonate whilst waiting for DEXA scan

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19
Q

reactive arthritis management

A

NSAIDS
INTRA ART STEROIDS

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20
Q

hydroxychloriquine affect eyes

A

severe or perm RETINOPATHY- flashes, floaters

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21
Q

PREDISPOSITIONs of pseudogout

A

Positively bifringent rhomboid crystals
haemochromatosis
hyperparathyroidism
low magnesium, low phosphate
acromegaly, Wilson’s disease

DOUBLE CONTOUR sign

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22
Q

Urinary hydroxyproline - Paget’s disease of bone.

Urinary porphobilinogen - acute intermittent porphyria

Urinary uroporphyrin - porphyria cutanea tarda

Urinary coproporphyrin - Dubin-Johnson syndrome

A

Urinary hydroxyproline - Paget’s disease of bone.

Urinary porphobilinogen - acute intermittent porphyria

Urinary uroporphyrin - porphyria cutanea tarda

Urinary coproporphyrin - Dubin-Johnson syndrome

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23
Q

what type of cell secretes TNF

A

macrophages

24
Q

OA features LOSS

A

Loss of joint space
Osteophytes
Subchondral cysts
Subchondral sclerosis

25
Q

periarticular osteopenia specific to ?

A

RA

26
Q

polyarteritis nodosa
cfs
antibody

A

CANCA
medium vasculitis
ass’d with hep b and middle aged men
mononeuritis multiplex= multiple nerve trunks affected

27
Q

allergic to aspirin may also be allergic to ?

A

sulfasalzine

28
Q

azathioprine in pregnancy and breasfteeding

A

safe to use

, mesalazine and sulfasalazine (with folic acid)

29
Q

treatment raynauds

A

first line- nifedipine

if this CI or not tolerated;
IV prostacyclin

30
Q

first XR finding on ANK SPON

A

syndesmophytes= first sign

late sign= bamboo spine

31
Q

bradycardia heart block newborn from mum with sle

A

anti ro

32
Q

early onset SLE assd with def in what complement

A

C4

33
Q

all lab criteria to diagnose antiphospholipid syndrome:

A

need to be twice at least 12 weeks apart

34
Q

familial mediterranean fever

A

aut rec
turkish armenian arabic
Features - attacks typically last 1-3 days
pyrexia
abdominal pain (due to peritonitis)
pleurisy
pericarditis
arthritis
erysipeloid rash on lower limbs

Management
colchicine may help

35
Q

RANK ligand inhibitor eg

A

denosumab

36
Q

complications of pagets

A

Complications
deafness (cranial nerve entrapment)
bone sarcoma (1% if affected for > 10 years)
fractures
skull thickening
high-output cardiac failure

37
Q

mycophenolate mofetil MOA

A

Inosine-5’-monophosphate dehydrogenase inhibitor

38
Q

SLE treatment

A

hydroxyhloriquine

39
Q

which DMARD is safe in pregnancy anc breastfeeding

A

sulfasalazine

40
Q

stills disease

A

Features
arthralgia
elevated serum ferritin
rash: salmon-pink, maculopapular
pyrexia
typically rises in the late afternoon/early evening in a daily pattern and accompanies a worsening of joint symptoms and rash
lymphadenopathy
rheumatoid factor (RF) and anti-nuclear antibody (ANA) negative

Management
NSAIDs should be trialled for at least a week before steroids are added.

steroids

if symptoms persist, the use of methotrexate, IL-1 or anti-TNF therapy can be considered
ANAKINRA= IL1

41
Q

bisphosphonates moa

A

inhibit osteoclasts

42
Q

syndesmophytes in ANK SPON = ?

A

Syndesmophytes (ossification of outer fibres of annulus fibrosus) are a feature of ankylosing spondylitis

43
Q

is RF usually positive or negative in stills disease

A

negative RF

44
Q

widening of the wrist joints due to an excess of non-mineralized osteoid at the growth plate
===?

A

rickets

45
Q

marfan syndrome chr affected
cfs
defect in what/???

A

A defect of the glycoprotein structure which usually wraps around elastin= fibrillin

chr 15

46
Q

common bowel problem in systemic sclerosis

A

bacterial overgrowth

47
Q

homogentisic acid in urine = ?

A

Alkaptonuria (ochronosis) autosomal recessive disorder of phenylalanine and tyrosine metabolism caused by a lack of the enzyme homogentisic dioxygenase (HGD)

Alkaptonuria is generally a benign and often asymptomatic condition. Possible features include:
pigmented sclera
urine turns black if left exposed to the air
intervertebral disc calcification may result in back pain
renal stones

Tx= high dose vit c

48
Q

hydroxychloriquine retinopathy symptoms

A

flashes, photophobia, decreased visual acuity

caused by
central depigmentation, speckled rings, hyperpigmentation,

49
Q

fibromyalgia how many tender points out of 18 needed

A

11/18 for diagnosis

50
Q

which TB medication can cause drug induced lupus

A

isoniazid

51
Q

LOW Ca and LOW phosphate
and
HIGH ALP and HIGH PTH

A

osteomalacia

52
Q

tennis elbow= and which mm affected

A

lateral epicondyle
EXTENDOR CARPI radialis brevis affected

53
Q

double contour sign. = ?

A

gout

54
Q

pregnancy and infliximab

A

stop infliximab at 16 weeks

55
Q

which joint condition is associated with polycythaemia

A

GOUT

M R C P (18 decks)

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