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4th year passmed > Rheum > Flashcards

Rheum Flashcards

1
Q

Outline the Gel and Coombs hypersensitivity classification with examples

A

Type 1 - Anaphylactic - IgE binds mast cells

Type 2 - Cell bound - IgM/G binds antigens on cell surface
AIHA, ITP, acute transfusion reactions

Type 3 - Immune complex - Free antigen and antibody combine
SLE, EAA, post strep glomerulonephritis

Type 4 - Delayed - T cells
TB, GvHD, allergic contact dermatitis, GB syndrome

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2
Q

What are the features of dermatomyositis?

A 
Skin: 
Photosensitive
Macular rash
Heliotrope rash (periorbital)
Gottrons papules
Other:
Proximal myopathy
Raynauds
Respiratory muscle weakness
Interstitial lung disease
Dysphagia
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3
Q

Which is the most sensitive antibody for dermatomyositis/

A

ANA (80%)

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4
Q

What is the first line management for ankylosing spondylitis?

A

NSAIDs and physio/exercise

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5
Q

What are the features of Reiter’s syndrome?

A

Uveitis
Urethritis
Arthritis

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6
Q

Why are chemo patients at increased risk of developing gout?

A

Increased urate production (both from drugs and lymphoproliferation in relevant cases)

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7
Q

What are the features of Marfan’s syndrome?

A 
High ape index
High arched palate
Arachnodactyly
Pes planus
Pectus excavatum
Scoliosis
Dilatation of aortic sinuses
MV prolapse
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8
Q

Pain pattern in OA?

A

Better in morning, worse on exercise

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9
Q

Which RA drug can be used safely in pregnancy?

A

Hydroxychloroquine

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10
Q

What are the features/Ix findings in polymyalgia?

A 
Rapid onset in older patient
Aching morning stiffness in proximal muscles WITHOUT weakness
May have systemic Fx
ESR >40 (V high)
CK normal)
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11
Q

What are the risk factors for pseudogout?

A 
Haemochromatosis
Hyperparathyroidism
Acromegaly
Low mag low phos
Wilson's disease
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12
Q

Which antibodies are associated with the two forms of systemic sclerosis?

A

Diffuse = scl70

Limited (central)=centromere

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13
Q

What is the pathology and inheritance pattern of osteogenesis inperfecta?

A

Collagen metabolism disorder

AutDom

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14
Q

What are the features of osteogenesis imperfecta?

A

Fractures following minor trauma
Blue sclerae
Deafness secondary to otosclerosis
Dental caries are common

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15
Q

What are the features of Ehler’s Danlos syndrome?

A 
Elastic, fragile skin
Joint hypermobility
Easy bruising
Aortic regurg and other valve disease
Subarachs
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16
Q

What is a Beighton score used for?

A

Used to assess hypermobility - 5/9 marks a positive result

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17
Q

What are the common complications of RA?

A

IHD (commonest)
Pulmonary fibrosis
Keratoconjunctivitis sicca (dry eyes)
Osteoporosis

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18
Q

What are the 5 different types of psoriatic arthropathy?

A

AOPSD

Arthritis mutilans - v severe
Oligoarthritis
Polyarthritis - RA like - commonest
Sacroiliitis
DIP joint disease
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19
Q

Which radiographic sign is pathognomoic of pseudogout?

A

Chondrocalcinosis

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20
Q

What should happen with patients already taking allopurinol during an acute attack?

A

They should continue taking it through the acute inflammation

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21
Q

What is the main side effect of colchicine?

A

Diarrhoea

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22
Q

When should urate lowering therapy be started/

A

After the first attack

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23
Q

When should patients taking steroids be offered prophylactic bisphosphonate treatment/

A

T score < 1.5

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24
Q

WHich medications should be avoided in patients taking methotrexate and why?

A

Trimethoprim and Co-trimoxazole, as the combination risks bone marrow aplasia

Aspirin should also be avoided due to reduced excretion

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25
Q

What should be coprescribed with methotrexate?

A

5mg folic acid

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26
Q

You refer a 24-year-old female to rheumatology with intermittent pain and swelling of the metacarpal phalangeal joints for the past 3 months. An x-ray shows loss of joint space and soft-tissue swelling. Rheumatoid factor is positive and a diagnosis of rheumatoid arthritis is made. What initial management is she most likely to be given to help slow disease progression?

A

Methotrexate and a short course of pred

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27
Q

What are the features of adult onset Still’s disease?

A 
Arthralgia
Raised ferritin
Salmon pink macpap rash
Evening pyrexia
LAopathy
Seronegative
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28
Q

Allergy to which medication may be a contraindication to Sulfasalazine prescription?

A

Aspirin

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29
Q

What are the typical features of Behcets?

A 
Oral ulcers
Genital ulcers
Anterior uveitis
Thromboflebitis
Arthritis
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30
Q

True or false, CK is raised in polymyalgia rheumatica/

A

False - it is normal

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31
Q

Aside from recurrent miscarriages, what are the features of antiphospholipid syndrome/

A

Thrombosis
Livedo reticularis (purple mottling)
Thrombocytopaenia

32
Q

Which protein is deficient in Marfan’s syndrome?

A

Fibrillin

33
Q

What is the first line management of Raynauds?

A

CCBs e.g. Nifedipine

34
Q

In which condition might you see periarticular erosions/

A

RA

35
Q

What is the main concerning complication of hydroxychloroquine therapy, and therefore what should be done on starting and as monitoring?

A

Bullseye retinopathy

Baseline opthalmological examination and annual screening is advised

36
Q

What are the side effects of Azathioprine therapy?

A

Bone marrow suppression
N/V
Pancreatitis

37
Q

What test should be done before commencing Azathioprine therapy?

A

TPMT

38
Q

What are the 6As of ankylosing spondylitis?

A 
Apical fibrosis
AV block
Achilles tendonitis
Anterior uveitis
Aortic regurgitation
Amyloidosis
39
Q

Which clinical test is assocaited with Ank Spon?

A

Schobers test <5cm

40
Q

What is the typical presentation of polyarteritis nodosa?

A 
Systemics + arthralgia
Wt loss
Livedo reticularis
Haematuria and renal failure
Hep B serology positive in 30%
41
Q

Which vasculitis is associated with Hep B infection and has no respiratory features?

A

Polyarteritis nodosa

42
Q

True or false, the CRP is raised in SLE.

A

False - its normal

43
Q

What is referred lumbar spine pain and how do you assess it clinically?

A

Femoral nerve compression may cause referred pain in the hip
Femoral nerve stretch test may be positive - lie the patient prone. Extend the hip joint with a straight leg then bend the knee. This stretches the femoral nerve and will cause pain if it is trapped

44
Q

Name some causes of drug induced lupus

A

Procainamide
Hydralazine
Isoniazid
Phenytoin

45
Q

What is the management of OA?

A 
Weight loss and exercise
Paracetamol and TOPICAL NSAIDs
2nd line is oral NSAIDs, opioids, capsaicin cream and intrarticular corticosteroids
\+PPI
Can also take glucosamine
46
Q

What is the cause and presentation of trochanteric bursitis?

A

Repeated movement of the iliotibial band

Presents with pain and tenderness over the lateral aspect of the thigh

47
Q

Which of the following is a consequence of TNF alpha (Ertanecept) therapy?

Triggering Granulomatosis with polyangiitis
Thrombocytosis
Tendonitis
Cardiomyopathy
Reactivation of TB
A

Reactivation of TB

48
Q

Outline the management of RA

A

Patients should be started on DMARDs as soon as possible

Now recommended a DMARD monotherapy +- short course of pred

Common DMARDs include Methotrexate, sulfasalazine, hydroxychloroquine, leflunomide

TNF inhibitors e.g. etanercept, infliximab, adalimumab

CD20 biologics e.g. Rituximab

49
Q

Which hand joints are typically affected in osteoarthritis vs. rheumatoid arthritis?

A

OA: DIPs and carpometacarpals
RA: PIPs and metacarpophalyngeals

50
Q

What should be advised regarding methotrexate and conception?

A

Both men and women should stop treatment at least 6 months before considering conception. Hydroxychloroquine is safe for use during pregnancy

51
Q

What is the earliest clinical sign of AnkSpon/

A

Reduced lateral lumbar flexion

52
Q

Combination of Azathioprine with which other drug gives a seriously increased risk of BM suppression?

A

Allopurinol

53
Q

Describe the joint aspirate seen in rheumatoid arthritis

A

High WCC - predominantly PMNs
Yellow and cloudy
Absence of crystals

54
Q

Which arthropathy is associated with IBD - and what is its serostatus and immunological typing?

A

Enteropathic arthritis is a seronegative spondyloarthropathy associated with HLA-B27

55
Q

What is the relationship between alendronate and GFR?

A

Contraindicated with GFR less than 35

56
Q

Which therapy is indicated if bisphosphonates not tolerated/CI’d?

A

Denosumab

57
Q

Which syndrome is associated with reactive arthritis when there becomes ocular and renal involvement?

A

Reiter’s - HLA B27 +ve

58
Q

What are the Xray findings in RA?

A

Early: Loss of joint space, juxta-articular osteoporosis, soft tissue swelling

Late: Periarticular erosion, subluxation

59
Q

The concurrent use of methotrexate and which antibiotic may cause a fatal pancytopaenia?

A

Trimethoprim

60
Q

Rx of acute reactive arthritis?

A

NSAIDs

61
Q

Which cause of joint pain shows the most marked response to steroids, and are thus first line in its management/

A

Polymyalgia rheumatica

62
Q

Which cause arthropathy is also known to occur as a paraneoplastic disease, and should therefore be investigated for cancer/

A

Dermatomyositis

63
Q

Triad seen in Felty’s sydnrome/

A

RA
Splenomegaly
Low WCC

64
Q

What demographic is Buergers disease common in, and what are its features?

A

Young male smokers

A 32-year-old man presents to the vascular clinic with symptoms of foot pain during exertion. He is a heavy smoker and has recently tried to stop smoking. On examination he has normal pulses to the level of the popliteal. However, foot pulses are absent. A diagnostic angiogram is performed which shows an abrupt cut off at the level of the anterior tibial artery, together with the formation of corkscrew shaped collateral vessels distally.

65
Q

Allergy to which drug should not be started on sulfasalazine?

A

Co-trimoxazole

66
Q

Bisphosphonates should be taken on a full or empty stomach?

A

Empty

67
Q

A 25-year-old man presents with a painful, swollen left knee. He returned 4 weeks ago from a holiday in Spain. There is no history of trauma and he has had no knee problems previously. On examination he has a swollen, warm left knee with a full range of movement. His ankle joints are also painful to move but there is no swelling. On the soles of both feet you notice a waxy yellow rash.

What is the most likely diagnosis?

What is the rash?

A

Reactive arthritis

Keratoderma blenorrhagica

68
Q

What causes leukonychia?

A

Hypoalbuminaemia

69
Q

What can cause dactylitis?

A 
Spondyloarthropathies - psoriactic and reactive arthritis
Sickle cell disease
TB
Sarcoid
Syphillis
70
Q

High or low BMI is a RF for osteoporosis?

A

Low

71
Q

What imaging should be done in RA patients pre-op and why?

A

Lateral and AP cervical spine radiographs due to the risk of atlantoaxial subluxation during surgery - which might lead to cord compression

72
Q

What is a potential serious complication of penicillamine?

A

Membranous glomeulonephritis

73
Q

A 71-year-old woman is diagnosed with polymyalgia rheumatica. She is started on prednisolone 15mg od. What is the most appropriate approach to bone protection?

A

Start alendronate and ensure calcium and Vit D repletion immediately - as the patient is starting long term steroids

74
Q

What is second line management in AnkSpon?

A

TNF therapy

75
Q

Which class of medication is associated with an increased risk of atypical stress fractures of the femoral shaft?

A

Bisphosphonates

4th year passmed (28 decks)

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