Rheum Flashcards

1
Q

What is seen on joint aspiration with Reactive arthritis ?

A

organism cannot be recovered from the joint aspiration

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2
Q

Ehler-Danlos syndrome what is defective

A

AD
affects type III collagen

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3
Q

What causes pain on the radial side of the wrist

tenderness over the radial styloid process

abduction of the thumb against resistance is painful

Finkelstein’s test: +ve

A

De Quervain’s tenosynovitis

sheath containing the extensor pollicis brevis and abductor pollicis longus tendons is inflamed.

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4
Q

How do you distinguish btwn primary (Raynaud’s disease) or secondary (Raynaud’s phenomenon).
What causes 2nadry raynauds

A

Raynaud’s disease typically presents in young women (e.g. 30 years old) with bilateral symptoms.

2dary causes;
1. connective tissue disorders
- scleroderma (most common)
RA
SLE
erythematosus
leukaemia
type I cryoglobulinaemia, cold agglutinins
use of vibrating tools

  1. drugs: oral contraceptive pill, ergot
  2. cervical rib
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5
Q

Rx raynauds

A

CCB- nifedipine

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6
Q

double-contour sign

A

Gout

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7
Q

Ankylosing spondylitis features

A

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

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8
Q

Repeated cramping and myoglobinuria after short bouts of exercise

A

McArdle’s disease
autosomal recessive type V glycogen storage disease

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9
Q

Dermatomyositis antibodies

A

ANA most common,
anti-Mi-2 most specific
but seen in 25% of pts

anti-Jo-1 antibodies are not commonly seen in dermatomyositis - they are more common in polymyositis where they are seen in a pattern of disease associated with lung involvement, Raynaud’s and fever

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10
Q

Anti-cardiolipin antibodies and anti-beta2 glycoprotein I

A

Antiphospholipid syndrome: arterial/venous thrombosis, miscarriage, livedo reticularis, prolonged APTT.

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11
Q

SE Azathioprine

A

bone marrow depression

nausea/vomiting

pancreatitis

increased risk of non-melanoma skin cancer

significant interaction may occur with allopurinol and hence lower doses of azathioprine should be used.

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12
Q

Sulfasalazine MAO and cautions

A
  1. decreasing neutrophil chemotaxis
  2. suppressing proliferation of lymphocytes and pro-inflammatory cytokines.

Cautions:
- G6PD deficiency
- allergy to aspirin or sulphonamides (cross-sensitivity)

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13
Q

Sjogren’s syndrome has increase risk of what type of cancer

A

lymphoid malignancies

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14
Q

What is Chondrocalcinosis and what is it ass w/

A

pseudogout,
Calcification on articular cartilage

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15
Q

T-score of X indicating osteoporosis.

A

-2.7

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16
Q

mao OF Bisphosphonates

A

inhibit osteoclasts

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17
Q

abnormality in type 1 collagen

A

osteogenesis imperfecta
AD

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18
Q

Abnormal Type 4 collagen

A

Alport’s syndrome - thinning and splitting of the glomerular basement membrane, presenting with isolated haematuria, sensorineural hearing loss, and ocular disturbances.

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19
Q

What caused
1. arthralgia
2. elevated serum ferritin
3. rash: salmon-pink, maculopapular
4. pyrexia- typically rises in the late afternoon/early evening w/ worsening of joint symptoms and rash
WHAT is IX & RX

A

Still’s disease in adults

Ix :
RF& ANA negative
Yamaguchi criteria

RX: NSAID or steroids

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20
Q

Denosumab SE

A

Dyspnoea and diarrhoea

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21
Q

‘large, dark shadow’ covering the superior visual field

A

GCA
anterior ischemic optic neuropathy (AION).

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22
Q

Sulfasalazine SE

A

oligospermia
Stevens-Johnson syndrome
pneumonitis / lung fibrosis
myelosuppression, Heinz body anaemia, megaloblastic anaemia
may colour tears → stained contact lenses

safe to use in both pregnancy and breastfeeding.

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23
Q

Low serum calcium, low serum phosphate,
raised ALP and raised PTH

A

osteomalacia

24
Q

Bone disease: causes of LOW Calcium (2)

A

Osteomalacia & CKD

25
Q

Bone disease: causes of HIGH PTH (3)

A

Primary hyperparathyroidism

CKD

Osteomalacia

26
Q

How do you differentiate Osteomalacia and CKD

A

Both will have Low Ca2+ and High PTH
But CKD has high phosphate and Osteomalacia has low Phosphate

27
Q

Difference between Buerger’s & Berger’s disease

A

Buerger’s
(thromboangiitis obliterans) med. vessel vasculidity
commonly in the arms and leg
Men 20-40 y/o use Tabacco
Jews Indian

Berger’s disease – IgA nephropathy

28
Q

defect in the FBN1 gene on chromosome 15 that codes for the protein fibrillin-1.

A

Marfan’s syndrome

29
Q

Marfan’s syndrome heart abnormalities

A

heart:
dilation of the aortic sinuses (seen in 90%) which may lead to aortic aneurysm, aortic dissection, aortic regurgitation
mitral valve prolapse (75%),

30
Q

What Cause

  1. Tingling/numbness of the 4th & 5th finger

2.wasting & paralysis of intrinsic hand muscles (except lateral two lumbricals) & the hypothenar muscles.

Froment’s test - pinch a piece of paper between the thumb and index

A

Cubital tunnel syndrome

31
Q

What are Syndesmophytes

A

ossification of outer fibres of annulus fibrosus are a feature of ankylosing spondylitis

32
Q

pilocarpine and what is it used for

A

stimulates the parasympathetic nervous system. = stimulating salivary gland secretion,
Sjogren’s syndrome

33
Q

Avascular necrosis of the hip x -ray findings

A

-may be normal initially.

Osteopenia & microfractures -early .

Collapse of the articular surface= crescent sign

MRI is the investigation of choice. It is more sensitive than radionuclide bone scanning

34
Q

Joint space narrowing, osteophytes and subchondral cysts

A

OA

35
Q

Marginal erosions, soft tissue swelling and periarticular osteoporosis

A

RA

36
Q

Soft tissue swelling, punched-out bone lesions and overhanging sclerotic margins

A

gout.

37
Q

What causes back pain associated with neurological problems in Marfan’s

A

dural ectasia

38
Q

Drug causes of gout

A

diuretics: thiazides, furosemide

ciclosporin

alcohol

cytotoxic agents

pyrazinamide

aspirin:

39
Q

Leflunomide SE
what needs to be monitored

A

gastrointestinal, especially diarrhoea
hypertension
weight loss/anorexia
peripheral neuropathy
myelosuppression
pneumonitis

Monitor BP, LFTs FBC

40
Q

Anti-U1 RNP

A

mixed connective tissue disease
arthralgia, myositis and Raynaud’s

41
Q

pain & tenderness localised to the lateral epicondyle

pain worse on wrist extension against resistance with the elbow extended or supination of the forearm with the elbow extended

A

Lateral epicondylitis
tennis elbow

hurts to straighten your fingers, bend your wrist back you may have tennis elbow.

Tennis, Lateral and outside all have T‘s,

42
Q

tenderness over the medial epicondyle of the humerus.

Pain is usually elicited by resisted wrist flexion with pronation while keeping the elbow flexed 90 degrees or

resisted forearm pronation w/ the elbow extended.

A

Medial epicondylitis, or golfer’s elbow

hurts to close your hand in a grip, you may have golfer’s elbow

affects the inside of the elbow

43
Q

numbness, tingling, and pain in the thumb, index finger, middle finger, and half of the ring finger.

nocturnal sx relieved by shaking hands.

A

carpal tunnel syndrome

44
Q

Methotrexate MOA
SE

A
  1. folic acid analog = decreased levels of THF
  2. Inhibits purine snx= halts DNA production (S phase )

Pneumonitis
bone marrow suppression
Megaloblastic anaemia
oral ulcers, gum bleeding, peptic ulcers, and hemorrhagic enteritis

Liver cirrhosis

teratogenic,

45
Q

Leflunomide mao & se

A

arresting the cell in the G1 phase of growth. = the proliferation of T-cells suppressed

Liver impairment
Interstitial lung disease
Hypertension
teratogenic

46
Q

MOA & SE Hydroxychloroquine

A

Takes 3-6 mo before effective
Inbitits TNF A & IL 1

Retinopathy
Corneal deposits
ventricular arrhythmias.

Use: RA and lupus
Safe in pregnancy

47
Q

MOA & SE
Sulfasalazine

A

safe in both pregnancy and breastfeeding take w/ folic acid

Inbitits TNF A & IL 1 by macrophages

Rashes
Oligospermia
Heinz body anaemia
Interstitial lung disease

48
Q

Low level intermitted PTH

A

= anabolic level= bone formation

49
Q

Chronic High level PTH =

A

Catabolic effect = bone reabsorption

50
Q

RX osteoporosis

A

1st line Alendronate if can tolerate offered risedronate or etidronate

2nd line Raloxifene and strontium ranelate

51
Q

Indications for bisphosphonates

A

Indications:
paget’s,
Osteogenesis imperfecta, osteoporosis,
metastatic disease, hypercalcaemia

52
Q

MOA bisphosphonates

A

Death to osteoclasts

53
Q

Denosumab moa & SE

A

prevents the maturation of osteoclasts by inhibiting RANKL.Given 2 yearly
good in CKD
Subcutaneous
SE: Dyspnoea and diarrhoea, hypoca, hypoMg

54
Q

MOA Calcitonin

A

Direct inhibition of osteoclast & stim osteoblasts

Increase secretion of phosphate & Ca2 in the urine

Indications: Post-men osteoporosis, steroid induced osteoporosis, hyperCa, & Pagets

55
Q

Teriparatide moa & SE

A

Recombinant PTH = prevent osteoblast death
administered in pulse like fashion = stim osteo blast

SE: osteosarcoma, transient HYPRca2
Limited to 2 year use

56
Q

MAO & SE SERM (Raloxifene & Tamoxifen)

A

oestrogen receptor antagonist and partial agonist.
Inhibit bone reabsorption
Reduces risk of breast ca – not for pre menopausal wmn (it induces menopause via estrogen)
* may worsen menopausal symptoms
* increased risk of thromboembolic events
* may decrease risk of breast cancer
* endometrial cancer
* menstrual disturbance: vaginal bleeding, amenorrhoea

57
Q
A