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MSRA > Rheum > Flashcards

Rheum Flashcards

1
Q

Renal impairment (raised creatinine, haematuria and proteinuria), SOB, Haemaoptysis
fatigue, weight loss, fever
Sinusitis
Vasculitic rash

A

ANCA asso vasculitis

cANCA - granulomatosis with polyangiitis
pANCA - eosinophilic granulomatosis with polyangiitis

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2
Q

Associated ft of Ank Spond (6)

A

Apical fibrosis
Aortic Regurg
Anterior Uveitis
Achilles tendonitis
AV node block
Amyloidosis

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3
Q

Xray findings in Ank Spond

A

Plain Xray Sacroiliac joints;
- squaring of vertebrae
- Bamboo spine
-Sacroilitis

CXR - apical; fibrosis

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4
Q

Tx for APS

A

primary prophylaxis = low dose aspirin

secondary prophylaxis - warfarin

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5
Q

SEs and cautions for Azathioprine

A

Adverse effects:
- bone marrow depression
- N/V
- Pancreatitis

Significant interaction may occur with Allopurinol
Check TPMT before use
Safe in pregnancy

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6
Q

Young man, oral ulcers, genital ulcers, eye problems, joint pain, DVTs

A

Behcet’s syndro

HLA B51, young turkish men, +ve FHx

Also asso w/ GI upset and erythema nodosum

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7
Q

Bone profile; Low Ca, Low Phos, normal ALP, normal PTH

A

Osteomalacia

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8
Q

Bone profile; Low Ca,, inc Phos, inc ALP, inc PTH

A

CKKD (-> secondary hyperpara)

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9
Q

Bone profile; Isolated rise in ALP

A

Pagets

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10
Q

Child/adolescent
Bone pain at ends of long bones,
Xray - sunburst appearance, Codman triangle

A

Osteosarcoma

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11
Q

Child/adolescent
Pain in pelvis/long bones
Xray - ‘onion skin; appearance

A

Ewings sacroma

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12
Q

Progressive symmetrical muscle weakness
Photosensitive, macular rash over shoulders/back
Red papules over extensor surfaces of fingers

A

Dermatomyositis

ANA +ve, Anti Jo1

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13
Q

Causes and Antibodies in drug induced Lupus

A

(-> malar rash, arthralgia, myalgia)

Causes;
Procainamide, Hydralazine, Isoniazid, phenytoin

Abs - Anti-histone, ANA, Anti-Ro

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14
Q

Fragile skin, joint hypermobility, freq dislocations
Easy bruising
AR
SAH

A

Ehler Danlos syndro
A Dom conn tissue disorder affecting T II collagen

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15
Q

Common drug causes of Gout

A

Diuretics
Ciclosporin
Alcohol
Cytotoxic agents

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16
Q

Synovial fluid; gout vs pseudogout

A

Gout - needle shaped, neg birefringent monosodium urate crystals

Pseudogout - weakly-positively birefringent rhomboid-shaped crystals

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17
Q

Tx for Gout

A

Acute attack - NSAIDs/colchicine

Offer Urate lowering therapy (Allopurinol) after first attack
2nd line = febuxostat

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18
Q

Third trimester
Groin pain with limited movement of hip, unable to weight bear
ESR elevated

A

Transient idiopathic osteoporosis

19
Q

Hip pain in pregnancy
Pain over pubic sym,phisis with radiation to groins and medial thigh
Waddling gait

A

Pubic symphysis dysfunction

(ligament laxity increases due to hormonal changes)

20
Q

HLA-B27 association (4)

A

Ank Spond
Reactive arthritis
Acute anterior uveitis
Psoriatic arthritis

21
Q

HLA-DR 2-4 associations

A

HLA-DR2 - goodpastures

3 - dermatitis herpetiformis, sjogrens, pbc

4 - T1DM

22
Q

Significant adverse effect for hydroxychloroquine

A

Bull’s eye retinopathy (may lead to permanent and severe vision loss)

Should have baseline opthal exam and yearly screening

23
Q

Adverse effects and cautions for methotrexate

A

Adverse effects:
- Pneumonitis (non prod cough, fever, SOB)
- Mucositis
- myelosuppression
- liver fibrosis

Cautions - men and women stop at least 6 months before conceiving
Avoid co-prescribing Trim/Co-Trim

24
Q

Xray findings in OA

A

LOSS
Loss of joint space
Osteophytes forming at joint margins
Subchondral sclerosis
Subchondral cysts

25
Xray findings in RA
Loss of joint space Juxta-articular osteoporosis Periarticular erosions Subluxation
26
Joints affected - OA vs RA
OA - large/weight bearing joints, carpometacarpal joint, DIP/PIP RA - MCP, PIP
27
Childhood Fracture after mild trauma Blue sclera Deafness +ve FHx
Osteogenesis imperfecta (brittle bone disease) A-Dom
28
Significant risk factors for osteoporosis
inc age Female sex - premature menopause, aromatase inhib (anastrazole) History of glucocortid use rheumatoid arthritis Alcohol excess, Current smoking. parental hip fracture history low BMI CKD
29
Meds that may worsen Osteoporosis
Glucocorticoids SSRIs antiepileptics proton pump inhibitors glitazones long term heparin therapy aromatase inhibitors e.g. anastrozoleWhe
30
Older woman, morning stiffness in proximal limb muscles (shoulders/hips) mild polyarthralgia, lethargy, depression, low-grade fever, anorexia, night sweats
PMR Ix - ESR raised Tx - Steroids (NB if no response withing 1 week, consider alternative diagnosis)
31
Symmetrical polyarthritis, asymmetrical oligoarthropathies, DIP joint disease, dactylitis, skin lesions Xray - combination of erosive bone changes and new bone formation , 'pencil in cup'
Psoriatic arthritis Tx - mild = NSAIDs, severe = methotrex
32
Tx for Raynauds
More common in young women (30),bilat sympto Tx - CCB (nifedipine)
33
Urethritis, Conjunctivitis, anterior uveitis Arthritis (asymetrical oligoarthritis of lower limbs) Dactylitis Recent STI/dystenteric illness
Reactive arthritis (HLA-B27) 'cant see, cant pee, cant climb a tree' Dev withing 4w of initial inf
34
Methotrex SEs (3)
Myelosuppression Liver cirrhosis Pneumonitis
35
Sulfasalazine SEs
Caution in G6PDdef Caution in aspirin allergy - cross reactivity SEs: Rashes Oligospermia
36
Hydroxychloroquine SEs
Retinopathy (bulls eye) Corneal deposits
37
Prednisolone SEs
Cushingoid, Osteoporosis Impaired gluc tollerance HTN Cataracts
38
NSAID SEs
Bronchospasm in asthmatics Dyspepsia, peptic ulceration
39
RA Mx
If evidence of joint effusion - start DMARD asap DMARD monotherapy (methotrex, sulfasalazine, leflunomide) with short bridging course of pred Manage flares with PO/IM corticosteroids Inadequate response to at least 2 DMARDs (inc metho) - TNF-alpha inhib (etanercept, infliximab, adalimumab) - NB - be wary of reactivation of TB
40
Swollen, painfull joints in hands/feet Morning stiffness Gradually involves larger joints Discomfort on squeezing across metacarpel or metatarsal joints
RA
41
Dry eyes, dry mucous membranes, arthralgia, Raynauds
Sjogrens Much more common in women Ix - RF +ve, ANA +ve, anti-Ro/ant-La Tx - artificial saliva/tears Pilocarpine
42
Fts and Abs in SLE
Fty - fatigue, fever, mouth ulcers, malar or discoid rash, photosensitivity, arthralgia, pericarditis Abs - ANA, Anti-dsDNA
43
Raised Ca, Raynauds, GORD sympto, hardened/tight skin across hands/fingers, Telengiectasia
limited cutaneous systemic sclerosis CREST (Calcinosis, Raynauds, Esophageal dysmotility, Sclerodactyly, Telengiectasia) Abs - ANA +ve, anti- scl-70, RF +ve, Anti-centromere
44

MSRA (21 decks)

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