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Rheum > Rheum > Flashcards

Rheum Flashcards

0
Q

Sjogrens have an increased risk of what type of malignancy

A

44 fold increase in NHL especially MALT
risk factors: disappearance of RF, low C4, cutaneous vasculitis and mixed monoclonal cryoglobulinaemia
Salivary glands most common location but can get unilateral or bilateral swelling that is benign

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1
Q

What is the prognostic importance of rheumatoid factor positivity in RA?

A

Erosive disease
Response to Rituximab
Extra-articular manifestations

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2
Q

What causes false positive anti-CCP?

A

TB
Psoriatic arthritis
SLE

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3
Q

If suspect RA and serology negative, should you repeat the test?

A

Probably not- low risk of seroconverting

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4
Q

Where to aspirate knee?

What does NORMAL fluid look like?

A

1cm medial to junction between the upper and middle thirds of the patella
Fluid is clear and VISCOUS (abnormal is cloudy and THIN)

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5
Q

How many white cells per mm3 do you expect for septic joint, inflammatory joint, non inflammatory and normal joint?

A

Normal less than 200
Noninflammatory 200-2000
Inflammatory 2000 - 100000
Septic usually over 50000

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6
Q

Aim for urate levels below this level reduces gout attacks?

A

35micromol/L

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7
Q

What are the SECONDARY causes of pseudogout which need to be considered in a younger patient who presents?

A 
haemochromatosis
hyperparathyroidism
low phosphate
low magnesium
hypothyroidism
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8
Q

Difference between oral ulcers in SLE and Becet’s?

A

Becet’s PAINFUL

SLE PAINLESS

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9
Q

What things in psoriasis increase the chance of getting psoriatic arthritis?

A

nail dystrophy
scalp involvement
intergluteal involvement
involvement three or more areas

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10
Q

Do you get renal involvement in MCTD?

A

No

Remember, ANA often up, RF often up, RNP MUST be up
but dsDNA, Sm, scleroderma Ab are ABSENT

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11
Q

IgG4 disease biopsy

A

plasma cells
small lymphocytes
often fibrosis

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12
Q

If looks like pancreatic cancer but then serum IgG4 up?

A

could still be cancer

cannot rely

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13
Q

Strongest evidence for fibromyalgia

A

aerobic exercise

first med choice is amitriptyline as per etg, or duloxetine, or pregabalin (pain sleep fatigue)
NOT SSRIs

for pain, also panadol, tramadol, tapentadol

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14
Q

Classic Becet’s picture

A

youngish mediterranean man with anterior uveitis, painful gentital and mouth ulcers

positive pathergy test suggests

also get thrombophlebitis, aspetic meningitis, arthritis, erythema nodosum, DVT

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15
Q

percent PMA to GCA

A

10-20%

but 40-60% GCA have PMR

16
Q

Most specific GCA symptom?

A

jaw claudication

17
Q

pathogenesis GCA?

A

TLR activate vascular dendritic cells–>Al17 and IFNgamma

18
Q

What other imaging would you do in GCA?

A

CTA or MRA to look for other organ involvement

19
Q

Muscle enzymes in PMR

A

normal
normal EMG too
normal muscle biopsy

20
Q

What interferes with response to TNF treatment?

A

smoking

21
Q

how many of the sjogrens are seroneg?

A

20%

can get small fibre neuropathy

22
Q

most common presenting feature scleroderma is

A

Raynauds

23
Q

Classic cause enthesitis

A

psoriatic
next reactive
next ankylosing spondylitis

24
Q

Classic OA joints in hands

A

1st CMC and PIPs

hand splints good for CMC
NSAIDS out these days

25
Q

Patellofemoral joint RA typical presentation

A

classically get pain getting out of chair and WALKING DOWN THE STAIRS

26
Q

How do APL induce thrombosis

A

interfere with clotting cascade especially protein C
induce tissue factor expression
induce adhesion molecule expression
promote thrombosis

27
Q

Contraindications for TNF

A 
previously untreated TB
recurrent LRTI
septic arth last 12 months
MS or demyelinating illness
IDC
infected prosthesis
malig within 10 years- BCC within 5 years
preg
CCF
skin ulcers NOT pyoderma gangrenosum
28
Q

which system NOT affected by PAN

A

pulmonary

think if vasculitis with orchitis without glom neph
idiopathic PAN–>steroids and cyclophos
hepatitis PAN–>plasmapheresis and antiviral

29
Q

good prognosis in RA if present with

A

large joint
just a few
acute
seroneg

30
Q

can you be CPPD positive and asymptomatic?

A

YES!

31
Q

Sjogrens and what type lymphoma

A

NHL

32
Q

ORganism most likely in vertebral OM

A

random: s aureus–>e coli

after surg on spine—>s epiderm–>propionebacterium acnes

33
Q

most specific Ab for APL syndrome

A

anticardiolipin ab most sensitive

APL ab most specific

34
Q

What to avoid in psoriatic arthritis

A

hydroxychloroquine

oral steroids- increase pustular psoriasis

35
Q

where are the most SPECIFIC SLE ulcers

A

palate

36
Q

Complement low in HSP

A

NO!

unlike cryo

37
Q

what is SAP in amyloid

A

all amyloid people have serum amyloid protein which is a GP that binds amyloid independently of the protein of origin

Rheum (12 decks)

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