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revision > rheum > Flashcards

rheum Flashcards

1
Q

rheumatoid arthritis, splenomegaly and low WCC

A

felty’s syndrome

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2
Q

test when starting on azathioprine

A

Thiopurine methyltransferase (TPMT) deficiency is present in about 1 in 200 people and predisposes to azathioprine related pancytopaenia

nausea/vomiting
pancreatitis
increased risk of non-melanoma skin cancer

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

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3
Q

causes of dactylitis

A

spondyloarthritis: e.g. Psoriatic and reactive arthritis
sickle-cell disease
other rare causes include tuberculosis, sarcoidosis and syphilis

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4
Q

DAS 28

A

disease activity score in 28 joints fo rRA

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5
Q

meds to avoid with methotrexate

A

Trimethoprim and co-trimoxazole, anti-folate antibiotics

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6
Q

mx of gout

A

acute: nsaids and colchicine +- PPI

long term: allopurinol 2nd line febuxostat

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7
Q

ix for osteomalacia

A 
low 25(OH) vitamin D (in 100% of patients, by definition)
raised alkaline phosphatase (in 95-100% of patients)
low calcium, phosphate (in around 30%)
x-ray: children - cupped, ragged metaphyseal surfaces; adults - translucent bands (Looser's zones or pseudofractures)
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8
Q

mx of ankspond

A

encourage regular exercise such as swimming
NSAIDs are the first-line treatment
physiotherapy
the disease-modifying drugs which are used to treat rheumatoid arthritis (such as sulphasalazine) are only really useful if there is peripheral joint involvement
the 2010 EULAR guidelines suggest: ‘Anti-TNF therapy should be given to patients with persistently high disease activity despite conventional treatments’ (2 NSAIDS)
research is ongoing to see whether anti-TNF therapies such as etanercept and adalimumab should be used earlier in the course of the disease

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9
Q

drugs and antibodies in drug induced lupus

A

procainamide
hydralazine

Less common causes
isoniazid
minocycline
phenytoin

antihistone antibodies

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10
Q

causes of positive anca

A

cANCA - granulomatosis with polyangiitis (Wegener’s granulomatosis)
pANCA - Churg-Strauss syndrome + others (see below)

Other causes of positive ANCA (usually pANCA)
inflammatory bowel disease (UC > Crohn’s)
connective tissue disorders: RA, SLE, Sjogren’s
autoimmune hepatitis

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11
Q

marfans abnormalirty

A

chromosome 15 that codes for the protein fibrillin-1

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12
Q

acromegaly pts can get

A

pseudogout

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13
Q

antibodies is most specific for limited cutaneous systemic sclerosis?

A

anticentromere

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14
Q

comlication of chemotherapy

A

Chemotherapy patients are at increased risk of gout from increased urate production

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15
Q

dermatomyositis associated with

A

breast, ovarian and lung ca

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16
Q

dermatomyositis antibodies

A

antibodies against histidine-tRNA ligase (also called Jo-1)
antibodies to signal recognition particle (SRP)
anti-Mi-2 antibodies

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17
Q

t score for bisphosphonates if on steroids

A

t -1.5

more than 7.5mg pred for 3 months

18
Q

mx of reactive arthritis

A

symptomatic: analgesia, NSAIDS, intra-articular steroids
sulfasalazine and methotrexate are sometimes used for persistent disease
symptoms rarely last more than 12 months

19
Q

mx of OA

A
  • weight loss advice
  • paracetamol +-topical NSAIDS
  • 2lin: oral NSAIDs
  • supports, shock absorbers
  • joint replacement
20
Q

features of antiphospholipid syndrome

A 
venous/arterial thrombosis
recurrent fetal loss
livedo reticularis
thrombocytopenia
prolonged APTT
other features: pre-eclampsia, pulmonary hypertension
21
Q

ehlers danlos

A

type 3 collagen
elastic, fragile skin
joint hypermobility: recurrent joint dislocation
easy bruising
aortic regurgitation, mitral valve prolapse and aortic dissection
subarachnoid haemorrhage
angioid retinal streaks

22
Q

(paradoxically) prolonged APTT + low platelets

A

antiphospholipid syndrome

23
Q

s/e of hydroxychloroquine

A

bull’s eye retinopathy - may result in severe and permanent visual loss
recent data suggest that retinopathy caused by hydroxychloroquine is more common than previously thought and the most recent RCOphth guidelines (March 2018) suggest colour retinal photography and spectral domain optical coherence tomography scanning of the macula
baseline ophthalmological examination and annual screening is generally recommened

A contrast to many drugs used in rheumatology, hydroxychloroquine may be used if needed in pregnant women.

24
Q

ank spond dx criteria

A

Sacroilitis on imaging* plus 1 or more spondyloarthritis features†
or
HLA-B27 plus 2 or more other spondyloarthritis feature

25
Q

polyarteritis nodosa fx

A

fever, malaise, arthralgia
weight loss
hypertension
mononeuritis multiplex, sensorimotor polyneuropathy
testicular pain
livedo reticularis
haematuria, renal failure
perinuclear-antineutrophil cytoplasmic antibodies (ANCA) are found in around 20% of patients with ‘classic’ PAN
hepatitis B serology positive in 30% of patients

26
Q

behcets features

A

classically: 1) oral ulcers 2) genital ulcers 3) anterior uveitis
thrombophlebitis and deep vein thrombosis
arthritis
neurological involvement (e.g. aseptic meningitis)
GI: abdo pain, diarrhoea, colitis
erythema nodosum

27
Q

different spondyloarthropathies

A

ankylosing spondylitis
psoriatic arthritis
Reiter’s syndrome (including reactive arthritis)
enteropathic arthritis (associated with IBD

28
Q

mx RA

A

DMARD monotherapy +/- a short-course of bridging prednisolone. In the past dual DMARD therapy was advocated as the initial step.

poor response to 2 DMARDS- tnf inhibitors
measure with DAS28 and CRP

29
Q

pencil and cup dips and pips

plantar spur

A

psoriatic arthritis

30
Q

Antisynthetase syndrome fx

A

autoantibodies against aminoacyl-tRNA synthetase e.g. anti-Jo1.

It is characterised by
myositis
interstitial lung disease
thickened and cracked skin of the hands (mechanic's hands)
Raynaud's phenomenon
31
Q

how to test if hip pain is referred from back

A

femoral nerve stress test

32
Q

complication of RA in surgery

A

atlantoaxial subluxation, screen with 2 view c spine x rays

33
Q

complication of penicillamine (chelating agent for wilsons)

A

membranous glomerulonephritis (nephrotic syndrome)

34
Q

bisphonsphonate holidays not allowed if

A 
ge >75
Glucocorticoid therapy
Previous hip/vertebral fractures
Further fractures on treatment
High risk on FRAX scoring
T score
35
Q

ank spond associations

A 
Apical fibrosis
Anterior uveitis
Aortic regurgitation
Achilles tendonitis
AV node block
Amyloidosis
36
Q

RA XRAY

A

Early x-ray findings
loss of joint space
juxta-articular osteoporosis
soft-tissue swelling

Late x-ray findings
periarticular erosions
subluxation

37
Q

score to assess hypermobility

A

beighton score

38
Q

patients who are allergic to x may also react to sulfasalazine

A

aspirin

39
Q

reactive artritis aspirate appearance

A

cloudy yellow, culture negative, no crystals, WCC 20,000/mm3

40
Q

interferon features and uses

A

Interferon-alpha
produced by leucocytes
antiviral action
useful in hepatitis B & C, Kaposi’s sarcoma, metastatic renal cell cancer, hairy cell leukaemia
adverse effects include flu-like symptoms and depression

Interferon-beta
produced by fibroblasts
antiviral action
reduces the frequency of exacerbations in patients with relapsing-remitting MS

Interferon-gamma
predominately natural killer cells. Also by T helper cells
weaker antiviral action, more of a role in immunomodulation particularly macrophage activation
may be useful in chronic granulomatous disease and osteopetrosis

41
Q

osteogenesis imperfecta

A

Overview
autosomal dominant
abnormality in type 1 collagen due to decreased synthesis of pro-alpha 1 or pro-alpha 2 collagen polypeptides

Features
presents in childhood
fractures following minor trauma
blue sclera
deafness secondary to otosclerosis
dental imperfections are common

revision (24 decks)

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