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Passmedicine MRCP Part 1 > Rheum Gap > Flashcards

Rheum Gap Flashcards

1
Q

ANA is associated with

A

diffuse cutaneous systemic sclerosis
Sjogren’s syndrome
limited cutaneous systemic sclerosis
SLE

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2
Q

Anti Jo Antibody is associated with

(Hint: Joey – Polygamy)

A

polymyositis

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3
Q

Behcets is a triad of

A

Oral Ulcer
Genital Ulcer
Anterior Uveitis

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4
Q

Behcet’s is associated with which HLA

A

B51

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5
Q

Which test is suggestive of Behcet’s

A

Pathergy Test

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6
Q

Investigations of Sjogrens Syndrome
(antibodies)

A

Rheumatoid factor (RF) positive in nearly 50% of patients
ANA positive in 70%
anti-Ro (SSA) antibodies in 70% of patients with PSS
anti-La (SSB) antibodies in 30% of patients with PSS

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7
Q

Rx of Osteoporosis

A
  1. Bisphosphonates are the first-line drug treatment for patients at risk of fragility fractures
    - oral ie alendronate and risedronate are typically first-line. These are often taken weekly
    - however, the NOGG recommend IV zoledronate as the first-line treatment following a hip fracture This is given yearly
  2. Denosumab is generally used as a second-line treatment: Single cubcut injection every 6 months-
  3. other possible treatment options include:
    strontium ranelate
    raloxifene
    teriparatide
    romosozumab

Plan to prescribe oral bisphosphonates for at least 5 years, or intravenous bisphosphonates for at least 3 years and then re-assess fracture risk.

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8
Q

Paget’s Disease Presentation

A
  • an older male with bone pain and an isolated raised ALP
  • bone pain (e.g. pelvis, lumbar spine, femur)
  • classical, untreated features: bowing of tibia, bossing of skull
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9
Q

Paget’s disease pathophysiology

A

excessive osteoclastic resorption followed by increased osteoblastic activity.

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10
Q

Organism of Osteomyelitis in Sickle Cell Disease

A

Salmonella

Usually- Staph Auerus

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11
Q

Osteopetrosis pathophysiology

A

Defective osteoclast function resulting in failure of normal bone resorption

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12
Q

Ehler-Danlos syndrome pathophysiology

A

Abnormality in type III and V collagen

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13
Q

Lesch-Nyhan syndrome is associated with

Enzyme: HGPT
Features: GRNLS
‘Nyhan’- Boys Name

A

Lesch-Nyhan syndrome
hypoxanthine-guanine phosphoribosyl transferase (HGPRTase) deficiency
x-linked recessive therefore only seen in boys
features: gout, renal failure, neurological deficits, learning difficulties, self-mutilation

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14
Q

gout, renal failure, neurological deficits, learning difficulties, self-mutilation indicates

A

Lesch-Nyhan syndrome
hypoxanthine-guanine phosphoribosyl transferase (HGPRTase) deficiency

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15
Q

Adverse effects of Azathioprine

A

- bone marrow depression- consider a full blood count if infection/bleeding occurs
- nausea/vomiting
- pancreatitis
- increased risk of non-melanoma skin cancer

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16
Q

Diffuse cutaneous systemic sclerosis
associated with —– antibodies

A

associated with anti scl-70 antibodies

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17
Q

limited cutaneous systemic sclerosis associated with —- antibodies

A

anti-centromere antibodies associated with limited cutaneous systemic sclerosis

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18
Q

Methotrexate M/A

A

Methotrexate is an antimetabolite that inhibits dihydrofolate reductase, an enzyme essential for the synthesis of purines and pyrimidines.

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19
Q

Methotrexate Adverse Effects

A
  • mucositis
  • myelosuppression
    -** pneumonitis- the most common pulmonary manifestation-** similar disease pattern to hypersensitivity pneumonitis secondary to inhaled organic antigens. typically develops within a year of starting treatment, either acutely or subacutely. presents with non-productive cough, dyspnoea, malaise, fever
  • pulmonary fibrosis
  • liver fibrosis
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20
Q

Chondromalacia patellae

A
  • Softening of the cartilage of the patella
  • Common in teenage girls
  • anterior knee pain on walking up and down stairs and rising from prolonged sitting
  • Usually responds to physiotherapy
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21
Q

Osteochondritis dissecans

A

Pain after exercise
Intermittent swelling and locking

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22
Q

Marfans Genetics

A

Marfan’s syndrome is an autosomal dominant connective tissue disorder. It is caused by a defect in the FBN1 gene on chromosome 15 that codes for the protein fibrillin-1. It affects around 1 in 3,000 people.

When did I see the marfans patient? on my ‘15th’ Night Shift.
She was very Active and Dominant- could do everything. - Autosomal Dominant

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23
Q

Drug Induced Lupus

A

Most common causes
- procainamide
- hydralazine

Less common causes
- isoniazid
- minocycline
- phenytoin

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24
Q

Rituximab

causes —– cell depletion?
what type of drug? —- antibody
works against which CD? —-?

A

anti-CD20 monoclonal antibody, results in B-cell depletion

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25
Q

M/A of Bisphophonates

A

Bisphosphonates are analogues of pyrophosphate, a molecule which decreases demineralisation in bone. They inhibit osteoclasts by reducing recruitment and promoting apoptosis.

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26
Q

Food that can precipitate Gout Attacks

A

Foods to avoid include those high in purines e.g.
- Liver
- Kidneys
- Seafood
- Oily fish (mackerel, sardines)
- Yeast products

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27
Q

Xray signs of Calcification (cartilage) in the joint - —-?
Xray with Widening in the joint (Kids) - —– ?

A

Xray signs of Calcification (cartilage) in the joint - Pseudogout
Xray with Widening in the joint (Kids) - Rickets

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28
Q

Which movement is affected most in adhesive capsulitis

A

Features typically develop over days
external rotation is affected more than internal rotation or abduction

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29
Q

pANCA is associated with

A

PCM

pANCA
Churg Srauss- eosinophilic granulomatosis with polyangiitis
MPO Positive

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30
Q

Inv for antiphospholipid syndrome

A

antibodies:
- anticardiolipin antibodies
- anti-beta2 glycoprotein I (anti-beta2GPI) antibodies
- lupus anticoagulant
thrombocytopenia
prolonged APTT

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31
Q

In of choice for avascular necrosis

A

MRI is the investigation of choice

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32
Q

causes of avascular necrosis

A

long-term steroid use
chemotherapy
alcohol excess
trauma

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33
Q

Vit D supplementation is indicated for

A

A - Age > 65
B - Breast feeding + pregnancy
C - Children 6 months to 3 years old
D - Dark skinned individuals
E - Exposure to sunlight poor

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34
Q

Most common Visual complication of GCA

A

anterior ischemic optic neuropathy accounts for the majority of ocular complications. It results from occlusion of the posterior ciliary artery (a branch of the ophthalmic artery) → ischaemia of the optic nerve head. Fundoscopy typically shows a swollen pale disc and blurred margins

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35
Q

Lab Values of Bone Disorders

A

check from Passmed

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36
Q

Rx of Raynauds

A
  1. first-line: calcium channel blockers e.g. nifedipine
    1. IV prostacyclin (epoprostenol) infusions: effects may last several weeks/months
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37
Q

Cubital Tunnel Syndrome

A

Tingling and numbness of the 4th and 5th finger which starts off intermittent and then becomes constant.

cUbital = Ulnar nerve

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38
Q

Tingling and numbness of the 4th and 5th finger which starts off intermittent and then becomes constant.

A

Cubital Tunnel Syndrome

occurs due to compression of the ulnar nerve as it passes through the cubital tunnel.

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39
Q

OsteoPetrosis info:
aka-
pathophysiology-
Biochemistry-
Rx-

A

**aka marble bone disease
rare disorder of defective osteoclast **function resulting in failure of normal bone resorption
results in dense, thick bones that are prone to fracture
bone pains and neuropathies are common.
calcium, phosphate and ALP are normal

stem cell transplant and interferon-gamma have been used for treatment

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40
Q

Presentation of Carpal Tunnel Syndrome

A

Carpal tunnel syndrome is caused by compression of median nerve in the carpal tunnel.

History
pain/pins and needles in thumb, index, middle finger

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41
Q

Examination findings of Carpal Tunnel Syndrome

A

Examination
weakness of thumb abduction (abductor pollicis brevis)
wasting of thenar eminence (NOT hypothenar)
Tinel’s sign: tapping causes paraesthesia
Phalen’s sign: flexion of wrist causes symptoms

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42
Q

What is Tinels sign

A

tapping causes paraesthesia

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43
Q

What is Phalens Sign

A

flexion of wrist causes symptoms

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44
Q

Carpal tunnel = —- nerve compressiob
Cubital Tunnel = —- Nerve

A

Carpal = Median
cUbital = Ulnar nerve

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45
Q

M/A Bisphosphonates

A

inhibit osteoclasts by reducing recruitment and promoting apoptosis.

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46
Q

M/A of:
Bisphosphonates: ——
Raloxifene: ——–
Strontium Ranelate: —–
Denosumab: ——-

A

Bisphosphonates: Inhibit osteoclast ( By inhibiting the recruitment and promoting apoptosis)

Raloxifene: Selective estrogen receptor modulator

Strontium Ranelate: (DUAL ACTION BONE AGENT)
Inhibiting osteoclast
Promoting differentiation of pre-osteoblast to osteoblast

Denosumab: Monoclonal antibody that inhibits RANK ligand and thereby preventing maturation of osteoclast.

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47
Q

Inv of choice for Ank Spondilitis

A

Pelvic Xray
( sacroiliitis: subchondral erosions, sclerosis
squaring of lumbar vertebrae
‘bamboo spine’ (late & uncommon)
syndesmophytes: due to ossification of outer fibers of annulus fibrosus
chest x-ray: apical fibrosis )

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48
Q

Poor prognostic features of RA

A

Poor prognostic features
rheumatoid factor positive
anti-CCP antibodies
poor functional status at presentation
X-ray: early erosions (e.g. after < 2 years)
extra articular features e.g. nodules
HLA DR4
insidious onset

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49
Q

Drug Causes of Gout

A

SPyCy ACiD

S- Salisilic acid - Asprin
Py- Pyrazinamide
Cy- Cytotoxic Agents
A- Alcohol
Ci- Ciclosporin
D - Diuretic - thiazide , frusamide

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50
Q

pain and 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

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51
Q

Lateral epicondylitis presents as

A

pain and 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

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52
Q

Red flags of LBP

A
  • age < 20 years or > 50 years
  • history of previous malignancy
  • night pain
  • history of trauma
  • systemically unwell e.g. weight loss, fever
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53
Q

Sensory loss posterolateral aspect of leg and lateral aspect of foot
Weakness in plantar flexion of foot
Reduced ankle reflex
Positive sciatic nerve stretch test

Which nerve root compression

A

S1

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54
Q

Sensory loss dorsum of foot
Weakness in foot and big toe dorsiflexion
Reflexes intact
Positive sciatic nerve stretch test

Which nerve root compression

A

L5

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55
Q

Rx of Spinal Stenosis

A

Laminectomy

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56
Q

CVS findings of Marfans

A

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

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57
Q

McArdle’s disaease:
Genetics : ——-
Type —— glycogen storage disease
caused by —- deficiency
causes reduced ——

A

autosomal recessive type V glycogen storage disease
caused by myophosphorylase deficiency
this causes decreased muscle glycogenolysis

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58
Q

Second wind phenomenon seen in

A

McArdle’s disease

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59
Q

a syndrome of paraesthesia or anaesthesia in the distribution of the lateral femoral cutaneous nerve (LFCN). It is an entrapment mononeuropathy of the LFCN- known as

A

Meralgia Paresthetica

LFCN originates from L2/3

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60
Q

Methotrexate toxicity
the treatment of choice for Methotrexate Toxicity

A

Folinic Acid

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61
Q

Methotrexate shouldn’t be co-prescribed with

A

Trimethoprim or co-trimoxazole - increases risk of marrow aplasia

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62
Q

Which medication increases the risk of Methotrexate toxicity

A

High dose aspirin

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63
Q

repeated episodes of inflammation and deterioration of cartilage.

A

Relapsing Polychondritis
- This most commonly affects the ear

Features:
Ears: auricular chondritis, hearing loss, vertigo
Nasal: nasal chondritis → saddle-nose deformity
Respiratory tract: e.g. hoarseness, aphonia, wheezing, inspiratory stridor
Ocular: episcleritis, scleritis, iritis, and keratoconjunctivitis sicca
Joints: arthralgia
Less commonly: cardiac valcular regurgitation, cranial nerve palsies, peripheral neuropathies, renal dysfunction

64
Q

Psudogout is associated with

A

haemochromatosis
hyperparathyroidism
low magnesium, low phosphate
acromegaly, Wilson’s disease

65
Q

Psudogout xray

A

x-ray: chondrocalcinosis
in the knee this can be seen as linear calcifications of the meniscus and articular cartilage

66
Q

Discoid Lupus Rx

A

Topical steroid cream
oral antimalarials may be used second-line e.g. hydroxychloroquine
avoid sun exposure

67
Q

Discoid Lupus is characterized by

A

Follicular Keratin Plugs

68
Q

SLE is —- type hypersensitivity reaction
associated with HLA —— ?

A

Type 3
(3 letters in SLE)

associated with 3 HLA:
associated with HLA B8, DR2, DR3

69
Q

Most common cardiac manifestation of Lupus

A

Pericarditis

70
Q

Antibodies associoated with Lupus

A
  • 99% are ANA positive: this high sensitivity makes it a useful rule out test, but it has low specificity
  • 20% are rheumatoid factor positive
    **- anti-dsDNA: highly specific (> 99%), but less sensitive (70%)
  • anti-Smith: highly specific (> 99%), sensitivity (30%)**
    also: anti-U1 RNP, SS-A (anti-Ro) and SS-B (anti-La)
71
Q

Rx of Choice for Lupus

A

Hydroxychloroquine

72
Q

Neonatal complications of Lupus are associated with —- antibodies

A

strongly associated withanti-Ro (SSA) antibodies

73
Q

common neonatal complication of Lupus

A

congenital heart block

74
Q

Patterns of systemic sclerosis

A
  • Diffuse cutaneous systemic sclerosis (associated with Anti-scl70)
  • Limited Cutaneous (associated with anti-centromere)
  • Scleroderma
75
Q

common cause of death in systemic sclerosis

A

the most common cause of death is now respiratory involvement, which is seen in around 80%: interstitial lung disease (ILD) and pulmonary arterial hypertension (PAH)

76
Q

which pattern of Systemic sclerosis has poor prognosis

A

Diffuse cutaneous

77
Q

Fundoscopy finding of anteriod ischemic optin neuropathy

A

Fundoscopy typically shows a swollen pale disc and blurred margins

78
Q

Which DMRD is safe for pregnancy and breastfeeding

A

Sulfasalazine

79
Q

Adverse effects of Sulfasalazine

A

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

80
Q

Cautious administration of sulfasalazine is required for

A
  • G6PD deficiency
  • allergy to aspirin or sulphonamides (cross-sensitivity)
81
Q

Xray finding of osteomalacioa

A

Looser’s zones- also known as pseudofractures or Milkman’s fractures, are characteristic radiographic features seen in Osteomalacia. These are areas of incomplete fracture that appear as lucent bands perpendicular to the surface of the bone, usually bilateral and symmetric

82
Q

X-Ray of Pagets

A

characteristic x-ray findings include a mixed pattern of sclerotic and lytic lesions, thickened trabeculae forming a ‘cotton-wool’ appearance, and cortical thickening leading to enlargement of bones affected.

83
Q

first line for ankylosing spondiytis
pcm vs nsaids?

A

nsaids

84
Q

McARDles disease genetics

A

AR
Type 5 glycogen storage disease

85
Q

X-Ray findings of OA and RA

A

OA:
L – loss of joint space
O – osteophytes
S – subchondral sclerosis
S – subchondral cysts

RA
L – loss of joint space
o- juxta-articular osteoporosis/osteopenia
S- soft tissue swelling
Er – Periarticular erosions
S- Subluxation

86
Q

Ehlers Danlos Syndrome —- type collaegn disorder

A

Ehlers Danlos Syndrome- 3 word- collagen 3 disorder

87
Q

Name the type of collagen disorders for each:
osteogenesis imperfecta
Goodpasture’s syndrome
Ehlers Danlos

A

Collagen type I is defective in osteogenesis Imperfecta. Collagen IV is defective in Goodpasture’s syndrome.
‘Good’- 4 lettes
3 in Ehlers- E has three stripes

88
Q

—– is most common form of haematogenous osteomyelitis in adults

A

vertebral osteomyelitis is the most common form of haematogenous osteomyelitis in adults

89
Q

Sjogrens syndrome has an increased risk of

A

Lymphoid malignancy

90
Q

Early feature of RA

A

juxta-articular osteoporosis/osteopenia

91
Q

RA vs Psoriatic Arthritis

A

RA involves PIP and MCP
Psoriatic Arthritis involves DIP

92
Q

Xray of Psoriatic Arthritis

A

often have the unusual combination of coexistence of erosive changes and new bone formation
periostitis
Pencil-in-cup’ appearance

93
Q

Associated features of Ankylosing spondiliutis

A

Other features - the ‘A’s
Apical fibrosis
Anterior uveitis
Aortic regurgitation
Achilles tendonitis
AV node block
Amyloidosis
and cauda equina syndrome
peripheral arthritis (25%, more common if female)

94
Q

Cannot see, cannot pee, cannot climb a tree- —- arthritis?

A

Reactive arthritis

  1. Joint- arthritis is typically an asymmetrical oligoarthritis of lower limbs, dactylitis
    2.Eye- Conjunctivitis, Anterior uveitis
  2. Skin- circinate balanitis (painless vesicles on the coronal margin of the prepuce)
    keratoderma blenorrhagica (waxy yellow/brown papules on palms and soles)
  3. Kidney- Urethritis
95
Q

Reactive arthritis is a tetrad of —–

A

Reactive arthritis

  1. Joint- arthritis is typically an asymmetrical oligoarthritis of lower limbs, dactylitis
  2. Eye- Conjunctivitis, Anterior uveitis
  3. Skin- circinate balanitis (painless vesicles on the coronal margin of the prepuce)
    keratoderma blenorrhagica (waxy yellow/brown papules on palms and soles)
  4. Kidney- Urethritis

+
presents within 4 weeks, not acutely

96
Q

Gonococcal vs reactive arthritis

A
  • causes septic arthritis, not reactive. there will be joint irritation, therefore not full range of movement. Also, in septic arthritis, the patient will be unwell.
  • Gonorrhoea in the history will likely have a mention of urethral discharge, as it is less commonly asymptomatic vs chlymidia.
  • presents during acute infection (rather than weeks later in reactive)
97
Q

Sjogrens association

A

Eyes- dry eyes: keratoconjunctivitis sicca
Mouth- dry mouth
Genitalia- vaginal dryness
Joints- arthralgia, Raynaud’s, myalgia
Nervous system- sensory polyneuropathy
recurrent episodes of parotitis
Kidney- renal tubular acidosis (usually subclinical)

NO CVS involvement

98
Q

First line test for suspected RA

A

RF

99
Q

RF reacts to—

A

Rheumatoid factor (RF) is a circulating antibody (usually IgM) that reacts with the Fc portion of the patients own IgG.. It is recommended as the first-line antibody test for patients with suspected rheumatoid arthritis.

100
Q

Anti ccp associated with

A

RA

not SLE for god’s sake

101
Q

most common organism for iliopsoasa abscess

A

staph aureus

102
Q

inv of choice for iliopsoasa abscess

A

CT

103
Q

Commonest secondary cause of Iliopsias abscess

A

Chron’s

104
Q
A
105
Q

Mixed Connective Tissue Disease is associated with

A

It is associated with anti-U1 ribonucleoprotein (RNP) antibodies

106
Q

Which autoimmune conditons are common in Male?

A

Speaking rheumatologically, autoimmune conditions commonly target females, except

BAP
Behcets
AS
Pagets

107
Q

Which autoimmunes conditions are equally prevalent in males and females

A

Conditions that prevail equally in both genders are;
psoriatic arthropathy and drug-induced SLE.

108
Q

De Quervans Tenosynovitis is inflammation of

A

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

109
Q

De Quervans tenosynovitis is ch by

A
  • 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: the examiner pulls the thumb of the patient in ulnar deviation and longitudinal traction. In a patient with tenosynovitis this action causes pain over the radial styloid process and along the length of extensor pollisis brevis and abductor pollicis longus
110
Q

What is Finkelstein’s test

A
  • Finkelstein’s test: the examiner pulls the thumb of the patient in ulnar deviation and longitudinal traction. In a patient with tenosynovitis this action causes pain over the radial styloid process and along the length of extensor pollisis brevis and abductor pollicis longus
111
Q

Finkelstein’s test positive in

A

De Quervans

112
Q
  • pain on the radial side of the wrist
  • tenderness over the radial styloid process
  • abduction of the thumb against resistance is painful
A

De Quervans

113
Q

Still’s disease management

A
  1. NSAIDs: should be used first-line to manage fever, joint pain and serositis. they should be trialled for at least a week before steroids are added.
  2. steroids; may control symptoms but won’t improve prognosis
    3. if symptoms persist, the use of methotrexate, IL-1 (eg: Anakinra) or anti-TNF therapy can be considered
114
Q

Diagnostic criteria of Stills disease:
RF +ve/-ve
ANA +ve/-ve
—- criteria

A

rheumatoid factor (RF) and anti-nuclear antibody (ANA) negative

The diagnosis of Still’s disease in adults can be challenging. The Yamaguchi criteria is the most widely used criteria and has a sensitivity of 93.5%.

115
Q

Which is more specific in SLE?

ANA
RF
anti-dsDNA
anti-Smith
anti-U1 RNP, SS-A (anti-Ro) and SS-B (anti-La)

A

99% are ANA positive- this high sensitivity makes it a useful rule out test, but it has low specificity
anti-dsDNA: highly specific (> 99%), but less sensitive (70%)
anti-Smith: highly specific (> 99%), sensitivity (30%)

116
Q

Name the ENAs and their associations:

Examples
anti-Ro: —–
anti-La: —–
anti-Jo 1: —-
anti-scl-70: ——–
anti-centromere: —–

A

Examples
anti-Ro: Sjogren’s syndrome, SLE, congenital heart block
anti-La: Sjogren’s syndrome
anti-Jo 1: polymyositis
anti-scl-70: diffuse cutaneous systemic sclerosis
anti-centromere: limited cutaneous systemic sclerosis

117
Q

Name the ENAs associated with these:
Sjogren’s syndrome, SLE, congenital heart block
Polymyositis
Dffuse cutaneous systemic sclerosis
Limited cutaneous systemic sclerosis

A

Examples
anti-Ro: Sjogren’s syndrome, SLE, congenital heart block
anti-La: Sjogren’s syndrome
anti-Jo 1: polymyositis
anti-scl-70: diffuse cutaneous systemic sclerosis
anti-centromere: limited cutaneous systemic sclerosis

118
Q

Polyarteritis nodosa is associated with which infection

A

Hep B

119
Q

Choice of Steroid for GCA

A

if there is no visual loss then high-dose prednisolone is used
if there is evolving visual loss IV methylprednisolone is usually given prior to starting high-dose prednisolone

120
Q

Marfans Genetics

A

autosomal dominant connective tissue disorder. It is caused by a defect in the FBN1 gene on chromosome 15 that codes for the protein fibrillin-1. Fibrillin. normally envelopes elastin

121
Q

Bone in Bone appearance in Xray

A

Osteopetrosis

122
Q

Name the defects of collagens ;
type 1
type 2
type 3
type 4
type 5

A

Type I: BONE - Osteogenesis Imperfecta
Type II: carTWOlage - Chondrodysplasia
Type III: ArTHREE (Artery) - Vascular type EDS
Type IV (Four): Under the Floor (basement membrane) - Thinning and splitting of GBS causing Alport Syndrome
Type 5 - Classic Ehlers Danlos Syndome

123
Q

Osteogenesis Imperfecta

A

fractures following minor trauma
blue sclera
deafness secondary to otosclerosis
dental imperfections are common

124
Q

deafness secondary to otosclerosis
fractures following minor trauma
blue sclera
dental imperfections are common

A

Osteogenesis Imperfecta

125
Q

Which one is. ot a risk factor of osetoporosis Smoking
Obesity/ Sedentary lifestyle/ Premature menopause/Female sex

A

Obesity

126
Q

What needs to be monitored for patient oon Leflunamide?

A

FBC/LFT and blood pressure

127
Q

DMARD with a very high wash out period

A

leflunomide has a very long wash-out period of up to a year which requires co-administration of cholestyramine

128
Q

what should you screen for following a diagnosis of Dermatomyositis

A

Malignancy.

may be idiopathic or associated with connective tissue disorders or underlying malignancy (typically ovarian, breast and lung cancer, found in 20-25% - more if patient older). Screening for an underlying malignancy is usually performed following a diagnosis of dermatomyositis

129
Q

Safe DMRDs in pregnancy

A

sulfasalazine and hydroxychloroquine

130
Q

Pagets disease RX

A

Bisphosphonates

131
Q

Lateral Epicondylitis

A

Mnemonic - LETS
Lateral epicondylitis, Extension Pain, Tennis Elbow, Supination Pain

132
Q

Rx of Familial Mediterranean Fever

A

Colchicine

133
Q

Dermatomyositis associated with

A

Anti Jo 1 antibody

134
Q

Risk factors of psueogout

A

ve some underlying risk factor, such as:
haemochromatosis
hyperparathyroidism
low magnesium, low phosphate
acromegaly, Wilson’s disease

135
Q

pain over the lateral side of hip/thigh
tenderness on palpation of the greater trochanter
indicates

A

Greater trochanteric pain syndrome or trochanteric bursitis.

136
Q

Greater trochanteric pain syndrome is also referred to as trochanteric bursitis.

A

pain over the lateral side of hip/thigh
tenderness on palpation of the greater trochanter

137
Q

What needs to be monitored for a patient on hydroxychroloquine

A
  • visual symptoms and monitor visual acuity annually using the standard reading chart

fear of bull’s eye retinopathy

138
Q

pain is typically distal to the epicondyle and worse on elbow extension/forearm pronation

A

Radial tunnel syndrome

139
Q

Antiphospholipid Syndrome Biochemistry

A

Low Platelet
Prolonged APTT

140
Q

Swelling over the posterior aspect of the elbow- with associated pain, warmth and erythema

A

Olecranon Bursitis

141
Q

Pain and tenderness localised to the medial epicondyle
pain is aggravated by wrist flexion and pronation
symptoms may be accompanied by numbness / tingling in the 4th and 5th finger due to ulnar nerve involvement

A

Medial epicondylitis (golfer’s elbow)

142
Q

Name the Rotator Cuff Muscles

A

SItS - small t for teres minor

Supraspinatus
Infraspinatus
teres minor
Subscapularis

143
Q

Pain with
- Internal Rotation of Hip joint indicates— ?
- External Rotation of shoulder joint— ?
- aBDUction of shoulder joint (arc)— ?
- Extension of wrist or supination of forearm causing elbow pain—?
- Flexion of wrist or pronating forearm causing elbow pain—?
- Pain increased on pronating forearm ( no references of wrist movements and tenderness distal to elbow joint) —?
- Pain at wrist (base of thumb) while moving towards ulnar side—?
- lateral hip TENDERNESS and pain, pain on internal and external rotation—?
- pain on hip extension—?

A
  1. Internal Rotation of Hip joint implies - Avascular Necrosis of Femoral bone
  2. External Rotation of shoulder joint - Frozen shoulder
  3. BDUction of shoulder joint (arc) - Supraspinatus tendonitis (Rotator cuff)
  4. Extension of wrist or supination of forearm causing elbow pain - Tennis elbow (Lateral epicondylitis)
  5. Flexion of wrist or pronating forearm causing elbow pain - Golf elbow (Medial epicondylitis)
  6. Pain increased on pronating forearm ( no references of wrist movements and tenderness distal to elbow joint) - Radial tunnel syndrome
  7. Pain at wrist (base of thumb) while moving towards ulnar side - De Quervain tenosynovitis
  8. Lateral hip TENDERNESS and pain, pain on internal and external rotation- Trochanteric bursitis: l
  9. pain on hip extension- iliopsoas abscess
144
Q

Proximal muscle weakness seen in

A

Osteomalacia
Polymyositis
Dermatomyosistis

145
Q

For Dermatomyositis:
Most common antibody
Most specific antibody

A

ANA most common, anti-Mi-2 most specific

146
Q

Interpretation of DEXA Scan

A

> -1 : normal

Between -2.5 & -1: Osteopenic

< -2.5: Osteoprosis

147
Q

Benign overgrowth of bone is knows as

A

Osteoma

148
Q

most common benign bone tumour

A

Osteochondroma

149
Q

Mention location of the following bone tumours:
Giant Cell Tumour
Osteosarcoma
Ewing Sarcoma

A

GEOMED

Giant= Epiphysis
Osteosarcoma = Metaphysis
Ewing = Diaphysis

150
Q

Onion skin appearance in xray

A

Ewing Sarcoma

151
Q

Denosumab M/A

A

It is a human monoclonal antibody that prevents the development of osteoclasts by inhibiting RANKL.

152
Q

Which Rx has the strongest evidence base for Fibromyalgia

A

aerobic exercise: has the strongest evidence base

153
Q

Mycofenolate M/A

A

Mycophenolate mofetil is an immunosuppressant commonly used to prevent rejection of organ transplants.

inhibits inosine monophosphate dehydrogenase, which is needed for purine synthesis
as T and B cells are particularly dependent on this pathway it can reduce the proliferation of immune cells

154
Q

Which cytokine is most important in the pathophysiology of RA

A

TNF

155
Q

How to confirm the dx of Antiphospholipid syndrome

A

In order to make a diagnosis of antiphospholipid syndrome, patients must fulfil one of the following clinical criteria + one of the following laboratory criteria:

Clinical criteria
1. Vascular thrombosis: ≥1 clinical episode of arterial, venous, or small-vessel thrombosis in any tissue or organ, validated by imaging studies or histopathology
2. Pregnancy morbidity: e.g. unexplained, consecutive, and spontaneous abortions

Laboratory criteria
1. Positive for LA on ≥2 occasions at least 12 weeks apart
2. Positive aCL on ≥2 occasions at least 12 weeks apart
3. Positive anti-β2GP1 antibodies on ≥2 occasions at least 12 weeks apart

Passmedicine MRCP Part 1 (11 decks)

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