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Theme III > Rheum/MSK > Flashcards

Rheum/MSK Flashcards

1
Q

HLA B27 associated with 3 conditions:

A

Ankylosing spondylitis
reactive arthritis
Enteropathic arthritis

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2
Q

HLA-DR3 associated with 2 conditions

A

Sjogren’s syndrome and SLE

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3
Q

Causes of Joint pain:

SOFTER TISSUE

A 
Sepsis
OA
Fracture
Tendon/muscle
Epiphyseal
Referred
Tumour
Ischaemia
Seropositive arthritides
Seronegative arthritides
Urate (other crystals)
Exa-articular rheumatism
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4
Q

5 Seropositive arthritis:

A

RA, SLE, Scleroderma, Dermatomysitis, Sjogren’s

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5
Q

4 Seronegative arthritis:

A

Ankylosing Spondylitis (Symm), Enteropathic arthritis (Symm), Reactive arthritis (ReA), psoriatic arthritis (PsA)

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6
Q

2 handfindings on OA:

A

thumb squaring
herbeden’s nodes (DIP)
Bouchards nodes (PID)

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7
Q

LOSS XRAY finding in OA:

A

Loss of joint space
Osteophytes
Subchondral sclerosis
Subchondral cysts

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8
Q

Symmetrical arthritis affecting the small joints. Morning stiffness

A

Rheumatoid arthritis

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9
Q

Rash, Photosensitivity, arthritis, CNS, GN, Raynaud’s phenomonen

A

SLE

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10
Q

Signs of Scleroderma?

A 
CREST:
Calcinosis
Raynaud's phenomon
Eosophageal
Sclerodactyl (skin tightness)
Telengactasia
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11
Q

Heliotrope Rash (peri-orbital), Shawl sign, macular oedema over chest and shoulder, Proximal muscle weakness

A

Dermatomyositis

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12
Q

CCB also increases _________ levels, possibly by a renal vasodilatory effect

A

uric acid

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13
Q

Side effects include liver cirrhosis, pneumonitis and myelosuppression

A

Methotrexate

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14
Q

Side effects include rashes, oligospermia, heinz body enzyme, interstital lung disease

A

Sulfasalazine

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15
Q

Side effects include retiniopathy, corneal deposits

A

Hydroxychloroquine

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16
Q

Side effects include Cushingoid features, Osteoporosis, Impaired glucose tolerance, hypertension, cataracts

A

Prednisolone

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17
Q

Side effects of Gold treatment

A

proteinuria

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18
Q

Side effects include Proteinuria and exacerbation of MG

A

Penicillamine

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19
Q

Reactivation of TB can occur with _______

A

BIological agents

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20
Q

NSAIDs cause _______ in asthmatics

A

Bronchospasma

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21
Q

Reactive arthritis (With Reiter’s arthritis) which is associated with ____, ____ and also ____

A

Chlamydia, gonorrhea and Gastroenteritis

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22
Q

Reactive arthritis is a HLAB27 Sero____ spondyloarthropathy.

A

Seronegative

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23
Q

Reactive arthritis typically develops within _______ weeks of initial infection and lasts around _______. Arthritis is typically an assymetrical/symmetrical oligo/polyarthritis. Also associated with ______

A

Reactive arthritis typically develops within 4 weeks of initial infection and lasts around 4-6months. Arthritis is typically an assymetrical oligoarthritis. Also associated with dactylitis

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24
Q

The combination of ______, ______ and _____ points to a diagnosis of psoriatic arthropathy

A

The combination of nail changes, skin changes and arthritis points to a diagnosis of psoriatic arthropathy

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25
Q

Does Psoriatic arthritis affect DIP or PIP?

A

DIP rather than PIP and MCP.

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26
Q

X-ray findings of Rheumatoid arthritis (LESS):

A

Los of joint space
Erosions
Soft tissue swelling
Soft bones - osteopenia

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27
Q

Xray findings of osteoarthritis (LOSS):

A

Loss of joint space
Osteophytes
Subchondral sclerosis
Subchondral cysts

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28
Q

6 A’s with Ankylosing spondylitis?

And one weird one but like totally related to back!

A 
Apical Fibrosis
Anterior Uveitis
Aortic regurgitation
Archilles Tendonitis
AV Node block
Amyloidosis

and cauda equina

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29
Q

Patient with Ankylosing spondylitis present with reduced _____ and _____ flexion. Aswell as reduced chest expansion

A

Reduced lateral and forward flexion

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30
Q

Bamboo spine on XRAY

A

Ankylosing spondylitis

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31
Q

Typically a young man who presents with lower back pain and stiffness of insidious onset. Pain typically worse at night and stiffness in the morning that improves with exercise.

A

Ankylosing Spondylitis

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32
Q

Methotrexate, Sulfasaline, Leflunomide and Hydroxychloroquinone are all examples of _____

A

DMARDs

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33
Q

The current indication for a TNF-inhibitor is an inadequate response to ….

A

at least two DMARDs including methotrexate

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34
Q

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

A

Rituximab

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35
Q

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

A

Infliximab

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36
Q

To differentiate between polymyalgia rheumatica and statin-induced myopathy, _____ is usually measured

A

ESR

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37
Q

Histology shows vasculitis with giant cells, characteristically ‘skips’ certain sections of affected artery whilst damaging others - overlaps with temporal arteritis

A

Polymyalgia Rheumatica

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38
Q

Muscle bed arteries affected most in ________

A

polymyalgia rheumatica

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39
Q

Typically affecting > 60 yo, Usually rapid onset (less then one month, aching, morning stiffness in proximal limb muscles). Also get polyarthlagia

A

Polymyalgia Rheumatic

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40
Q

In Polymyalgia Rheumatica you get reduced CD__ T cells

A

CD8+ T cells

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41
Q

Multi-system vasculopathy manifested by recurrent thromboembolic events, spontaneous abortions and thrombocytopenia

A

Anti-Phospholipid syndrome

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42
Q

Laboratory investigations for APLA?

A

Lupus anticoagulant, Anti-cardiolipin Ab, Anti-b2 glycoprotein Ab

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43
Q

Mx of APLA? (Thrombosis, Recurrent Fetal loss and catastrophic APS)

A

Mx:
Thrombosis - life-long anti-coagulation with warfarin (target INR 2.0 - 3.0)
Recurrent fetal loss: heparin or LMWH +/- aspirin in pregnancy
Catastrophic APS

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44
Q

A non-inflammatory autoimmune disorder characterized by widespread small vessel vasculopathy and brosis

A

Scleroderma

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45
Q

Scleroderma: CREST syndrome:

A

Calcinosis: Calcium deposits on skin
Raynauds Phenomenon
Eosophageal dysfunction - acid reflux
Sclerodactyl: tightening of the skin on digits
Telengiectasia: superficial dilated blood vessels

46
Q 
Idiopathic vasculopathy (not vasculitis) leading to atrophy and  fibrosis of tissues. 
ƒIntimal proliferation and media mucinus degeneration --> progressive obliteration of vessel lumeng --> fibrotic tissue
A

Scleroderma

47
Q

Scleroderma can be __1__ or __2___. In 1 there is ____________ and affects. in 2 it is either Limited systemic (CREST) or diffuse systemic.

A
  1. Localised or 2. Systemic

In localised there is non involvement of internal organs

48
Q

In Scleroderma, ______ is the most common cause of morbidity and mortality.

A

Lung disease

49
Q

What bloodwork would you do for Scleroderma?

A

Anti-topoisomerase 1/anti-Scl-70: specific nut not sensitive for diffuse systemic sclerosis.
Anti-centromere: favours diagnosis of CREST

50
Q

________ (blood test) favours diagnosis of CREST

A

Anto-centromere

51
Q

What investigations would you order for scleroderma?

A 
Blood work (FBE, Cr, ANA), anti-topoisomerase, antoicentromere
PFT, CXR, Echo?
52
Q

Dry eyes (Keratoconjunctivitis/xerophthalmia) - foreign bod sensation, Dry Mouth (Xerostomia) - trouble swallowing and Arthritis (Small joints)

A

Sjogren’s Syndrome

53
Q

Inflammation secondary to pathological clotting, affects small and medium-sized vessels of distal extremities, may lead to distal claudication and gangrene, most important etiologic factor is cigarette smoking
Most common in young Asian males

A

Buerger’s disease

54
Q

Leukocytoclastic vasculitis, multi-system disorder presenting with ocular involvement (uveitis), recurrent oral and genital ulceration, venous thrombosis, skin and joint involvement, more common in Mediterranean and Asia, average age 30s, M>F

A

behcet’s disease

55
Q

Medium vessel vascultiis: (2):

A

Kawasaki and Polyarteritis Nodosa

56
Q

“Pulseless disease”, unequal peripheral pulses, chronic inflammation, most often the aorta and its branches
Usually young adults of Asian descent, F>M; risk of aortic aneurysm

A

Takayasu’s Arteritis

57
Q

Two Large vessel vasculitides?

A

temporal Arteritis and takasayu’s

58
Q

c-ANCA associated small vessel vasculitis?

A

Granulomatosis with Polynagitis

59
Q

50% ANCA positive - Granulomatous inflammation of vessels with hypereosinophilia, with frequent lung involvement (asthma, allergic rhinitis)

A

Churg-Strauss syndrome

60
Q

Necrotizing granulomatous vasculitis of lower and upper respiratory tract + Focal segmental glomerulonephritis

A

Granulomatosis with Polyangiitis

61
Q

There is an association between ______ and Polyarteritis Nodosa

A

Hep B surface antigen positivity

62
Q

Consider ______ in a non-diabetic patient with mononeuritis multiplex.

A

Polyarteritis Nodosa

63
Q

40 yo male, Weight loss, myalgia, Livedo Reticularis (mottled reticular pattern over skin), Neuropathy with testicular pain

A

Polyarteritis Nodosa

64
Q

New onset temporal headache, with sudden, painless loss of vision and/or diplopia with tongue and jaw claudication

A

Temporal arteritis - needs urgent referral.

65
Q

What are the four seronegative spndyloarthritis?

A

AS, Psoriatic, reactive and Enteropathic

66
Q

Anti-CCP are present and highly specific for ____ in it’s ____ stages.

A

RA in it’s early stages

67
Q

Anti-dsDNA is commonly seen in _____ with positive ____

A

SLE also with a positive ANA

68
Q

Rheum Blood tests for SLE:

A

ANA - highly sensitive
RH - 20% pos
Anti-dsDNA (highly specific but not sensitive)
Anti-Smith Very specific but not that sensitive
Consider anti-Ro and Anti-La
C3, C4 are low during active disease

69
Q

______ titres can be used for disease monitoring in SLE

A

Anti-dsDNA

70
Q

Anti-Jo1 are highly associated iwth

A

Polymyositis and Dermatomyositis

71
Q

How do you differentiate between Polymyositis and Polymyalgia Rheumatica?
Age group, Bloodwork?

A

Age - Polymyositis affects people between 40-60, PR affects peopel over 60.
Polymyositis has increased CK

72
Q

In RA we use ______ to induce remission. And if that doesn’t work you can add on either ______

A

Methotrexate with Folic acid. Can add on other DMARD’s Hydroxychloroquine and/or Sulfalazine

73
Q

In patients with RA, if remission hasnt been achieved by DMARDs and prednisolone you can try adding ____

A

Biological agents

74
Q

How to mantain remission in RA?

A

Use low dose effective DMARDs?

75
Q

It is caused by a defect in the fibrillin-1 gene on chromosome 15 and affects around 1 in 3,000 people.

A

Marfan’s

76
Q

T or F. Steroids do not cause osteonecrosis?

A

F - they do!

77
Q

First line manage of Raynaud’s ?

A

Nifedipine

78
Q

For Osteoarthritis, second-line treatment is …

A

Second-line treatment is oral NSAIDs/COX-2 inhibitors, opioids, capsaicin cream and intra-articular corticosteroids. A proton pump inhibitor should be co-prescribed with NSAIDs and COX-2 inhibitors. These drugs should be avoided if the patient takes aspirin

79
Q

Side effects of Colchine?

A

Diarrhea, nausea, cramping, abdominal pain, and vomiting

80
Q

A 68-year-old female presents with a two week history of intermittent headaches and lethargy. Blood tests show raised ESR

A

Temporal Arteritis

81
Q

Mx of AS?

A
  1. Exercise - swimming.
  2. Paracetamol and NSAIds
    2a. DMARDs only used if peripheral disease
  3. Consider biologics in severe AS
82
Q

Old man, bone pain, raised ALP

A

Paget’s disease

83
Q

disease of increased but uncontrolled bone turnover

A

Paget;s disease

84
Q

What happens to calcium, phosphate and ALP in Paget’s disease?

A

Elevated ALP, Normal Calcium and phosphate usually. Calcium can become raised if prolonged immbolisation

85
Q

Complications of Paget’s disease?

A

Deafness (cranial nerve entrapment), bone sarcome (1% affected for >10 years), Fracture, skull thickening

86
Q

_______ can cause facial palsies, parotid enlargement, hypercalcaemia and ocular problems, as seen in this case.

A

Sarcoidosis

87
Q

Erythema nodosum, bilateral hilar lymphadenopathy, swinging fever, polyarthralgia, hypercalcaemia, dyspnea, weight loss

A

Sarcoidosis

88
Q

Which syndrome of Sarcoidosis?

Bilateral Hilar lymphadenopathy, erythema nodosum, fever and polyarthralgia.

A

Lofgren’s Syndrome

89
Q

In Mikulicz syndrome* there is enlargement of the _______ glands due to sarcoidosis, tuberculosis or lymphoma

A

Parotid and lacrimal gland enlargement

90
Q

Heerfordt’s syndrome (uveoparotid fever) there is_____, _____ and ____ secondary to sarcoidosis

A

Parotid enlargement, fever and uveitis

91
Q

T-score:
0 –> -1 = _______
-1 –> -2.5 = _______
< -2.5 = _____

A

Normal, Osteopaenia, Osteoporosis

92
Q

(paradoxically) prolonged APTT + low platelets

A

Phospholipid syndrome

93
Q

______ is positive in 40% of people with RA who test negative for RF.

94
Q

Pencil-in-cup deformity is the description given to one of the appearances on plain radiograph in______-

A

psoriatic arthritis

95
Q

You review a 48-year-old woman who is taking methotrexate for rheumatoid arthritis. Concurrent prescription of which other medication should be avoided?

A

Trimethoprim - there is a risk of haematological toxicity

96
Q

4 Clinical uses of bisphosphonates?

A

Prevention and treatment of Osteoporosis
Hypercalcaemia
Pain from Bone Metastases
Paget’s diseas

97
Q

Adverse effects with bisphosphonates:

A
  1. Oesophageal reactions: Oesophagitis, oesophageal ulcers
  2. Osteonecrosis of jaw
  3. increased risk of atypucal stress fracture of proximal femoral shaft
98
Q

Chondrocalcinosis is pathognomonic for ______

A

Pseudogout

99
Q

Oral and genital ulcers - Arthritis, Skin Pathergy test to diagnose

A

Behcet’s disease

100
Q

Kid - with rash all over legs and butt, arthritis and abdo pain

A

Henoch Schonlein Purpura

101
Q

Atopy + Eosinophilia + GN + P-Anca

A

Churg Strauss Syndrome

102
Q

Headache, temporal tenderness, jaw claudication, amaurosis fugax, high ESR

A

Temporal Arteritis

103
Q

Anti-CCP

104
Q

Anti-ro, Anti-LA

A

Sjogren’s?

105
Q

Anti-dsDNA and anti-Smith

106
Q

C3/C4 increases/decreases as the disease progresses?

107
Q

Anti-cardiolipin and Anti-Beta Ziploprotein

A

Anti-Phospholipid syndrome

108
Q

Anti-Topiomerase 1 and Anti-Scl

A

Diffuse Scleroderma

109
Q

Anti-centromere

A

CREST Scleroderma

110
Q

Anti-Jo

A

Polymyositis

111
Q

Anti-Mi2

A

Dermatomyositis

Theme III (15 decks)

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