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Medical Shorts > Rheumatoid Arthritis > Flashcards

Rheumatoid Arthritis Flashcards

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USMLE® Step 1 flashcards
1
Q

What is the key factor in RA that leads to cartilage and bone destruction

A

Synovial hypertrophy

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2
Q

What are the key cytokines involved in the pathogenesis of RA

A

TNF-alpha

Interleukin-1

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3
Q

Which HLA markers are associated with RA, particularly regarding severity

A

HLA-DR4

HLA-DR1

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4
Q

In a classical presentation of RA, which joints are affected

A

Symmetrical pattern

MCP
PIP
Wrists
MTP
Forefoot joints
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5
Q

What are the severe complications of RA

A

Atlanto-axial subluxation
Amyloidosis
Pericarditis
Scleritis

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6
Q

What other systems are affected in RA

A 
Haematological
Neurological
Pulmonary
Cardiac
Cutaneous
Ocular
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7
Q

What are the haematological manifestations of RA

A

Anaemia
Neutrophilia
Thrombocytosis
Felty’s syndrome

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8
Q

What are the neurological manifestations of RA

A

Carpal tunnel syndrome
Atlanto-axial subluxation
Peripheral neuropathies

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9
Q

What are the pulmonary manifestations of RA

A

Pleural effusions
Interstitial lung disease
Bronchiolitis obliterans

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10
Q

What are the cardiac manifestations of RA

A 
Pericarditis
Coronary vasculitis (rare)
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11
Q

What are the cutaneous manifestations of RA

A

Rheumatoid nodules
Peripheral vasculitis
Leg ulcers
Alopecia

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12
Q

What are the ocular manifestations of RA

A

Dry eye
Scleritis
Episcleritis

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13
Q

What are some other extra-articular manifestations of RA

A

Dry mouth
Osteoporosis
Muscle wasting

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14
Q

What is bronchiolitis obliterans

A

Inflammatory obstruction of the bronchioles

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15
Q

What is scleritis

A

Painful inflammation of the sclera

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16
Q

What are the signs of RA

A 
Subluxation and ulnar deviation at MCPs
Subluxation at wrist
Swan-neck deformity
Boutonniere's deformity
'Z' thumbs
Muscle wasting (disuse atrophy)
Rheumatoid nodules (elbows)

May have surgical scars:-
Carpal tunnel release
Joint replacement (esp. thumb)
Tendon transfer (dorsum of hand)

17
Q

What is tendon transfer

A

Performed to improve lost hand function following tendon rupture

18
Q

What radiological changes would you expect to find in RA

A

PALS

Periarticular osteoporosis
Articular erosions
Loss of joint space
Soft tissue swelling

19
Q

What percentage of patients with RA have a positive RF

A

80%

20
Q

What criteria do you use to diagnose RA

A

American College of Rheumatology Criteria

4/7 needed

21
Q

What are the American College of Rheumatology Criteria

A 
Morning stiffness for over an hour
Arthritis in 3+ joint areas simultaneously
Arthritis of hands
Symmetrical arthritis
Rheumatoid nodules
Positive RF
Erosions on joint radiographs
22
Q

What DMARDs are available

A 
Methotrexate
Hydroxychloroquine
Sulphasalazine
Corticosteroids
Azathioprine
Gold complexes
Penicillamine
23
Q

What are the side effects of methotrexate

A

Neutropaenia
Pulmonary toxicity
Hepatitis

24
Q

How would you monitor methotrexate treatment

A

CXR
FBC
LFT

25
Q

What are the side effects of hydroxychloroquine

A

Retinopathy

26
Q

How would you monitor hydroxychloroquine treatment

A

Visual acuity

27
Q

What are the side effects of sulphasalazine

A

Rash

Bone marrow suppression

28
Q

How would you monitor sulphasalazine treatment

A

FBC

29
Q

What are the side effects of corticosteroids

A 
Osteoporosis
Cushings syndrome
Hyperglycaemia
Stomach ulcers
Glaucoma
30
Q

What are the side effects of gold complexes

A

Thrombocytopaenia

Rash

31
Q

How do you monitor gold complex treatment

A

FBC

32
Q

What are the side effects of penicillamine

A

Nephrotic syndrome

Thrombocytopaenia rash

33
Q

How do you monitor penicillamine treatment

A

FBC

Urine dip

Medical Shorts (2 decks)

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