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AKT > Rheumatology 1 > Flashcards

Rheumatology 1 Flashcards

1
Q

ANCA are associated with which type of disease?
Give three examples

A

Small vessel vasculitis
1. Granulomatosis with polyangitis (Wegener’s)
2. Eosinophilic granulomatosis with polyangitis (Churg-Strauss)
3. Microscopic polyangitis

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2
Q

Type of ANCA
Granulomatosis with polyangitis/ Wegener’s?

A

cANCA

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3
Q

Type of ANCA
Eosinophillic granulomatosis/ Churg Strauss?

A

pANCA

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4
Q

Type of ANCA
Microscopic polyangitis?

A

pANCA

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5
Q

Other pANCA conditions (4)

A

UC (70%)
PSC (70%)
AntiGBM (25%)
Crohn’s (20%)

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6
Q

Ankylosing spondylitis HLA

A

HLA B27

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7
Q

What is Schober’s test?

A

a line is drawn 10 cm above and 5 cm below the back dimples (dimples of Venus). The distance between the two lines should increase by more than 5 cm when the patient bends as far forward as possible

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8
Q

Features of ank spond (7)

A

Apical fibrosis
Anterior uveitis
Aortic regurgitation
Achilles tendonitis
AV node block
Amyloidosis
Cauda equina

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9
Q

Ank spond O/E: (3)

A

Reduced lateral flexion, forward flexion, chest expansion

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10
Q

Ank spond Ix of choice
If negative then which Ix

A

Plan XR - sacroiliac joints
MR

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11
Q

Findings on sacroiliac joint (4) and CXR (1) for ank spond
MR findings (1)

A

Bamboo spine
Sacroilitis
Subchondral erosions
Syndesmophytes

Apical fibrosis

Bone marrow oedema

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12
Q

Ank spond Mx (4)

A

Exercise e.g swimming
NSAIDs
Physio
DMARDS if peripheral joint involvement

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13
Q

Features of antiphospholipid syndrome (5)

A

Recurrent fetal loss
Recurret VTE/ arterial thrombosis
Thrombocytopenia
Prolonged APTT
Livedo reticularis (mottled skin)

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14
Q

Antiphospholipid syndrome is associated with which condition?

A

SLE

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15
Q

Antiphospholipid syndrome Mx
Primary thromboprophylaxis
Secondary
INR range
Recurrent VTE mx (2)

A

Primary thromboprophylaxis: Low dose aspirin
Secondary thromboprophylaxis:
Initial VTE or aterial: warfarin INR 2-3
Recurrent VTE INR 3-4 + aspirin

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16
Q

Which test should be used to check for azathioprine toxicity?

A

TPMT test

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17
Q

Triad of symptoms for Behcet’s syndrome?

A

Oral ulcers
Genital ulcers
Anterior uveitis

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18
Q

Behcet’s
What is it?
Ethnicity
Gender
Age
HLA

A

Automimmune vasculitis all sizes large, medium and small vessel
Turkish
M>F
20-40yo
HLA B51

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19
Q

What it the pathergy test?

A

Puncture site following needle prick becomes inflamed with small pustule forming/ ulcer formation = test for Behcet’s

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20
Q

Bisphosphonates counselling

A

‘Tablets should be swallowed whole with plenty of water while sitting or standing; to be given on an empty stomach at least 30 minutes before breakfast (or another oral medication); patient should stand or sit upright for at least 30 minutes after taking tablet’

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21
Q

When do you stop bisphosphonates? (3)

A

Stopped after 5 years if:
Patient <75yo
Femoral neck T score >2.5
Low risk FRAX

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22
Q

Osteoporosis
Ca
Phos
ALP
PTH

A

Ca normal
Phos normal
ALP normal
PTH normal

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23
Q

Osteomalacia
Ca
Phos
ALP
PTH

A

Ca low
Phos low
ALP normal
PTH normal

24
Q

Primary hyperparathyroidism
Ca
Phos
ALP
PTH

A

Ca high
Phos low
ALP high
PTH high

25
Q

Secondary hyperparathyroidism (CKD)
Ca
Phos
ALP
PTH

A

Ca low
Phos high
ALP high
PTH high

26
Q

Paget’s
Ca
Phos
ALP
PTH

A

Ca normal
Phos normal
ALP high
PTH normal

27
Q

Osteopetrosis
Ca
Phos
ALP
PTH

A

Ca normal
Phos normal
ALP normal
PTH normal

28
Q

XR double bubble/ soap bubble appearance is keeping with which benign tumour?

What age group?
Where does it commonly occur?

A

Giant cell tumour
20-40yo
Epiphyses of long bones

29
Q

Where does an osteoma commonly occur?
Associated with which syndrome?

A

Skull
Gardner’s syndrome (variant of familial adenomatous polyposis)

30
Q

What is the most common benign bone tumour?
Gender
Age

A

Osteochondroma -cartilage-capped bony projection on the external surface of a bone
M>F
Age <20yo

31
Q

What is the most common primary malignant bone tumour?
Where does it occur?
Age range

A

Osteosarcoma
Long bones - femur, tibia, humerus
Children and adolesents

32
Q

Osteosarcoma is associated which conditions (2)?

A

Retinoblastoma
Paget’s disease of the bone

33
Q

What is the Codman triangle?
Seen in which condition?

A

XR finding seen in osteosarcoma

Sunburst appearance

34
Q

Which type of bone malignancy would you see an onion skin appearance on XR?

A

Ewing’s sarcoma

35
Q

Which malignant bone tumour is most common in middle aged?

A

Chondrosarcoma
(Malignant tumour of cartilage)

36
Q

CFS Mx (5)

A
  1. CBT
  2. Graded exercise
  3. Pacing
  4. Low dose amitriptyline
  5. Pain management clinic
37
Q

Causes of dactylitis (6)

A

Psoariatic arthritis
Reactive arthritis
Sickle cell
TB
Sarcoidosis
Syphillis

38
Q

How often is denosumab given for treatment of osteoporosis?

A

SC 60mg every 6 months

39
Q

Mx of osteoporosis (2)

A
  1. Bisphosphonates - alendronate if not tolerated then alternative risedronate or etidronate
  2. Raloxifene
40
Q

What is dermatomyositis?

A

Inflammatory disorder causing symmetrical proximal muscle weakness and skin lesions

Usually an underlying malignancy

41
Q

What are Gottron’s papules?
Which condition are they found in?

A

Dermatomyositis
Roughened red papules over extensor surfaces of fingers

42
Q

Name five skin features of dermatomyositis

A

Macular papular rash across chest and back
Heliotrope rash in periorbital region
Gottron’s papules
Dry and scaly hands
Photosensitivity

43
Q

Dermatomyositis auto-antibody positive (3)
80%
30% 30%

A

ANA (80%)
anti-Jo1 anti Mi-2 (30%)

44
Q

Discoid lupus
Gender
Does it progress to SLE?
Characterised by?

A

F>M
Rarely progresses to SLE
Follicular keratin plugs

45
Q

Discoid lupus is commonly found where?
Describe the lesion
Healing lesions can cause?

A

Face, scalp, ears, neck
Erythematous, raised rash, scaly
Scarring alopecia and pigmentation

46
Q

Discoid lupus Mx (3)

A
  1. Topical steroid cream
  2. Anti-malarials e.g hydroxychloroquine
  3. Avoid sun exposure
47
Q

Ehler Danlos
AD or AR
Affects which type of collagen?
Associated with which conditions? (4)

A

AD
Type III
Aortic regurg, MV prolapse, aortic dissection, SAH

48
Q

What drugs can cause drug induced lupus? (3)

A

Hydralazine
Isoniazid
Phenytoin

49
Q

Mx fibromyalgia (3)
Name three medications that can be used

A

Explanation
Aerobic exercise
CBT
Pregabalin, duloxetine, amitriptyline

50
Q

Gout synovial fluid analysis
When do you check urate levels?

A

Negatively birefringent crystals
2 weeks after the acute attack

51
Q

Gout radiological findings (5)

A

Joint effusion
Punched out erosions
Eccentric erosions
Soft tissue tophi
Preservation of joint space

52
Q

Gout mx
Acute (3)
What should happen to allopurinol?

A
  1. NSAIDs/ colchicine - until D2 post symptoms have resolved +/- PPI
  2. Pred 15mg OD/ intra-articular steroid
    Continue allopurinol
53
Q

When should you offer ULT? (urate lowering therapy e.g allopurinol) (5)

A

=>2 attacks in last year
Tophi
Renal disease
Uric acid renal stones
As prophylaxis if on diuretics or cytotoxics

54
Q

How should allopurinol be titrated?
What should you give with allopurinol?

A

100mg OD, up titrated every few weeks until serum uric acid <300
Colchine cover or NSAIDs –> may need to be continued for 6 months

55
Q

What can you give if allopurinol is not tolerated?

A

Febuxostat (xanthine oxidase inhibitor)

56
Q

Which drug can cause gout?

A

Thiazide diuretics

AKT (52 decks)

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