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Year 4 PassMed Incorrect Qs > Rheumatology 1 > Flashcards

Rheumatology 1 Flashcards

1
Q

Most common anti-body +ve in antiphospholipid syndrome?

3 main features of antiphospholipid syndrome?

A

anticardiolipin antibody

  1. Arterial/venous thrombosis
  2. miscarriage
  3. livedo reticularis - mottled skin thought to be due to spasms of the blood vessels
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2
Q

Management of GCA if visual loss and if no visual loss?

A

Visual loss
methylprednisolone IV

No visual loss
Oral prednisolone high dose

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3
Q

Anti-antiphospholipid syndrome complications CLOTs

A

APS causes CLOTs

Clots in arteries and veins
Livedo reticularis
Obstetric problems/miscarriages
Thromobocytopaenia (and paradoxical prolonged APTT)

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4
Q

What is the antibody for:
Diffuse cutaneous systemic sclerosis

Limited cutaneous systemic sclerosis

A

Diffuse cutaneous systemic sclerosis is associated with anti Scl-70 antibodies

Limited- Anti-centromere

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5
Q

Inflammatory arthritis involvinf DIP swelling and all fingers being completely swollen?

A

Psoriatic arthritis
- DIP swelling and dactylitis points to a diagnosis of psoriatic arthritis (sausage fingers)

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6
Q

Triad for Behcet’s disease

A

Oral ulcers + genital ulcers + anterior uveitis

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7
Q

Which joint is most commonly affected in gout?

A

first metatarsophalangeal joint of the first toe

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8
Q

What clinical exam findings would you see in ankylosing spondlysis
1)
2) + Test
3)
4)

A

1) reduced lateral flexion
2) reduced forward flexion - Schober’s test - 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
3) reduced chest expansion
4) tragus wall test/ occiput wall test/ Flesche Test- Test thoracic kyphosis and abnormality is occiput not touching the wall.

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9
Q

Explain what you would see in a joint aspiration of both gout and pseudo-gout (4 each)

A
  1. No bacterial growth
  2. Needle shaped crystals
  3. Negative birefringent monosodium urate crystals
  5. No bacterial growth
  6. Rhomboid/ brick shaped crystals
  7. Positive birefringent calcium pyrophosphate deposition
    4.
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10
Q

Padgets disease 3 STEM features
+ extra STEM

A
  1. Old man
  2. Bone pain (AXIAL BONES- skull, spine, pelvis but also femur and tibia)
  3. Raised ALP

STEM- deafness (cranial nerve entrapment)

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11
Q

Hydroxychloroquine side effect (4)

Safe in preg?

A

1) Bulls eye retinopathy
2) Nightmares
3) Skin pigmentation
4) Liver toxicity

Yes safe in preg!

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12
Q

If a patient is taking Sulfasalazine what drug allergies should they be CAUTIOUS about? (2)

also what underlying condition?

A

allergy to aspirin or sulphonamides (cross-sensitivity)

Sulphonamide eg. Co-trimoxazole

G6PD Def!!!

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13
Q

Features in history of Systemic juvenile idiopathic arthritis (3 + Rash description)

A
  • Gradual onset
  • Morning stiffness and spiking fevers.
  • May also be a history of school absences or avoidance of physical activities.
  • Rash= A flat, pale pink rash may appear.
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14
Q

Dermatomyositis

STEM THAT YOU MUST DO…

Presentation: non skin (5)

Presentation skin features (5)

A

STEM: CHeck for underlying malignancy such as ovarian, breast, lung

Presentation
- Prox muscle weakness +_ tenderness
- Raynauds
- Resp. muscle weakness
- ILD- Fibrosing alveolitis or organising pneumonia
- dysphagia- dysphonia

Skin features
- photosensitive
macular rash over back and shoulder
- Heliotrope rash periorbit
- Gottron’s papules - roughened red papules over extensor surfaces of fingers
- ‘mechanic’s hands’: extremely dry and scaly hands with linear ‘cracks’ on the palmar and lateral aspects of the fingers
- nail fold capillary dilatation

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15
Q

What does a T score of -2.5 mean on a DEXA scan?

A

T scores describe one’s bone density as a standard deviation (SD) score in comparison to the mean value derived from a reference population of young healthy adults - usually 30 years old

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16
Q

What condition is diagnosed with:
+ve cANCA

+ve pANCA

A

+ve cANCA = granulomatosis with polyangiitis

pANCA = eosinophilic granulomatosis with polyangiitis (Churg-Straus) microscopic polyangiitis or Goodpasture’s disease.

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17
Q

Ankylosing spondylitis management
1. First line concservative
2. + First line med
3. Conservative
4. Med
5. Maybe?

A
  1. Encourage regular exercise such as swimming
  2. First line med- NSAIDs are the first-line treatment
  3. Physiotherapy
  4. DMARD BUT if peripheral joint involvement- sulphasalazine)
  5. Maybe Anti-TNF therapy should be given if persistently high disease activity- adilimumab or etenercept
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18
Q

Still’s Disease

STEM-

Presentation (stem +3)

Investigations- Bloods (1 rule in, 2 to rule out)

A

STEM- Salmon pink rash on back

  1. arthralgia
  2. rash: salmon-pink, maculopapular
  3. pyrexia- typically rises in the late afternoon/early evening in a daily pattern and accompanies a worsening of joint symptoms and rash
  4. lymphadenopathy
  5. elevated serum ferritin
  6. rheumatoid factor (RF) and anti-nuclear antibody (ANA) negative
19
Q

Stills Disease

Name of criteria to diagnose

Management
1.
2.
3.

A

Yamaguchi criteria

Management
1. NSAIDs- trial for atleast a week before…
2. steroids
may control symptoms but won’t improve prognosis
3. if symptoms persist, the use of methotrexate, IL-1 or anti-TNF therapy can be considered

20
Q

Spot diagnosis antibodies
Anti-La and Anti-Ro

Anti-Scl-70

Anti-CCP and Rh F

anti-centromere antibodies and ANA

Anti-Jo-1(2)

Anti-Smith antibody

A

Anti-La and Anti-Ro
- Sjogren’s syndrome ( dry mouth and eyes and parotid gland swelling.)

Anti-Scl-70
- diffuse cutaneous systemic sclerosis (diffuse scleroderma (thickening of the skin), CREST symptoms AND systemic organ involvement)

anti-centromere antibodies (more sensitive) and ANA- Limited cutaneous systemic sclerosis JUST CREST

Anti-CCP and Rh F
- RA

Anti-Jo-1
- dermatomyositis (proximal muscle weakness and a blue-purple heliotrope rash, often found on the face, upper eyelids and trunk.)
- ALSO +ve in polymyositis

Anti-Smith antibody- specific for SLE

21
Q

Osteoperosis in a male

Cause?

Key blood test?

Physiology of how this impacts bone formation? (2)

A

Hypogonadism- either hypergonadotropic (primary gonadal failure) or hypogonadotropic (secondary to a defect in the hypothalamic-pituitary axis) hypogonadism.

Tesosterone

  1. First, androgens stimulate bone formation during puberty.
  2. Second, androgens prevent bone resorption during and after puberty.
22
Q

Methotrex causes pneumonitis and pulmonary fibrosis but what is the difference?

A

pneumonitis- presents as cough, dyspnoea, malaise, and fever and typically develops within a year of starting treatment

pulmonary fibrosis- scaring of lung parenchyma, develops due to long-term exposure to methotrexate, restrictive picture on spirometry.

23
Q

Osteoperosis by long-term steroid medication.

What is the over-arching rule?

When deciding, go for age governed rules.

T scores explained (3)

If you are giving bone protection:
First line =
But check… first

A

Give prophylactic use if going to be taking the equivalent of prednisolone 7.5mg a day for 3 or more months

  1. Patients over the age of 65 years or those who’ve previously had a fragility fracture should be offered bone protection.
  2. Patients under the age of 65 years should be offered a bone density scan, with further management dependent:

T score
> 0 = reassure
0 to -1.5 = Repeat bone density scan in 1-3 years
< -1.5 = Offer bone protection

Management
First line = alendronate.
But ensure calcium and vitamin D replete first

24
Q

Pagets disease

Indications for treatment: 4

Management
first line =
Oral =
IV eg =

A
  • bone pain
  • skull or long bone deformity
  • fracture
  • periarticular Paget’s

first line = bisphosphonate (either oral risedronate or IV zoledronate)

calcitonin is less commonly used now

25
Q

Lady with RA going for lap chole surgery, what investigation is needed to be done beforehand and why?

A

Anteroposterior and lateral cervical spine radiographs

Why?

Atlantoaxial subluxation is a rare complication of rheumatoid arthritis, but important as it can lead to cervical cord compression.
Ensuring the patient goes to surgery in a C-spine collar and the neck is not hyperextended on intubation.

26
Q

Hip pain which is referred from the lumbar spine can be elicited with what exam finding?
How do you do the test?

A

Femoral nerve stretch test Aka Ely Test may be positive
- Lie the patient prone. Extend the hip joint with a straight leg then bend the knee. This stretches the femoral nerve and will cause pain if it is trapped

27
Q

Gout
When are you offered prophylaxis treatment + with what?

Particular recommnded if: (5)

When should you start it?

First line:
Class
Dose and titrate until…
Why would some people start at a lower dose?

Second-line-

In refractory cases-

A

Urate lowering therapy to all patients after their first attack!

Particular recommnded if:
- >=2 attacks in 12 months
- tophi
- renal disease
- uric acid renal stones
- prophylaxis if on cytotoxics or diuretics

  • Delay until inflam has settled

First-line: Allopurinol (xanthine oxidase inhibitors) 100mg OD and titirated until serum uric acid is <300
- Start at lower dose if reduced eGFR

Second-line- febuxostat

Refractory cases- pegloticase (polyethylene glycol modified mammalian uricase) can achieve rapid control of hyperuricemia.

28
Q

Antiphospholipid syndrome

Management
- Never had a clot before =
- If had previous clots =

A
  • Never had a clot before = low-dose aspirin
  • Previous clots = Warfarin, target INR 2-3
29
Q

What is Polyarteritis nodosa (PAN)?

Assoc. with what infection?

Features (7)

Antibody in 20%?

A

vasculitis affecting medium-sized arteries with necrotizing inflammation leading to aneurysm formation

hepatitis B infection

  • fever, malaise, arthralgia
  • weight loss
  • hypertension
  • mononeuritis multiplex, sensorimotor polyneuropathy
  • testicular pain
  • livedo reticularis
  • haematuria, renal failure

perinuclear-antineutrophil cytoplasmic antibodies (ANCA)

30
Q

Which TB drug can cause drug induced lupus?

and what is the antibody assoc with drug induced lupus?

A

Isoniozid

Antihistone antibodies

31
Q

Rotator cuff muscles

Name them and their movement

A

Supraspinatus- AB (does the first 20 degrees then deltoid takes over)

Infraspinatous- External rotation

Subscapularis- Internal rotation

Teres minor (basically just helps infraspinatous and does ext. rotation)

32
Q

Side effect of IFN-alpha (2) for Hep C

A
  • Flu-like symp
  • Depression
33
Q

What is the triad of Feltys Syndrome

A
  • RA
  • Low WCC
  • Splenomegaly
34
Q

Ank Spond XRay findings (4)

One chest xray finding

A
  • sacroilitis: subchondral erosions, sclerosis
  • squaring of lumbar vertebrae
  • Bamboo spine
  • syndesmophytes: due to ossification of outer fibers of annulus fibrosus

chest x-ray: apical fibrosis

35
Q

What antibody would you associate with any vasulitis?

General antibody =

1)…..- 2 vasculiditis
2) ……- 1 vasculitis

A

ANCA!

p-ANCA (MPO antibodies):
- Microscopic polyangiitis (Good-pastures, also anti-GBM)
- Churg-Strauss syndrome aka eosinophilic granulomatosis polyangiitis

c-ANCA (PR3 antibodies): Granulomatosis with polyangiitis aka Wegners Syn.

36
Q

Reactive arthritis features

classic triad

others:
- Hands
- skin (2)

A

Reiters syn; Cant see, cant pee cant climb a tree

1) urethritis
2) conjunctivitis or ant. uvietitis
3) arthritis

  • Dactylitis (seen in psoriatic too ofc.)
    Skin:
  • circinate balanitis (painless vesicles on the coronal margin of the prepuce)
  • keratoderma blenorrhagica (waxy yellow/brown papules on palms and soles)
37
Q

SLE what blood test can be monitored in ACTIVE flare up and is it low or high?

A

Compliment levels are usually low during active disease - may be used to monitor flares

38
Q

Describe how you should take Bisphosphonates

A

Take at least 30 mins before breakfast with plenty of water and sit upright for 30 mins

39
Q

Diffuse systemic sclerosis management for renal disease and respiratory disease

A

Renal disease- ACEi to decrease BP

systemic sclerosis-associated interstitial lung disease- IV cyclophosphamide

40
Q

GCA if have negative biopsy (very possible due to skip lesions) when should the biopsy be retaken?

A

Within 7 days

41
Q

Salfasalazine

is it safe in preg?

STEM! - caution in who? (2)

SE:
(5)

A

Yes- but need to take folic acid 5mg
Max dose if preg is 2g/day and need folic acid supp ofc.

Caution- if aspirin sensitivity or sulphonamide sensivity
Caution - G6PD def

SE
1. Can colour tears
2. Steven-Johnson syn
3. Temporary male infertility
4. Myelosurpression- can get heinz body anaemia (obvs would make G6PD wrose)
5. Pneumonitis/ fibrosis

42
Q

Leflunamide

SE (6)

A
  1. Hypertension
  2. peripheral neuropathy
  3. Tiatrogenic
  4. BM surpression
  5. Mouth ulcers
    6 Rash
43
Q

Methotrexate
MOA-
Route-
What prescribed with it?-
When is this given?-

NEVER PRESCRIBE WITH… (2)

ANOTHER KEY DRUG INTERACTION

Treatment for methotrexate toxiticity?

A

MOA- Anti-folic metabolsim
Route- IM or tablet once a week
What prescribed with it?- 5 mg Folic acid
When is this given?- 24hrs after

NEVER
- Trimethoprim
- Co-trimoxazole, both lead to myelosurpression

  • High dose aspirin as can cause toxity of methotrexate secondary to decreased extertion

Follinic acid

44
Q

Methotrexate

SE (5)

Monitoring rules?

Methotrexate baseline investigations? (3)

Preg rules (2)

A
  1. Tiatrogenic
  2. Mouth ulcers
  3. BM suppression
  4. Pulmonary fibrosis
  5. Liver cirrhosis

Monitor- baseline before, weekly, then when stable every 2/3 months
Baseline:
1. CXR- TB
2. FBC, U+E, LFT,
3. Sometimes pulmonary function tests

Preg
- M+F should stop 6 months before tryig to conceive
- Effective contraception 6 months after stopping

Year 4 PassMed Incorrect Qs (37 decks)

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