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MRCP > Rheumatology > Flashcards

Rheumatology Flashcards

1
Q

MOA bisphosphonates

A

inhibits bone resorption by osteoclasts

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2
Q

What is Churg Strauss syndrome?

A

small- medium vessel vasculitis

asthma + eosinophilia

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3
Q

Criteria for Churg-Strauss syndrome

4+ of…

A 
asthma
eosinophilia
paranasal sinusitis
pulmonary infiltrates
vasculitis on histology
polyneuropathy or mononeuritis multiplex
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4
Q

Features hereditary haemochromatosis

A

high iron

Diabetes
CCF 
DCM (reversible with Rx)
Cirrhosis 
Hypogonadism
Pseudogout
Bronze/ Slate grey skin (reversible)
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5
Q

Inheritance hereditary haemochromatosis

A

AR

HFE gene mutation

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6
Q

Ix hereditary haemochromatosis

A

ferritin >1000

genetic testing

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7
Q

Features of PMR

A

pelvic and shoulder muscle stiffness
(DON’T get proximal muscle pain)
fever, anorexia, weight loss

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8
Q

Ix for PMR

A

normocytic anaemia
ESR can be >50
High CRP

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9
Q

Rx for PMR

A

Prednisolone

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10
Q

Condition seen in 30% PMR patients

A

GCA

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11
Q

Features GCA

A 
Visual disturbances
Headache
Temporal tenderness
Jaw claudication 
TIAs
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12
Q

Features of PCP pneumonia

Drug that is RF for PCP

A

post exertional hypoxia
dry cough, fever, weight loss

Drug RF = anti=TNF

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13
Q

Define Raynaud’s

A

Pallor digits

Then colour change (cyanosis, erythema)

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14
Q

MOA of Raynaud’s

A

vasospasm without endothelial damage

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15
Q

Types of Raynaud’s

A

primary

secondary

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16
Q

When to suspect secondary Raynaud’s e.g. connective tissue disease

A 
Onset >30 
Painful ASYMMETRICAL episodes
ANA positive
ulcers/gangrene/ischaemia digits
abnormal nail fold capillaries
episodes last > 1 hour
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17
Q

Drug that interacts w azathioprine (purine synthesis inhibitor)

A

Allopurinol (gout)

  • xanthine oxidase inhibitor
  • xanthine oxidase breaks down azathioprine
  • Azathioprine toxicity -> pancytopenia
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18
Q

Osteomalacia Ix

A

Low Ca
Low Phos
Low Vit D
High ALP (increased osteoblast activity, released f/ bone)

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19
Q

Most likely underlying metabolic cause gout

A

decrease renal excretion urate

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20
Q

Serum urate level that increases risk of gout

A

> 7

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21
Q

SLE Ab

A

ANA

anti ds-DNA

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22
Q

anti-centromere Ab

A

limited cutaneous systemic sclerosis (CREST)

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23
Q

Anti-Scl-70

A

diffuse cutaneous systemic sclerosis

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24
Q

Anti Ro and Anti La

A

Sjogrens

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25
Q

Anti-Jo-1

A

Dermatomyositis

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26
Q

Anti histone Ab

A

Drug-induced lupus

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27
Q

Features Takayasu’s arteritis

A

Large vessel vasculitis

Normally young Japanese women

28
Q

Signs/Sx Takayasu’s arteritis

A

Limb claudication on exertion
CP
Systemic Sx - weight loss, fatigue, fever, myalgia

29
Q

Artery commonly affected in Takayasu’s arteritis

A

Branches of aorta

Commonly subclavian artery

30
Q

Rx Takayasu’s arteritis

A

Glucocorticoids

Methotrexate and azathioprine

31
Q

Tocolizumab MOA and indication

A

anti-IL6 monoclonal Ab

Moderate- severe RA and not responded to DMARD/TNF antagonist

32
Q

Atabacept MOA

A

cytotoxic T cell antigen 4 (CTLA 4) homologue

33
Q

Examples anti TNF-alpha agents

A 
infliximab
adalimumab
etanercept
golimumab
certolizumab
34
Q

Indications anti-TNF alpha agents

A 
RA
psoriatic arthritis
ankylosing spondylitis
Crohn's 
juvenile idiopathic arthritis
35
Q

Rituximab MOA and indication

A

Anti CD-20

RA and haem malignancies

36
Q

Anakinra MOA and indications

A

anti-IL 1 Ab

RA and adult onset still’s disease

37
Q

Risk acute lymphoblastic leukaemia and treatment of disease

A

avascular necrosis of femoral head

38
Q

2 drugs associated w/drug induced lupus

A

Hydralazine
Quinidine
Procainamide

39
Q

Risk with zolendronic acid (bisphosphonate)

A

jaw osteonecrosis

40
Q

RA spinal complication

A

Atlanto-axial subluxation

41
Q

Low C4 and rheumatoid factor positive

A

Cryoglobulinaemia

42
Q

Rx for ankylosing spondylitis

A

NSAIDs and PT

43
Q

Ab causing neonatal lupus (and complete HB)

A

Anti Ro

44
Q

Anti Jo1 Ab

A

Dermatomyositis

Polymyositis

45
Q

First line for prevention steroid induced osteoporosis

A

Bisphosphonate e.g. alendronic acid

46
Q

Blood monitoring for methotrexate dose change

A

Every 2 weeks for 6 weeks

Then monthly until dose + disease stable for 1 year

47
Q

Drug induced lupus features

A

Lower incidence nephritis
No skin involvement
Anti-histone Abs

48
Q

Drugs causing drug induced lupus

A

Procainamide, hydralazine , minocycline

anti-TNF agents, statins

49
Q

Conditions associated w/ iritis

A

Reiter’s
Behcets
Psoriatic arthropathy (20%)
IBD

50
Q

Proteinuria + diarrhoea in RA. What do you Ix for? What is Ix?

A

Secondary (AA) amyloidosis (complication of RA) -> nephropathy
Ix = Biopsy (GI/ rectum) and histology

51
Q

Blood that suggest polymyositis rather than PMR

A

Raised CK

52
Q

Rx for <65 year old on steroids if osteoporotic/have fragility fracture

A

Bisphosphonates

53
Q

Rx psoriatic arthritis

A

DMARD

54
Q

MOA systemic sclerosis

A

Increased fibroblast activity + fibrosis in different organs

Chronic AI disease

55
Q

GI problems in systemic sclerosis (limited and diffuse cutaneous)

A

Malabsorption + malnutrition
Anywhere from mouth to anus
Due to dysmotility because of infiltration of intestinal wall w/ fibrous tissue

56
Q

Conditions associated w/ anterior uveitis

A

AS, reactive arthritis, IBD, sarcoidosis, Behcets

57
Q

Malar rash seen in

A

SLE, pellagra (niacin), dermatomyositis

58
Q

What is discitis? Features?

A

Inflammation vertebral disc space often due to infection

Insidious onset pain, locally tender worsening on activity (NOT STIFFNESS)

59
Q

What is spondylolisthessis

A

Movement of vertebra due to instability
Pain worse on activity (as with OA)
May be associated w nerve root compression

60
Q

PD drugs:

Selegeline MOA

A

MAO inhibitor

stop DA breakdown in synapse

61
Q

Pt with PD

Starts drooling

Mx?

A

glycopyrronium

62
Q

Levodopa for PD

Normally given with which drug?

A

carbidopa/ benserazide

(decarboxylase inhibitor)

stops peripheral metabolism to DA

63
Q

SE of levodopa

A 
dyskinesia
on off effect
dry mouth 
anorexia
palpitations
postural drop
psychosis
64
Q

PD drugs

bromocriptine, cabergoline, ropinirole, apomorphine

MOA?

A

dopamine receptor agonist

65
Q

SE of dopamine receptor agonists

e.g bromocriptine, cabergoline, ropinirole, apomorphine

A

fibrosis

cardiac, petroperitoneal, pulmonary

66
Q

Rx for drug - induced parkinsonism

A

procyclidine, benzotropine, trihexyphenidyl (benzhexol)

Antimuscarinics
stop tremor + rigidity
block cholinergic receptors

MRCP (12 decks)

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