Rheumatology Flashcards
What Crystal is deposited in the synovium to cause gout
Monosodium urate monohydrate
What deficiency leads to lesch nyhan syndrome
HGPRTase deficiency
What is the MOA of colchicine
Inhibits microtubule polymerisation and neutrophil motility
What is deposited in the synovium to cause pseudogout
calcium pyrophosphate dihydrate
What are the risk factors for pseudogout
Wilson’s, haemochromatosis, hyperparathyroidism, hypothyroidism, acromegaly, low Mg, low PO4
Which GU infection is most linked with reactive arthritis
Chlamydia
What presentation characterises gonococcal arthritis
Dermatitis-polyarthritis-tenosynovitis syndrome
What is rheumatoid factor
IgM antibody against Fc portion of IgG
What are the early X-ray findings of rheumatoid arthritis
Periarticular osteopenia, osteoporosis and decalcification
What is the MOA of tocilizumab
Anti-IL6 receptor
Which monoclonal antibody acts on CD20 to result in B cell depletion
Rituximab
What is felty’s syndrome
Active RA + splenomegaly + low WCC
Which drug inhibits dihydrofolate reductase
Methotrexate
Which cancer has an increased risk associated with Sjögren’s syndrome
Non Hodgkin’s lymphoma
What is the main risk associated with hydroxychloroquine
Retinopathy
Which blood markers are positive in Sjögren’s syndrome
RF, ANA, Anti-Ro, Anti-La
How is ankylosing spondylitis diagnosed and monitored
Plain XRay of sacroiliac joints
What is the MOA of Ustekinumab
IgG1k monoclonal antibody to IL12/23
What condition causes a salmon-coloured rash and swinging pyrexia?
Adult onset stills disease
Which drug can cause 6-MP toxicity when given with azathioprine?
Allopurinol
What is the main risk associated with hydroxychloroquine?
Retinopathy (bull’s eye appearance on fundoscopy, visual field defects)
Which autoimmune condition increases the risk of non Hodgkin’s lymphoma
Sjorgrens
How is sjorgrens syndrome diagnosed
Schirmers test (<5mm in 5 mins)
What is the most common type of psoriatic arthritis
Symmetrical polyarthritis
Which particular biomarker is characteristically increased in adult onset stills disease
ferritin
Which antibodies are most specific for SLE
Anti-dsDNA, Anti-Smith
Which antibody is increased in 95% of drug induced lupus cases?
Anti-histone antibodies
What are the two drugs that commonly cause drug induced lupus
Hydralazine, procainamide
What blood tests are characteristic of antiphospholipid syndrome
Raised APTT, normal PT, low Platelets
Which antibody tests are diagnostic of antiphospholipid syndrome
Anticardiolipin antibodies, lupus anticoagulant
What is seen on biopsy in polyarteritis nodosa
Necrotising inflammation (fibrinoid necrosis appearance)
Which small-medium vasculitic disease seen in smokers spares coronary arteries but can lead to gangrene of the digits
Thromboangitis obliterans
Which vasculitis is associated with hepatitis B
Polyarteritis nodosa
Which vasculitis can cause livedo reticularis and testicular pain
Polyarteritis nodosa
What test is specific for Behçet’s disease
Positive pathergy test
Which antibodies are related to cANCA
Anti-proteinase 3 Abs
Which antibodies are associated with pANCA
Myeloperoxidase Abs
Which valvular disease is seen in Takayasu’s arteritis
Aortic regurgitation
Which vasculitis is hepatitis C associated with
Type II cryoglobulinaemia
How is reynauds diagnosed
Nail fold capillaroscopy
What is the underlying mechanism of systemic sclerosis
Increased fibroblast activity and fibrosis
Which antibody is seen in 90% of localised scleroderma (morphea)
Anti-cu/zn superoxide dismutase
What is the treatment of scleroderma renal crisis
Oral ACEi
What skin changes are seen in dermatomyositis
Shawl sign, heliotrope rash, gottron’s papules
Which disease is characterised by anti-RNP
Mixed connective tissue disease
What investigation is best in a patient with longstanding RA that develops proteinuria and diarrhoea
Rectal biopsy for amyloid AA deposition
What is seen on congo red staining in amyloidosis
apple green birefringence
Which disease is associated with keratoderma blenorrhagica (waxy yellow/brown papules on palms and soles)
Reactive arthritis
Which drug does sulfasalazine sometimes show cross-reactivity with
aspirin
Which feature is most commonly seen on Xray in ankylosing spondylitis
syndesmophytes
What is elevated in the urine in Paget’s disease?
urinary hydroxyproline
which joints are characteristically involved in hand osteoarthritis
Carpometacarpal and DIP joints
Which antibodies are associated with congenital heart block in SLE
Anti-Ro
What are the early Xray features of RA
Juxta-articular osteoporosis/osteopenia
What is the MOA of mycophenolate mofetil
inhibits inosine-5’-monophosphate dehydrogenase which is needed for purine synthesis
Which protein is affected in Marfan’s syndrome
Fibrillin-1
Which joints do Heberden’s nodes involve
Distal IP joints
Which joints do Bouchard’s nodes involve
Proximal IP joints
What blood markers are seen in Paget’s disease
Raised ALP, normal Ca and PO4
What T score is significant for diagnosis of osteoporosis
< -2.5
What T score is significant for starting treatment in patients on long-term steroids
T < -1.5
What is the MOA of raloxifene
Selective oestrogen receptor modulator
What is the MOA of strontium ranelate
Dual action (increased osteoblast and decreased osteoclast activity)
Which drug inhibits RANK ligand
Denozumab
What is the MOA of teriparatide in the treatment of osteoporosis
PTH analogue - increases osteoblast activity
Which condition causes dense, thick bones due to defective osteoclast function
Osteopetrosis
What blood results are characteristic of osteomalacia
Low Ca, low PO4, low Vit D, raised ALP
What condition is associated with Loosers zones on X-ray
Osteomalacia
Which protein is altered in osteogenesis imperfecta leading to increased fractures
Type 1 collagen
Which condition causes attacks of fever and peritonitis lasting 1-3 days
Familial Mediterranean Fever
What causes nephrotic syndrome in Familial Mediterranean Fever
Renal Amyloidosis
What is the management of Familial Mediterranean Fever
Colchicine
What muscles are strained in lateral epicondylitis
Extensor muscles of forearm and wrist
What agrevates pain in medial epicondylitis
Wrist flexion and pronation
Where is pain most prominent in radial tunnel syndrome
4-5cm distal to lateral epicondyle
Which condition is caused by inflammation of the sheath containing tendons of the thumb
DeQuervain’s tenosynovitis
What are the causes of Dactylitis
Spondyloarthropathies, sickle cell, TB, sarcoidosis, syphillis
What sensory loss occurs with L3 compression
Anterior thigh
What sensory loss occurs with L4 compression
Anterior aspect of knee
What sensory loss occurs with L5 compression
Dorsum of foot
What sensory loss occurs with S1 compression
Lateral aspect of foot
Which nerve root is tested with biceps tendon reflex
C5
Which nerve root is tested with supinator tendon reflex
C6
Which nerve root is tested with triceps tendon reflex
C7
What is the treatment of Charcot foot
Total contact plaster and rest for 3 months
Which cells secrete TNF
Macrophages
Which receptors does TNF alpha bind to
p55 and p75 - induces apoptosis
What are the contraindications to prescribing TNF-alpha blockers
Active infection, TB, multiple sclerosis, HF, pregnancy, breastfeeding
Name 3 TNF inhibitors used in the treatment of rheumatoid arthritis
Etanercept, infliximab, adalimumab
What are the common complications of ankylosing spondylitis
Apical fibrosis, anterior uveitis, aortic regurgitation, amyloidosis, AV block
What causes reduced vision in GCA
Anterior ischaemic optic neuropathy
What is the pathophysiology of rickets causing swollen wrists
Excessive non-mineralised osteoid
Which condition is associated with repeated cramping and myoglobinuria after short bouts of exercise
McArdle’s disease
What are syndesmophytes
Ossification of outer fibres of annulus fibrosus - seen in ankylosing spondylitis
Which cause of lower back pain is typically worse on walking and relieved by sitting down, leaning forwards and crouching
Spinal stenosis
What autoantibodies are found in polyarteritis nodosa
No autoantibodies are likely to be positive (20% associated with pANCA)
What are the causes of mononeuritis multiplex (painful sensory and motor neuropathy involving at least 2 separate nerves)
Polyarteritis Nodosa, DM, sarcoidosis, rheumatoid arthritis
Which condition is associated with retinal angioid streaks and plucked chicken skin due to an abnormality in elastic fibres
Pseudoxanthoma elasticum
What is the most common cardiac abnormality is pseudoxanthoma elasticum
Mitral valve prolapse
Which skin manifestations are seen in reactive arthritis
Circinate balanitis, keratoderma blenorrhagica (waxy yellow/brown papules on palms and soles)
Which condition is associated with recurrent otitis media, lytic bone lesions and tennis-racket shaped Birbeck granules on microscopy
Langerhans cell histiocytosis
What is a common cause of lower back pain in Marfan’s syndrome
Dural ectasia
What is the MOA of Anakinra
IL-1 inhibitor
What is the next management step if a patient can’t tolerate alendronate for the treatment of osteoporosis
Offer risedronate or etidronate
Which cause of joint effusion has a double contour sign on USS
Gout
which condition is bone expansion with a coarsened trabecular pattern seen on imaging
Paget’s disease
What is the most common cause of death in diffuse systemic sclerosis
ILD and pulmonary arterial hypertension
What is the difference between limited cutaneous and diffuse systemic sclerosis
Limited cutaneous affects distal extremities and face, diffuse involves scleroderma of the trunk and proximal limbs
What is the most common secondary cause of ileopsoas abscess
Crohn’s disease
Which condition causes persistent fever and pain on extension of the affected hip
Iliopsoas abscess
What should be monitored when prescribing leflunomide
FBC, LFT, blood pressure
Which blood test has the highest predictive value for DVT in patients with antiphospholipid syndrome
Lupus anticoagulant
What are the causes of avascular necrosis of the hip
Long-term steroids, chemotherapy, alcohol excess, trauma, sickle cell, lupus, APLS
What is the investigation of choice for avascular necrosis of the hip
MRI hip
What are the criteria for ankle X-ray
Malleolar pain plus one of: tenderness over lateral malleolar zone, tenderness over medial malleolar zone, can’t walk 4 steps
Which nerve root supplies sensation to anterior aspect of knee
L4 (aLL 4s)
What can be used to stimulate saliva production in Sjögren’s syndrome
Pilocarpine
Which organisms can lead to a post-dysenteric form of reactive arthritis 1-4 weeks following infection
Shigella, Salmonella, Yersinia, Campylobacter
What is the most common organism that causes acute osteomyelitis after a puncture wound
Pseudomonas aeruginosa
What disease causes ILD, vertebral involvement and diabetes insipidus in a young smoker
Langerhans cell Histiocytosis
What is the diagnostic test for langerhans cell Histiocytosis
Transbronchial lung biopsy
Which antibody is often positive in drug induced lupus related to thiazide diuretics
Anti-Ro antibodies
What is Caplan’s syndrome
RA + massive fibrotic nodules with pneumoconiosis after coal dust exposure
Which organs are affected in polyarteritis nodosa
All except the lungs
What causes inflammation of the external ear, a saddle nose and relapsing/remitting arthritis
Relapsing polychondritis
What condition is associated with pain over the greater tuberosity and a painful arc on abduction of the shoulder
Supraspinatus tendinitis
What is the management of VTE in Bechets
Control inflammation with corticosteroids + immunosuppressants (azathioprine, cyclophosphamide or cyclosporin)
What is the best test to determine a Charcot joint
Indium-labelled white cell scan
What causes swan neck deformity of the fingers
Rheumatoid arthritis
What is the treatment of Felty syndrome
Pulsed corticosteroid therapy
Which conditions are associated with increased risk of osteosarcoma
- Retinoblastoma
- Paget’s
- Inherited cancer syndromes e.g. Li-Fraumeni
- Hereditary multiple ostochondromas
What is the treatment of an acute gout attack
Colchicine (start allopurinol after 2 weeks)
What is the most important blood test for determining suitability for bisphosphonate use
eGFR (excreted unchanged in the urine)
