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mrcp > Rheumatology > Flashcards

Rheumatology Flashcards

1
Q

What Crystal is deposited in the synovium to cause gout

A

Monosodium urate monohydrate

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2
Q

What deficiency leads to lesch nyhan syndrome

A

HGPRTase deficiency

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3
Q

What is the MOA of colchicine

A

Inhibits microtubule polymerisation and neutrophil motility

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4
Q

What is deposited in the synovium to cause pseudogout

A

calcium pyrophosphate dihydrate

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5
Q

What are the risk factors for pseudogout

A

Wilson’s, haemochromatosis, hyperparathyroidism, hypothyroidism, acromegaly, low Mg, low PO4

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6
Q

Which GU infection is most linked with reactive arthritis

A

Chlamydia

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7
Q

What presentation characterises gonococcal arthritis

A

Dermatitis-polyarthritis-tenosynovitis syndrome

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8
Q

What is rheumatoid factor

A

IgM antibody against Fc portion of IgG

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9
Q

What are the early X-ray findings of rheumatoid arthritis

A

Periarticular osteopenia, osteoporosis and decalcification

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10
Q

What is the MOA of tocilizumab

A

Anti-IL6 receptor

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11
Q

Which monoclonal antibody acts on CD20 to result in B cell depletion

A

Rituximab

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12
Q

What is felty’s syndrome

A

Active RA + splenomegaly + low WCC

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13
Q

Which drug inhibits dihydrofolate reductase

A

Methotrexate

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14
Q

Which cancer has an increased risk associated with Sjögren’s syndrome

A

Non Hodgkin’s lymphoma

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15
Q

What is the main risk associated with hydroxychloroquine

A

Retinopathy

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16
Q

Which blood markers are positive in Sjögren’s syndrome

A

RF, ANA, Anti-Ro, Anti-La

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17
Q

How is ankylosing spondylitis diagnosed and monitored

A

Plain XRay of sacroiliac joints

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18
Q

What is the MOA of Ustekinumab

A

IgG1k monoclonal antibody to IL12/23

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19
Q

What condition causes a salmon-coloured rash and swinging pyrexia?

A

Adult onset stills disease

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20
Q

Which drug can cause 6-MP toxicity when given with azathioprine?

A

Allopurinol

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21
Q

What is the main risk associated with hydroxychloroquine?

A

Retinopathy (bull’s eye appearance on fundoscopy, visual field defects)

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22
Q

Which autoimmune condition increases the risk of non Hodgkin’s lymphoma

A

Sjorgrens

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23
Q

How is sjorgrens syndrome diagnosed

A

Schirmers test (<5mm in 5 mins)

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24
Q

What is the most common type of psoriatic arthritis

A

Symmetrical polyarthritis

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25
Q

Which particular biomarker is characteristically increased in adult onset stills disease

A

ferritin

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26
Q

Which antibodies are most specific for SLE

A

Anti-dsDNA, Anti-Smith

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27
Q

Which antibody is increased in 95% of drug induced lupus cases?

A

Anti-histone antibodies

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28
Q

What are the two drugs that commonly cause drug induced lupus

A

Hydralazine, procainamide

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29
Q

What blood tests are characteristic of antiphospholipid syndrome

A

Raised APTT, normal PT, low Platelets

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30
Q

Which antibody tests are diagnostic of antiphospholipid syndrome

A

Anticardiolipin antibodies, lupus anticoagulant

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31
Q

What is seen on biopsy in polyarteritis nodosa

A

Necrotising inflammation (fibrinoid necrosis appearance)

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32
Q

Which small-medium vasculitic disease seen in smokers spares coronary arteries but can lead to gangrene of the digits

A

Thromboangitis obliterans

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33
Q

Which vasculitis is associated with hepatitis B

A

Polyarteritis nodosa

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34
Q

Which vasculitis can cause livedo reticularis and testicular pain

A

Polyarteritis nodosa

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35
Q

What test is specific for Behçet’s disease

A

Positive pathergy test

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36
Q

Which antibodies are related to cANCA

A

Anti-proteinase 3 Abs

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37
Q

Which antibodies are associated with pANCA

A

Myeloperoxidase Abs

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38
Q

Which valvular disease is seen in Takayasu’s arteritis

A

Aortic regurgitation

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39
Q

Which vasculitis is hepatitis C associated with

A

Type II cryoglobulinaemia

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40
Q

How is reynauds diagnosed

A

Nail fold capillaroscopy

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41
Q

What is the underlying mechanism of systemic sclerosis

A

Increased fibroblast activity and fibrosis

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42
Q

Which antibody is seen in 90% of localised scleroderma (morphea)

A

Anti-cu/zn superoxide dismutase

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43
Q

What is the treatment of scleroderma renal crisis

A

Oral ACEi

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44
Q

What skin changes are seen in dermatomyositis

A

Shawl sign, heliotrope rash, gottron’s papules

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45
Q

Which disease is characterised by anti-RNP

A

Mixed connective tissue disease

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46
Q

What investigation is best in a patient with longstanding RA that develops proteinuria and diarrhoea

A

Rectal biopsy for amyloid AA deposition

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47
Q

What is seen on congo red staining in amyloidosis

A

apple green birefringence

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48
Q

Which disease is associated with keratoderma blenorrhagica (waxy yellow/brown papules on palms and soles)

A

Reactive arthritis

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49
Q

Which drug does sulfasalazine sometimes show cross-reactivity with

A

aspirin

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50
Q

Which feature is most commonly seen on Xray in ankylosing spondylitis

A

syndesmophytes

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51
Q

What is elevated in the urine in Paget’s disease?

A

urinary hydroxyproline

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52
Q

which joints are characteristically involved in hand osteoarthritis

A

Carpometacarpal and DIP joints

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53
Q

Which antibodies are associated with congenital heart block in SLE

A

Anti-Ro

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54
Q

What are the early Xray features of RA

A

Juxta-articular osteoporosis/osteopenia

55
Q

What is the MOA of mycophenolate mofetil

A

inhibits inosine-5’-monophosphate dehydrogenase which is needed for purine synthesis

56
Q

Which protein is affected in Marfan’s syndrome

A

Fibrillin-1

57
Q

Which joints do Heberden’s nodes involve

A

Distal IP joints

58
Q

Which joints do Bouchard’s nodes involve

A

Proximal IP joints

59
Q

What blood markers are seen in Paget’s disease

A

Raised ALP, normal Ca and PO4

60
Q

What T score is significant for diagnosis of osteoporosis

A

< -2.5

61
Q

What T score is significant for starting treatment in patients on long-term steroids

A

T < -1.5

62
Q

What is the MOA of raloxifene

A

Selective oestrogen receptor modulator

63
Q

What is the MOA of strontium ranelate

A

Dual action (increased osteoblast and decreased osteoclast activity)

64
Q

Which drug inhibits RANK ligand

A

Denozumab

65
Q

What is the MOA of teriparatide in the treatment of osteoporosis

A

PTH analogue - increases osteoblast activity

66
Q

Which condition causes dense, thick bones due to defective osteoclast function

A

Osteopetrosis

67
Q

What blood results are characteristic of osteomalacia

A

Low Ca, low PO4, low Vit D, raised ALP

68
Q

What condition is associated with Loosers zones on X-ray

A

Osteomalacia

69
Q

Which protein is altered in osteogenesis imperfecta leading to increased fractures

A

Type 1 collagen

70
Q

Which condition causes attacks of fever and peritonitis lasting 1-3 days

A

Familial Mediterranean Fever

71
Q

What causes nephrotic syndrome in Familial Mediterranean Fever

A

Renal Amyloidosis

72
Q

What is the management of Familial Mediterranean Fever

A

Colchicine

73
Q

What muscles are strained in lateral epicondylitis

A

Extensor muscles of forearm and wrist

74
Q

What agrevates pain in medial epicondylitis

A

Wrist flexion and pronation

75
Q

Where is pain most prominent in radial tunnel syndrome

A

4-5cm distal to lateral epicondyle

76
Q

Which condition is caused by inflammation of the sheath containing tendons of the thumb

A

DeQuervain’s tenosynovitis

77
Q

What are the causes of Dactylitis

A

Spondyloarthropathies, sickle cell, TB, sarcoidosis, syphillis

78
Q

What sensory loss occurs with L3 compression

A

Anterior thigh

79
Q

What sensory loss occurs with L4 compression

A

Anterior aspect of knee

80
Q

What sensory loss occurs with L5 compression

A

Dorsum of foot

81
Q

What sensory loss occurs with S1 compression

A

Lateral aspect of foot

82
Q

Which nerve root is tested with biceps tendon reflex

A

C5

83
Q

Which nerve root is tested with supinator tendon reflex

A

C6

84
Q

Which nerve root is tested with triceps tendon reflex

A

C7

85
Q

What is the treatment of Charcot foot

A

Total contact plaster and rest for 3 months

86
Q

Which cells secrete TNF

A

Macrophages

87
Q

Which receptors does TNF alpha bind to

A

p55 and p75 - induces apoptosis

88
Q

What are the contraindications to prescribing TNF-alpha blockers

A

Active infection, TB, multiple sclerosis, HF, pregnancy, breastfeeding

89
Q

Name 3 TNF inhibitors used in the treatment of rheumatoid arthritis

A

Etanercept, infliximab, adalimumab

90
Q

What are the common complications of ankylosing spondylitis

A

Apical fibrosis, anterior uveitis, aortic regurgitation, amyloidosis, AV block

91
Q

What causes reduced vision in GCA

A

Anterior ischaemic optic neuropathy

92
Q

What is the pathophysiology of rickets causing swollen wrists

A

Excessive non-mineralised osteoid

93
Q

Which condition is associated with repeated cramping and myoglobinuria after short bouts of exercise

A

McArdle’s disease

94
Q

What are syndesmophytes

A

Ossification of outer fibres of annulus fibrosus - seen in ankylosing spondylitis

95
Q

Which cause of lower back pain is typically worse on walking and relieved by sitting down, leaning forwards and crouching

A

Spinal stenosis

96
Q

What autoantibodies are found in polyarteritis nodosa

A

No autoantibodies are likely to be positive (20% associated with pANCA)

97
Q

What are the causes of mononeuritis multiplex (painful sensory and motor neuropathy involving at least 2 separate nerves)

A

Polyarteritis Nodosa, DM, sarcoidosis, rheumatoid arthritis

98
Q

Which condition is associated with retinal angioid streaks and plucked chicken skin due to an abnormality in elastic fibres

A

Pseudoxanthoma elasticum

99
Q

What is the most common cardiac abnormality is pseudoxanthoma elasticum

A

Mitral valve prolapse

100
Q

Which skin manifestations are seen in reactive arthritis

A

Circinate balanitis, keratoderma blenorrhagica (waxy yellow/brown papules on palms and soles)

101
Q

Which condition is associated with recurrent otitis media, lytic bone lesions and tennis-racket shaped Birbeck granules on microscopy

A

Langerhans cell histiocytosis

102
Q

What is a common cause of lower back pain in Marfan’s syndrome

A

Dural ectasia

103
Q

What is the MOA of Anakinra

A

IL-1 inhibitor

104
Q

What is the next management step if a patient can’t tolerate alendronate for the treatment of osteoporosis

A

Offer risedronate or etidronate

105
Q

Which cause of joint effusion has a double contour sign on USS

A

Gout

106
Q

which condition is bone expansion with a coarsened trabecular pattern seen on imaging

A

Paget’s disease

107
Q

What is the most common cause of death in diffuse systemic sclerosis

A

ILD and pulmonary arterial hypertension

108
Q

What is the difference between limited cutaneous and diffuse systemic sclerosis

A

Limited cutaneous affects distal extremities and face, diffuse involves scleroderma of the trunk and proximal limbs

109
Q

What is the most common secondary cause of ileopsoas abscess

A

Crohn’s disease

110
Q

Which condition causes persistent fever and pain on extension of the affected hip

A

Iliopsoas abscess

111
Q

What should be monitored when prescribing leflunomide

A

FBC, LFT, blood pressure

112
Q

Which blood test has the highest predictive value for DVT in patients with antiphospholipid syndrome

A

Lupus anticoagulant

113
Q

What are the causes of avascular necrosis of the hip

A

Long-term steroids, chemotherapy, alcohol excess, trauma, sickle cell, lupus, APLS

114
Q

What is the investigation of choice for avascular necrosis of the hip

A

MRI hip

115
Q

What are the criteria for ankle X-ray

A

Malleolar pain plus one of: tenderness over lateral malleolar zone, tenderness over medial malleolar zone, can’t walk 4 steps

116
Q

Which nerve root supplies sensation to anterior aspect of knee

A

L4 (aLL 4s)

117
Q

What can be used to stimulate saliva production in Sjögren’s syndrome

A

Pilocarpine

118
Q

Which organisms can lead to a post-dysenteric form of reactive arthritis 1-4 weeks following infection

A

Shigella, Salmonella, Yersinia, Campylobacter

119
Q

What is the most common organism that causes acute osteomyelitis after a puncture wound

A

Pseudomonas aeruginosa

120
Q

What disease causes ILD, vertebral involvement and diabetes insipidus in a young smoker

A

Langerhans cell Histiocytosis

121
Q

What is the diagnostic test for langerhans cell Histiocytosis

A

Transbronchial lung biopsy

122
Q

Which antibody is often positive in drug induced lupus related to thiazide diuretics

A

Anti-Ro antibodies

123
Q

What is Caplan’s syndrome

A

RA + massive fibrotic nodules with pneumoconiosis after coal dust exposure

124
Q

Which organs are affected in polyarteritis nodosa

A

All except the lungs

125
Q

What causes inflammation of the external ear, a saddle nose and relapsing/remitting arthritis

A

Relapsing polychondritis

126
Q

What condition is associated with pain over the greater tuberosity and a painful arc on abduction of the shoulder

A

Supraspinatus tendinitis

127
Q

What is the management of VTE in Bechets

A

Control inflammation with corticosteroids + immunosuppressants (azathioprine, cyclophosphamide or cyclosporin)

128
Q

What is the best test to determine a Charcot joint

A

Indium-labelled white cell scan

129
Q

What causes swan neck deformity of the fingers

A

Rheumatoid arthritis

130
Q

What is the treatment of Felty syndrome

A

Pulsed corticosteroid therapy

131
Q

Which conditions are associated with increased risk of osteosarcoma

A
  • Retinoblastoma
  • Paget’s
  • Inherited cancer syndromes e.g. Li-Fraumeni
  • Hereditary multiple ostochondromas
132
Q

What is the treatment of an acute gout attack

A

Colchicine (start allopurinol after 2 weeks)

133
Q

What is the most important blood test for determining suitability for bisphosphonate use

A

eGFR (excreted unchanged in the urine)

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