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MRCP Part 1 > Rheumatology > Flashcards

Rheumatology Flashcards

1
Q

MTX MOA?

A

Inhibits dihydrofolate reductase

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2
Q

give some SEs of MTX

A 
mucositis
myelosuppression
pneumonitis
pulmonary fibrosis
liver fibrosis
folate deficiency
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3
Q

What drugs should you avoid prescribing with MTX?

A

Trimethoprim + Co-trimoxazole –> Risk of marrow aplasia

High dose aspirin –> risk of MTX toxicity (by reducing excretion)

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4
Q

What is discoid lupus characterised by?

A

Follicular keratin plugs - when lesiosn peeled off skin looks like “carpet tack”

Scarring + scarring alopecia

Common in face, neck, scalp

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5
Q

Antibodies in limited vs diffuse systemic sclerosis

A

Limited: anti-centromere

Diffuse: anti-Scl-70

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6
Q

What antibodies in RA?

A

Anti-CCP

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7
Q

Give a common side effect of MTX therapy?

A

mucositis

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8
Q

Polymyositis antibodies

A

Anti-Jo-1

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9
Q

Dermatomyositis antibodies

A

Anti-Mi-2

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10
Q

low serum calcium, low serum phosphate, raised ALP and raised PTH - what condition?

A

Osteomalaxia

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11
Q

What might be seen on XR in pseudogout

A

Chondrocalcinosis of the knee (linear calcifications of the meniscus + articular cartilage)

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12
Q

Antibodies associated with Sjogrens

A

RF
Anti Ro
Anti La

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13
Q

Ankylosing spondylitis features

A 
A's:
Apical fibrosis
Anterior uveitis
Aortic regurgitation
Achilles tendonitis
AV node block
Amyloidosis
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14
Q

How does dural ectasia present and what is it associated with?

A

Ballooning of dural sac at lumbosacral level

Back pain, urinary incontinence, headaches, leg pains

Associated with marfan’s syndrome

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15
Q

Pesudogout joint aspirate

A

Positively birefringent rhomboid shaped crystals under light microscopy

calcium pyrophosphate

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16
Q

What cells secrete the majority of tumour necrosis factor?

A

Macrophages

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17
Q

What might you see on the palms/soles in someone with reactive arthritis?

A

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

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18
Q

commonest cause of osteomyelitis in general? What about in patients with sickle cell disease

A

S Aureus

Salmonella

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19
Q

What is anti-RNP associated with?

A

Mixed connective tissue disease

RNP - raynaoud, N swollen hands No synovitis, P Pain in musces + joints

20
Q

Dactylitis and DIP joint swelling indicate what?

A

Psoriatic arthritis

21
Q

In patient’s allergic to aspirin, what else might they react to?

A

Sulfasalazine (5-ASA)

22
Q

What joints are characteristically affected in the hand in osteoarthritis?

A

Carpometacarpal + DIPJs

23
Q

What is the minimum steroid intake a patient should be taking before they are offered osteoporosis prophylaxis?

A

7.5mg or more each day for 3 months

24
Q

What collagen is defected in Ehler-Danlos syndrome?

A

Type 3

25
Q

What collagen is defected in osteogenesis imperfecta?

A

Type 1

26
Q

What collagen is defected in goodpasture’s?

A

Type 4

27
Q

What protein is effected in marfan’s syndrome?

A

Fibrillin 1

28
Q

What antibody is highly sensitive for SLE?

what antibodies are highly specific for

A

Sensitive: ANA (therefore good rule out test) - has low specificity

Specific: ant dsDNA + anti Sm

29
Q

How does anikinra work?

A

IL-1 inhibitor

30
Q

Restless leg syndrome drug treatment + MoA

A

Ropinirole (dopamine agonist)

31
Q

Poor prognosis RA

A 
rheumatoid factor positive
anti-CCP antibodies
poor functional status at presentation
X-ray: early erosions (e.g. after < 2 years)
extra articular features e.g. nodules
HLA DR4
insidious onset
32
Q

When are topical NSAIDs indicated in OA?

A

Knee or hand involvement

33
Q

What rheumatological drug might patients be allergic to if they are allergic to aspirin?

A

Sulfasalazine

34
Q

Antibodies in sjogren’s?

A

anti Ro + La

35
Q

HLA in RA?

A

DRB1 04:01

36
Q

In RA what Ix is best for detecting early disease/synovial inflammation?

A

Colour doppler US (detects earlier than MRI)

37
Q

EXAM Q: What part of the nephron does PTH act on?

A

Proximal tubule

decreases phosphate reabsorption

38
Q

Gout vs pseudogout radiological features?

A

Pseudogout: chondrocalcinosis (white lines)

39
Q

Gout vs pseudogout birefringment + microscopy?

A

Gout: negative + needle shaped of uric acid crystals

Pseudogout: rhomboid crystals + weakly positive. Calcium pyrophosphate crystals

40
Q

In thrombocytopaenia in SLE, what drug should be used?

A

Hydroxychloroquine

41
Q

Calcium level in osteomalacia?

A

Low

42
Q

Systemic sclerosis + chronic diarrhoea –> what is this likely to be? What is the treatment?

A

small intestine bacterial overgrowth syndrome

Metronidazole

43
Q

In reactive arthritis what might you see on the palms and soles?

A

Keratoderma blennhoragiccum

44
Q

3 antibodies seen in antiphospholipid syndrome?

A

Lupus anticoagulant
Anti-cardiolipid
anti-B2 glycoprotein

45
Q

Felty syndrome triad

A

RA
Splenomegaly
Low wcc

MRCP Part 1 (19 decks)

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