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Finals Revision > Rheumatology > Flashcards

Rheumatology Flashcards

1
Q

What are the antibodies associated with rheumatoid arthritis?

A

Rheumatoid Factor, Anti-CCP

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2
Q

What are the antibodies associated with SLE and Drug-induced Lupus?

A

ANA

Anti-DSDNA, Anti-Sm, Anti-phospholipid

Drug-induced lupus: Anti-histone antibodies

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3
Q

What are the antibodies associated with Sjogren’s Syndrome?

A

ANA

Anti-Ro and Anti-La

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4
Q

What are the antibodies associated with Anti-phospholipid syndrome?

A

Anti-cardiolipin, Lupus anticoagulant and Anti-B2 glycoprotein 1

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5
Q

What are the antibodies associated with Systemic Sclerosis?

A

ANA

Anti-centromere, Anti-RNA polymerase III, Anti- Scl 70

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6
Q

What are the antibodies associated with Dermatomyositis and Polymyositis?

A

ANA

Anti-Jo1 in both

Anti-Mi2 in polymyositis

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7
Q

What is the blood marker associated with seronegative inflammatory arthritis?

A

HLA-B27

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8
Q

What are the 4 types of seronegative inflammatory arthritis?

A

Psoriatic Arthritis

Reactive Arthritis

Enteropathic Arthritis

Ankylosing Spondylitis

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9
Q

What is the classic pattern of joint involvement in seropositive arthritis?

A

Symmetrical
Small joint
Polyarthritis

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10
Q

What is the classic pattern of joint involvement in seronegative arthritis?

A

Asymmetrical
Larger joint
Mono/oligo arthritis

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11
Q

What is the classic pattern of joint involvement in crystal arthropathy?

A

Asymmetrical
Small-Large joint
Monoarthropathy

Most commonly affecting 1st MTP joint first and moving proximally with disease progression.

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12
Q

What is the classic pattern of joint involvement in Osteoarthritis?

A

Symmetrical
Large and Small Joint
Oligo/Polyarthritis

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13
Q

What would you expect to find on examination in Rheumatoid Arthritis?

A 
Rheumatoid Nodules
Ulnar Drift
Boutonneire Deformity
Swan neck Deformity
Palmar Subluxation
Joint Stiffening, Swelling
Hammer Toe Deformity
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14
Q

What would you expect to find on examination in lupus?

A 
Butterfly/Malar Rash or Discoid Rash
Raynaud's
Photosensitivity
Non-scarring alopecia
Oral Ulcers
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15
Q

What drugs are associated with causing lupus?

A 
Sulfa-drugs
Phenytoin
Isoniazid
Methyldopa
TNFa inhibitors
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16
Q

What would you expect to find on examination in Sjogren’s Syndrome?

A 
Dry eyes and Dry mouth
Raynaud's
May also have vaginal dryness
Vasculitic rash
Parotid gland swelling
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17
Q

What is Schirmer’s Test?

A

Test used in Sjogren’s syndrome to measure tear production.

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18
Q

What are the key symptoms of anti-phospholipid syndrome?

A 
Recurrent vascular thrombosis / unprovoked VTE
Recurrent Miscarriage
Livedo Reticularis
Prolonged APTT
Thrombocytopenia
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19
Q

What would you expect to find on examination in dermatomyositis?

A 
Heliotrope Rash
Gottron's Papule's
Shawl sign over upper chest
Holster sign on lateral thigh
Periungal erythema

Raynaud’s and photosensitivity

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20
Q

What would you expect to find on examination in polymyositis?

A

Heliotrope Rash
Raynaud’s
Proximal muscle weakness
Dysphagia/aspiration

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21
Q

What would you expect to find on examination in systemic sclerosis?

A 
Raynaud's
Thickening of skin over fingers
Taught, shiny skin with pigment change
Sclerodactyl
Oesophageal involvement - dysphagia, GORD/dyspepsia
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22
Q

What would you expect to find on knee aspiration of gout?

A

Negatively birefringent, yellow, needle shaped crystals

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23
Q

What would you expect to find on joint aspiration in pseudo gout?

A

Weakly positively birefringent, blue, rhomboid shaped crystals - calcium pyrophosphate

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24
Q

What would you expect to see on joint x-ray in a person with osteoarthritis?

A

Loss of joint space
Osteophytes
Subchondral cysts
Subcondral sclerosis

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25
Q

What would you expect to see on joint x-ray in gout?

A

First presentation- probably NAD
Chronic disease- periarticular erosion

joint effusion is an early sign
well-defined 'punched-out' erosions
relative preservation of joint space until late 
eccentric erosions
no periarticular osteopenia 
soft tissue tophi may be seen
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26
Q

What is the management for osteoarthritis?

A

Conservative: weight loss, exercise, assistive devices and aids

  1. Paracetamol
  2. Topical NSAIDs - > oral
  3. Intra-articular steroid injection
  4. Joint replacement
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27
Q

What would you expect to see on x-ray in rheumatoid arthritis?

A

Loss of joint space
Erosions
Periarticular osteopenia
Joint deformity

28
Q

Which DMARD is safest in pregnancy?

A

Sulfasalazine

29
Q

What is the management for Gout?

A
  1. NSAIDs to settle acute attack + PPI
    a. Colchicine if renal impairment
    b. Oral steroids also alternative
  2. Allopurinol long term (initiated 2w after acute attack settles) + colchicine cover <6m
    a. Febuxostat = alternative in renal impairment

Lifestyle advice: reduction in red meat and alcohol consumption, stop smoking, exercise/lose weight

Medication review e.g. stopping thiazides

30
Q

What is the management of pseudogout?

A

Oral NSAIDs and PPI
Intra-articular steroid injection
Systemic steroids

31
Q

What are the associated symptoms with reactive arthritis?

A

Conjunctivitis and Urethritis

Can’t see, can’t pee, Can’t climb a tree

32
Q

What are the symptoms associated with ankylosing spondylitis?

A

Lower back pain and stiffness - worst on waking, better with activity
Anterior Uveitis / Iritis
Usually presents in late teens/early 20s

33
Q

What is the test for ankylosing spondylitis?

A

Schober’s test

34
Q

Which condition is most commonly associated with polymyalgia rheumatica?

A

Giant cell arteritis

35
Q

Where does polymyalgia rheumatic most commonly affect?

A

Shoulders
Neck
Pelvic Girdle

Worse with movement and interrupt sleep

36
Q

Which test discriminates between myositis and polymyalgia rheumatica?

A

Creatine Kinase

  • levels raised in true myositis, not in PR
37
Q

What are the key symptoms of GCA?

A

Scalp tenderness
Jaw claudication
Visual disturbance (unilateral)
Amaurosis Fugaux

38
Q

What is the diagnostic test for GCA?

A

Temporal artery biopsy

39
Q

What is the management for GCA?

A

High dose oral prednisolone
IV methylprednisolone if visual changes developing
PPI + bisphosphonates to protect stomach and bones.

40
Q

What are the key symptoms of takayasu’s arteritis?

A 
Limb claudication on exertion
Dizziness on upper limb exertion
Unequal BP in the arms
Absent pulses
Associates with aortic regurgitation
41
Q

What are the key symptoms of Kawasaki Disease?

A 
Child <4/5yo
>5 day history of fever
Strawberry tongue
Vasculitic rash- polymorphic, maculopapular, erythematous
Conjunctivitis
Unilateral cervical lymphadenopathy
42
Q

What is the management for Kawasaki disease?

A

IVIG + high dose aspirin

Z score determines whether aspirin continued

Only scenario where aspirin is given to children

43
Q

What is the classic triad of EGPA?

A

Eosinophilia
Granulomatous inflammation
Vasculitis

ie. associated with asthma, allergic rhinitis, sinusitis

44
Q

What is the classic triad of GPA/Wegener’s?

A

Nasal symptoms, haemoptysis and haematuria

Upper respiratory tract, lower respiratory tract and glomerulonephritis

URT: nasal crusting, epistaxis, otorrhoea/otalgia, ulcers, saddle nose

LRT: SOB, cough, haemoptysis, dyspnoea

GN: haematuria

45
Q

What are the 4 key symptoms of HSP?

A

Purpuric Rash
Abdominal Pain
Arthritis/arthralgia
Glomerulonephritis

46
Q

Which conditions are associated with C and P-ANCA?

A

C-ANCA: GPA/Wegener’s

P-ANCA: EGPA, microscopic polyangiitis, Ulcerative colitis, Primary sclerosing cholangitis

47
Q

What are the systemic features associated with ankylosing spondylitis?

A 
The A's:
Apical fibrosis
Anterior uveitis
Aortic regurgitation
Achilles tendonitis
AV node block
Amyloidosis
and cauda equina syndrome
peripheral arthritis (25%, more common if female)
48
Q

What is the management for anti-phospholipid syndrome?

A

Aspirin low-dose = primary thromboprophylaxis

Secondary= lifelong warfarin with target INR 2-3

49
Q

What are the common adverse effects of azathioprine?

A

bone marrow depression
nausea/vomiting
pancreatitis
increased risk of non-melanoma skin cancer

Thiopurine methyltransferase (TPMT) test may be needed to look for individuals prone to azathioprine toxicity

50
Q

What are the common features of Behcet’s syndrome?

A

Oral ulcers + genital ulcers + anterior uveitis

thrombophlebitis and deep vein thrombosis
arthritis
neurological involvement (e.g. aseptic meningitis)
GI: abdo pain, diarrhoea, colitis
erythema nodosum

51
Q

What are adverse effects of bisphosphonates?

A

Risk of gastritis
Increased risk of jaw osteonecrosis
Increased risk of femoral shaft fractures
acute phase response: fever, myalgia and arthralgia may occur following administration

52
Q

What is denosumab?

A

Second-line treatment for OA

It is a human monoclonal antibody that prevents the development of osteoclasts by inhibiting RANKL

53
Q

What is Ehler-Danlos Syndrome?

A

autosomal dominant connective tissue disorder that mostly affects type III collagen

Features:
elastic, fragile skin
joint hypermobility: recurrent dislocation
easy bruising
aortic regurgitation, mitral valve prolapse and aortic dissection
subarachnoid haemorrhage
angioid retinal streaks

54
Q

What is Marfan’s syndrome?

A

Autosomal dominant connective tissue disorder- defect in FBN1 gene which codes for fibrillin.

55
Q

What are the features of Marfan syndrome?

A 
Tall stature
High-arched palate
Arachnodactyly
Pectus excavatum
Scoliosis
Flatfoot (pes Planus)
Dilation of aortic sinuses, aortic aneursym, aortic regurge
Mitral valve prolapse in 75%
Repeated pneumothoraces
Blue sclera
56
Q

What are the prescribing considerations for methotrexate?

A

Taken weekly
Folic acid should be taken alongside 5mg weekly
FBC, U&E and LFTs need to be regularly monitored- weekly until stabilised, then every 2-3m

Avoid prescribing alongside trimethoprim or cotrimoxazole

In the case of methotrexate toxicity, folinic acid should be given

57
Q

What is osteogenesis imperfecta?

A

Disorders of collagen metabolism resulting in bone fragility and fractures
Type 1 = most common
Autosomal dominant inheritance

presents in childhood
fractures following minor trauma
blue sclera
deafness secondary to otosclerosis
dental imperfections are common
58
Q

What is osteomalacia?

A

Softening of the bones due to low vitamin D levels -> decreased bone mineral content

Causes:
Vit D deficiency (diet/malabsorption/lack of light)
CKD
Anticonvulsants
Liver cirrhosis
59
Q

What are symptoms of osteomalacia?

A

bone pain
bone/muscle tenderness
fractures: especially femoral neck
proximal myopathy: may lead to a waddling gait

Bloods show: low vis D, calcium, phosphate but raised ALP and PTH
Translucent bands on x-ray

60
Q

How is osteomalacia managed?

A

Vitamin D supplements

Calcium supplements

61
Q

How do you assess patients with osteoporosis?

A

If >75 and have a fragility fracture- start bisphosphonate without need for DEXA

If <75, DEXA scan should be arranged and used in a FRAX score

62
Q

How should osteoporosis be managed?

A

DEXA scan and FRAX score if appropriate
Vitamin D and calcium supplementation should be offered to all women unless confident it is unnecessary
Alendronate = first line
If can’t tolerate: risedronate or etidronate

Strontium ranelate and raloxifene are recommended if patients can’t tolerate bisphosphonates

HRT can also help reduce risk of post-menopausal osteoporosis

63
Q

What are features of polymyositis?

A 
proximal muscle weakness +/- tenderness
Raynaud's
respiratory muscle weakness
interstitial lung disease: e.g. fibrosing alveolitis or organising pneumonia
dysphagia, dysphonia
64
Q

What is first line treatment for Raynaud’s?

A

Nifedipine

65
Q

What triad of features make up Felty’s syndrome?

A

RA + splenomegaly + low WCC

Finals Revision (23 decks)

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