Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

MSRA > Rheumatology > Flashcards

Rheumatology Flashcards

1
Q

ank spond treatment?

A
  • encourage regular exercise such as swimming
  • NSAIDs are the first-line treatment
  • physiotherapy

DMARDS (e.g. sulfasalazine) in severe disease.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Diagnosis of old man, bone pain, raised ALP?

A

pagets

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Hypersensitivity reactions - types?

A

Type 1 - Anaphylaxis

Type 4 - delayed hypersensitivity

2 and 3 and 5 all kinds of other shit

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Most common cause of death in marfans?

A

Aortic dissection

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

femoral nerve stretch test?

A

Patient lies on their side and the hip is extended with a straight leg. Flexing the knee then recreates the pain

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

RA specific antibodies?

A

AntiCCP

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

SLE antibodies

A

Anti-dsDNA

ANA is positive always

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

When to give bisphosphonates in osteoporosis?

A

Treatment is indicated following osteoporotic fragility fractures in postmenopausal women who are confirmed to have osteoporosis (a T-score of - 2.5 SD or below).

In women aged 75 years or older, a DEXA scan may not be required ‘if the responsible clinician considers it to be clinically inappropriate or unfeasible’.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What bloods do you need to check before starting azathioprine?

A

check thiopurine methyltransferase deficiency (TPMT) before treatment

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Features of PMR?

A

typically patient > 60 years old
usually rapid onset (e.g. < 1 month)
aching, morning stiffness in proximal limb muscles
weakness is not considered a symptom of polymyalgia rheumatica
also mild polyarthralgia, lethargy, depression, low-grade fever, anorexia, night sweats

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Common causes of drug induced lupus?

A

procainamide

hydralazine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Management of PMR?

A

Steroids (e..g pred 15mg OD)
Review in 1 week
If not responding reconsider diagnosis.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What is Livedo reticularis?

A

Livedo reticularis is the skin rash most commonly associated with antiphospholipid syndrome

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Common drug cause of cataracts?

A

Pred

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Common drug cause of Corneal opacities?

A

Hydroxychloroquine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Common drug cause of Interstitial lung disease?

A

Sulfasalazine and leflunomide

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Ank spond examination features?

A
  • reduced lateral flexion
  • reduced forward flexion - Schober’s test - a line is drawn 10 cm above and 5 cm below the back dimples (dimples of Venus). The distance between the two lines should increase by more than 5 cm when the patient bends as far forward as possible
  • reduced chest expansion
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Features of osteomalacia?

A
  • bone pain
  • bone/muscle tenderness
  • fractures: especially femoral neck
  • proximal myopathy: may lead to a waddling gai
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Osteoporosis management?

A

Alendronate first line, if not tolerated then risendronate. If neither are tolerated then rheum referral for ?strontium ranelate or raloxifene

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Treatment of pagets disease?

A

Bisphosphonates

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What food do you need to avoid with gout?

A

Liver, kidneys, seafood, oily fish (mackerel, sardines) and yeast products

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Methotrexate side effects?

A

Myelosuppression
Liver cirrhosis
Pneumonitis
Pneumonitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Sulfasalazine side effects?

A

Rashes
Oligospermia
Heinz body anaemia
?Interstitial lung disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Leflunomide side effects?

A

Liver impairment
Interstitial lung disease
Hypertension

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Hydroxychloroquine side effects?

A

Retinopathy

Corneal deposits

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

prednisolone side effects?

A 
Cushingoid features
Osteoporosis
Impaired glucose tolerance
Hypertension
Cataracts
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

Gold side effects?

A

Proteinuria

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

penicillamine side effects ?

A

Proteinuria

Exacerbation of myasthenia gravis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

Etanercept, infliximab, adalimumab side effect?

A

Reactivation of TB?

30
Q

What factors predict poor prognosis in 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
31
Q

What joints can you give topical nsaids for osteoarthritis?

A

Hands or knee

32
Q

What do you do if a patient has been on bisphosphonates for 5 years?

A

Reassess fracture risk with DEXA/Bisphosphonates and risk factors:

Age >75
Glucocorticoid therapy
Previous hip/vertebral fractures
Further fractures on treatment
High risk on FRAX scoring
T score
33
Q

Diagnosis for long term steroid therapy and insidious onset joint pain on movement?

A

Osteonecrosis of femoral head

34
Q

Untreated physical signs of pagets disease?

A

bowing of tibia, bossing of skull

35
Q

Skin changes in reactive arthritis?

A 
circinate balanitis (painless vesicles on the coronal margin of the prepuce)
keratoderma blenorrhagica (waxy yellow/brown papules on palms and soles)
36
Q

Management of phospholipid syndrome?

A

Management - based on EULAR guidelines

Primary thromboprophylaxis (no VTE)
low-dose aspirin
Secondary thromboprophylaxis (had VTE)
- initial venous thromboembolic events: lifelong warfarin with a target INR of 2-3
  • Recurrent venous thromboembolic events: lifelong warfarin; if occurred whilst taking warfarin then consider adding low-dose aspirin, increase target INR to 3-4
  • Arterial thrombosis should be treated with lifelong warfarin with target INR 2-3
37
Q

When you start allopurinol for the first time what other drug may you also need to prescribe?

A

Colchicine cover should be considered when starting allopurinol.

NSAIDs can be used if colchicine cannot be tolerated.

The BSR guidelines suggest this may need to be continued for 6 months

38
Q

RA xray changes?

A

Early x-ray findings

  • loss of joint space
  • juxta-articular osteoporosis
  • soft-tissue swelling

Late x-ray findings

  • periarticular erosions
  • subluxation
39
Q

Management of raynauds phenomena?

A 
all patients with suspected secondary Raynaud's phenomenon should be referred to secondary care
first-line: calcium channel blockers e.g. nifedipine
IV prostacyclin (epoprostenol) infusions: effects may last several weeks/months
40
Q

Causes of raynauds phenomena?

A

Raynaud’s disease (primary) typically presents in young women (e.g. 30 years old) with bilateral symptoms.

Secondary causes of Raynaud’s phenomenon

  • connective tissue disorders; scleroderma (most common); rheumatoid arthritis; systemic lupus erythematosus
  • leukaemia
  • type I cryoglobulinaemia, cold agglutinins
  • use of vibrating tools
  • drugs: oral contraceptive pill, ergot
  • cervical rib
41
Q

What investigations should you perform before starting biologics?

A

Tuberculin skin test and CXR to look for active or latent TB

42
Q

What pt groups are advised to take vitamin d supplementation?

A

all pregnant and breastfeeding women should take a daily supplement containing 10µg of vitamin D

all children aged 6 months - 5 years. Babies fed with formula milk do not need to take a supplement if they are taking more than 500ml of milk a day, as formula milk is fortified with vitamin D

adults > 65 years

‘people who are not exposed to much sun should also take a daily supplement’ e.g. housebound patients

43
Q

Calcium, PTH, ALP and phosphate in CKD? (secondary hyperparathyroidism)

A

Low serum calcium, raised serum phosphate, raised ALP and raised PTH

Kidneys not able to activate vit d or excrete phosphate (calcium then is used up boud to phosphate - calcium phospahte) - the low blood calcium raises PTH (to raise calcium levels, osteoclasts activated which raises ALP.

44
Q

Bleeding times (APTT and PT) and Plts in antiphospholipid syndrome?

A

Antiphospholipid syndrome leads to a raised APTT and normal PT and can result in thrombocytopenia.

45
Q

Calcification of cartilage on XR common in gout or pseudogout?

A

Pseudogout

46
Q

Location of heberdens and bouchards nodes?

A

Heberden’s nodes - swelling of the distal interphalangeal joints.

Bouchard’s nodes - swelling of proximal interphalangeal joints

47
Q

How long does chronic fatigue syndrome have to be present for diagnosis?

A

4 months

48
Q

If someone is going to start long term steroid therapy what is the guidelines around bone protection?

A

If above 65 or previous fragility fracture - start

If not then do DEXA.

Greater than 0 - Reassure
Between 0 and -1.5- Repeat bone density scan in 1-3 years
Less than -1.5 - Offer bone protection

49
Q

Associated conditions/features of Ank spond?

A 
Apical fibrosis
Anterior uveitis
Aortic regurgitation
Achilles tendonitis
AV node block
Amyloidosis
50
Q

What RA drug should be avoided if allergic to aspirin?

A

Sulfasalazine

51
Q

How does femoroacetabular impingement present?

A

active young adult

hip/groin pain worse on prolonged sitting and associated with snapping, clicking or locking of the hip

52
Q

How many episodes of gout before offering allopurinol?

A

Just offer after first

53
Q

Where is pain often felt in radial tunnel syndrome?

A

Tender distal to the common extensor origin with no pain overlying the lateral epicondyle itself

54
Q

Common SE of colchicine to warn patients of?

A

Diarrhoea

55
Q

Drug causes of gout?

A 
diuretics: thiazides, furosemide
ciclosporin
alcohol
cytotoxic agents
pyrazinamide
aspirin
56
Q

What test should you use to diagnose RSV?

A

Nasopharyngeal aspirate

57
Q

Colles fracture in ventrally of dorsally displaced?

A

dorsally

58
Q

What is the urinary sodium in pre-renal failure?

A

Low (<20)

59
Q

What is the most common cause of renal AKI?

A

acute tubular necrosis

60
Q

What is the urinary sodium and the urea in acute tubular necrosis?

A

Urea <150

Sodium typically >30

61
Q

Difference in UTI relapse and recurrent UTI?

A

Recurrent if new organism

Relapse if the same

62
Q

Epilepsy choice of drug summarised

A

All have sodium valproate as first line option apart from focal which has carbamazapine or lamotrigine.

Absence has ethosuximide as well
Tonic clonic has lamotrigine as well

63
Q

Most common type of renal stone?

A

Calcium oxalate

64
Q

COmmon ABG finding with PE?

A

Type 1 resp failure (May blow off CO2 and be alkalotic)

65
Q

What drugs to avoid if taking azathioprine?

A

Allopurinol, ACEI and Warfarin

66
Q

What antihypertensives may cause impotence?

A

Thiazides and b-blockers

67
Q

extra -renal complications of PCKD?

A

Mitral valve prolapse
Berry aneurysms
increased colonic dilatations
RCC

68
Q

What vitamin deficiency is most associated with angular chelitis?

A

B2

69
Q

What organism commonly causes erysipelas?

A

Strep pyogenes

70
Q

Reed sternberg cells indicate what?

A

hodgkins lymphoma

71
Q

What antidepressants have the least drug interactions?

A

Citalopram and sertraline

MSRA (22 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions