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AA Y4 Finals cards NE > Rheumatology > Flashcards

Rheumatology Flashcards

1
Q

Name the 4 signs of OA on XR?

A
  1. Loss of joint space
  2. Osteophytes
  3. Subchondral sclerosis
  4. Subchondral cysts
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2
Q

What are 1st line pharmacological management of OA?

A

Paracetamol and topical NSAIDs

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3
Q

What are 2nd line pharmacological management of OA?

A

Oral NSAIDs (+PPI), opioids, IA steroid injections

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4
Q

Describe the serology seen in RA?

A

RF +ive

Anti-CCP positive

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5
Q

Describe the 1st line treatment of RA?

A

methotrexate
DMARD mono therapy and short course of prednisolone

Steroid used as a bridging treatment until the DMARD kicks in

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6
Q

What do NICE recommend using to monitor RA disease activity?

A

CRP and DAS28 score

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7
Q

What tests must be done prior to starting someone on methotrexate? Why?

A

FBC
LFTs

Methotrexate can cause myelosupression and cirrhosis

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8
Q

Other than methotrexate, name 3 DMARDs?

A

Sulfasalazine
Hydroxychloroquine
leflunomide

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9
Q

When is anti-TNF therapy indicated in RA?

A

When there has been an inadequate response to 2 DMARDs

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10
Q

Name 2 anti-TNF drugs?

A
  1. Infliximab

2. Etanercept

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11
Q

Are spondylarthropathies sero +ive or -ive?

What does seronegative mean?

A

All spondylarthropathies are seronegative

They are negative for rheumatoid

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12
Q

Describe some key features of spondylarthropathies

A
  1. inflammatory arthritis (typically fewer than 5 lower limb joints)
  2. Dactylitis (swelling of entire finger)
  3. Enthesitis
  4. Anterior uveitis, ulcers, rashes
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13
Q

Which disease is associated with ‘bamboo spine’ in XR

A

Ank spond

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14
Q

Why might a young man with ank spond suffer with red eye and blurred vision

A

Associated with anterior uveitis

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15
Q

Which aortic murmur is associated with ank spond?

A

Aortic regurgitation

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16
Q

Which blood tests are raised in an acute flare of ank spond?

A

Raised ESR and CRP

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17
Q

In psoriatic arthritis, what tends to develop 1st? Arthritis or psoriasis?

A

Psoriasis develops 1st

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18
Q

How is psoriatic arthritis managed?

A

Same as RA

1st line: NSAIDs, physio

Progressive disease: DMARDs, anti-TNF

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19
Q

What does “can’t see, can’t pee, can’t bend the knee” describe

A

Reactive arthritis

Patients present with uveitis, urethritis and arthritis.

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20
Q

Describe the history preceding reactive arthritis

A

Develops 1-4 weeks after an infection, usually a gastroenteritis (salmonella) or STI (chlamydia)

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21
Q

Is reactive arthritis sterile or septic?

A

It is a sterile synovitis

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22
Q

Which joint is commonly affected in reactive arthritis?

A

Knee

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23
Q

What is another name for the triad seen in reactive arthritis?

A

Reiter’s syndrome

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24
Q

What 2 investigations should be done in reactive arthritis?

A
  1. Urine chlamydia

2. Joint aspirate (rule out septic arthritis)

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25
Q

How is reactive arthritis that becomes relapsing and remitting treated?

A

DMARDs

Normally, it can be treated with just rest and NSAIDs

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26
Q

Which type of arthritis may present with GI upset and erythema nodosum?

A

Enteropathic arthritis

Arthritis associated with IBD

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27
Q

Name 3 ways in which urate secretion may be reduced?

A
  1. CKD
  2. Hypothyroidism
  3. Drugs - diuretics, chemotherapies
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28
Q

The deposition of needle shaped, negatively bifringent sodium urate crystals in joints is indicative of which disease?

A

Gout

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29
Q

Why may gout be difficult to differentiate from psoriatic arthritis?

A

Chronic gout can result in the development of tophi.

Tophi are large, painless, white deposits of sodium urate

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30
Q

Describe the difference in the crystals seen in gout vs pseudogout?

A

Gout - needle shaped, negatively bifringent sodium urate crystals

Pseudogout - rhomboid shaped, weakly positive calcium pyrophosphate crystals

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31
Q

Describe the management of acute gout

A

Dietary advice

1st line: NSAIDs with PPI

2nd line: Colchine (if NSAIDS are C/I’d)

3rd line: steroids

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32
Q

How is chronic gout managed? When is chronic management indicated?

A
  1. Allupurinol
  2. Febuxostat

Chronic management indicated after 1st acute flare up
Chronic management shouldn’t be started until 2-4 weeks after flare up

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33
Q

Which drug can allopurinol not be given alongside?

A

Azathioprine (DMARD)

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34
Q

Describe the difference in distribution between RA and psoriatic arthritis?

A

RA typically presents as a symmetrical polyarthritis

Psoriatic arthritis most commonly presents as an oligoarthritis (it involves fewer than 3 joints for the 1st 6 months)

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35
Q

What class of drug are allopurinol and febuxosat?

A

Xanthase oxidase inhibitors

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36
Q

How does the distribution of pseudogout differ from that of gout?

A

Pseudogout tends to affect knee, wrist and shoulder

Gout tends to affect small joints in the foot

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37
Q

What will XR of pseudogout show?

A

Chondrocalcinosis

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38
Q

How does management of pseudogout differ from gout?

A

Both have the same acute management:

  1. NSAIDs +/- IA steroids
  2. Colchine
  3. Steroids

BUT - pseudogout has no prophylactic treatment (ie- dont use allopurinol)

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39
Q

What type of hypersensitivity reaction is SLE?

A

T3 hypersensitivity

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40
Q

At least 4 of which body areas need to be affected for a diagnoses of SLE to be made?

A
  1. Consitiutional: fever, wt loss, malaise
  2. Skin - malar rash
  3. Membranes
  4. MSK- non erosive small joint arthritis
  5. Serotosis (pleuritis, pericarditis)
  6. Kidneys
  7. CVS
  8. CNS
  9. Haem: lymphadenopathy, thrombocytopenia
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41
Q

Name the 4 immunological tests that can be used to identify SLE?

A
  1. Anti-ANA
  2. Anti-dsDNA
  3. Anti-ENA
  4. Complement
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42
Q

Describe the specificity of anti-dsDNA?

A

anti-dsDNA is more specific than anti ANA

Titire of anti-dsDNA correlates with disease activity - high titre indicates active disease

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43
Q

Which type of anti-ENA antibody can be passed from mother to foetus and cause neonatal lupus or congenital heart block?

A

Anti-Ro

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44
Q

Which diseases is anti-Ro associated with?

A

Cutaneous disease and secondary sjogren’s

Anti-Ro is commonly found alongside anti-La

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45
Q

What does complement level indicate in SLE?

ie - what does a low C3/C4 level indicate regarding SLE

A

It reflects disease activity

A low C3/C4 level indicates active disease

46
Q

Describe how mild, moderate and severe SLE is managed?

A

Mild: Hydroxychloroquine, NSAIDs, topical steroids

Moderate: immunosupression- methotrexate, azathioprine, oral steroids

Severe: IV steroids, cyclophosphamide, rituximab

47
Q

Which drug most commonly causes drug induced lupus?

A

Hydralazine

48
Q

Which AI condition presents with recurrent DVTs, recurrent unexplained miscarriages and migraines?

A

Anti-phospholipid syndrome

49
Q

Give 3 clinical manifestations of anti-phospholipid syndrome?

A

Thrombocytopenia
Superficial thrombophlebitis
Transverse myelitis

50
Q

Name the 3 antibodies that are positive in anti-phospholipid syndrome?

A

Anti-cardiolipin
Lupus anti-coagulation test
Anti B2 glycoprotein

51
Q

what is given for primary prophylaxis in anti phospholipid syndrome?

ie - in those who have not yet experienced a VTE?

A

Low dose aspirin

52
Q

How is a secondary thrombosis managed in anti-phospholipid syndrome?

A

Patients are on life long warfarin following a VTE

If the event happens while patient is on warfarin, add low dose aspirin too

53
Q

What medication should a pregnant women with anti-phospholipid syndrome take?

A

Aspirin and warfarin during pregnancy

54
Q

Describe the pathophysiology of Sjogren’s syndrome?

A

Lymphocytic infiltration of exocrine glands, usually resulting in their fibrosis

As these glands that usually secrete fluids have been attacked, it results in sicca symptoms

55
Q

What are sicca symptoms?

A

Sicca symptoms = dry eyes, dry mouth

56
Q

What are those with Sjogren’s at an increased risk of?

A

Hodgkins B cell lymphoma

57
Q

What is the status of RF and ANA in sjogren’s syndrome?

What 2 antibodies are classed as unique to this disease?

A

RF and ANA +ive

Anti-Ro and Anti-La

58
Q

What does a gland biopsy show in Sjögren’s syndrome?

A

Lymphocytic infiltration

59
Q

Which drug can be used in Sjögren’s syndrome to stimulate salivary and ocular lesions?

What class of drug is this?

A

Pilocarpine

A muscarinic antagonist

60
Q

What is the commonest cause of death in scleroderma?

A

Cardiopulmonary involvement

61
Q

What is scleroderma characterised by?

A

Excessive deposits of collagen in the skin or other organs

62
Q

Why does RA not affect the spine or DIP joints?

A

It only affects joints with synovial fluid…

Only C1 and C2 spinal joints have synovial fluid so they’re the only ones that can be affected by RA

DIP joints are tiny and don’t have much synovial fluid

63
Q

Describe the 2 forms of localised scleroderma?

A

Morphea: there are individual patches of skin fibrosis

Linear: skin fibrosis follows a dermatomal pattern

64
Q

How is systemic sclerosis different from localised scleroderma?

A

Systemic sclerosis has skin fibrosis and also sclerosis of the viscera (organs)

65
Q

Describe the difference between limited and diffuse systemic sclerosis?

Which is more prevalent?

A

Diffuse: skin sclerosis and also organ involvement (dry cough)

Limited: sclerosis only affects distal limbs

Limited sclerosis is more common (70%)

Diffuse sclerosis only makes up 30%

66
Q

Describe the immunological identification of limited vs diffuse systemic sclerosis?

A

Limited: anti-centromere antibodies

Diffuse: anti-Scl antibodies

67
Q

Describe the classic features of limited systemic sclerosis?

(ie - what does CREST+ P stand for?)

A

CREST + P!

Calcinosis 
Raynauds 
Esophageal dysmotility 
Sclerodactyly 
Talangectasia

Pulmonary hypertension

68
Q

How is systemic sclerosis managed?

A

Annual ECHO and chest CT
Control BP - ACEi
Immunosuppression- azathioprine
Pulmonary hypertension- bosentan

69
Q

What is the difference between dermatomyositis and polymyositis?

A

They are the same disease.

The only difference is dermatomyositis has skin involvement too

70
Q

Briefly describe the cause of polymyositis?

A

Muscle inflammation causing weakness

71
Q

Describe the presentation of polymyositis?

A

Proximal muscle weakness, slow onset

Usually affects the shoulder girdles

Presents as difficulties with ADLs

raised CK

72
Q

Describe the skin manifestations in dermatomyositis?

A

Gottron’s sign - scaly, pink, rough papules over the knuckles

Shawl sign - macular rash over the back and shoulders

Heliotropic rash around the eyes

Photosensitive

73
Q

What is the most common systemic manifestation of polymyositis?

A

SOB due to interstitial lung disease

74
Q

Name other manifestations of polymyositis?

A 
Dysphagia
Myocarditis 
Fever
Weightloss 
Raynauds 
Polyarthritis
75
Q

Those with polymyositis are at increased risk of which cancers?

A

Breast, ovarian, lung, bladder and bowel malignancies

76
Q

Which blood test is very elevated in polymyositis?

A

Very raised CK

77
Q

What investigation is diagnostic in polymyositis?

A

Biopsy

Shows perivascular inflammation and muscle necrosis

78
Q

How is dermo/polymyositis managed?

A

Malignancy screening

Immunosupression: steroids and DMARDs (azathioprine)

79
Q

What sex is polymyositis more common in?

A

Woman aged 30-50

80
Q

What are the 5 factors make inclusion body myositis different from polymyositis?

A
  1. Affects men more than women
  2. Muscle weakness is asymmetrical
  3. CK isn’t as elevated as in polymyositis
  4. Biopsy shows inclusion bodies
  5. Responds poorly to treatment
81
Q

How is the presentation of polymyositis different from poly myalgia rheumatica (PMR)?

Name 2 factors?

A
  1. PMR tends to present with muscle pain rather than weakness
  2. CK is normal in PMR (unlike polymyositis)
82
Q

Describe systemic features of PMR?

A

Fatigue, fever, weightless, depression

83
Q

How is PMR treated?

What if it is complicated by GCA?

A

15mg oral prednisolone

A dramatic response is seen within a few days

If GCA, 40-60mg oral prednisolone

84
Q

Which vasculitis causes a saddle nose deformity? Why?

A

GPA - saddle nose occurs due to nasal cartilage collapse

85
Q

Why do small vessel vasculitis present with haematuria and proteinuria?

A

Due to the rapidly progressing glomerulonephritis

86
Q

Which vasculitis is C-ANCA positive and which is P-ANCA positive?

A

C-ANCA: GPA

P-ANCA: EGPA (eosinophilic GPA)

87
Q

Which vasculitis presents with late onset asthma, sinusitis and mono neuritis multiplex?

A

Eosinophilic GPA

88
Q

What blood component is raised in EGPA?

A

Eosinophils!

89
Q

Describe the immunology in EGPA?

A

P-ANCA positive

MPO positive

90
Q

Describe the immunology in GPA?

A

C-ANCA positive

PR3 positive

91
Q

Name 2 side effects of azathioprine toxicity?

A

Bone marrow suppression and pancreatitis

92
Q

Give the reasons why XRays are required prior to starting methotrexate or biologics?

A

Methotrexate can cause pneumonitis

Biologics can reactivate latent TB

93
Q

What enzyme must be tested for prior to starting azathioprine?

A

TPMT enzyme

It is responsible for metabolising azathioprine - insufficient quantities of it in the body will lead to azathioprine toxicity

94
Q

How does a PET CT differ from a normal CT?

A

In PET CTs, glucose is injected and its uptake is monitored by the CT scan

Allows areas of high energy requirements to be identified (ie- tumours)

95
Q

Which joint of the hand is commonly affected by OA?

A

Carpometacarpal

96
Q

Which part of the MSK system to spondylarthropathies effect?

A

They effect the enthesis

(ie - spinous ligaments etc…)

Result in plantar fasciitis, tendonitis

97
Q

Which 2 conditions does dactylitis exclusively occur in?

A
  1. Psoriatic arthritis

2. Sarcoidosis

98
Q

Name the test specific for sarcoidosis?

A

Serum ACE

99
Q

Why is a FHx in possible psoriatic arthritis so important

A

A family member that has psoriasis is considered the same as the patient themselves having the psoriasis

So, in a patient with arthritis whose mum has psoriasis, they can be diagnosed with psoriatic arthritis

100
Q

Name the main symptoms of Behchet’s disease?

A 
Recurrent oral and genital ulceration 
Uveitis 
Diarrhoea 
Erythema nodosum 
Possible thrombophlebitis and DVT
101
Q

Is large vessel vasculitis ANCA pos or neg?

A

Usually negative

102
Q

Is thrombocytosis a recognised feature of anti-phospholipid syndrome?

A

No

Venous thrombosis is a feature tho

103
Q

Which type of systemic sclerosis presents with early onset respiratory symptoms (like pulmonary fibrosis)

A

Diffuse systemic sclerosis

104
Q

Which blood test is most useful in diagnosing polymyalgia rheumatica?

A

ESR

105
Q

Which medium vessel vasculitis presents with punched out ulcers, renal failure, purpura and is associated with Hep B?

A

Polyarteritis nodosa (PAN)

106
Q

What is the childhood version of polyarteritis nodosa called?

What is the buzzword for this disease?

A

Kawasaki disease

“a child with a strawberry tongue”

107
Q

Which small vessel vasculitis presents with chronic sinusitis, epistaxis, nasal crusting and a cough and hemoptysis?

A

Granulomatous with polyangitis

108
Q

Which small vessel vasculitis presents with late onset asthma and mononeuritis multiplex?

A

Eosinophilic granulomatosis with polyangitis

109
Q

Other than EGPA, which other 2 diseases is P-ANCA associated with?

A
  1. Ulcerative colitis

2. PSC

110
Q

Which vasculitis is most likely to result in a rapidly progressive glomerulonephirits?

A

Microscopic polyangitis

111
Q

How is vasculitis managed?

A

Immunosuppression:

Methotrexate and steroids OR
Azathioprine and steroids

112
Q

Name 2 complications of azathioprine toxicity?

A
  1. Bone marrow supression

2. Pancreatitis

AA Y4 Finals cards NE (40 decks)

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