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Passmed > Rheumatology > Flashcards

Rheumatology Flashcards

1
Q

Presentation of antiphospholipid syndrome

A

CLOTS

  • clots
  • livedo reticularis (net like mottling of the skin)
  • obstetric complications
  • thrombocytopenia

Ix

  • diagnostic blood tests:
    • thrombocytopenia and a paradoxically prolonged APTT, as well as positive anti-phospholipid antibodies. These antibodies include anti-cardiolipin, anti-beta-2-glycoprotein-1 antibodies and lupus anti-coagulant.
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2
Q

What is Ewing’s sarcoma?

A

Malignant tumour that occurs most frequentlt in teh diaphyssi of the pelvis and long bones

  • affects children
  • onion skin appearance on xray
  • fna of lesion shows EWS-FLI1 protein
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3
Q

Name benign bone tumours

A
  • osteoma
  • osteochondroma
  • giant cell tumour
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4
Q

Name malignant bone tumours

A
  • osteosarcoma
  • Ewing’ sarcoma
  • chondrosarcoma
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5
Q

What is an osteoma?

A
  • benign ‘overgrowth’ of bone, most typically occuring on the skull
  • associated with Gardner’s syndrome (a variant of familial adenomatous polyposis, FAP)
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6
Q

What is an osteochondroma?

A
  • most common benign bone tumour
  • more in males, usually diagnosed in patients aged < 20 years
  • cartilage-capped bony projection on the external surface of a bone
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7
Q

What is a giant cell tumour?

A
  • tumour of multinucleated giant cells within a fibrous stroma
  • peak incidence: 20-40 years
  • occurs most frequently in the epiphyses of long bones
  • X-ray shows a ‘double bubble’ or ‘soap bubble’ appearance
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8
Q

What is an osteosarcoma?

A
  • most common primary malignant bone tumour
  • children and adolescents
  • occurs in the metaphyseal region of long bones prior to epiphyseal closure:
    • with 40% occuring in the femur, 20% in the tibia, and 10% in the humerus
  • x-ray shows Codman triangle (from periosteal elevation) and ‘sunburst’ pattern
  • mutation of the Rb gene significantly increases risk of osteosarcoma (hence association with retinoblastoma)
  • other predisposing factors include Paget’s disease of the bone and radiotherapy
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9
Q

What is Chondrosarcoma?

A
  • malignant tumour of cartilage
  • most commonly affects the axial skeleton
  • more common in middle-age
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10
Q

What is dermatomyositis

A
  • an inflammatory disorder causing symmetrical, proximal muscle weakness and characteristic skin lesions
  • may be from underlying malignancy
  • 80% are ANA positive
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11
Q

What is Marfan’s syndrome?

A

Marfan’s syndrome is an autosomal dominant connective tissue disorder. It is caused by a defect in the FBN1 gene on chromosome 15 that codes for the protein fibrillin-1.

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12
Q

Common side effects of biphosphonates

A
  • oesophageal reactions
  • osteonecrosis of the jaw
  • atypical stress fracture
  • hypocalcaemia
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13
Q

Features of psoriatic arthropathy

A
  • symmetrical polyarthritis
  • asymmetrical oligoarthritis
  • sacroilitis
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14
Q

CREST syndrome

A

Type of systemic sclerosis

  • Calcinosis
  • Raynaud’s phenomenon
  • Oesophageal dysmotility
  • Sclerodactly
  • Telangiectasia
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15
Q

What is a type I hypersensitivity

A
  • Anaphylaxis
  • atopy (asthma, eczema, hayfever)
  • Antigen reacts with IgE bound to mast cells
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16
Q

What is a type II hypersensitivity?

A

Cell bound

- Autoimmune haemolytic anaemia
• ITP
• Goodpasture's syndrome
• Pernicious anaemia
• Acute haemolytic transfusion reactions
• Rheumatic fever
• Pemphigus vulgaris / bullous pemphigoid
  • IgG or IgM binds to antigen on cell surface
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17
Q

What is type III hypersensitivity?

A

Immune complex

Serum sickness
• Systemic lupus erythematosus
• Post-streptococcal glomerulonephritis
• Extrinsic allergic alveolitis (especially acute phase)

  • Free antigen and antibody (IgG, IgA) combine
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18
Q

What is Type IV hypersensitivity

A

Delayes hypersensitivity

T cell mediated

Tuberculosis / tuberculin skin reaction
• Graft versus host disease
• Allergic contact dermatitis
• Scabies
• Extrinsic allergic alveolitis (especially chronic phase)
• Multiple sclerosis
• Guillain-Barre syndrome
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19
Q

Aspiration of gout shows

A

Negatively birefringent crystals

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20
Q

Blood tests of an osteomalacia patient

A

Low calcium and phosphate

High alkaline phosphotase

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21
Q

Treatment for osteomalacia

A

Vitamin D supplementation

- a loading dose is often needed initially

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22
Q

What is a poor prognosis for 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
23
Q

Drug interactions of methotrexate?

A

avoid prescribing trimethoprim or co-trimoxazole concurrently - increases risk of marrow aplasia
high-dose aspirin increases the risk of methotrexate toxicity secondary to reduced excretion
*treatment of choice for methotrexate toxicity is folinic acid

24
Q

X-ray findings of ankolysis spondylitis

A

Subchondral erosions, sclerosis and sqauring of lumbar vertebrae
Syndesmophytes

25
Q

What antibodies seen in drug induced lupus?

A

Anti-histone antibodies

26
Q

Skin features in dermatomyositis

A

photosensitive
macular rash over back and shoulder
heliotrope rash in the periorbital region
Gottron’s papules - roughened red papules over extensor surfaces of fingers
‘mechanic’s hands’: extremely dry and scaly hands with linear ‘cracks’ on the palmar and lateral aspects of the fingers
nail fold capillary dilatation

27
Q

Blood tests seen in osteoporosis

A

Normal Ca, PO, ALP, PTH

28
Q

Blood tests seen in osteomalacia

A

Decreased Ca and PO

Increased ALP and PTH

29
Q

Blood tests seen in primary hyperparathyroidism

Osteitis fibrosa cystica

A

Increased Ca, ALP and PTH

Decreased phosphate

30
Q

Blood tests seen in CKD

Secondary hyperparathyroidism

A

Decreased Ca

Increased phosphate, ALP, PTH

31
Q

Blood tests seen in Paget’s disease

A

Normal Ca, PO, PTH

Increased ALP

32
Q

Blood tests seen in osteopetrosis

A

All normal

Ca, PO, ALP, PTH

33
Q

Blood tests in osteogenesis imperfecta

A

Normal Ca, PO, PTH, ALP

34
Q

Ankolysing spondylitis features

A

The A’s

  • apical fibrosis
  • anterior uveitis
  • aortic regurgitation
  • achilles tendonitis
  • AV node block
  • Amyloidosis
35
Q

DEXA scan

How is Z score adjusted

A

Age, gender, ethnic factors

36
Q

DEXA scan

What is T score based on

A

Based on bone mass of young reference population

37
Q

HLA- A3 association

A

Haemochromotosis

38
Q

HLA-B51 association

A

Bechet’s disease

39
Q

HLA-B27 assosciation

A
  • ankolysing spondylitis
  • reactive arthritis
  • acute anterior uveitis
40
Q

HLA-DQ2/ DQ8 association

A
  • coeliac disease
41
Q

HLA-DR2 association

A
  • narcolepsy

- Goodpasture’s

42
Q

HLA-DR3 association

A
  • dermatitis herpetiformis
  • Sjogren’s syndrome
  • primary biliary cirrhosis
43
Q

HLA-DR4 association

A
  • T1DM

- RA (in particular the DRB1 gene)

44
Q

What score is used for hypermobility?

A

Beighton score

45
Q

Adverse effects of methotrexate

A
  • mucositis
  • myleosuppression
  • pneumonitis
  • pulmonary fibrosis
  • liver fibrosis
46
Q

What is Felty’s syndrome?

A

Splenomegaly and neutropenia in a patient with RA

47
Q

Antibodies associated with Sjogren’s syndrome

A
  • anti-Ro (70%)

- anti-La (30%)

48
Q

What are the rotator cuff muscles

A

SItS

  • supraspinatus
  • infraspinatus
  • teres minor
  • subscapularis
49
Q

Function of supraspinatus

A

Abducts arm before deltoid and is most commonly injured

50
Q

Function of infraspinatus

A

Rotates arm laterally

51
Q

Function of teres minor

A

Adducts and rotates arm laterally

52
Q

Function of subscapularis

A

Adducts and rotates arm medially

53
Q

Which drugs co-prescribed casues bone marrow suppresion

A

Azathioprine and allopurinol

54
Q

First line treatment for osteoarthritis

A
  • paracetomal and topical NSAIDs

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