Rheumatology Flashcards
1
Q
Side effects of trimethoprim and methotrexate
A
Bone marrow suppression and fatal pancytopenia
2
Q
What gene is Dermatitis herpetiformis
A
HLA-DR3
3
Q
What problems can bisphosphonates cause?
A
Oesophageal problems
Alendronic Acid
4
Q
Side effect of hydroxychloroquine
A
Severe and permanent retinopathy
5
Q
Risk factor for pseudogout
A
Hyperparathyroidism
6
Q
Investigation for osteoporosis in a man
A
Check testosterone
7
Q
What bones does Paget’s Disease affect?
A
Skull, spine, pelvis and long bones of the lower extremities
8
Q
Investigation for Pagets disease
A
Isolated rise in alkaline phosphatase
9
Q
How long should patients with antiphospholipid syndrome be on anticoagulation for after the first VTE
and what anticoagulation
A
Lifelong warfarin
10
Q
Renal impairment, respiratory symptoms, joint pain, systemic features
A
ANCA associated vasculitis
11
Q
Interferon alpha
A
Flu-like Sx
12
Q
Cardiac complications of Ehlers Dhanlos
A
Aortic regurgitation
13
Q
Before starting biologics for RA what do you investigate?
A
CXR to look for TB
14
Q
Arterial/venous thromboembolism, miscarriage, livedo reticularis
A
Antiphospholipid syndrome
15
Q
Key investigation for polymyalgia rheumatica
A
Raised inflammatory markers
16
Q
Elderly and gout - management
A
NSAIDs avoided due to GI haemorrhage
Give Colchicine instead
17
Q
What type of hypersensitivity reaction is SLE
A
3
18
Q
Joint aspirate in RA
A
High WBC count, predominantly PMNs
Appearance is cloudy with an absence of crystals
19
Q
Antibody in Dermatomyositis
A
Anti-Jo
20
Q
Osteoporosis blood test values
A
Normal
21
Q
Sjogren’s syndrome increased risk of…
A
Lymphoid malignancies e.g. lymphoma
22
Q
Investigation before starting on azathioprine
A
Check TPMT
23
Q
2 features of Marfan’s syndrome
A
Pectus excavatum and pes planus
24
Q
ABx for septic arthritis
A
IV flucloxacillin
25
triad in behcet's
Oral ulcers
Genital ulcers
Anterior uveitis
26
Patients who are allergic to aspirin may also react to...
sulfasalazine
27
Diagnosis of ankylosing spondylitis
Sacro-ilitis on a pelvic xray
28
What type of hypersensitivity reaction is ITP
2
29
Bone pain, tenderness and proximal myopathy (--> waddling gait)
Osteomalacia
30
Treatment of suspected visual loss secondary to temporal arteritis
```
IV methylprednisolone
(otherwise oral if no vision change)
```
31
Prolonged APTT
Antiphospholipid syndrome
32
Investigation for ankylosing spondylitis
Plain radiography of the pelvis
33
What does haemochromatosis increase the risk of?
Gout
34
What forms the basis of the T score from the DEXA scan?
The T score is based on the bone ass of a young reference population
35
Features of reactive arthritis
Develop 4 weeks after precipitating infection and run a relapsing remitting course
36
3 features of temporal arteritis
Constant throbbing headache
Pain on chewing (jaw claudication)
Tender scalp (when brushing hair)
37
5 features of ankylosing spondylitis on xray
```
Syndesmophytes
Bamboo spine (late sign rarely seen in practise)
```
Subchondral erosions
Sclerosis
Squaring of the lumbar vertebrae
38
Side effect of bisphosphonates
Osteonecrosis of the jaw
39
Swollen first finger and wrist pain with fatigue, 1st degree relative with psoriasis
Psoriatic arthritis
| dactylitis
40
Sjogrens disease
Feature
Test
Antibodies
Reduced saliva, joint arthralgia, fatigue
Positive Schirmer's test
Anti-Ro/Anti-La
41
Interaction between allopurinol and azathioprine
Bone marrow suppression
42
Malignancy and raised creatinine kinase
Polymyositis
43
Lytic lesion in the diaphysis of pelvis and long bones with an 'onion appearance'
Ewing's Sarcoma
44
Which test would be useful to rule out SLE?
ANA
45
Pharmacological treatment of Raynaud's
Nifedipine
46
1st line treatment for SLE
Hydrochloroquine
47
2 side effects of methotrexate
Mucositis (apthous-like ulcers)
| Pulmonary fibrosis
48
cANCA
granulomatosis with polyangiitis
49
pANCA
Churg-Strauss syndrome
Ulcerative Colitis
eosinophilic granulomatosis with polyangiitis
50
Dermatological finding in Behcet's syndrome
Erythema nodosum
51
Epicondylitis: which gives pain on flexion/extension?
Pain on extension: lateral
| Pain on flexion: medial
52
Positively bifringent rhomboid shaped crystals
Pseudogout
53
Negatively bifringement needle shaped crystals
Gout
54
Frank haematuria, persistent dry cough, dysponea, sinusitis, nosebleeds, saddle shaped nose and bibasal crepitations
Granulomatosis with polyangiitis
55
Crystals in pseudogout
Calcium pyrophosphate crystals
56
Joint pain, pink bumpy rash, fever
Bilateral cervical lymphadenopathy, palpable spleen
Negative RF and ANA
Adult onset still's disease
57
Starting allopurinol
Give colchicine 'cover' when starting
58
Three features of Felty's syndrome
Rheumatoid Arthritis
Splenomegaly
Low white cell count
59
Results of adjusted calcium, PTH, ALP and PO4 in osteogenesis imperfecta
Normal
60
Antibodies in antiphospholipid syndrome
Anti-Cardiolipin Antibody
61
Management of renal complications with systemic sclerosis
ACEi
62
Treatment of acute reactive arthritis
NSAIDs
intraarticular steriods if resistant to NSAIDs and small number of joints affected
63
Score to assess hypermobility
Beighton score
64
What is schirmer's test
Determines whether the eye produces enough tears to make it moist
65
Bone pain tenderness and proximal myopathy with a waddling gait
Osteomalacia
66
treatment of pagets disease
Bisphosphonates
67
Joint aspirate in reactive arthritis (reiter syndrome)
Sterile synovial fluid with a high white blood cell count
68
Side effect of isoniazid
Drug-induced lupus
69
FIRST thing you do with suspected temporal arteritis
High dose oral prednisolone
70
Score for disease activity in RA
DAS28
71
The 6 A's in Ankylosing Spondylitis
```
Apical fibrosis
Anterior uveitis
Aortic regurgitation
Achilles tendonitis
AV node block
Amyloidosis
```
72
What autoimmune disease is pericarditis associated with?
SLE
73
What type of hypersensitivity is allergic contact dermatitis
Type 4
74
Low levels of which type of complement are associated with the development of SLE?
C4
75
What is the Z score adjusted for in DEXA scans?
Age, gender and ethnic factors
76
Juxa-articular osteoporosis/osteopenia is an early xray feature of which arthritis?
RA
77
What auto-antibody is reactive arthritis associated with?
HLA-B27
78
Myositis with anti-Jo antibodies can predispose what?
lung fibrosis
79
What condition is associated with dermatomyositis
Internal malignancy
80
Swelling in RIGHT INDEX FINGER
Psoriatic arthritis
81
Methotrexate and pregnancy
Stop 6 months before trying
82
What should you check before starting azathioprine due to increased risk of toxicity?
Thiopurine methyltransferase deficiency
83
creatinine kinase in polymyalgia rheumaticA
Normal
84
creatinine kinase in polymyositis
raised
85
Primary raynauds
young women with bilateral symptoms
86
Initial treatment of ankylosing spondylititis
NSAIDs and physio
86
Thromboprophylaxis for antiphospholipid syndrome with no previous thrombosis
Aspirin
87
What hand sign can reactive arthritis cause
Dactylitis
88
Duration of ABx for septic arthritis
4-6 weeks
89
Distinguish gout from pseudogout
Chondrocalcinosis
90
What antibodies are associated with drug induced lupus?
Antihistone antibodies
91
Renal impairment, respiratory symptoms, joint pain
ANCA associated vasculitis
92
Is obesity and rheumatoid arthritis a risk factor for osteoporosis
Obesity - no
| RA - yes
93
Is azathioprine safe to use in pregnancy?
Yes
94
Bisphosphonate holiday
Repeat DEXA and FRAX and stop if low risk then review in 2 years
95
What condition are chemotherapy patients at higher risk for?
Gout
96
What investigation is used to monitor SLE and what will the result be?
Complement levels - levels are usually low during active disease
97
What rash is found with reactive arthritis
Keratoderma blenorrhagica
98
Septic arthritis investigation
Synovial fluid analysis
99
What movement of the spine is reduced in ankylosing spondylitis?
Reduced lateral flexion
100
Most common organism in septic arthritis - young adults and adults
Young adults: Neisseria gonorrhoeae
| Adults: Staphlococcus aureus
101
Pathophysiology of marfans
Mutation in a protein called Fibrillin-1
102
What inheritance is marfans?
Autosomal dominant
103
Suspected rheumatoid first line imaging
xray
104
is hydroxychloroquine safe in pregnancy
yes
105
How many NSAIDs must have failed for a patient with ankylosing spondylitis to have anti-TNFa drugs
2
106
You can start an oral bisphosphonate without a DEXA scan
107
Side effect of colchicine
Diarrhoea
108
Patients who are allergic to aspirin might also react to...
... sulfasalazine
109
Side effects to alendronate
Give risedronate
110
Is there limb weakness in polymyalgia rheumatica?
No - power is normal
111
Periarticular erosions are seen in which arthrititis?
RA
112
Examination test in ank spond
Schobers test
113
Giant cell arteritis Sx but normal biopsy - what do you do?
Continue the prednisolone regardless of the biopsy result
114
Initial management of RA
Methotrexate plus a short course of oral prednisolone
115
What condition increases the risk of temporal arteritis
Polymyalgia rheumatica
116
First line pain relief for osteoarthritis
Paracetamol
117
Most specific test for SLE
Anti-dsDNA
118
What does a raised CRP in a patient with SLE indicate
Underlying infection
