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Medicine Year 4 > Rheumatology > Flashcards

Rheumatology Flashcards

1
Q

Side effects of trimethoprim and methotrexate

A

Bone marrow suppression and fatal pancytopenia

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2
Q

What gene is Dermatitis herpetiformis

A

HLA-DR3

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3
Q

What problems can bisphosphonates cause?

A

Oesophageal problems

Alendronic Acid

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4
Q

Side effect of hydroxychloroquine

A

Severe and permanent retinopathy

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5
Q

Risk factor for pseudogout

A

Hyperparathyroidism

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6
Q

Investigation for osteoporosis in a man

A

Check testosterone

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7
Q

What bones does Paget’s Disease affect?

A

Skull, spine, pelvis and long bones of the lower extremities

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8
Q

Investigation for Pagets disease

A

Isolated rise in alkaline phosphatase

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9
Q

How long should patients with antiphospholipid syndrome be on anticoagulation for after the first VTE
and what anticoagulation

A

Lifelong warfarin

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10
Q

Renal impairment, respiratory symptoms, joint pain, systemic features

A

ANCA associated vasculitis

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11
Q

Interferon alpha

A

Flu-like Sx

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12
Q

Cardiac complications of Ehlers Dhanlos

A

Aortic regurgitation

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13
Q

Before starting biologics for RA what do you investigate?

A

CXR to look for TB

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14
Q

Arterial/venous thromboembolism, miscarriage, livedo reticularis

A

Antiphospholipid syndrome

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15
Q

Key investigation for polymyalgia rheumatica

A

Raised inflammatory markers

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16
Q

Elderly and gout - management

A

NSAIDs avoided due to GI haemorrhage

Give Colchicine instead

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17
Q

What type of hypersensitivity reaction is SLE

A

3

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18
Q

Joint aspirate in RA

A

High WBC count, predominantly PMNs

Appearance is cloudy with an absence of crystals

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19
Q

Antibody in Dermatomyositis

A

Anti-Jo

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20
Q

Osteoporosis blood test values

A

Normal

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21
Q

Sjogren’s syndrome increased risk of…

A

Lymphoid malignancies e.g. lymphoma

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22
Q

Investigation before starting on azathioprine

A

Check TPMT

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23
Q

2 features of Marfan’s syndrome

A

Pectus excavatum and pes planus

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24
Q

ABx for septic arthritis

A

IV flucloxacillin

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25
Q

triad in behcet’s

A

Oral ulcers
Genital ulcers
Anterior uveitis

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26
Q

Patients who are allergic to aspirin may also react to…

A

sulfasalazine

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27
Q

Diagnosis of ankylosing spondylitis

A

Sacro-ilitis on a pelvic xray

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28
Q

What type of hypersensitivity reaction is ITP

A

2

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29
Q

Bone pain, tenderness and proximal myopathy (–> waddling gait)

A

Osteomalacia

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30
Q

Treatment of suspected visual loss secondary to temporal arteritis

A 
IV methylprednisolone
(otherwise oral if no vision change)
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31
Q

Prolonged APTT

A

Antiphospholipid syndrome

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32
Q

Investigation for ankylosing spondylitis

A

Plain radiography of the pelvis

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33
Q

What does haemochromatosis increase the risk of?

A

Gout

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34
Q

What forms the basis of the T score from the DEXA scan?

A

The T score is based on the bone ass of a young reference population

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35
Q

Features of reactive arthritis

A

Develop 4 weeks after precipitating infection and run a relapsing remitting course

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36
Q

3 features of temporal arteritis

A

Constant throbbing headache
Pain on chewing (jaw claudication)
Tender scalp (when brushing hair)

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37
Q

5 features of ankylosing spondylitis on xray

A 
Syndesmophytes 
Bamboo spine (late sign rarely seen in practise)

Subchondral erosions
Sclerosis
Squaring of the lumbar vertebrae

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38
Q

Side effect of bisphosphonates

A

Osteonecrosis of the jaw

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39
Q

Swollen first finger and wrist pain with fatigue, 1st degree relative with psoriasis

A

Psoriatic arthritis

dactylitis

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40
Q

Sjogrens disease
Feature
Test
Antibodies

A

Reduced saliva, joint arthralgia, fatigue
Positive Schirmer’s test
Anti-Ro/Anti-La

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41
Q

Interaction between allopurinol and azathioprine

A

Bone marrow suppression

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42
Q

Malignancy and raised creatinine kinase

A

Polymyositis

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43
Q

Lytic lesion in the diaphysis of pelvis and long bones with an ‘onion appearance’

A

Ewing’s Sarcoma

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44
Q

Which test would be useful to rule out SLE?

A

ANA

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45
Q

Pharmacological treatment of Raynaud’s

A

Nifedipine

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46
Q

1st line treatment for SLE

A

Hydrochloroquine

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47
Q

2 side effects of methotrexate

A

Mucositis (apthous-like ulcers)

Pulmonary fibrosis

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48
Q

cANCA

A

granulomatosis with polyangiitis

49
Q

pANCA

A

Churg-Strauss syndrome
Ulcerative Colitis
eosinophilic granulomatosis with polyangiitis

50
Q

Dermatological finding in Behcet’s syndrome

A

Erythema nodosum

51
Q

Epicondylitis: which gives pain on flexion/extension?

A

Pain on extension: lateral

Pain on flexion: medial

52
Q

Positively bifringent rhomboid shaped crystals

A

Pseudogout

53
Q

Negatively bifringement needle shaped crystals

A

Gout

54
Q

Frank haematuria, persistent dry cough, dysponea, sinusitis, nosebleeds, saddle shaped nose and bibasal crepitations

A

Granulomatosis with polyangiitis

55
Q

Crystals in pseudogout

A

Calcium pyrophosphate crystals

56
Q

Joint pain, pink bumpy rash, fever
Bilateral cervical lymphadenopathy, palpable spleen
Negative RF and ANA

A

Adult onset still’s disease

57
Q

Starting allopurinol

A

Give colchicine ‘cover’ when starting

58
Q

Three features of Felty’s syndrome

A

Rheumatoid Arthritis
Splenomegaly
Low white cell count

59
Q

Results of adjusted calcium, PTH, ALP and PO4 in osteogenesis imperfecta

A

Normal

60
Q

Antibodies in antiphospholipid syndrome

A

Anti-Cardiolipin Antibody

61
Q

Management of renal complications with systemic sclerosis

A

ACEi

62
Q

Treatment of acute reactive arthritis

A

NSAIDs

intraarticular steriods if resistant to NSAIDs and small number of joints affected

63
Q

Score to assess hypermobility

A

Beighton score

64
Q

What is schirmer’s test

A

Determines whether the eye produces enough tears to make it moist

65
Q

Bone pain tenderness and proximal myopathy with a waddling gait

A

Osteomalacia

66
Q

treatment of pagets disease

A

Bisphosphonates

67
Q

Joint aspirate in reactive arthritis (reiter syndrome)

A

Sterile synovial fluid with a high white blood cell count

68
Q

Side effect of isoniazid

A

Drug-induced lupus

69
Q

FIRST thing you do with suspected temporal arteritis

A

High dose oral prednisolone

70
Q

Score for disease activity in RA

A

DAS28

71
Q

The 6 A’s in Ankylosing Spondylitis

A 
Apical fibrosis
Anterior uveitis
Aortic regurgitation
Achilles tendonitis
AV node block
Amyloidosis
72
Q

What autoimmune disease is pericarditis associated with?

A

SLE

73
Q

What type of hypersensitivity is allergic contact dermatitis

A

Type 4

74
Q

Low levels of which type of complement are associated with the development of SLE?

A

C4

75
Q

What is the Z score adjusted for in DEXA scans?

A

Age, gender and ethnic factors

76
Q

Juxa-articular osteoporosis/osteopenia is an early xray feature of which arthritis?

A

RA

77
Q

What auto-antibody is reactive arthritis associated with?

A

HLA-B27

78
Q

Myositis with anti-Jo antibodies can predispose what?

A

lung fibrosis

79
Q

What condition is associated with dermatomyositis

A

Internal malignancy

80
Q

Swelling in RIGHT INDEX FINGER

A

Psoriatic arthritis

81
Q

Methotrexate and pregnancy

A

Stop 6 months before trying

82
Q

What should you check before starting azathioprine due to increased risk of toxicity?

A

Thiopurine methyltransferase deficiency

83
Q

creatinine kinase in polymyalgia rheumaticA

A

Normal

84
Q

creatinine kinase in polymyositis

A

raised

85
Q

Primary raynauds

A

young women with bilateral symptoms

86
Q

Initial treatment of ankylosing spondylititis

A

NSAIDs and physio

86
Q

Thromboprophylaxis for antiphospholipid syndrome with no previous thrombosis

A

Aspirin

87
Q

What hand sign can reactive arthritis cause

A

Dactylitis

88
Q

Duration of ABx for septic arthritis

A

4-6 weeks

89
Q

Distinguish gout from pseudogout

A

Chondrocalcinosis

90
Q

What antibodies are associated with drug induced lupus?

A

Antihistone antibodies

91
Q

Renal impairment, respiratory symptoms, joint pain

A

ANCA associated vasculitis

92
Q

Is obesity and rheumatoid arthritis a risk factor for osteoporosis

A

Obesity - no

RA - yes

93
Q

Is azathioprine safe to use in pregnancy?

A

Yes

94
Q

Bisphosphonate holiday

A

Repeat DEXA and FRAX and stop if low risk then review in 2 years

95
Q

What condition are chemotherapy patients at higher risk for?

A

Gout

96
Q

What investigation is used to monitor SLE and what will the result be?

A

Complement levels - levels are usually low during active disease

97
Q

What rash is found with reactive arthritis

A

Keratoderma blenorrhagica

98
Q

Septic arthritis investigation

A

Synovial fluid analysis

99
Q

What movement of the spine is reduced in ankylosing spondylitis?

A

Reduced lateral flexion

100
Q

Most common organism in septic arthritis - young adults and adults

A

Young adults: Neisseria gonorrhoeae

Adults: Staphlococcus aureus

101
Q

Pathophysiology of marfans

A

Mutation in a protein called Fibrillin-1

102
Q

What inheritance is marfans?

A

Autosomal dominant

103
Q

Suspected rheumatoid first line imaging

A

xray

104
Q

is hydroxychloroquine safe in pregnancy

A

yes

105
Q

How many NSAIDs must have failed for a patient with ankylosing spondylitis to have anti-TNFa drugs

A

2

106
Q

You can start an oral bisphosphonate without a DEXA scan

A
107
Q

Side effect of colchicine

A

Diarrhoea

108
Q

Patients who are allergic to aspirin might also react to…

A

… sulfasalazine

109
Q

Side effects to alendronate

A

Give risedronate

110
Q

Is there limb weakness in polymyalgia rheumatica?

A

No - power is normal

111
Q

Periarticular erosions are seen in which arthrititis?

A

RA

112
Q

Examination test in ank spond

A

Schobers test

113
Q

Giant cell arteritis Sx but normal biopsy - what do you do?

A

Continue the prednisolone regardless of the biopsy result

114
Q

Initial management of RA

A

Methotrexate plus a short course of oral prednisolone

115
Q

What condition increases the risk of temporal arteritis

A

Polymyalgia rheumatica

116
Q

First line pain relief for osteoarthritis

A

Paracetamol

117
Q

Most specific test for SLE

A

Anti-dsDNA

118
Q

What does a raised CRP in a patient with SLE indicate

A

Underlying infection

Medicine Year 4 (13 decks)

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