Rheumatology Flashcards
1
Q
Conditions associated w/ pANCA
A
UC
PSC
Anti-GBM disease
Crohn’s disease
2
Q
Other features of ankylosing spondylitis - the A’s
A
Apical fibrosis Anterior uveitis Aortic regurgitation Achille's tendonitis AV node block Amyloidosis Cauda equina syndrome
3
Q
If Ankylosing spondylitis suspicion high but no signs on X-ray what investigation should be done:
A
MRI
4
Q
Management Ankylosing spondylitis:
A
Regular exercise encouraged
NSAIDs first line
Anti-TNF drugs given if persistently high disease activity
DMARDs
5
Q
Anti-phospholipid syndrome blood results:
A
Paradoxical INCREASED aPTT and thrombocytopenia
6
Q
APS is commonly associated w/ which other CTD
A
SLE
7
Q
APS primary prophylaxis:
APS secondary prophylaxis
A
Low-dose aspirin
Lifelong WARFARIN
8
Q
Anti-synthetase syndrome antibody:
A
Anti-Jo1
Also seen in dermatomyositis
9
Q
Azathioprine MoA:
A
Inhibits purine synthesis
10
Q
Azathioprine adverse effects: (4)
A
Pancreatitis
Nausea and vomiting
Bone marrow depression
Increased risk of non-melanoma skin cancer
11
Q
Is Azathioprine safe in pregnancy?
A
YES
12
Q
Behcet’s triad:
A
Oral ulcers
Genital ulcers
Anterior uveitis
13
Q
Bisphosphonates MoA:
A
Inhibit osteoclasts
14
Q
Bisphosphonates clinical uses:
A
Prevention and tx. of osteoporosis
Hypercalcaemia
Paget’s disease
Pain from bone mets
15
Q
Bisphosphonates adverse effects:
A
Oesophageal reactions: Oesophagitis, ulcers
Osteonecrosis of jaw
Atypical stress fractures of femur
16
Q
How should bisphosphonates be taken:
A
Taken while sitting or standing on an EMPTY stomach at least 30 minutes before breakfast or any other medication
17
Q
What should be corrected prior to giving bisphosphonates
A
Hypocalcaemia/vitamin D deficiency
18
Q
Benign bone tumours:
A
Osteoma
Osteochondroma
Giant cell tumour
19
Q
Benign tumour affecting skull typically assoc. w/ Gardner’s syndrome:
A
Osteoma
20
Q
Most common benign bone tumour:
A
Osteochondroma
21
Q
Benign bone tumour w/ ‘double bubble’ or ‘soap bubble’ appearance:
A
Giant cell
22
Q
Malignant bone tumours:
A
Osteosarcoma
Ewing’s sarcoma
Chrondrosarcoma
23
Q
Most common primary malignant bone tumour:
Where is it commonly seen:
A
Osteosarcoma
Long bones
24
Q
Malignant bone tumour w/ sunburst pattern:
A
Osteosarcoma
25
Small round blue cell tumour:
| seen most frequently in:
Ewing's sarcoma
| Pelvis and long bones
26
Bone tumour showing 'onion skin appearance on x-ray'
Ewing's sarcoma
27
Malignant tumour of cartilage
Most commonly affects axial skeleton
Most common in middle age
Chrondrosarcoma
28
Mx. Chronic fatigue syndrome
CBT (very effective)
29
Other causes of dactylitis other than spondyloarthropathy
Sickle-cell disease
TB
Sarcoidosis
Syphilis
30
Drug-induced lupus which antibody is found:
Anti-HISTONE
31
Difference between SLE and drug-induced SLE
Renal and Neuro involvement unusual in drug-induced
32
Most common causes of drug-induced lupus
Hydralazine and procainamide
33
Describe dermatomyositis
An inflammatory disorder causing symmetrical proximal muscle weakness and characteristic skin lesions
34
Dermatomyositis w/out skin manifestations =
Polymyositis
35
Skin features of dermatomyositis: (4)
```
Photosensitivity
Macular rash over back and shoulder
Heliotrope rash in peri-orbital region
Gottron's papules
Mechanic's hands - dry and scaly hands w/ linear cracks on the palmar and lateral aspects of fingers
```
36
Muscle features in dermatomyositis:
Proximal muscle weakness
37
Cardiac problems in Ehlers-Danlos
Aortic regurgitation
Mitral valve prolapse
Aortic dissection
38
Urate levels in Gout:
| When should these be checked:
May be high or normal or low during acute attacks
| 2 weeks after an attack
39
Radiological features of gout:
Joint effusions = early sign
'Punched out' erosions in juxta-articular distribution
NO PERIARTICULAR OSTEOPENIA in contrast to rheumatoid arthritis
40
Drug cause of gout:
DIURETICS - decreased excretion of uric acid
41
GOUT management:
NSAIDS or colchicine first line
| Oral steroids considered if NSAIDs/Colchicine contraindicated
42
Urate lowering therapy:
Allopurinol
43
ULT: when should this be commenced:
After acute attack has settled down
44
Anti-hypertensive medication which may be of benefit to reduce gout in co-existent hypertension
LOSARTAN
45
Referred lumbar spine hip pain test:
Femoral stretch test - flexion of knee and hip pulls femoral nerve and will produce pain
46
HLA-DR4 conditions
T1DM
| Rheumatoid arthritis
47
HLA-DR3 conditions
Dermatitis herpetiformis
Sjogren's syndrome
PBC
48
HLA-DQ2/DQ8
Coeliac disease
49
HLA-B51:
Behcet's disease
50
Can hydroxychloroquine be used in pregnancy:
YES
51
Most abundant immunoglobulin in the body:
IgG
52
Pentamer immunoglobulin
IgM - also first Ig produced in response to infection
53
Ig which mediates type 1 hypersensitivity reaction
IgE
54
Marfan's syndrome cardio complications:
Dilation of aortic sinuses leading to aortic aneurysm
Aortic regurgitation
Aortic Dissection
Mitral valve prolapse
55
Marfan's ophthalmic complications:
Upward lens dislocation, blue sclera, myopia
56
Marfan's monitoring
Regular echocardiography
| and BB/ACEi therapy
57
Methotrexate adverse effects:
```
Mucositis
Myelosuppression
Pneumonitis
Pulmonary fibrosis
Liver fibrosis
```
58
How often is Methotrexate taken:
Weekly rather than daily
59
Methotrexate monitoring:
FBCs, U&Es, LFTs every 2-3 months
60
What should be co-prescribed w/ Methotrexate
FOLIC acid 5 mg
MTX is a folic acid inhibitor
61
Methotrexate: other medications to avoid while taking:
Trimethoprim or co-trimoxazole (marrow aplasia)
| High dose aspirin increases risk of MTX toxicity secondary to reduced excretion
62
Rheumatoid arthritis X-ray findings:
Loss of joint space
Juxta-articular osteoporosis
Peri-articular erosions
Subluxation
63
OA first line medical mx.
Paracetamol and topical NSAIDs
64
Topical NSAIDs are only indicated in OA of:
Knee or hand
65
OA second line management:
ORAL NSAIDs/cox-2 inhibitors
66
What should be co-prescribed w/ NSAIDs/COX-2 inhibitors
PPI
67
Osteogenesis imperfecta Calcium,phosphate, PTH, ALP levels
ALL normal
68
What is osteomalacia:
Softening of the bones secondary to low Vitamin D -> leads to decreased bone mineral content
69
Fx of Osteomalacia:
Proximal myopathy - waddling gait
Bone pain
Bone/muscle tenderness
Fractures: especially in femoral neck
70
X-ray features of osteomalacia:
Translucent bands - (Looser's zones or pseudofractures)
71
Tx. Osteomalacia ->
Vitamin D supplementation - loading dose often needed initially
72
Any patient w/ fragility fracture and > 75 yrs should automatically receive:
Oral BISPHOSPHONATE
73
Fragility fracture and pt. is <75 yrs:
Arrange DEXA scan ->
| FRAX assessment
74
Medications that may worsen osteoporosis:
```
PPIs
SSRIs
Anti-epileptics
Glitazones
Long term heparin therapy
Aromatase inhibitors
```
75
First-line tx. for Osteoporosis
ORAL Alendronate
| Vitamin D and calcium should be offered to all women unless clinician confident they're receiving enough in their diet
76
How is Denosumab given:
Single SC injection once every 6 months
77
Tx. Paget's disease:
Bisphosphonate (oral risedronate or IV zoledronate
78
Polyarteritis nodosa associated w/ which infection
Hepatitis B
79
Polymyalgia rheumatica important negative finding:
Weakness - Not typically associated with PMR
80
Polymyalgia rheumatica investigation findings: Bloods:
Raised inflammatory markers - ESR > 40 mm/hr
CK and EMG normal
NO INCREASE in CK
81
Polymyositis: blood results -
Elevated CK
| other muscle enzymes (LDH, AST, ALT are also elevated in 85-95% of pts.
82
Polymyositis anti-bodies:
Anti-synthetase antibodies
| Anti-Jo-1 antibodies
83
Pseudogout crystals:
Calcium pyrophosphate crystals
weakly-positively birefringent rhomboid-shaped crystals
84
Pseudogout most commonly affected joints:
Knee, wrist, shoulders
85
Management of pseudogout:
Aspiration of joint fluid to exclude septic arthritis
86
Drug mx. pseudogout:
NSAIDs or intra-articular, intra-muscular or oral steroids as for gout
87
Treatment of psoriatic arthritis:
Similar to RA
Mild peripheral arthritis/mild axial disease may be treated with an NSAID rather than DMARD
MABs - Ustekinumab, secukinumab
88
Periarticular disease in Psoriatic arthritis:
Tenosynovitis and soft tissue inflammation which results in:
Enthesitis
Tenosynovitis
Dactylitis
89
Reactive arthritis Tx.
Symptomatic: analgesia, NSAIDs, intra-articular steroids
| Sulfasalazine and methotrexate are sometimes used for persistent disease
90
Most common complication of rheumatoid arthritis:
Keratoconjunctivitis sicca
91
Felty's syndrome triad:
RA
Splenomegaly
Low WCC
92
Sulphasalazine side effects:
Rashes
Oligospermia
Heinz body anaemia
Interstitial lung disease
93
Gold side effects:
Proteinuria
94
What investigation is recommended for ALL pts. w/ suspected RA
X-rays of hands and feet
95
Rheumatoid arthritis initial management:
DMARD monotherapy +/- course of bridging prednisolone
96
Flares of Rheumatoid arthritis mx.
Oral or IM Corticosteroids
97
TNF inhibitors major side-effect:
Reactivation of latent TB
98
Poor prognostic factors in RA:
```
RF and anti-ccp positive
Poor functional status at presentation
X-ray showing early erosions
Extra-articular features - nodules
HLA DR4
Insidious on-set
```
99
RA LATE x-ray findings:
Periarticular erosions
| Subluxation
100
Teres minor role:
Adducts and rotates arm laterally
101
Septic arthritis m/c organism overall
Staphylococcus aureus
102
Septic arthritis most common organism in young adults who are sexually active
Neisseria gonorrhoea
103
Septic arthritis Ix.
Synovial fluid sampling is obligatory
Blood cultures
Joint imaging
104
Mx. septic arthritis:
Flucloxacillin for 4-6 weeks
Clindamycin if allergic
Needle decompression may be needed to decompress the joint
105
Seronegative arthritis: usually follows which pattern of arthritis:
Asymmetrical, peripheral
106
Mx Sjogren's:
Artificial saliva and tears
| Pilocarpine may stimulate saliva production
107
Sulfasalazine should be used with caution if patient has:
G6PD deficiency
| Allergy to aspirin or sulphonamides
108
SLE tests:
ANA - highly sensitive
Anti-dsDNA: highly specific
Anti-smith: highly specific
20% are rheumatoid factor positive
109
Complement levels during SLE active disease:
LOW - consumption of complement
110
SLE advice
| tx.
NSAIDs
Wear sun-block
Hydroxychloroquine
111
SLE tx. if internal organ involvement: (renal, neuro, eye)
Prednisolone
| cyclophosphamide
112
CREST syndrome:
```
Calcinosis
Raynauds
oEsophageal dysmotility
Sclerodactyly
Telangiectasia
```
113
Key examination in pts. presenting w/ temporal arteritis
Vision testing
114
Temporal arteritis tx.
Vision loss
No vision loss
Vision loss: IV methylprednisolone
No-vision loss: High dose oral prednisolone
