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MSRA exam > Rheumatology > Flashcards

Rheumatology Flashcards

1
Q

What 3 systems does vasculitis commonly affect?

A

Renal
Respiratory
ENT

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2
Q

What would you see on urine dip in an ANCA positive person

A

positive for protein and blood

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3
Q

What is c ANCA associated with

A

Granulomatosis with polyangiitis

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4
Q

What is p ANCA associated with?

A

eosinophilic granulomatous with polyangiitis
UC
PSC

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5
Q

What is Schober’s test ?

A

Reduced forward flexion

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6
Q

Name 3 As associated with ankylosing spondylitis

A

Anterior uveitis
Aortic regurg
Achilles Tendonitis
AV node block

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7
Q

4 predispositions associated with anti phospholipid syndrome?

A

Venous thromboses
arterial thromboses
recurrent foetal loss
thrombocytopenia

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8
Q

What happens to the APTT in anti phospholipid syndrome>

A

Rises

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9
Q

What is the treatment for anti phospholipid syndrome (primary and secondary thromboprophylaxis)

A

Primary: aspirin
Secondary: warfarin

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10
Q

What is a TPMT test done for?

A

To look if individuals are prone to azathioprine toxicity

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11
Q

3 adverse effects of azathioprine?

A

Bone marrow depression
Nausea/Vomiting
Pancreatitis

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12
Q

Is azathioprine safe to use in pregnancy ?

A

Yes

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13
Q

What is the triad of Bechet’s Disease?

A

Oral ulcers
Genital ulcers
Anterior uveitis

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14
Q

What is the pathophysiology behind Bechet’s disease?

A

autoimmune mediated inflammation of the arteries and veins

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15
Q

What do you need to correct before starting a bisphosphonate?

A

calcium and phosphate

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16
Q

What would happen to calcium phosphate, ALP and PTH in the following condition… osteomalacia?

A

Calcium decrease
Phosphate decrease
ALP increase
PTH increase

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17
Q

What would happen to calcium phosphate, ALP and PTH in the following condition… primary hyperparathyroidism?

A

Calcium increase
Phosphate decrease
ALP increase
PTH increase

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18
Q

What would happen to calcium phosphate, ALP and PTH in the following condition… CKD?

A

Calcium decrease
Phosphate increase
ALP increase
PTH increase

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19
Q

What would happen to calcium phosphate, ALP and PTH in the following condition… Paget’s Disease?

A

Calcium normal
Phosphate normal
ALP increase
PTH normal

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20
Q

is an osteochondroma benign or malignant?

A

Benign

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20
Q

is an osteochondroma benign or malignant?

A

Benign

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21
Q

What is seen on x ray of a giant cell tumour of bone?

A

double bubble or soap bubble appearance.. note it is benign

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22
Q

most common malignant bone tumour?

A

osteosarcoma

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23
Q

most common malignant bone tumour?

A

osteosarcoma

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24
Q

what cancer do you get a codman triangle on?

A

osteosarcoma

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25
Q

what cancer does paget’s disease increase your risk of having

A

osteosarcoma

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26
Q

what cancer will you see onion skin appearance in?

A

ewing’s sarcoma

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27
Q

what is the management of ME?

A

graded exercise therapy
pacing therapy
low dose amitriptyline

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28
Q

what 3 malignancies is dermatomyositis associated with?

A

ovarian
breast
lung

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29
Q

Give two features seen in dermatomyositis ?

A

Gottron’s papules and Heliotrope rash

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30
Q

What autoantibody are people with dermatomyositis normally positive for?

A

ANA

31
Q

what blood test is normally positive in drug induced lupus?

A

ANA (note normally dsDNA negative)

32
Q

Two main causes of drug induced lupus?

A

Procainamide
Hydralazine

33
Q

what type of collagen does EDS affect

A

type 3 collagen

34
Q

what three medications trigger gout?

A

Thiazide diuretics
Ciclosporin
Furosemide
Pyrazinamide

35
Q

What is first line treatment for an acute gout attack ?

A

Colchicine
NSAIDs

36
Q

First and second line treatment for chronic gout?

A

Allopurinol
Febuxostat

37
Q

What do you typically give when starting a person on allopurinol ?

A

Colchicine

38
Q

What is meralgia paraesthetica ?

A

compression of the lateral cutaneous nerve of the thigh. causing burning sensation over antero lateral aspect of the thigh.

39
Q

what is an adverse effect of hydroxychloroquine?

A

Bull’s eye retinopathy.

40
Q

What is a type 1 gell and coombs classification?

A

Anaphylaxis (IgE)

41
Q

What is a type 2 gell and coombs classification?

A

AI haemolytic anaemia, ITP and good pasture’s syndrome

Ig G or Ig M bound

42
Q

What is a type 3 gell and coombs classification?

A

immune complex: SLE or extrinsic allergic alveolitis

43
Q

What is a type 4 gell and coombs classification?

A

T cell mediated- TB, scabies, MS or graft vs host.

44
Q

What is lateral epicondylitis

A

Tennis elbow

45
Q

Where do you get pain in lateral epicondylitis?

A

pain and tenderness localised to lateral epicondyle. Pain worse on wrist extension against resistance and on supination of the forearm

45
Q

Where do you get pain in lateral epicondylitis?

A

pain and tenderness localised to lateral epicondyle. Pain worse on wrist extension against resistance and on supination of the forearm

46
Q

3 adverse side effects of methotrexate

A

Mucositis
Myelosupression
Pulmonary Fibrosis

47
Q

For how long shall women avoid getting pregnant after stopping methotrexate?

A

6 months

48
Q

4 features of rheumatoid arthritis on x ray

A

Loss of joint space
Juxta articular osteoporosis
Periarticular erosions
Subluxation

49
Q

What is the inheritance pattern of osteogenesis imperfecta ?

A

Autosomal Dominant abnormality in type 1 collagen.

50
Q

Name 3 features of osteogenesis imperfecta

A

Blue sclera
fractures after mild trauma
deafness secondary to otosclerosis

NOTE: normally bloods are normal

51
Q

What is rickets referred to in adults?

A

Osteomalacia

52
Q

What would be the blood results you would get in osteomalacia>

A

Low calcium
Low phosphate
Low Vit D
High Alk Phosph

53
Q

Management of osteoporosis in people > 75

A

Anyone that has a fragility fracture >75 yr old is assumed to have underlying osteoporosis without needing a DEXA scan

54
Q

Management of osteoporosis in <75 yr olds

A

Anyone under the age of 75 that has a fragility fracture is to have a DEXA scan and to have a FRAX score calculated.

55
Q

Name 5 causes of osteoporosis

A

SHATTERED Family

Steroid use >5mg/day prednisolone
Hyperthyroidism; hyperparathyroidism, hypercalciuria
Alcohol and tobacco use
Thin (BMI <22)
Testosterone low (e.g. anti androgen in cancer of prostate)
Early menopause
Renal or liver failure
Erosive/inflammatory bone disease (e.g. RA or myeloma)
Dietary Ca low/malabsorption or Diabetes mellitus type 1
Family history

56
Q

At what t score value should bone protection be offered in someone taking steroids>

A

T -1.5 or less

57
Q

What T score confirms osteoporosis?

A

T score <-2.5 SD

58
Q

How do you treat Paget’s disease

A

Bisphosphonates

59
Q

Name 3 complications of paget’s disease

A

Osteosarcoma
Skull thickening
High output cardiac failure
Deafness

60
Q

What is medial epicondylitis

A

Pain on pronation or flexion of the wrist

61
Q

What does Polyarteritis nodosa lead to?

A

aneurysm formation

62
Q

What type of vasculitis is Polyarteritis nodosa?

A

It is a medium vessel vasculitis

63
Q

What infection is polyarteritis nodosa associated with ?

A

Hep B

64
Q

If given steroids for suspected PMR how should the person respond?

A

dramatically improve

65
Q

what crystals do you get in pseudo gout?

A

calcium pyrophosphate ?

66
Q

what x ray appearance would you have on pseudo gout ?

A

chondrocalcinosis

67
Q

What is the management of raynaud’s phenomenon ?

A

Nifedipine

68
Q

Two skin lesions associated with reactive arthritis

A

Circinate balanitis painless
Keratoderma blenorrhagica papules on the palms/soles

69
Q

What is a SE of methotrexate

A

Myelosuppression
Liver cirrhosis
Pneumonitis

70
Q

What is a SE of sulfasalzine

A

Rashes
Oligospermia
Heinz body anaemia
Interstitial lung disease

71
Q

What is a SE of gold

A

proteinuria

72
Q

What medication exacerbates myasthenia gravis

A

penicilliamine

73
Q

What drug can cause demyelination-

A

Etanercept

74
Q

What is the most common antibody found in sjogren’s syndrome

A

anti- ro antibody

MSRA exam (16 decks)

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