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Sophie’s Flash Cards > Rheumatology > Flashcards

Rheumatology Flashcards

1
Q

Eye side effects of hydroxychloroquine

A

Retinopathy
Severe and permanent
“Bull eye retinopathy” -> severe and permanent visual loss
More commonly causes keratopathy, considered fairly benign
Hydroxychloroquine can be used in pregnancy

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2
Q

Previous chemo now develop R hip pain, worse on exercising. O/E passive movement of the hip is painful in all directions esp internal rotation. X-ray normal
Most likely dx
A. trachanteric bursitis
B. AVN of femoral head
C. metastatic deposits

A

B
Causes: long term steroid use, previous chemo, alcohol excess, trauma

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3
Q

Urate lower therapy indication

A
  • ≥ 2 attacks in 12 months
  • Tophi
  • Renal disease
  • Uric acid renal stones
  • Prophylaxis if on cytotoxics or diuretics
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4
Q

ARBs beneficial in gout

A

Losartan: specific uricouric action
Suitable for co-existing gout and HTN

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5
Q

MOA of colchicine

A

Inhibit microtubules polymerisation by binding to tubulin, interfering with mitosis. Also inhibits neutrophil motility and activity

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6
Q

Investigations of osteomalacia

A
  • Low vit D
  • Low Ca and phosphate (30%)
  • Raised ALP (95-100%)
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7
Q

When do use pred / methylpred in GCA

A

Oral pred 40-60mg in uncomplicated GCA (no visual involvement +/- jaw/tongue claudication)
IV methylpred 50–1000mg for 3 days before pred for complicated GCA (with visual involvement +/- jaw / tongue claudication)

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8
Q

What autoAb screen returns if diagnosis of PAN
A. Anti-CCP
B. RF
C. Anti-RNP
D. No autoAb
E. anti-smith

A

No AutoAbs

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9
Q

Which drug least likely to cause gout
Lithium, bendroflumethiazide, alcohol, pyrazinamide, furosemide

A

Lithium

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10
Q

Organism most commonly a/w reactive arthritis

A

Post-dysenteric form
- Shigella flexneri
- Salmonella typhimurium
- Salmonella enteritidis
- Yersinia enterocolitica
- Campylobacter
Post-STI form
- Chlamydia trachomatis

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11
Q

Radiological features of ankylosing spondylitis
A. chondrocalcinosis B. osteolysis C. osteophytes, D. subchondral sclerosis E. syndesmophytes

A

Syndesmophytes - classification or heterotopic ossifications inside a spinal ligament or of the annulus fibrosus
Other features: sacroiliitis, squaring of lumbar vertebrae, bamboo spine (late and uncommon)

Chondrocalcinosis: pseudogout, gout, OA, hypoMa
Osteophytes: aging, degeneration, mechanical instability, OA
Subchondral sclerosis: OA

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12
Q

McArdle’s disease

A

Autosomal recessive type V glycogen storage disease
- Muscle pain and stiffness following exercise
- Muscle cramps
- Myoglobuinuria
- Low lactate level during exercise

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13
Q

Which one least a/w Sjogen
A. RTA
B. Xerostomia
C. Sensory polyneuropathy
D. Dilated cardiomyopathy
E. Raynaud’s phenomenon

A

D

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14
Q

Which is not a risk factor for osteoporosis
A. smoking B. obesity C. sedentary lifestyle D. premature menopause E. F

A

Obesity (Low body mass is risk factor)

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15
Q

Mechanism of mycophenolate mofetil

A

Inosin-5’ - monophosphate dehydrogenase inhibitor -> reduce lymphocyte production

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16
Q

Combination of prolonged APTT + thrombocytopenia suggestive of

A

APS

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17
Q

Instruction on taking alendronate

A

Take at least 30 minutes before breakfast with plenty of water + sit up right for 30 minutes following

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18
Q

Secondary causes of raynaud

A

CTD (Scleroderma - most common, SLE, RA)
Leukaemia
Type 1 cryoglobulinaemia, cold agglutinins
Use of vibrating tools
Drugs: OCP, ergot
Cervical rib

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19
Q

Factors suggest primary raynaud

A
  • Present in young women (onset before 40) with bilateral symptoms
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20
Q

Clinical manifestations of fibromyalgia

A
  • Chronic pain: at multiple site
  • Lethargy
  • Cognitive impairment: ‘fibro fog’
  • Sleep disturbance, headaches, dizziness
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21
Q

Poor prognostic factors of RA

A
  • RF positive
  • Anti-CCP
  • Poor functional status at presentation
  • X-ray: early erosions
  • Extra articular features e.g. nodules
  • HLA DR4
  • Insidious onset
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22
Q

Neurological disorder a/w PAN

A

Mononeuritis multiplex (painful, asymmetrical, asynchronous sensory and motor peripheral neuropathy involving isolated damage to at least 2 separate nerve areas)

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23
Q

Marfan’s syndrome - dural ectasia

A
  • Affects around 60% of patients with Marfan’s
    A/W bladder and bowel dysfunction
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24
Q

SLE abs a/w congenital heart block

A

Anti-Ro

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25
Q

What type of collagen is primarily affected by Ehlers-Danlos syndrome

A

Collagen type 3
- Autosomal dominant connective tissue disorder that mostly affects type III -> tissue being more elastic
- Elastic, fragile skin
- Joint hypermobility, recurrent joint dislocation
- Easy bruising
- AR, MVP, aortic dissection
- SAH
- Angioid retinal streaks

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26
Q

Sulfasalazine (cautions and S/E)

A

Safe in pregnancy and BF
Cautions
- G6PD deficiency
- Allergy to aspirin or sulphonamides
S/E
- Oligospermia
- SJS
- Pneumonitis/lung fibrosis
- Myelosupression, Heinz body anaemia, megaloblastic anaemia
- May colour tears -> stained contact lenses

27
Q

Paget disease of the bone

A

bony pain, unilateral hearing loss, isolated raised ALP

28
Q

Meralgia paraesthetica

A

Affecting lateral cutaneous nerve of the thigh

28
Q

Meralgia paraesthetica

A

Affecting lateral cutaneous nerve of the thigh

29
Q

Pain on wrist extension against resistance

A

Lateral epicondylitis

30
Q

Late chest finding of ankylosing spondylitis

A

Apical fibrosis

31
Q

Organism of osteomyelitis in sickle cell anaemia

A

Salmonella predominant

32
Q

Dermatomyositis AutoAbs

A

ANA positive in 60%, anti-Mi-2 highly specific%

33
Q

S/E of AZA

A

Safe in pregnancy
Cause
- BM depression
- N/V
- Pancreatitis
- Increased risk of non-melanoma skin cancer

34
Q

US finding of gout

A
  • Double contour sign
35
Q

Osteogenesis imperfecta
Abnormality in which type of collagen

A

Type 1
Present in childhood, fractures following minor trauma, blue sclera, deafness secondary to otosclerosis, dental imperfections are common
- Ca, PO4, PTH, ALP usually normal

36
Q

TNF inhibitors in ankylosing spondylitis improve all except
A. QoL
B. Radiological progression
C. spinal mobility
D. Extra-articular features
E. Early morning stiffness

A

B
It improves radiological progression in RA and psoriatic arthritis

37
Q

Chondrocalcinosis occurs in pseudogout or gout

A

Pseudogout

38
Q

Which one is elevate in paget’s disease
A. urinary coproporphyrin
B. urinary delta-aminolevulinic acid
C. Urinary hydroxyproline
D. Urinary porphyobilinogen
E. urinary Uroporphyrin

A

C

39
Q

Management of discoid lupus erythematous

A

Topical steroid -> hydroxychloroquine
Avoid sun exposure

40
Q

Complications of paget’s disease

A
  • Deafness cranial nerve entrapment)
  • Bone sarcoma
  • Fractures
  • Skull thickening
  • High output cardiac failure
41
Q

Drug induced lupus, least common seen
- GN
- Arthralgia
- Myalgia
- Malar rash
- Pleurisy

A

GN
Common drugs: hydralazine, procainamide

42
Q

Which least a/w Behcet’s syndrome
A. Mouth ulcers
B. Genital ulcers
C. Conjunctivitis
D. DVT
E. Aseptic meningitis

A

C.
More a/w anterior uveitis
Diagnosis: positive pathergy test (puncture site following needle prick becomes inflamed with small pustule forming)
A/W HLA B51

43
Q

Chronic back pain, which most suggest a dx of AS
A. reduced lateral flexion of lumbar spine
B. Pain worsening during the day
C. Accentuated lumbar lordosis
D. Pain on straight leg raising
E. Loss of thoracic kyphosis

A

A
Reduced lateral flexion
Reduced forward flexion (Schober’s test)
Reduced chest expansion
The A’s
- Apical fibrosis
- Anterior uveitis
- AR
- Achilles tendonitis
- AV node block
- Amyloidosis
- And Cauda equina syndrome
- Peripheral arthritis

44
Q

Sjogren syndrome increased risk of which malignancy

A

Lymphoid malignancies

45
Q

What is RF

A

IgM against the Fc portion of IgG

46
Q

Most common cause of death in Ssc

A

Respiratory involvement - ILD and PAH

47
Q

Which ROM of shoulder is classically impair in adhesive capsulitis

A

External rotation

48
Q

Which is not typically seen in adult onset still’s disease
A. Maculopapular rash
B. RF
C. Pyrexia
D. High ferritin
E. Lymphadenopathy

A

B
Normally RF and ANA negative

49
Q

Interactions of MTx

A
  • Avoid trimethoprim or co-trimoxazole -> risk of marrow aplasia
  • Avoid high dose aspirin -> risk of MTx toxicity secondary to reduced excretion
50
Q

Percentage of psoriasis develop associated arthropathy

A

10-20%

51
Q

Correct about discoid lupus
A. commonly progress to SLE
B. Causes non-scarring alopecia
C. Characterised by follicular keratin plugs
D. Is rarely photosensitive
E. Typically presents in older males

A

C

52
Q

S/E of leflunomide

A

C/I: pregnancy, caution in pre-existing lung and liver disease
S/E: GI, HTN, weight loss/anorexia, peripheral neuropathy, myelosuppression, pneumonitis
Stopping: very long wash out period up to 1 year which requires c co-administration of cholestyramine

53
Q

MOA of AZA

A

Inhibit purine synthesis

54
Q

If confirm diagnosis of dermatomyositis, what would be the most important next step?

A

Urgent malignancy screen

55
Q

Features of lateral epicondylitis

A

Pain worse with wrist extension or supination of forearm with elbow extended

56
Q

Features of medial epicondylitis

A

Pain with wrist flexion and pronation
+/- numbness in 4th and 5th finger due to ulnar nerve involvement

57
Q

Features of radial tunnel syndrome

A

Compression of posterior interosseuous branch of radial nerve
- similar to lateral epicondylitis
- Pain tends to be around 4-5cm distal to the lateral epicondyle

58
Q

Feature of cubital tunnel syndrome

A

Compression of ulnar nerve
- Intermittent tingling of 4th and 5th finger

59
Q

Common eye disorder in Marfan

A

Superotemporal ectopic lentis

60
Q

Most useful marker to monitor disease activity in SLE?

A

Anti-dsDNA titres

61
Q

EAM of eye signs in RA
A . keratoconjunctivitis sicca
B. Anterior uveitis
C. Mucus fishing syndrome
D. Peripheral ulcerative keratitis
E. Scleromalacia perforans

A

A, D, E

62
Q

High risk Abs in scleroderma a/w renal crisis

A

RNA polymerase III Abs

Sophie’s Flash Cards (9 decks)

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