Rheumatology Flashcards by Sophie Zhong

Eye side effects of hydroxychloroquine

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

How well did you know this?

Not at all

Perfectly

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

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

How well did you know this?

Not at all

Perfectly

Urate lower therapy indication

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

How well did you know this?

Not at all

Perfectly

ARBs beneficial in gout

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

How well did you know this?

Not at all

Perfectly

MOA of colchicine

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

How well did you know this?

Not at all

Perfectly

Investigations of osteomalacia

Low vit D
Low Ca and phosphate (30%)
Raised ALP (95-100%)

How well did you know this?

Not at all

Perfectly

When do use pred / methylpred in GCA

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)

How well did you know this?

Not at all

Perfectly

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

No AutoAbs

How well did you know this?

Not at all

Perfectly

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

Lithium

How well did you know this?

Not at all

Perfectly

Organism most commonly a/w reactive arthritis

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

How well did you know this?

Not at all

Perfectly

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

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

How well did you know this?

Not at all

Perfectly

McArdle’s disease

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

How well did you know this?

Not at all

Perfectly

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

How well did you know this?

Not at all

Perfectly

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

Obesity (Low body mass is risk factor)

How well did you know this?

Not at all

Perfectly

Mechanism of mycophenolate mofetil

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

How well did you know this?

Not at all

Perfectly

Combination of prolonged APTT + thrombocytopenia suggestive of

APS

How well did you know this?

Not at all

Perfectly

Instruction on taking alendronate

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

How well did you know this?

Not at all

Perfectly

Secondary causes of raynaud

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

How well did you know this?

Not at all

Perfectly

Factors suggest primary raynaud

Present in young women (onset before 40) with bilateral symptoms

How well did you know this?

Not at all

Perfectly

Clinical manifestations of fibromyalgia

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

How well did you know this?

Not at all

Perfectly

Poor prognostic factors of RA

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

How well did you know this?

Not at all

Perfectly

Neurological disorder a/w PAN

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

How well did you know this?

Not at all

Perfectly

Marfan’s syndrome - dural ectasia

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

How well did you know this?

Not at all

Perfectly

SLE abs a/w congenital heart block

Anti-Ro

How well did you know this?

Not at all

Perfectly

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

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

Sulfasalazine (cautions and S/E)

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

Paget disease of the bone

bony pain, unilateral hearing loss, isolated raised ALP

Meralgia paraesthetica

Affecting lateral cutaneous nerve of the thigh

Meralgia paraesthetica

Affecting lateral cutaneous nerve of the thigh

Pain on wrist extension against resistance

Lateral epicondylitis

Late chest finding of ankylosing spondylitis

Apical fibrosis

Organism of osteomyelitis in sickle cell anaemia

Salmonella predominant

Dermatomyositis AutoAbs

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

S/E of AZA

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

US finding of gout

- Double contour sign

Osteogenesis imperfecta Abnormality in which type of collagen

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

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

B It improves radiological progression in RA and psoriatic arthritis

Chondrocalcinosis occurs in pseudogout or gout

Pseudogout

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

Management of discoid lupus erythematous

Topical steroid -> hydroxychloroquine Avoid sun exposure

Complications of paget's disease

- Deafness cranial nerve entrapment) - Bone sarcoma - Fractures - Skull thickening - High output cardiac failure

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

GN Common drugs: hydralazine, procainamide

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

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

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 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

Sjogren syndrome increased risk of which malignancy

Lymphoid malignancies

What is RF

IgM against the Fc portion of IgG

Most common cause of death in Ssc

Respiratory involvement - ILD and PAH

Which ROM of shoulder is classically impair in adhesive capsulitis

External rotation

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

B Normally RF and ANA negative

Interactions of MTx

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

Percentage of psoriasis develop associated arthropathy

10-20%

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

S/E of leflunomide

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

MOA of AZA

Inhibit purine synthesis

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

Urgent malignancy screen

Features of lateral epicondylitis

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

Features of medial epicondylitis

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

Features of radial tunnel syndrome

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

Feature of cubital tunnel syndrome

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

Common eye disorder in Marfan

Superotemporal ectopic lentis

Most useful marker to monitor disease activity in SLE?

Anti-dsDNA titres

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

A, D, E

High risk Abs in scleroderma a/w renal crisis

RNA polymerase III Abs