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RACP 2022 Written > Rheumatology > Flashcards

Rheumatology Flashcards

1
Q

Which of the following is not useful in treatment of ankylosing spondylitis?

  1. Etanercept
  2. Adalimumab
  3. Secukinumab
  4. Abatacept
  5. Ixekizumab
A
  1. Abatacept

Principles of ank spond treatment:
1st line: physical therapy + NSAIDs
2nd line after failed x2 NSAIDs trialled for 2-4 weeks each: TNF alpha inhibitor (i.e. etanercept, adalimumab) OR IL-17 inhibitor (Ixekizumab, secukinumab)

3rd line: switch to IL-17 inhibitor OR trial a different TNF-alpha blocker (if inital response then failure)

Abatacept - T cell costimulator, evidence in RA and PsA but not Ank spond

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2
Q

What is the first line pharmacologic treatment for Raynaud’s?
What is the second line treatment?
Other than cold, what else can exacerbate Raynaud’s?

A
  1. Dihydropyrine ca channel blockers - amlodipine, nifedipine
  2. PDE5 inhibitors (i.e. sildenafil), topical nitrates (i.e. nitroglycerin ointment), some evidence for ARBs and fluoxetine
  3. Smoking, vasoconstricting drugs (i.e. tryptans)
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3
Q

Which of the following indicates the patient is more likely to have primary rather than secondary Raynaud’s?

  1. Signs of tissue ischemia
  2. Male gender
  3. Age >40
  4. Symmetry
  5. Positive nailfold capillaroscopy
A
  1. Symmetry is more common in primary Raynauds

Nailfold capillarascopy = scleroderma

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4
Q

Name 5 features of mixed connective tissue disease

A
  1. Pulmonary hypertension ( most common cause of death, associated with anti-cardiolipin IgG)
  2. Arthritis
  3. Antibodies - anti-U1-RNP (diagnostic), anti-SNRP
  4. Swollen hands
  5. Raynaud’s
  6. Esophageal dysmotility
  7. Myositis
  8. Acrosclerosis (stiff thick skin on distal fingers(
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5
Q

Which rheumatologic disorders are associated with anterior uvieitis?
Which is not?

A

Spondyloarthropathies - ank spond, psoriatic arthritis, reactive arthritis

JIA
Sjogren’s
Kawasaki’s
Sweet syndrome

AIN

Scleritis OR AU: SLE, Sarcoidosis, relapsing polychnditis, IBD

Anterior uveitis NOT associated with RA (scleritis/episcleritis is)

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6
Q

The following antibodies are associated with an increased risk of what in Scleroderma?

  • Anti-Scl-70 (topoisomerase I)
  • Anti-centremere
  • Anti-RNA polymerase III
A

Anti-Scl-70 (topoisomerase I) - pulmonary fibrosis, more common with diffuse scleroderma

Anti-RNA-polymerase III - diffuse scleroderma, increased skin disease and renal crisis.

Anti-centromore - pulmonary HTN + esophageal disease, more common with limited scleroderma. Protective against fibrosis.

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7
Q

Rheumatologic disorder strongly associated with anti-U1 RNP (U1 ribonucleoprotein) antibodies? ANA pattern

A

Mixed connective tissue disorder

Speckled ANA

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8
Q

Rheumatologic disorder strongly associated with anti-histone antibodies

ANA pattern?

A

Drug induced lupus

Homogenous ANA

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9
Q

Seronegative polyarthritis with fever, rash and high ferritin

A

Still’s disease

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10
Q

Rheumatologic disorder strongly associated with Anti-SS-B (anti-La) antibodies

A

Sjogren’s. Poor specificity. Anti-Ro = CHB in SLE.

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11
Q

Rheumatologic disorder strongly associated with anti-ribosomal P protein antibodies

A

SLE. Highly specific but poor sensitivity. Associated cutaneous manifestation

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12
Q

Role of IL-1B in OA?

A

Inhibits chondrocytes (along with TNF)
Inhibits aggrecanase and collagen II
Stimulates release of MMPs

End product = cartilage destruction

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13
Q

Features of DISH (dish diffuse idiopathic skeletal hyperostosis)

A

Older male age >50
Diabetes in 20%
Negative HLA-B27
Thoracic spine pain with loss off thoracic lateral flexion)

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14
Q

Which autoimmune disorders can cause RTA? Which type?

A

Distal (Type 1)

Sjögren’s syndrome
Autoimmune hepatitis/primary biliary cirrhosis
Systemic lupus erythematosus (also can generate hyperkalemic RTA)
Rheumatoid arthritis

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15
Q

HLA type associated with Behcets

A

HLA-B51

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16
Q

HLA type associated with hypersensitivity to allopurinol

A

HLA-B58*01

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17
Q

Dermatomyositis associated with mild/amyopathic muscle involvement and rapidly progressive ILD

A

anti-MDA5 antibodies

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18
Q

What is bimekizumab and what is it used for?

A

Anti-IL17

Plaque psoriasis

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19
Q

What is avacopan and what is it used for?

A

Anti-C5 receptor
ANCA vasculitis

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20
Q

Which of the following does not have a role in Scleroderma ILD?
A. Cyclophosphamide
B. MTX
C. Azathioprine
D. Tociluzimab
E. MMF

A

B - MTX

MMF 1st line, cyclo 2nd line

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21
Q

What is the “triad” of Felty syndrome

A

RA, Neutropenia, Splenomegaly.

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22
Q

5 factors associated with poor prognosis in RA

A

Smoking
Elevated CRP/ESR
High anti-CCP/RF titres
Erosions at baseline
HLA-DRB1*04 homozygosity
Older age

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23
Q

What is the major cause for premature death in RA?

24
Q

What percentage of patients with GCA will have vision loss?

25
Which autoimmune diseases are associated with hyposplenism?
Antiphospholipid syndrome Goodpastures GPA (PR3) cANCA Hashimotos thyroiditis PAN RA SLE IBD Celiac Also sarcoid/amyloid
26
Most common neurologic manifestation of RA
Carpal tunnel
27
Cardiac manifestations of RA
Pericarditis (restrictive and granulomatous) Myocarditis Coronary artery disease Heart failure Atrial fibrillation Asymptomatic myocardial disease
28
HLA type associatd with RA
HLA DRB1
29
What is the cause of GI hypomotility (oesophagus, stomach, and small/ large intestine) in scleroderma?
Autonomic nerve dysfunction of the GIT Results in esophageal dysmotility, strictures, gastroparesis and psuedo-obstructive
30
Infection commonly associated with PAN
Hepatitis B
31
Key features of anti-synthetase syndrome
inflammatory myopathy interstitial lung disease "mechanic's hands" inflammatory arthritis, Raynaud phenomenon anti-Jo 1
32
HLA associated with Behcets
HLA B51
33
Factors increase risk of Leflunomide use
low weight, ETOH, pregnancy and concurrent use with methotrexate
34
Pathognomonic + characteristic features of Dermatomyositis?
Path: Heliotorpe rash, GOttron papules Char: Malar erythema, Shawl sign, periungual and cuticular changes NOT raynauds
35
Biolgoical agent useful in GCA?
Tocilizumab
36
Describe Inclusion body myo9sitis?
old man, insidious onset (can be five years), painless muscle weakness often starts proximal (hard to get up from chair). Characteristic = weakness distal finger flexors (does not happen in polymyositis). On exam distal muscle groups asymmetric. normal CK (usually elevated in Polymyositis). Biopsy: endomysial inflammation. EMG neuropathic and myopathic features (only myopathic in poly)
37
Describe Polymyositis?
AKA Anti-synthetase syndrome Anti Jo+ ILD = anti-synthestase syndrome Symmetric, progressive weakness. fever, maliase, weight loss, Raynauds. upper oesphages dysphagia also can get conduction defects Non-erosive arthritis "mechanics hands" Raised CK.
38
Mandatory parts of PMR diagnosis
age >50, bilateral shoulder ache abnormal CRP/ESR
39
Common feature of limited scleroderm, common feature of diffuse?
Limited: telangiectasia, diffuse - tendon friction rubs
40
Common histo type fo ILD in systemic sclerosis?
NSIP and responds to cyclophosphamide
41
Characterisics of scleroderma renal crisis? Mx?
Malignant HTN Mild Protenuria microangiopathinc anemia and RNA polyerase positivity NOT GN Treat with ACE -I
42
Four categories of RA classicficaton
# of Joints Sero (RF and Anti - CCP) CRP/ESR Duration >6 weeks
43
Clinical Triad of Felty? Complications?
RA, neutropenia and splenomegaly recurrent infections, hyperspleen =aneamia and thrombocytopenia, lymphadenopathy, skin hyperpig and cutaneous ulceration. Control underlying RA. +/- splecectomy
44
Seronegative arthropathies
Ank Spon Psoriatic Rective Enteropathic spon Undifferentiated spondylo
45
Which is not a TNF inhbitor SE? Demyelinating disease infusion reaction Irreversible Lupus like syndrome reactivate TB Cardiac Failure
Irreversible lupus like syndrome DOes but is REVersible lupus like syndrome ANA positive
46
Mech of Action Infliximab, Etanercept, Adalimumab
TNF inhbitor
47
Target of action ANakinra
IL-1
48
Classic Still's Disease?
16-35 yo arthralgia, high ferritin, salmon pink maculopaula rash, fever, lymphadenopathy RF and ANA negative
49
Clues to Behcet's Disease
Erythema nodosum Recurrent genital ulceraction Recurrent oral ulcerations elevated ESR inflam eye diease pred to involved organ.
50
Broad classes that raise serum urate?
Diuretics (except Losartan), anti-TB, anti-virals, immunosupressives (except MMF) and chemo drugs
51
Which organs are rarely effected in limited scleroderma? A which ab is and not assoicated
Cardiac and renal Limited: Anti-Centromere Ab Diffuse: Anti-top Ab (Scl-70) Renal: Anti-RNA polymerase III
52
radiograph features of RA
symmetirc, marginal erosieon, jiont space narrowing, DIP sparing, Juxta artiulcar op, periarticular soft tissue swelling
53
WHich DMARD no evidence for slow progression of RA radiographically?
Hydroxychloroquine DO: MTx, abatacept, sulfasalazine, pred
54
Which RA drug causes eye problems?
MTX maculopathy vortex keratopathy
55
IBD vs RA STAT4 and STAT3 which is which
IBD - STAT3 RA - STAT4, APDI, DR4 PTPN22
56
Most Common organism in imunocomp Rhem patients?
staph
57
What bone problem is phenytoin therapy linked with?
enchanced vit d metablism leading to osteomalacia not osteoporsis,

RACP 2022 Written (21 decks)

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