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AMC MCQ > Rheumatology > Flashcards

Rheumatology Flashcards

1
Q

Normals ESR

A

Men < 50: 15 mm/hr.
Men > 50: 20 mm/hr
Women < 50: 20 mm/hr
Women > 50: 30 mm/hr

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2
Q

Normal CRP

A

0.8 mg/L

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3
Q

Rheumatoid factor (RF)

A
  • RF positivity is associated with more aggressive disease and more extra-articular manifestations
  • sensitivity is equal to anti-CCP for diagnosis of RA
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4
Q

Anti-CCP

A
  • strong predictor of erosive disease
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5
Q

Anti-DNA topoisomerase I (Scl-70) antibodies

A

diffuse cutaneous
systemic sclerosis

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6
Q

DMARDs in pregnancy

A

cytotoxic and teratogenic
- prescribe corticoseteroids

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7
Q

MS prevalence in Aus

A

1:1000

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8
Q

CREST syndrome

A

(Calcinosis cutis,
Raynaud phenomenon, Esophageal dysmotility, Sclerodactyly, and Telangiectasia)

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9
Q

diagnosis of CREST syndrome

A

anti-centromere antibodies

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10
Q

elderly px + elevated ESR + CRP pain and stiffness in hips and shoulders in the morning

A

Polymyalgia rheumatica

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11
Q

Polymyalgia rheumatica underlying pathology

A

giant cell arteritis

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12
Q

headaches over 50 + Fever + Anemia + High ESR

A

Giant cell arteritis

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13
Q

face rash + URTI + migrating athralgia

A

Parvovirus-associated arthritis

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14
Q

Parvovirus-associated arthritis investigation

A

diagnostic: detection of parvovirus B19 specific IgM antibodies

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15
Q

Giant cell arteritis investigation

A

1- Elevated ESR.
2- Normochromic or slightly hypochromic anemia.
3- Liver function abnormalities-increased alkaline phosphatase levels
diagnostic: Temporal artery biopsy

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16
Q

Giant cell arteritis management

A
  • glucocorticoid prednisolone
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17
Q

rheumatoid nodulosis

A

Local glucocorticoid injections

RA medication with methotrexate and
other DMARDs can increase the frequency and number of rheumatoid nodules—a
condition known as accelerated nodulosis.

Treatment consists of intralesional steroid injection to decrease size
NSAIDs may improve the pain but does not reduce the size and number of nodules

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18
Q

Malar rash (butterfly rash),

A
  • highly specific for
    the diagnosis of SLE
  • flat, scaly, non-pruritic and
    characteristically spares the nasolabial fold
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19
Q

SLE management

A

long term cornerstone: hydroxychloroquine

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20
Q

proximal muscle weakness and pain and a heliotrope (lilac color of the periorbital) rash about her eyes.

A

dermatomyositis
(This rash surrounds both eyes and may extend
onto the malar eminences, the eyelids, the bridge of the nose, and the forehead)

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21
Q

Back pain caused by an inflammatory condition

A

(rheumatoid arthritis, ankylosing
spondylitis, Reiter syndrome)

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22
Q

focal and segmental glomerulonephritis + cytoplasm ANCA antibodies+ affecting upper airway

A

Wegener granulomatosis (WG)

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23
Q

vasculitis of small and medium
sized arteries and veins

A

C-ANCA
Wegener granulomatosis (WG

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24
Q

female + widespread pain> 3 months + Fatigue and sleep difficulties + Normal CRP, ESR

A

fibromyalgia

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25
metacarpophalangeal joint + wrists are warm and tender + swollen
RA
26
worsening headaches + episodes transient visual loss and diplopia + on chewing, her jaw muscles ache until she stops chewing. tender nodular right temporal + mild normocytic anemia + sedimentation rate is 95
Temporal arteritis
27
neuropathy + myopathy + noncaseating granulomas
Sarcoidosis
28
dry mouth and a gritty sensation in eyes + buccal mucosa appears dry + salivary glands are enlarged bilaterally + arthritis
Sjögren syndrome Schirmer test and measurement of autoantibodies anti-Ro (SSA), anti -La
29
Sjögren syndrome treatment
Conservative: - artificial tears - artificial saliva - nasal sprays Pharcological: - Hydroxych
30
risk factors for developing pseudogout
Age more than 70 years. -The family history of pseudogout. -Hypothyroidism. -Haemochromatosis. -Hyperparathyroidism. -Hypercalcemia. -Hypomagnesaemia
31
Drug-induced lupus syndrome
– Hydralazine. – Procainamide. – Quinidine. – Phenytoin. – Chlorpromazine. – Isoniazid. – Methyldopa. – ACE inhibitors.
32
SLE
(ANA) is indicated as the best initial screening test. The dsDNA is 90% specific - affects women in high estrogen period - more common in female - weight loss - malar rash and oral ulcers - most common presentation of this arthritis is symmetrical polyarthritis affecting the hands, wrist and knees.
33
Bradycardia in a patient with SLE antibody
Anti-Ro
34
Ankylosing spondylitis
- dull pain, insidious, felt deep in the lower lumbar orgluteal region,low-back morning stiffness - HLA-B27 is of little use - Plain x-ray of the sacroiliac joints is the most useful investigation in establishing the diagnosis. - Spirometry- restrictive pattern - The disease-modifying drugs are useful if there is peripheral joint involvement
35
highest specificity for rheumatoid arthritis
Anti-citrullinated peptide antibody
36
knee pain and swelling + Knee aspiration fluid showed negative birefringent test
Gout
37
osteoarthritis joint involvement
1-The first carpometacarpal joint of the thumb. 2-First metatarsophalangeal joint of the big toe. 3-Distal interphalangeal joint. 4-Proximal interphalangeal joint. 5-Cervical and lumbar spine. 6-Knee joint. 7-Hip joint.
38
X-ray changes of osteoarthritis
narrowing of joint space subchondral sclerosis and osteophytes. These changes are seen years after the onset of osteoarthritis.
39
DEXA
confirm a diagnosis of osteoporosis.
40
X-ray findings (periarticular swelling with normal joint space)
episode of monoarticular gout
41
pain and swelling of the right big toe + low dose aspirin, atorvastatin, metoprolol, nitrates and frusemide + joint is swollen shiny and red
Acute gout
42
history of rheumatoid arthritis + on methotrexate + dysuria and urgency + initial drug
- cephalexin is the drug of choice Trimethoprim, co-trimoxazole, Co-amoxiclav, Ciprofloxacin increases the risk of methotrexate toxicity
43
long-term urate-lowering therapy for gout
- Frequent or disabling gout flares Frequent or disabling gout flares (Two flares or more annually) -Tophi and structural joint damage ( Urate-lowering therapies such as allopurinol, probenecid, or febuxostat can help reduce tophaceous deposits that may be present) - Gout with renal insufficiency Gout with renal insufficiency – Patients with a creatinine clearance (CrCl) <60 mL/minute/1.73 m (stage 3 or higher chronic kidney disease [CKD]).
44
Acute gout
NSAIDS Colchicine glucocorticoids prednisolone - if above two are contraindicated
45
colchicine contraindications
1- Renal insufficiency. 2-Cytopenias. 3-Abnormal liver functions. 4-Sepsis.
46
Chronic use of methotrexate
1-Hepatotoxicity 2-Folic acid deficiency 3-Myelosuppression with low platelet and white cell count. 4-Interstitial pneumonitis 5-Fatigue 6-Nausea and vomiting 7-Stomatitis or mouth ulcers.
47
patients who are steroid dependent for surgery
1-Give intravenous 100 mg hydrocortisone pre-operatively and 100 mg IV hydrocortisone intra-operatively. 2-During first 24 hours post-op give intravenously 100 mg hydrocortisone 6-8 hourly. This can be reduced by half over the next 48 hours. 3-Then change it to oral when patient tolerates oral diet.
48
medications of choice for lupus nephritis
cyclophosphamide and mycophenolate
49
steroid-sparing immunosuppressive drugs
hydroxychloroqulne Methotrexate
50
precipitating factors for acute attack of gout
- Alcoholic Binge – Drugs ( furosemide, thiazides, Low dose aspirin ) – Starvation – Chronic kidney disease – Myeloproliferative disorders – Lymphoproliferative disorders – Cytotoxic drugs – Sugary soft drinks.
51
Disorders and factors associated with Raynaud phenomenon
Sjögren's syndrome Scleroderma Dermatomyositis Systemic lupus erythematosus Thoracic outlet syndrome Emboli Carpal tunnel syndrome Migraine headache
52
Thrombotic thrombocytopenic purpura
- thrombotic microangiopathy - severely reduced activity of the von Willebrand factor-cleaving protease ADAMTS13 - small-vessel platelet-rich thrombi that cause thrombocytopenia, microangiopathic hemolytic anemia, and sometimes organ damage
53
High serum uric acid level can be managed by dietary measure including:
– Decreasing purine diet. – Limiting ethanol use. – Decreasing fructose containing food. – Avoiding diuretics. – Increasing liquid intake
54
Uveoparotid fever or Heerfordt’s syndrome
rare manifestation of sarcoidosis Uveitis Parotiditis Chronic fever Palsy of facial nerves in some cases
55
getting out of chair or walking difficulty + worsening weakness + 3/5 strength proximally + red confluent macular rash on her and reflexes are normal.
Dermatomyositis
56
non-itchy non-pitting swellings + laryngeal oedema + abdominal pain + vomiting + diarrhoea
hereditary angioedema
57
hereditary angioedema investigation
- low C1 and C4 levels
58
acquired angioedema investogation
- low C1 q level
59
earliest sign of flexor sheath tenosynovitis infection
passive extension pain
60
Sheath infection tenosynovitis common findings
Kanavel signs: - exquisite pain - flexed resting position - fusiform swelling - tenderness

AMC MCQ (59 decks)

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