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MRCP > Rheumatology > Flashcards

Rheumatology Flashcards

1
Q

SLE: type of hypersensitivity reaction

A

Type 3

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2
Q

SLE associations

A

HLA B8, DR2, DR3

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3
Q

SLE epidemiology

A

Young adults
Black Americans

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4
Q

SLE symptoms

A

fatigue
fever
mouth ulcers
lymphadenopathy

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5
Q

SLE skin features

A

malar (butterfly) rash: spares nasolabial folds
discoid rash: scaly, erythematous, well demarcated rash in sun-exposed areas. Lesions may progress to become pigmented and hyperkeratotic before becoming atrophic
photosensitivity
Raynaud’s phenomenon
livedo reticularis
non-scarring alopecia

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6
Q

SLE MSK features

A

arthralgia
non erosive arthritis

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7
Q

SLE CVS features

A

Pericarditis and myocarditis

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8
Q

SLE respiratory symptoms

A

pleurisy
fibrosing alveolitis

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9
Q

SLE renal symptoms

A

proteinuria
glomerulonephritis (diffuse proliferative glomerulonephritis is the most common type)

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10
Q

SLE neuropsychiatry symptoms

A

anxiety and depression
psychosis
seizures

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11
Q

SLE antibodies

A

ANA (v sensitive so if negative rules it out)
anti-dsDNA (specific)
anti-Smith, anti-Ro and anti-LaS

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12
Q

SLE monitoring

A

ESR
Low C3 and C4

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13
Q

SLE management

A

Hydroxychloroquine

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14
Q

SLE pregnancy

A

Associated with neonatal heart block

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15
Q

RA management

A
  1. Short course oral pred to go into remission

+ methotrexate
(other options sulfalazine, lefluonamide)

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16
Q

RA monitoring

A

CRP and DAS28 (disease burden(

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17
Q

When to use a TNF alpha blocker?

A

If 2 DMARDs have failed
- etanercept, infliximab, adalimumab

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18
Q

When to use rituximab in RA

A

anti-CD20

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19
Q

Etanercept SE

A

reactivation of TB (need to have CXR prior to starting)

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20
Q

RA antibodies

A

Anti CCP if positive is diagnostic

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21
Q

Stills disease diagnostic indicator

A

Very raised ferritin

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22
Q

what is stills disease?

A

Stills disease is a rare form of RA that has a bimodal distributioni

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23
Q

Stills disease symptoms

A

arthralgia
elevated serum ferritin
rash: salmon-pink, maculopapular
pyrexia
typically rises in the late afternoon/early evening in a daily pattern and accompanies a worsening of joint symptoms and rash
lymphadenopathy

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24
Q

Stills disease antibodies

A

ANA and RF positive

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25
Q

Stills disease management

A

NSAIDs –> Steroids –> methotrexate

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26
Q

Behcets syndrome age

A

Young adults, smokers

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27
Q

Triad for Behcets

A
  1. Oral ulcers
  2. Anterior uveitis
  3. Genital ulcers
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28
Q

Behcets management

A
  1. steroids
  2. cyclophosphamide, etanercept, rituximab
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29
Q

Sjogrens what is there an increased risk of

A

Lymphoid malignancyS

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30
Q

Sjogrens sx

A

Dry eyes, dry mouth
Arthralgia
Raynauds

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31
Q

Sjogrens ix

A

rheumatoid factor (RF) positive in nearly 50% of patients
ANA positive in 70%
anti-Ro (SSA) antibodies in 70% of patients with PSS
anti-La (SSB) antibodies in 30% of patients with PSS
Schirmer’s test: filter paper near conjunctival sac to measure tear formation
histology: focal lymphocytic infiltration
also: hypergammaglobulinaemia, low C4

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32
Q

Sjogrens management

A

Artificial saliva, pilocarpine

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33
Q

GCA fundoscopy

A

Pale optic discs and swollen optic nerves

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34
Q

Mx GCA

A

If no visual loss - high dose oral pred
If visual loss - IV methylpred

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35
Q

SLE complement levels

A

C4 is low

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36
Q

Giut precipitating factor

A

IndapamideC

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37
Q

Cryoglobulinaemia

A

arthralgia, purpura, skin ulcers

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38
Q

Cryoglobuliaemia associations

A

HIV
Hep C

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39
Q

Cryoglobulinaemia mx

A

Symptomatic control

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40
Q

GCA cause of vision loss

A

Anterior ischaemic optic neuritis

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41
Q

Ank spon genes

A

HLA B27

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42
Q

GCA classic symptoms

A

reduced lateral flexion
reduced forward flexion - Schober’s test - a line is drawn 10 cm above and 5 cm below the back dimples (dimples of Venus). The distance between the two lines should increase by more than 5 cm when the patient bends as far forward as possible
reduced chest expansion

43
Q

GCA other symptoms

A

Apical fibrosis
Anterior uveitis
Aortic regurgitation
Achilles tendonitis
AV node block
Amyloidosis
and cauda equina syndrome
peripheral arthritis (25%, more common if female)

44
Q

ank spon xr findings

A
  1. XR
    sacroiliitis: subchondral erosions, sclerosis
    squaring of lumbar vertebrae
    ‘bamboo spine’ (late & uncommon)
    syndesmophytes: due to ossification of outer fibers of annulus fibrosus
    chest x-ray: apical fibrosis
45
Q

GCA mx

A
  1. regular exercise
  2. NSAIDs
  3. Physio
  4. DMARDs if peripheral symptoms
46
Q

RA gene

A

HLA DR4

47
Q

Antiphospholipid antibodies

A

antibodies
anticardiolipin antibodies
anti-beta2 glycoprotein I (anti-beta2GPI) antibodies
lupus anticoagulant
thrombocytopenia
prolonged APTT

48
Q

Antiphopholipid management

A
  1. Primry thromboprophylaxis - low dose aspirin
  2. Secondary thromboprophylaxis
    initial venous thromboembolic events: lifelong warfarin with a target INR of 2-3
    recurrent venous thromboembolic events: lifelong warfarin; if occurred whilst taking warfarin then consider adding low-dose aspirin, increase target INR to 3-4
    arterial thrombosis should be treated with lifelong warfarin with target INR 2-3
49
Q

What is antiphospholipid associated with?

A

SLE

50
Q

HLA B27

A

Ank spon

51
Q

HLA B8

A

Primary biliary cholangitis

52
Q

HLA B51

A

Behcets disease

53
Q

HLA DQ2

A

Coeliac disease

54
Q

HLA DR3

A

Insulin dependent diabetes

55
Q

Treatment if T score <-2.5 but eGFR <35

A

Denosumab (CI in hypocalcaemia and hypophosphataemia)

56
Q

Dose of oral pred in GCA

A

1mg/kgq

57
Q

Limited sclerorsis

A

CREST

calcinosis
raynauds
oesophageal dysfunction
sclerodactyly
telengiectasia

anti-centromere

58
Q

Diffuse sclerosis

A

Anti Scl

59
Q

Feltys syndrome

A
  1. RA
  2. Neutropenia
  3. Splenomegaly
60
Q

Ank spon mx

A
  1. physio
  2. DMARD
61
Q

Preisers disease

A

Bilateral idipathic avascualr necrosis of the scaphoid bone

62
Q

2 x NSAIDs in ank spon next line management

A

Biological agent e.g. etanercept or adalimumab

DMARDS ARE NOT USED IN ANK SPON

63
Q

SLE renal classification

A

I: Minimal change
II: mesangial
II: focal segmental proliferative
IV: diffuse proliferative
V: membranous
VI: glomerulosclerosis

64
Q

Class I/II SLE renal disease management

A

Hydroxychloroquine

65
Q

Class III/IV SLE renal disease management

A

high dose steroids + IV cyclophosphamide/mofetil

66
Q

Class VI SLE renal disease management

A

Usually too advanced and not treated

67
Q

osteomalacia bloods

A

Vitamin D deficiency:
- raised ALP
- low calcium
- low phosphate
- may have raised PTH

68
Q

Osteomalacia sx

A

Difficulty walking up stairs
Muscle weakness
Boney tenderness

69
Q

Osteomalacia XR finding

A

Translucent bands

70
Q

DMARD unsafe for male to take if trying for baby

A

azathioprine (reduces sperm count)O

71
Q

Osteoporosis management

A
  1. alendronic acid
  2. raloxifene (oestrogen receptor modulator)
  3. terparatide (v expensive, used in severe cases)

*strontium (used rarely as increased risk of CVS disease and VTE)

72
Q

Diffuse systemic sclerosis antibodies

A

anti-SCL70

73
Q

Limited systemic sclerosis antibodies

A

anti-centromere (CREST syndrome)

74
Q

Pagets treatment

A

Bisphosphonates

75
Q

Felty syndrome

A

RA, neutropenia, splenomegaly

76
Q

Rugger jersey finding on XR

A

Renal osteodystrophy

77
Q

Ank spon XR findings

A

Syndesmophytes
Tramlines
Bamboo spine
Subchondral sclerosis

78
Q

Behcets disease

A
  • genital and oral ulcers
  • uveitis
  • thrombophlebitis
79
Q

If a newborn baby has this antibody then they have an increased risk of neonatal heart block

A

Anti-Ro

80
Q

Polymyositis cause of renal injury

A

Acute tubular necrosis

81
Q

When to avoid etanercept

A

Previous MS diagnosis

82
Q

SLE most common tissue involved

A

Joints

83
Q

Most common respiratory symptoms of SLE

A

Pleural effusion

84
Q

Bloods RA

A

Normochromic normocytic anaemia (anaemia of chronic disease)

85
Q

SLE opthalmological signs

A

Cataracts (will require a lens replacement)

86
Q

Polymyalgia rheumatica steroid dose

A

Oral 25mg with calcium and vitamin D supplementation

87
Q

Pagets disease symptoms

A

Bowed legs, deafness, FHx of osteosarcoma

88
Q

Polyarteritis nodosa, most common blood finding

A

Elevated creatinine

89
Q

RA management

A
  1. Steroids
  2. DMARDS (methotrexate, sulfalazine, hydroxychloroquine)
  3. TNF alpha blockers once 2 DMARDs have failed e.g. etanercept, infilximab, adalimumab or anti CD20 rituximab
90
Q

RA pregnancy safe drugs

A

Sulfalazine and hydroxychloroquine

91
Q

When to stop methotrexate in pregnancy

A

Stop 6 months before conception

92
Q

Antiphospholipid management

A

Primary prophylaxis: low dose aspirin

Secondary prophylaxis: warfain INR 2-3
- if having recurrent thrombis 3-4

93
Q

Anti Jo

A

Polymyositis

94
Q

RA rituximab reactivation

A

Hep B

95
Q

SLE bloods

A

normochromic normocytic anaeamia

96
Q

RA HLA

A

HLA DR4

97
Q

Polymyositis ix

A

Muscle biopsy

98
Q

Polymyositis antibody

A

anti-Jo-1

99
Q

Dermatomyositis antibody

A

anti-Mi-2

100
Q

Limited vs diffuse systemic sclerosis skin coverage

A

Limited: below elbows and below knees

Diffuse: whole body

101
Q

Haemochromatosis

A

Hepatic injury, tanned, ED

102
Q

Felty syndrome

A

HLA-DRW4

103
Q

Eosinophilic fasciitis

A

swelling and tenderness in fingers
peau d’orange
hypergammaglobulinaemia
raised eosinophils

104
Q

Neonatal lupus antobody

A

anti-Ro

MRCP (28 decks)

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