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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
Stills disease management
NSAIDs --> Steroids --> methotrexate
26
Behcets syndrome age
Young adults, smokers
27
Triad for Behcets
1. Oral ulcers 2. Anterior uveitis 3. Genital ulcers
28
Behcets management
1. steroids 2. cyclophosphamide, etanercept, rituximab
29
Sjogrens what is there an increased risk of
Lymphoid malignancyS
30
Sjogrens sx
Dry eyes, dry mouth Arthralgia Raynauds
31
Sjogrens ix
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
32
Sjogrens management
Artificial saliva, pilocarpine
33
GCA fundoscopy
Pale optic discs and swollen optic nerves
34
Mx GCA
If no visual loss - high dose oral pred If visual loss - IV methylpred
35
SLE complement levels
C4 is low
36
Giut precipitating factor
IndapamideC
37
Cryoglobulinaemia
arthralgia, purpura, skin ulcers
38
Cryoglobuliaemia associations
HIV Hep C
39
Cryoglobulinaemia mx
Symptomatic control
40
GCA cause of vision loss
Anterior ischaemic optic neuritis
41
Ank spon genes
HLA B27
42
GCA classic symptoms
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
GCA other symptoms
Apical fibrosis Anterior uveitis Aortic regurgitation Achilles tendonitis AV node block Amyloidosis and cauda equina syndrome peripheral arthritis (25%, more common if female)
44
ank spon xr findings
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
GCA mx
1. regular exercise 2. NSAIDs 3. Physio 4. DMARDs if peripheral symptoms
46
RA gene
HLA DR4
47
Antiphospholipid antibodies
antibodies anticardiolipin antibodies anti-beta2 glycoprotein I (anti-beta2GPI) antibodies lupus anticoagulant thrombocytopenia prolonged APTT
48
Antiphopholipid management
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
What is antiphospholipid associated with?
SLE
50
HLA B27
Ank spon
51
HLA B8
Primary biliary cholangitis
52
HLA B51
Behcets disease
53
HLA DQ2
Coeliac disease
54
HLA DR3
Insulin dependent diabetes
55
Treatment if T score <-2.5 but eGFR <35
Denosumab (CI in hypocalcaemia and hypophosphataemia)
56
Dose of oral pred in GCA
1mg/kgq
57
Limited sclerorsis
CREST calcinosis raynauds oesophageal dysfunction sclerodactyly telengiectasia anti-centromere
58
Diffuse sclerosis
Anti Scl
59
Feltys syndrome
1. RA 2. Neutropenia 3. Splenomegaly
60
Ank spon mx
1. physio 2. DMARD
61
Preisers disease
Bilateral idipathic avascualr necrosis of the scaphoid bone
62
2 x NSAIDs in ank spon next line management
Biological agent e.g. etanercept or adalimumab DMARDS ARE NOT USED IN ANK SPON
63
SLE renal classification
I: Minimal change II: mesangial II: focal segmental proliferative IV: diffuse proliferative V: membranous VI: glomerulosclerosis
64
Class I/II SLE renal disease management
Hydroxychloroquine
65
Class III/IV SLE renal disease management
high dose steroids + IV cyclophosphamide/mofetil
66
Class VI SLE renal disease management
Usually too advanced and not treated
67
osteomalacia bloods
Vitamin D deficiency: - raised ALP - low calcium - low phosphate - may have raised PTH
68
Osteomalacia sx
Difficulty walking up stairs Muscle weakness Boney tenderness
69
Osteomalacia XR finding
Translucent bands
70
DMARD unsafe for male to take if trying for baby
azathioprine (reduces sperm count)O
71
Osteoporosis management
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
Diffuse systemic sclerosis antibodies
anti-SCL70
73
Limited systemic sclerosis antibodies
anti-centromere (CREST syndrome)
74
Pagets treatment
Bisphosphonates
75
Felty syndrome
RA, neutropenia, splenomegaly
76
Rugger jersey finding on XR
Renal osteodystrophy
77
Ank spon XR findings
Syndesmophytes Tramlines Bamboo spine Subchondral sclerosis
78
Behcets disease
- genital and oral ulcers - uveitis - thrombophlebitis
79
If a newborn baby has this antibody then they have an increased risk of neonatal heart block
Anti-Ro
80
Polymyositis cause of renal injury
Acute tubular necrosis
81
When to avoid etanercept
Previous MS diagnosis
82
SLE most common tissue involved
Joints
83
Most common respiratory symptoms of SLE
Pleural effusion
84
Bloods RA
Normochromic normocytic anaemia (anaemia of chronic disease)
85
SLE opthalmological signs
Cataracts (will require a lens replacement)
86
Polymyalgia rheumatica steroid dose
Oral 25mg with calcium and vitamin D supplementation
87
Pagets disease symptoms
Bowed legs, deafness, FHx of osteosarcoma
88
Polyarteritis nodosa, most common blood finding
Elevated creatinine
89
RA management
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
RA pregnancy safe drugs
Sulfalazine and hydroxychloroquine
91
When to stop methotrexate in pregnancy
Stop 6 months before conception
92
Antiphospholipid management
Primary prophylaxis: low dose aspirin Secondary prophylaxis: warfain INR 2-3 - if having recurrent thrombis 3-4
93
Anti Jo
Polymyositis
94
RA rituximab reactivation
Hep B
95
SLE bloods
normochromic normocytic anaeamia
96
RA HLA
HLA DR4
97
Polymyositis ix
Muscle biopsy
98
Polymyositis antibody
anti-Jo-1
99
Dermatomyositis antibody
anti-Mi-2
100
Limited vs diffuse systemic sclerosis skin coverage
Limited: below elbows and below knees Diffuse: whole body
101
Haemochromatosis
Hepatic injury, tanned, ED
102
Felty syndrome
HLA-DRW4
103
Eosinophilic fasciitis
swelling and tenderness in fingers peau d'orange hypergammaglobulinaemia raised eosinophils
104
Neonatal lupus antobody
anti-Ro

MRCP (28 decks)

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