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Daisy Finals Revision > Rheumatology > Flashcards

Rheumatology Flashcards

1
Q

What is the triad of Behçet’s syndrome?

A

Oral ulcers
Genital ulcers
Anterior uveitis

Can have thrombophlebitis and dvt

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2
Q

What heart defect is a complication of ehlers Danlos syndrome?

A

Aortic regurgitation
Also mitral valve prolapse and aortic dissection

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3
Q

What is felty’s syndrome?

A

Rheumatoid arthritis, splenomegaly, low white cell count

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4
Q

What type of hypersensitivity reaction is SLE?

A

Type 3

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5
Q

diagnosis - 65 yo builder with gradual onset L hip pain worse with activity and late in day?

A

osteoarthritis

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6
Q

4 x ray findings in osteoarthritis?

A

LOSS
loss of joint space
osteophytes
subcondral cysts
subcondral sclerosis

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7
Q

lumps on fingers in OA?

A

heberden’s nodes
bouchard’s nodes

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8
Q

affected joints in hand signs of OA?

A

heberdens - DIP
bouchards - PIP

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9
Q

non medical options for mgt of OA?

A

weight loss
physiotherapy

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10
Q

medical/surgical management for hip OA?

A

replacement
NSAIDS
steroid injections

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11
Q

diagnosis - 43 yo with symmetrical joint pain, swelling and stiffness in hands, wrists and feet. sx worst in morning

A

rheumatoid arthritis

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12
Q

which antibodies are associated with rheumatoid arthritis?

A

rheumatoid factor
CCP antibodies (cyclic citrullinated peptide)

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13
Q

hand deformities in RA?

A

swan neck deformity
ulnar deviation at MCP jts
Z shaped deformity
boutonniere’s deformity

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14
Q

investigation for synovitis in RA?

A

ultrasound

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15
Q

scoring system for RA?

A

DAS28

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16
Q

first line mgt for RA?

A

methotrexate
leflunomide
sulfasalazine

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17
Q

initial type of biologic?

A

TNF inhibitor
eg infliximab, adalimumab

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18
Q

dx - 35yo with asymmetrical pain and stiffness in fingers and feet. skin and nail changes

A

psoriatic arthritis

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19
Q

nail changes in psoriatic arthritis?

A

onycholysis
nail pitting

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20
Q

name for inflam of entire digit? (in PA)

A

dactylitis

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21
Q

screening tool for psoriatic arthritis?

A

PEST
psoriasis epidemiological screening tool

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22
Q

most severe form of psoriatic arthritis with osteolysis and telescoping of digits?

A

arthritis mutilans

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23
Q

dx - 42 yo with knee pain and swelling 2 weeks post gastroenteritis?

A

reactive arthritis

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24
Q

classic triad in reactive arthritis?

A

cant see cant pee cant climb a tree
conjunctivitis
balanitis
arthritis

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25
Q

most common triggers in reactive arthritis?

A

STIs - chlamydia
gastroenteritis

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26
Q

gene associated with reactive arthritis?

A

HLA B27

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27
Q

most important differential for reactive arthritis?

A

septic arthritis

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28
Q

ix to exclude other causes?

A

joint aspirate

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29
Q

gene associated with ankylosing spondylitis?

A

HLA B27

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30
Q

what are the main symptoms of ankylosing spondylitis in the back?

A

pain on lateral flexion
pain/stiffness on forward flexion

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31
Q

is ankylosing spondylitis worse with movement or rest?

A

rest

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32
Q

what is the special test for ankylosing spondylitis?

A

schobers

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33
Q

x ray finding in late ankylosing spondylitis?

A

bamboo spine

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34
Q

MRI finding in early ankylosing spondylitis?

A

bone marrow oedema

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35
Q

is ankylosing spondylitis worse in morning or eve?

A

morning

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36
Q

diagnosis: hair loss, malar rash, SOB, splenomegaly, joint pain, lymphadenopathy, myalgia

A

SLE

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37
Q

what worsens the rash in SLE?

A

sunlight

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38
Q

initial antibody test for SLE?

A

ANA (antinuclear abs)

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39
Q

specific antibody tests for SLE?

A

anti-double stranded DNA (anti-DSDNA)
anti-smith

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40
Q

first line management for mild SLE?

A

hydroxychloroquine

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41
Q

biologic used in severe SLE, targeting B cells?

A

rituximab

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42
Q

diagnosis: 30yo with skin lesions on face and pathces of hair loss. sx worse with sunlight

A

discoid SLE

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43
Q

diagnostic investigation for discoid SLE?

A

skin biopsy

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44
Q

tx options for discoid SLE?(4)

A
  1. sun protection
  2. topical steroids
  3. intralesion steroid injections
  4. hydroxychloroquine
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45
Q

what type of cancer can discoid SLE lesions become?

A

squamous cell carcinoma

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46
Q

what are the 3 stages of raynaud’s?

A

white -> blue -> red

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47
Q

what % of people with raynaud’s have an associated underlying disease?

A

10-20%

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48
Q

what CT disease is raynaud’s most associated with?

A

systemic sclerosis

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49
Q

screening blood test for systemic sclerosis?

A

antinuclear antibodies

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50
Q

test to examine the small blood vessels in the fingers?

A

nailfold capillaroscopy

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51
Q

medical management for raynauds?

A

prophylactic nifedipine

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52
Q

what does crest stand for in crest syndrome?

A

Calcinosis
Raynaud’s
Esophageal dysmotility
Sclerodactyly
Telangiectasia

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53
Q

what antibodies are checked initially in suspected connective tissue dx?

A

antinuclear antibodies

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54
Q

antibodies in limited cutaneous systemic sclerosis?

A

anti-centromere abs

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55
Q

antibodies in diffuse cutaneous systemic sclerosis?

A

anti-scl-70 abs

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56
Q

diagnosis: 65 yo white woman with 1mo shoulder and pelvic girdle pain and stiffness, worse in am

A

polymyalgia rheumatica

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57
Q

abnormal blood tests in polymyalgia rheumatica?

A

raised CRP and ESR
raised plasma viscosity

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58
Q

treatment for polymyalgia rheumatica?

A

prednisolone 15mg OD

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59
Q

additional medx to protect against s/es of pred?

A
  1. bisphosphonates
  2. calcium and vit d
  3. PPI
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60
Q

what is next course of action if they don’t respond to steroids in PMR?

A

stop steroids
usually respond dramatically to steroids
? diff dx

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61
Q

what should be co prescribed with methotrexate?

A

folate
reduce risk of myelosuppression

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62
Q

which antibiotic cannot be prescribed with methotrexate?

A

trimethoprim (or anything containing it)

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63
Q

features of antiphospholipid syndrome?

A

venous/art thrombosis
recurrent miscarriages
livedo reticularis
other features: pre-eclampsia, pulm htn

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64
Q

which antibody should be tested for when suspecting antiphospholipid syndrome?

A

anti-cardiolipin ab

65
Q

what is the pattern of arthropathies in psoriatic arthritis?

A

assymetrical oligoarthritis (hands and feet)
symmetrical polyarthritis (similar to RA)

66
Q

medication for acute gout?

A

colchicine

67
Q

medication for gout prophylaxis?

A

allopurinol

68
Q

can hydroxychloroquine be used in pregnancy?

69
Q

what are the clinical features of osteomalacia?

A

bone pain, tenderness and proximal myopathy (waddling gait)

70
Q

when should bisphosphonates be started?

A
  1. Anyone with a BMD >-2.5 on DEXA
  2. Anyone 75 or Over with a Fragility Fracture
  3. Anyone on High Dose Corticosteroids (>7.5mg for >3months)
71
Q

diagnosis - 55yo with pain and weakness in thighs, shoulders and upper arms. Purplish rash on eyelids.

A

dermatomyositis

72
Q

initial blood test in dermatomyositis?

A

creatine kinase

73
Q

which antihypertensive medications cause gout?

A

thiazide diuretics
eg bendroflumethiazide

74
Q

diagnosis: 72 yo with R sided temporal headache with scalp tenderness and aching in jaw while chewing

A

giant cell arteritis

75
Q

condition associated with GCA?

A

polymyalgia rheumatica

76
Q

what is the key complication of giant cell arteritis?

A

vision loss

77
Q

what is the key blood test for GCA?

78
Q

what is the definitive test for GCA?

A

temporal artery biopsy

79
Q

what is the initial tx for GCA?

A

prednisolone (high dose - 40-60mg/day)

80
Q

what is a similar diagnosis to dermatomyositis but without skin changes?

A

polymyositis

81
Q

what is the name of the lesions on the hands in dermatomyositis?

A

gottron lesions

82
Q

what antibodies are associated with dermatomyositis?

A

anti-jo 1 (polymyositis)
anti-mi 2 (dermato)
antinuclear antibodies

83
Q

what is the definitive ix for dermatomyositis?

A

muscle biopsy

84
Q

what should be considered in new cases of dermatomyositis?

A

possible underlying malignancy

85
Q

what is the first line tx in dermatomyositis?

A

corticosteroids

86
Q

dx: 45yo woman with dry eyes and mouth. sex affected by vaginal dryness

A

sjogren’s syndrome

87
Q

what are the affected structures in sjogren’s?

A

exocrine glands

88
Q

what is sjogren’s syndrome secondary to?

89
Q

what antibodies are associated with sjogren’s syndrome?

A

anti ro
anti la

90
Q

what is the test for dry eyes?

A

schirmer test
paper in eye measures liquid production

91
Q

what drug is used to halt disease progression in sjogren’s?

A

hydroxychloroquine

92
Q

dx: sinusitis, nosebleeds, saddle shaped nose, cough, wheeze, haemoptysis, glomerulonephritis

A

wegener’s
ie granulomatosis with polyangiitis

93
Q

what type of disease is granulomatosis with polyangiitis?

A

small vessel vasculitis

94
Q

what is the blood test for small vessel vasculitis?

95
Q

what are the treatments for small vessel vasculitis?

A

steroids
immunosuppressants

96
Q

dx: 28yo with recurrent eps of oral and genital ulcers, and episodes of knee pail and swelling

A

behcet’s disease

97
Q

what gene is associated with behcet’s disease?

98
Q

what is the special test for behcet’s disease?

A

pathergy test

99
Q

what is the disease pattern of behcet’s disease?

A

relapsing-remitting

100
Q

what is the topical tx for mouth ulcers in behcet’s disease?

A

steroids (soluble betamethasone)

101
Q

what are 7 causes of mouth ulcers?

A

simple aphthous ulcers
IBD
coeliac
vit B12, folate or iron deficiency
HSV
hand, foot and mouth
squamous cell carcinoma

102
Q

what joint is usually affected in gout?

A

first metatarso-phalangeal

103
Q

what blood test is raised in gout?

A

serum urate

104
Q

what is seen on aspirated fluid in gout?

A

negatively birefringent needle shaped crystals

105
Q

what is first line for an acute flare of gout?

106
Q

what medication is used for acute gout in renal impairment?

A

colchicine

107
Q

what is the main s/e of colchicine?

108
Q

dx: 70yo with hot, swollen, stiff, painful knee

A

pseudogout (CPPD)

109
Q

what is in the joint in pseudogout?

A

calcium pyrophosphate crystals

110
Q

how do CPP crystals appear on joint fluid microscopy?

A

rhomboid shaped crystals that are positively birefringent of polarised light

111
Q

what is the first line mgt of pseudogout?

112
Q

what is the risk assessment tool for osteoporosis?

113
Q

what is the key investigation for osteoporosis?

A

DEXA scanning

114
Q

what is the T score needed for diagnosis of osteoporosis?

115
Q

guidelines for deciding whether to treat osteoporosis?

A

NOGG guideline

116
Q

first line tx for osteoporosis?

A

bisphosphonates

117
Q

moab tx for osteoporosis?

118
Q

dx: 74yo housebound south asian lady w/ fatigue, muscle weakness and bone pain. XR - abnormal fractures

A

osteomalacia

119
Q

what is seen on pelvic XR in osteomalacia?

A

looser zones - demineralized osteoid

120
Q

cause of osteomalacia?

A

vit D deficiency

121
Q

what abnromal electrolytes appear in osteomalacia?

A

low calcium and phosphate

122
Q

which liver test is abnormal in osteomalacia?

A

alkaline phosphatase (ALP)

123
Q

what hormone is abnormal in osteomalacia?

A

parathyroid hormone - raised

124
Q

what is the management for osteomalacia?

A

tx dose vit D

125
Q

dx: 68 yo with bone pain, deformity, pathological fractures and hearing loss

A

paget’s disease of the bone

126
Q

what is the name for well defined osteolytic lesions on XR in paget’s dx of the bone?

A

osteoporosis circumscripta

127
Q

classic skull XR appearance in paget’s?

A

‘cotton wool’ appearance

128
Q

key abnormal blood test in paget’s dx of bone?

A

raised ALP

129
Q

main tx in paget’s disease of bone?

A

bisphosphonates

130
Q

which bones are typically affected in pagets?

A

skull, spine/pelvis, long bones of lower extremities

131
Q

what is the most common causative organism in septic arthritis?

A

staph aureus

132
Q

which STI organism is the most likely causative organism in reactive arthritis?

A

neisseria gonorrhoeae

133
Q

what is the morphology of neisseria gonorrhoeae?

A

gram negative diplococci

134
Q

how are acute flares of rheumatoid arthritis managed?

A

oral or IM corticosteroids

135
Q

what are the risks associated with bisphosphonates?

A
  1. oesophageal reactions
  2. osteonecrosis of the jaw
  3. inc risk of atypical stress fractures
  4. acute phase response
  5. hypocalcaemia
136
Q

what is the management for ankylosing spondylitis?

A

1st line: exercise and NSAIDs
DMARDs useful if there’s peripheral joint involvement
eg sulfasalazine

137
Q

what is seen on CXR in pneumonitis?

A

interstitial infiltration and alveolar shadowing

138
Q

how does pneumonitis present?

A

cough
dyspnoea
fever
malaise

139
Q

what is the first line management for osteoarthritis?

A

topical NSAIDs
then oral
then steroid injections if orals not working

140
Q

how does still’s disease present?

A

arthralgia
elevated serum ferritin
salmon pink maculopapular rash
pyrexia (cyclical)
lymphadenopathy
RF and ANA NEGATIVE

141
Q

features of pagets disease?

A

older male with bone pain and isolated raised ALP
bowing of tibia and bossing of skull

142
Q

management of pagets disease?

A

bisphosphonate

143
Q

ankylosing spondylitis xr findings?

A

subchondral erosions
sclerosis
squaring of lumbar vertebrae

144
Q

antibody associated with scleroderma?

A

anti-centromere

145
Q

antibody for SLE?

A

anti-dsDNA

146
Q

tx for methotrexate toxicity?

A

folinic acid

147
Q

differentiation between gout and pseudogout on xr?

A

chondrocalcinosis on XR in pseudogout

148
Q

features of osteogenesis imperfecta?

A

presents in childhood
fractures following minor trauma
blue sclera
deafness secondary to otosclerosis
dental imperfections common

149
Q

inheritance of osteogenesis imperfecta?

A

autosomal dominant
-» abnormality in type 1 collagen due to dec synthesis of pro-alpha 1 or pro-alpha 2 collagen polypeptides

150
Q

mgt for acute reactive arthritis?

151
Q

mgt for ankylosing spondylitis?

A
  1. exercise and NSAIDs
  2. DMARDs if peripheral joint involvement
152
Q

reactive arthritis genetic association?

153
Q

osteomalacia blood results?

A

low ca
low phosphate
raised alp
raised pth

154
Q

mgt for rheumatoid arthritis?

A

initially: DMARD monotherapy (methotrexate/sulfasalazine/leflunomide) +/- short course of bridging prednisolone

155
Q

Gout medication that interacts with azathioprine?

A

Allopurinol

156
Q

Lesion in young person in diaphysis of pelvis and long bones?

A

Ewing sarcoma

157
Q

Low levels of which types of complement are associated with the development of systemic lupus erythematous?

158
Q

Xr findings late ankylosing spondylitis

A

Apical fibrosis

159
Q

Tx SLE

A

Hydroxychloroquine

Daisy Finals Revision (25 decks)

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