Rheumatology Flashcards
1
Q
What is the triad of Behçet’s syndrome?
A
Oral ulcers
Genital ulcers
Anterior uveitis
Can have thrombophlebitis and dvt
2
Q
What heart defect is a complication of ehlers Danlos syndrome?
A
Aortic regurgitation
Also mitral valve prolapse and aortic dissection
3
Q
What is felty’s syndrome?
A
Rheumatoid arthritis, splenomegaly, low white cell count
4
Q
What type of hypersensitivity reaction is SLE?
A
Type 3
5
Q
diagnosis - 65 yo builder with gradual onset L hip pain worse with activity and late in day?
A
osteoarthritis
6
Q
4 x ray findings in osteoarthritis?
A
LOSS
loss of joint space
osteophytes
subcondral cysts
subcondral sclerosis
7
Q
lumps on fingers in OA?
A
heberden’s nodes
bouchard’s nodes
8
Q
affected joints in hand signs of OA?
A
heberdens - DIP
bouchards - PIP
9
Q
non medical options for mgt of OA?
A
weight loss
physiotherapy
10
Q
medical/surgical management for hip OA?
A
replacement
NSAIDS
steroid injections
11
Q
diagnosis - 43 yo with symmetrical joint pain, swelling and stiffness in hands, wrists and feet. sx worst in morning
A
rheumatoid arthritis
12
Q
which antibodies are associated with rheumatoid arthritis?
A
rheumatoid factor
CCP antibodies (cyclic citrullinated peptide)
13
Q
hand deformities in RA?
A
swan neck deformity
ulnar deviation at MCP jts
Z shaped deformity
boutonniere’s deformity
14
Q
investigation for synovitis in RA?
A
ultrasound
15
Q
scoring system for RA?
A
DAS28
16
Q
first line mgt for RA?
A
methotrexate
leflunomide
sulfasalazine
17
Q
initial type of biologic?
A
TNF inhibitor
eg infliximab, adalimumab
18
Q
dx - 35yo with asymmetrical pain and stiffness in fingers and feet. skin and nail changes
A
psoriatic arthritis
19
Q
nail changes in psoriatic arthritis?
A
onycholysis
nail pitting
20
Q
name for inflam of entire digit? (in PA)
A
dactylitis
21
Q
screening tool for psoriatic arthritis?
A
PEST
psoriasis epidemiological screening tool
22
Q
most severe form of psoriatic arthritis with osteolysis and telescoping of digits?
A
arthritis mutilans
23
Q
dx - 42 yo with knee pain and swelling 2 weeks post gastroenteritis?
A
reactive arthritis
24
Q
classic triad in reactive arthritis?
A
cant see cant pee cant climb a tree
conjunctivitis
balanitis
arthritis
25
most common triggers in reactive arthritis?
STIs - chlamydia
gastroenteritis
26
gene associated with reactive arthritis?
HLA B27
27
most important differential for reactive arthritis?
septic arthritis
28
ix to exclude other causes?
joint aspirate
29
gene associated with ankylosing spondylitis?
HLA B27
30
what are the main symptoms of ankylosing spondylitis in the back?
pain on lateral flexion
pain/stiffness on forward flexion
31
is ankylosing spondylitis worse with movement or rest?
rest
32
what is the special test for ankylosing spondylitis?
schobers
33
x ray finding in late ankylosing spondylitis?
bamboo spine
34
MRI finding in early ankylosing spondylitis?
bone marrow oedema
35
is ankylosing spondylitis worse in morning or eve?
morning
36
diagnosis: hair loss, malar rash, SOB, splenomegaly, joint pain, lymphadenopathy, myalgia
SLE
37
what worsens the rash in SLE?
sunlight
38
initial antibody test for SLE?
ANA (antinuclear abs)
39
specific antibody tests for SLE?
anti-double stranded DNA (anti-DSDNA)
anti-smith
40
first line management for mild SLE?
hydroxychloroquine
41
biologic used in severe SLE, targeting B cells?
rituximab
42
diagnosis: 30yo with skin lesions on face and pathces of hair loss. sx worse with sunlight
discoid SLE
43
diagnostic investigation for discoid SLE?
skin biopsy
44
tx options for discoid SLE?(4)
1. sun protection
2. topical steroids
3. intralesion steroid injections
4. hydroxychloroquine
45
what type of cancer can discoid SLE lesions become?
squamous cell carcinoma
46
what are the 3 stages of raynaud's?
white -> blue -> red
47
what % of people with raynaud's have an associated underlying disease?
10-20%
48
what CT disease is raynaud's most associated with?
systemic sclerosis
49
screening blood test for systemic sclerosis?
antinuclear antibodies
50
test to examine the small blood vessels in the fingers?
nailfold capillaroscopy
51
medical management for raynauds?
prophylactic nifedipine
52
what does crest stand for in crest syndrome?
Calcinosis
Raynaud's
Esophageal dysmotility
Sclerodactyly
Telangiectasia
53
what antibodies are checked initially in suspected connective tissue dx?
antinuclear antibodies
54
antibodies in limited cutaneous systemic sclerosis?
anti-centromere abs
55
antibodies in diffuse cutaneous systemic sclerosis?
anti-scl-70 abs
56
diagnosis: 65 yo white woman with 1mo shoulder and pelvic girdle pain and stiffness, worse in am
polymyalgia rheumatica
57
abnormal blood tests in polymyalgia rheumatica?
raised CRP and ESR
raised plasma viscosity
58
treatment for polymyalgia rheumatica?
prednisolone 15mg OD
59
additional medx to protect against s/es of pred?
1. bisphosphonates
2. calcium and vit d
3. PPI
60
what is next course of action if they don't respond to steroids in PMR?
stop steroids
usually respond dramatically to steroids
? diff dx
61
what should be co prescribed with methotrexate?
folate
reduce risk of myelosuppression
62
which antibiotic cannot be prescribed with methotrexate?
trimethoprim (or anything containing it)
63
features of antiphospholipid syndrome?
venous/art thrombosis
recurrent miscarriages
livedo reticularis
other features: pre-eclampsia, pulm htn
64
which antibody should be tested for when suspecting antiphospholipid syndrome?
anti-cardiolipin ab
65
what is the pattern of arthropathies in psoriatic arthritis?
assymetrical oligoarthritis (hands and feet)
symmetrical polyarthritis (similar to RA)
66
medication for acute gout?
colchicine
67
medication for gout prophylaxis?
allopurinol
68
can hydroxychloroquine be used in pregnancy?
yes
69
what are the clinical features of osteomalacia?
bone pain, tenderness and proximal myopathy (waddling gait)
70
when should bisphosphonates be started?
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
diagnosis - 55yo with pain and weakness in thighs, shoulders and upper arms. Purplish rash on eyelids.
dermatomyositis
72
initial blood test in dermatomyositis?
creatine kinase
73
which antihypertensive medications cause gout?
thiazide diuretics
eg bendroflumethiazide
74
diagnosis: 72 yo with R sided temporal headache with scalp tenderness and aching in jaw while chewing
giant cell arteritis
75
condition associated with GCA?
polymyalgia rheumatica
76
what is the key complication of giant cell arteritis?
vision loss
77
what is the key blood test for GCA?
ESR
78
what is the definitive test for GCA?
temporal artery biopsy
79
what is the initial tx for GCA?
prednisolone (high dose - 40-60mg/day)
80
what is a similar diagnosis to dermatomyositis but without skin changes?
polymyositis
81
what is the name of the lesions on the hands in dermatomyositis?
gottron lesions
82
what antibodies are associated with dermatomyositis?
anti-jo 1 (polymyositis)
anti-mi 2 (dermato)
antinuclear antibodies
83
what is the definitive ix for dermatomyositis?
muscle biopsy
84
what should be considered in new cases of dermatomyositis?
possible underlying malignancy
85
what is the first line tx in dermatomyositis?
corticosteroids
86
dx: 45yo woman with dry eyes and mouth. sex affected by vaginal dryness
sjogren's syndrome
87
what are the affected structures in sjogren's?
exocrine glands
88
what is sjogren's syndrome secondary to?
SLE
RA
89
what antibodies are associated with sjogren's syndrome?
anti ro
anti la
90
what is the test for dry eyes?
schirmer test
paper in eye measures liquid production
91
what drug is used to halt disease progression in sjogren's?
hydroxychloroquine
92
dx: sinusitis, nosebleeds, saddle shaped nose, cough, wheeze, haemoptysis, glomerulonephritis
wegener's
ie granulomatosis with polyangiitis
93
what type of disease is granulomatosis with polyangiitis?
small vessel vasculitis
94
what is the blood test for small vessel vasculitis?
ANCA
95
what are the treatments for small vessel vasculitis?
steroids
immunosuppressants
96
dx: 28yo with recurrent eps of oral and genital ulcers, and episodes of knee pail and swelling
behcet's disease
97
what gene is associated with behcet's disease?
HLA B51
98
what is the special test for behcet's disease?
pathergy test
99
what is the disease pattern of behcet's disease?
relapsing-remitting
100
what is the topical tx for mouth ulcers in behcet's disease?
steroids (soluble betamethasone)
101
what are 7 causes of mouth ulcers?
simple aphthous ulcers
IBD
coeliac
vit B12, folate or iron deficiency
HSV
hand, foot and mouth
squamous cell carcinoma
102
what joint is usually affected in gout?
first metatarso-phalangeal
103
what blood test is raised in gout?
serum urate
104
what is seen on aspirated fluid in gout?
negatively birefringent needle shaped crystals
105
what is first line for an acute flare of gout?
NSAIDS
106
what medication is used for acute gout in renal impairment?
colchicine
107
what is the main s/e of colchicine?
diarrhoea
108
dx: 70yo with hot, swollen, stiff, painful knee
pseudogout (CPPD)
109
what is in the joint in pseudogout?
calcium pyrophosphate crystals
110
how do CPP crystals appear on joint fluid microscopy?
rhomboid shaped crystals that are positively birefringent of polarised light
111
what is the first line mgt of pseudogout?
NSAIDs
112
what is the risk assessment tool for osteoporosis?
FRAX tool
113
what is the key investigation for osteoporosis?
DEXA scanning
114
what is the T score needed for diagnosis of osteoporosis?
<-2.5
115
guidelines for deciding whether to treat osteoporosis?
NOGG guideline
116
first line tx for osteoporosis?
bisphosphonates
117
moab tx for osteoporosis?
denosumab
118
dx: 74yo housebound south asian lady w/ fatigue, muscle weakness and bone pain. XR - abnormal fractures
osteomalacia
119
what is seen on pelvic XR in osteomalacia?
looser zones - demineralized osteoid
120
cause of osteomalacia?
vit D deficiency
121
what abnromal electrolytes appear in osteomalacia?
low calcium and phosphate
122
which liver test is abnormal in osteomalacia?
alkaline phosphatase (ALP)
123
what hormone is abnormal in osteomalacia?
parathyroid hormone - raised
124
what is the management for osteomalacia?
tx dose vit D
125
dx: 68 yo with bone pain, deformity, pathological fractures and hearing loss
paget's disease of the bone
126
what is the name for well defined osteolytic lesions on XR in paget's dx of the bone?
osteoporosis circumscripta
127
classic skull XR appearance in paget's?
'cotton wool' appearance
128
key abnormal blood test in paget's dx of bone?
raised ALP
129
main tx in paget's disease of bone?
bisphosphonates
130
which bones are typically affected in pagets?
skull, spine/pelvis, long bones of lower extremities
131
what is the most common causative organism in septic arthritis?
staph aureus
132
which STI organism is the most likely causative organism in reactive arthritis?
neisseria gonorrhoeae
133
what is the morphology of neisseria gonorrhoeae?
gram negative diplococci
134
how are acute flares of rheumatoid arthritis managed?
oral or IM corticosteroids
135
what are the risks associated with bisphosphonates?
1. oesophageal reactions
2. osteonecrosis of the jaw
3. inc risk of atypical stress fractures
4. acute phase response
5. hypocalcaemia
136
what is the management for ankylosing spondylitis?
1st line: exercise and NSAIDs
DMARDs useful if there's peripheral joint involvement
eg sulfasalazine
137
what is seen on CXR in pneumonitis?
interstitial infiltration and alveolar shadowing
138
how does pneumonitis present?
cough
dyspnoea
fever
malaise
139
what is the first line management for osteoarthritis?
topical NSAIDs
then oral
then steroid injections if orals not working
140
how does still's disease present?
arthralgia
elevated serum ferritin
salmon pink maculopapular rash
pyrexia (cyclical)
lymphadenopathy
RF and ANA NEGATIVE
141
features of pagets disease?
older male with bone pain and isolated raised ALP
bowing of tibia and bossing of skull
142
management of pagets disease?
bisphosphonate
143
ankylosing spondylitis xr findings?
subchondral erosions
sclerosis
squaring of lumbar vertebrae
144
antibody associated with scleroderma?
anti-centromere
145
antibody for SLE?
anti-dsDNA
146
tx for methotrexate toxicity?
folinic acid
147
differentiation between gout and pseudogout on xr?
chondrocalcinosis on XR in pseudogout
148
features of osteogenesis imperfecta?
presents in childhood
fractures following minor trauma
blue sclera
deafness secondary to otosclerosis
dental imperfections common
149
inheritance of osteogenesis imperfecta?
autosomal dominant
->> abnormality in type 1 collagen due to dec synthesis of pro-alpha 1 or pro-alpha 2 collagen polypeptides
150
mgt for acute reactive arthritis?
NSAIDs
151
mgt for ankylosing spondylitis?
1. exercise and NSAIDs
2. DMARDs if peripheral joint involvement
152
reactive arthritis genetic association?
HLA B27
153
osteomalacia blood results?
low ca
low phosphate
raised alp
raised pth
154
mgt for rheumatoid arthritis?
initially: DMARD monotherapy (methotrexate/sulfasalazine/leflunomide) +/- short course of bridging prednisolone
155
Gout medication that interacts with azathioprine?
Allopurinol
156
Lesion in young person in diaphysis of pelvis and long bones?
Ewing sarcoma
157
Low levels of which types of complement are associated with the development of systemic lupus erythematous?
C3 + C4
158
Xr findings late ankylosing spondylitis
Apical fibrosis
159
Tx SLE
Hydroxychloroquine
