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Medicine > Rheumatology > Flashcards

Rheumatology Flashcards

1
Q

Name 4 DMARDs

A

Methotrexate
Leflunomide
Sulfasalazine
Hydroxychloroquine

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2
Q

Name 2 DMARDs which are contraindicated in pregnancy

A

Methotrexate
Leflunomide

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3
Q

Name 2 DMARDs which are safe in pregnancy

A

Sulfasalazine
Hydroxychloroquine

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4
Q

What additional medication needs to be taken with methotrexate? Why?

A

Folic acid (but never on the same day as it impairs the efficacy of methotrexate)

It reduces GI SE’s

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5
Q

What is the MOA of methotrexate?

A

promotion of T cell apoptosis

aldo dihydrofolate reductase inhibitor

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6
Q

What is the side effect profile of methotrexate and leflunomide?

A

Methotrexate - BM suppression, liver toxicity, leukopenia, teratogenesis

Leflunomide - above + HTN, peripheral neuropathy

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7
Q

How is RA managed?

A

DMARD (methotrexate) monotherapy

+ short course of bridging prednisolone

consider biologics in really bad cases

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8
Q

What is Adalimumab used for?

A

anti-TNF

Biologic therapy for RA

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9
Q

What are Secukinumab / ixekizumab used for?

A

3rd line in Ankylosing Spondylitis

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10
Q

How is Ankylosing Spondylitis treated?

A

1st line - NSAIDs
2nd line - Anti-TNF (Etanercept)
3rd line - Secukinumab / ixekizumab

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11
Q

What is the MOA of Allopurinol?

A

xanthine oxidase inhibitor

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12
Q

When are bisphosphonates indicated?

When is it contraindicated?

A

T score </= -2.5

contraindicated if eGFR <35

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13
Q

What is the Abx of choice for septic arthritis?

What is the regime?

A

IV fluxlocacillin

(IV clindamycin if penicillin allergic)

IV for 2-4 weeks, oral for another 2 weeks

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14
Q

How is reactive arthritis managed?

A

Bog standard - trigger, NSAIDs, steroid injections, systemic steroids if multiple joints

Most cases resolve in 6 months, recurrent cases need DMARDs or anti-TNF

if chlamydia then doxycycline

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15
Q

What is the problem associated with using steroids in psoriatic arthritis?

A

Corticosteroids can get a rebound flare of the skin disease as the steroids wear off

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16
Q

How is osteoporosis managed?

A

Vitamin D and calcium supplements

Bisphosphonates

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17
Q

How is Paget’s disease managed?

A

Vitamin D and calcium supplements

Bisphosphonates

NSAIDs

Maybe surgery

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18
Q

What is the MOA of bisphosphonates?

A

Interfere with osteoclast activity and retore normal bone metabolism

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19
Q

How is osteomalacia managed?

A

Vitamin D (colecalciferol)

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20
Q

What are the 1st line options for SLE?

A

Hydroxychloroquine
If joint pain -> NSAIDs, steroids

consider DMARDs and biologics

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21
Q

How is discoid lupus managed?

A

Hydroxychloroquine

consider topical or intralesional steroid injections

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22
Q

How is polymyalgia rheumatica managed?

A

15mg prednisolone OD

assess weekly, should have a good response after a week if PMR

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23
Q

How is GCA managed?

A

no vision involvement -> PO prednisolone

vision involvement -> IV methylprednisolone

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24
Q

How are dermatomyositis and polymyositis managed?

A

Corticosteroids

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25
Q

How is Sjogren’s syndrome managed?

A

Hydroxychloroquine

lubricate everything

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26
Q

How is ANCA vasculitis managed?

A

All - corticosteroids

Moderate / mild - mycophenolate, methotrexate

Severe - cyclophosphamide, rituximab, plasma exchange

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27
Q

How is Gout managed?

How is pseudogout management different?

A

Acutely -> colchicine, NSAIDs, steroids

Chronic -> allopurinol (after acute attack has settled)

In psuedogout cases, acutely they’re the same but chronically you want to offer low dose colchicine, hydroxychloroquine, and methotrexate

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28
Q

What is the main side effect of hydroxychloroqiune?

A

Bull’s eye retinopathy (causing severe and permanent visual loss)

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29
Q

Name the associations of Ankylosing Spondylitis

A

5As

Anterior uveitis
Aortic regurgitation
AV block
Apical lung fibrosis
ACD

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30
Q

What is the relationship of obesity with osteoporosis and osteoarthritis?

A

Protective factor for osteoporosis
Exacerbates osteoarthritis

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31
Q

How is Vitamin D deficiency defined?

A

Serum 25-hydroxyvitamin D is the lab test for vitD

<25 -> deficient
25-50 -> inufficient
75+ optimal

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32
Q

What are the 3 features of Felty’s syndrome?

A

RA
Splenomegaly
decreased WCC

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33
Q

Describe the lab values in osteoperosis

A

Normal

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34
Q

Describes the lab values in osteopetrosis

A

Normal

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35
Q

Describe the lab values in Paget’s disease

A

^ALP

otherwise normal

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36
Q

Describe the lab values in Osteomalacia

A

^ALP, PTH

decreased calcium and phosphate

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37
Q

Decribe the lab values in primary hyperparathyroidism

A

decreased phosphate

Otherwise increased

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38
Q

Describe the lab values in CKD leading to secondary hyperparathyroidism

A

decreased Ca2+

otherwise increased

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39
Q

What is the ophthalmological presentation of Bechet’s disease?

A

Anterior uveitis

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40
Q

What is the genetic association of Bechet’s disease?

A

HLA-B51

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41
Q

What is the genetic association of anterior uveitis?

A

HLA-B27

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42
Q

Name 2 side effects of colchicine

A

Abdominal pain
Bloody diarrhoea

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43
Q

What are the features of LcSSc?

A

CREST

calcinosis
raynaud’s
Oesophageal dysmotility (reflux)
Sclerodactyly
talengiectasia

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44
Q

How does ankylosing spondylitis manifest in the feet?

A

Plantar fasciitis

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45
Q

What gene mutation is associated with Marfan syndrome?

A

fibrillin 1

46
Q

Which test would you use to support a diagnosis of Sjogren’s syndrome?

A

Schirmer’s test

47
Q

What are the findings of a joint aspirate associated with septic arthritis?

A

Yellow
WCC > 10 000
neutrophils > 90%

48
Q

What sized vessels does Takyasu’s arteritis affect?

A

Large vessels

49
Q

Which Abs are associated with Sjogren’s syndrome?

A

anti-Ro
anti-La

50
Q

How would you differentiate Polymyalgia Rheumatica and Polymyositis?

A

PMR - pain
Polymyositis - weakness

51
Q

What molecule are pseudogout crystals comprised of?

A

Calcium pyrophosphate

52
Q

Which rheumatological condition is associated with haemochromatosis?

A

Psuedogout

53
Q

Which Abs are associated with drug-induced lupus?

A

anti-histone Abs

54
Q

What is the most common cause of septic arthritis in young sexually active patients?

A

Gonorrhoea

55
Q

Why do all patients with SLE need a urine dip?

A

Proteinuria suggests Lupus Glomerulonephritis

56
Q

Which Abs are associated with AI hepatitis?

A

Anti-SM Abs

57
Q

What is Caplan’s syndrome?

A

Also called rheumatoid pneumoconiosis

1) Intrapulmonary nodules
2) RA
3) Known eposure to dust particles

58
Q

Which organ is normally spared in Polyarteritis Nodosa?

A

Lungs

59
Q

Which antigen is associated with RA?

A

HLA-DR4

60
Q

What sort of vaccines are contraindicated in those taking methotrexate?

Could you name an example?

A

Live vaccines

yellow fever vaccine

61
Q

Which antibody is associated with LcSSc?

A

Anti-centromere Ab

62
Q

Tuberculosis treatment with which drugs is known to precipitate gout flares?

A

Pyrazinamide
Ethambutol

63
Q

Which viral infection is associated with polyarteritis nodosa?

Within what time frame following this infection will PAN occur?

A

Hepatitis B

6 weeks

64
Q

Which Ab is associated with diffuse cutaneous systemic sclerosis?

A

Anti-Scl-70

65
Q

How does SLE affect the complement system?

A

Low C3 and C4

66
Q

What do different DAS scores indicate?

A

<2.6 - disease remission
2.6-3.2 - low disease activity
3.2-5.1 - moderate disease activity
>5.1 - high disease activity

67
Q

What life threatening condition is associated with dermatomyosits?

A

lung cancer

68
Q

Which cardiovascular disease is associated with GCA?

A

aortic aneurysm

69
Q

Which gout medication can cause SJS?

A

Allopurinol

70
Q

How would you manage renal crisis in systemic sclerosis?

A

ACEi

71
Q

Within what time period of an infection would reactive arthritis occur?

A

4 weeks

72
Q

Which antigen is associated with reactive arthritis?

A

HLA-B27

73
Q

What is polyarteritis nodosa?

A

Vasculitis of medium-seized muscular arteries

74
Q

Exposure to which hormone can trigger a flare of SLE?

A

Oestrogen

75
Q

What is the most common dermatological feature of SLE?

A

photosensitive malar rash

76
Q

What is the most common cause of lupus-related death?

A

Lupus nephritis

77
Q

What feature on a clotting screen would support the diagnosis of SLE?

Why?

A

prolonged PTT

suggests the presence of lupus anticoagulant

78
Q

Which auto Ab has the highest sensitivity for SLE?

A

ANA

79
Q

Which auto Ab has the highes specificity for SLE?

A

anti-dsDNA

80
Q

How would you differentiate GPA and eosinophilic granulomatosis with polyangiitis?

A

GPA - URTI, renal picture
eosin - asthma

81
Q

What is the most common respiratory complication of rheumatoid arthritis?

A

Exudative pleural effusions

82
Q

What percentage of chidren with asthma wil have bronchospasm with NSAIDs or asthma?

A

10-20%

83
Q

What is the second line preventative treatment for gout behind allopurinol?

A

Febuxostat

84
Q

Why shouldn’t you start allopurinol in an acute flare of gout?

A

it can make things worse

85
Q

What type of diuretic is known to exacerbate gout?

A

Thiazide diuretic

86
Q

Which dermatological sign is seen in antiphospholoipid syndrome?

A

livedo reticularis

87
Q

Neonatal lupus syndrome is associated with which cardiac anomaly?

A

Congenital Heart Block

88
Q

What is the most common form of RF antibody?

A

IgM against IgG

89
Q

Why do patients on bisphosphonates need regular dental checkups?

A

Risk of osteonecrosis of the jaw (particularly if administered IV)

90
Q

What might a weakly positive c-ANCA and p-ANCA indicate?

A

chronic infection

not just the weird vasculitis stuff!:)

91
Q

When methotrexate and trimethoprim are co-administered, you risk pancytopaenia

How would you manage this?

A

IV Folinic acid (not folic acid)
IV Abx (neutropenia)
Blood transfusion

If unresponsive then GCSF

92
Q

Why might NSAIDs be offered alongside allopurinol in gout?

A

Allopurinol can acutely raise the level of urate before lowering the levels of gout, causing a flair

Covering with an NSAID for 3 months can reduce the risk of another flair

93
Q

Describe Beurger’s disease

A

Smoker
Claudication
lower limb atherosclerosis
absent pedal pulses

94
Q

What sort of haemolytic anaemia is particularly common in northern europe?

A

Hereditary Spherocytosis

95
Q

If a patient is allergic to aspirin, what other drug may they have an allergy to?

A

Sulfasalazine

96
Q

Which antigen is found to be positive in Enteropathic arthritis?

A

HLA-B27

97
Q

How might you differentiate spider naevi from telangiectasia?

A

spider naevi - fill from centre

telangiectasia - fill from edge

98
Q

What risk is associated with Etanercept?

A

Tb reactivation

(as with all anti-TNFalpa drugs)

99
Q

Describe Jaccoud’s arthropathy

A

SLE pts w/ rheumatoid like hands that are reducible in extension

100
Q

How may splenectomy cause a flasely raised HbA1c?

A

^RBC lifespan

Haem more time to become glycosylated

101
Q

Which drug when coadministered with Allopurinol caues BM suppression?

A

Azathioprine

102
Q

Which drugs might cause rhabdomyolysis/

A

Statins

(particularly when combined with clarithromycin)

103
Q

What is the relationship between p-ANCA and IBD?

A

+ in UC

  • in Crohn’s
104
Q

What is the value in using ABPI in venous ulcers?

A

You need to make sure their arteiral supply is enough to allow for some compression with dressings

105
Q

What might allopurinol interact with to cause BM suppression?

A

Allopurinol

106
Q

Why is it important to perform a CXR prior to starting biologics for RA?

A

May provoke TB reactivation

107
Q

What are the x-ray features of AS?

A

AnkyloSing SpondylitiS (SSS)

Squaring L vertebrae
Subchondral erosions
Sclerosis

108
Q

How would you manage an acute flaire of RA?

A

methylprednisolone

109
Q

What is the most common cardiac manifestation of SLE?

A

Pericarditis

110
Q

What needs to be regularly monitored in pts taking methotrexate?

A

FBCs
LFTs

111
Q

Name 4 characteristics of Still’s disease in adults

A

Arthralgia
^ferritin
Salmon-pink rash
evening fever

112
Q

How might you monitor flares of SLE?

A

Comlement levels low (C3,4)

Medicine (21 decks)

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