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Year 4 Placements > Rheumatology > Flashcards

Rheumatology Flashcards

1
Q

Achilles tendinitis is associated with what rheumatological complaint?

A

Ankylosing spondylitis

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2
Q

Methotrexate should always be co-prescribed with what?

A

Folic acid

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3
Q

Which test can be used for lumbar spine mobility?

A

Modified Schober’s test

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4
Q

What may be seen on pelvic X-ray in those with ankylosing spondylitis?

A

Sacroiliitis

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5
Q

Which digits are most commonly affected in carpal tunnel?

A

Lateral 3.5

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6
Q

What types of crystals are seen in gout joint aspiration?

A

Negatively birefringent needle shaped monosodium urate crystals

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7
Q

What type of crystals are seen in pseudogout joint aspiration?

A

Positively birefringent rod/rhomboid shaped calcium pyrophosphate crystals

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8
Q

Which genetic syndrome is associated with recurrent gout?

A

Lesch-Nyan syndrome
- leads to uric acid overproduction

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9
Q

Name 3 types of medication that increase risk of developing gout

A

Thiazide diuretics, ACEI’s, aspirin

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10
Q

Which hormonal syndrome can increase the risk of developing pseudogout?

A

Hyperparathyroidism
- leads to increased calcium; pseudogout crystals are calcium pyrophosphate

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11
Q

What type of foods trigger gout?

A

Seafood, high protein

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12
Q

When should colchicine be used rather than NSAIDs in gout management?

A

Renal impairment, cardiac failure, peptic ulcers, IHD

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13
Q

High doses of colchicine can cause what?

A

Diarrhoea

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14
Q

How long after an acute attack of gout can allopurinol be initiated?

A

2 weeks

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15
Q

Which sub-cut injection can be given for osteoporosis?

A

Denosumab every 6 months

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16
Q

Alendronate can be used for what?

A

Osteoporosis

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17
Q

Polymyalgia rheumatica will show what levels of:
CRP?
CK?

A

CRP - high
CK - normal

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18
Q

It is important to ask PMR patients about symptoms of what?

A

Temporal artery tenderness, headaches, jaw claudication, night sweats
- due to association of PMR with giant cell arteritis

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19
Q

What medication at what dose should be initiated in PMR patients?

A

15mg prednisolone daily
- until symptoms are controlled than reduce

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20
Q

Seropositive arthritis is characterised by presence of what in the blood?

A

Rheumatoid factor or anti-CCP

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21
Q

Which blood marker is most specific and sensitive for rheumatoid arthritis?

A

Anti-CCP

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22
Q

Which 2 joints are typically spared in rheumatoid arthritis?

A

DIPJ, SI

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23
Q

Felty syndrome is characterised by a triad of what?

A

Splenomegaly + rheumatoid arthritis + neutropenia

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24
Q

Which scoring system is used for rheumatoid arthritis?

A

DAS28

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25
Q

Which scan needs to be undertaken at baseline before initiating methotrexate therapy?

A

CXR

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26
Q

Which 3 blood tests are important in monitoring DMARDs?

A

FBC, U&E, LFTs

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27
Q

What is the mainstay of treatment in milder SLE?

A

NSAIDs + hydroxychloroquine

28
Q

How often is methotrexate given?

A

Once a week

29
Q

What advice should be given for concomitant use of methotrexate and folic acid?

A

Take both once a week on DIFFERENT days

30
Q

Pulmonary pressure of over what is considered abnormal?

A

> 20mmHg

31
Q

What are the features of limited cutaneous systemic sclerosis/CREST syndrome?

A

C - calcinosis (calcium deposits in skin)
R - Raynaud’s
E - eosophageal dysfunction (dysphagia, GORD)
S - sclerodactyly
T - telangiectasia

32
Q

Nifedipine can be used for what manifestation of systemic sclerosis?

A

Raynaud’s

33
Q

Which auto-antibodies are specific to limited cutaneous systemic sclerosis?

A

Anticentromere

34
Q

Which auto-antibodies are specific to diffuse cutaneous systemic sclerosis?

A

Anti-SCL-70

35
Q

Chronic sinusitis and haematuria are manifestations of which type of vasculitis?

A

Wegener’s / granulomatosis with polyangiitis

36
Q

Induction therapy for Wegener’s is achieved via what?

A

High dose glucocorticoids
- prednisolone, methylprednisolone, dexamethasone, betamethasone

37
Q

Eosinophilia and adult onset asthma are suggestive of what type of vasculitis?

A

Churg-Strauss

38
Q

Which auto-antibodies are specific to Wegener’s?

A

C-ANCA

39
Q

Which 2 auto-antibodies can be seen in SLE?

A

ANA, anti-dsDNA

40
Q

Dry eyes, dry mouth and vaginal dryness are suggestive of what syndrome?

A

Sjogren’s

41
Q

Which auto-antibodies are specific to Sjögren’s syndrome?

A

Anti-Ro, anti-La

42
Q

What can be used for managing dry eyes in Sjögren’s syndrome?

A

Hypromellose

43
Q

Dysphonia, dysphagia and T2RF are late manifestations of which disease?

A

Polymyositis/dermatomyositis

44
Q

Which 5 enzymes are elevated in polymyositis/dermatomyositis?

A

CK, LDH, aldolase, ALT, AST

45
Q

What features decipher polymyositis from PMR?

A

Polymyositis - weakness
PMR - pain and stiffness

46
Q

Livedo reticularis is a skin manifestation of which syndrome?

A

Antiphospholipid

47
Q

What treatment should be initiated in antiphospholipid patients:
Without first VTE?
With first VTE?

A

Without - low dose aspirin
With - warfarin

48
Q

Which auto-antibodies are detected in psoriatic arthritis?

A

None

49
Q

Which dose of folic acid should be given with methotrexate?

A

5mg; on a different day to methotrexate

50
Q

Patients with ankylosing spondylitis are at increased risk of what bone complication?

A

Osteoporosis

51
Q

What is the first line drug used in rheumatoid arthritis?

A

Methotrexate
+ folic acid 5mg

52
Q

When should biologics be considered in rheumatoid arthritis?

A

After limited response to 2 DMARDs and 1 anti-TNF alpha (e.g. infliximab)
- biologic e.g. rituximab

53
Q

Raynaud’s phenomenon and sclerodactyly are suggestive of what? Which autoantibodies are associated with this disease?

A

Systemic sclerosis;
LSCC - anti-centromere autoantibodies
DSCC - anti-SCL-70 autoantibodies

54
Q

Pregnant patients with APS should use what medications to reduce risk of miscarriage?

A

Low dose aspirin + LMWH

55
Q

Recurrent miscarriage is suggestive of what connective tissue disease?

A

APS

56
Q

Adult onset asthma is strongly associated with which connective tissue disease?

A

Churg Strauss (eosinophilic granulomatosis with polyangiitis)

57
Q

Recurrent nosebleeds and chronic sinusitis are suggestive of what connective tissue disease?

A

Wegener’s (granulomatosis with polyangiitis)

58
Q

What is the gold standard for investigating ankylosing spondylitis?

A

MRI
Note x ray is normally first line as MRI takes longer to arrange

59
Q

Which blood marker can be used to predict prognosis in rheumatoid arthritis?

A

Anti-CCP
- low anti-CCP - good prognosis

60
Q

Which metabolic syndrome is a risk factor for pseudogout?

A

Hyperparathyroidism

61
Q

What class of medications can increase the risk of non-traumatic fractures?

A

Anti-epileptic drugs
- carbamazepine, gabapentin, phenytoin, phenobarbital

62
Q

Haemochromatosis increases the risk of developing what joint complication?

A

Pseudogout

63
Q

Methotrexate should be switched to what during pregnancy?

A

Sulfasalazine

64
Q

Which 2 classes of medication should be given when initiating treatment for GCA?

A

Bisphosphonates and PPI

65
Q

Which autoantibodies are associated with:
Wegener’s?
Churg-Strauss?

A

Wegener’s - c-ANCA
Churg-Strauss - p-ANCA

Year 4 Placements (10 decks)

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