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MRCP 2 > Rheumatology > Flashcards

Rheumatology Flashcards

1
Q

AS treatment

A

anti TNFa
sulfasalazine or MTX for peripheral arthritis

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2
Q

diagnosing antiphospholipid

A

one clinical event (thrombosis or pregnancy complication)
two positive blood tests 3 months apart (lupus anticoagulant or anticardiolipin)

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3
Q

treating antiphospholipid

A

warfarin INR 2-3
DOAC as alternative but not if triple positive
no treatment required if asymptomatic
aspirin or LMWH for pregnancy

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4
Q

antiphospholipid antibodies

A

lupus anticoagulant
anticardiolipin
anti beta 2 glycoprotein 1

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5
Q

behcet’s diagnosis

A

recurrent oral ulcers

plus 2:
- recurrent genital ulcers
- erythema nodosum, aceniform lesions, papulopustular/nodular lesions
- uveitis, hypopyon
- positive pathergy test
- GI symptoms
- DVT, thrombophlebitis (rare)
- seizures, CN palsies, dizziness, memory impairment

RF, ANA, ANCA negative
HLA B51 positive

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6
Q

management of behcet’s

A

ulcers:
topical steroids
colchicine, oral steroids 1-2y
TNFai 1-2y

eyes:
pred + azathioprine
pred + infliximab/adalimumab

GI/CNS:
pred + infliximab

major vascular:
pred + ciclosporin

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7
Q

charcot

A

degeneration and bony destruction of joint
> deformity
in people with peripheral neuropathy

dx: weight bearing XR, MRI if inconclusive

presents as erythema, warmth, swelling
joint deformity as a late sign
pain not always present due to neuropathy

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8
Q

dermatomyositis antibodies

A

anti Mi2 are specific but only present in 30%
ANCA and ANA may be present

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9
Q

dermatomyositis diagnosis

A

CK, AST, LDH
ANA, anti Mi2, Anti Jo1
muscle biopsy and electromyography
screen for underlying malignancy in adults

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10
Q

diagnosing fibromyalgia

A

widespread pain both sides of body above and below waist 3/12
or
11 tender points out of 18

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11
Q

antidepressants for fibromyalgia

A

SSRI best for low mood
TCA best as adjuvant for pain relief

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12
Q

diagnosing GCA

A

3 of:
age of onset > 50y
new headache
temporal artery tender or reduced pulsation
raised ESR
positive temporal artery biopsy

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13
Q

GCA treatment

A

40-60mg pred per day and taper
MTX for relapsing
aspirin to reduce stroke risk

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14
Q

GCA complications

A

visual loss, stroke
aortic aneurysm, dissection

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15
Q

gonococcal arthritis presentation

A

bacteraemic form:
polyarthritis, tenosynovitis and dermatitis

septic arthritis form:
pain, redness and swelling in one or more joints

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16
Q

goodpasture

A

HLADR15, HLADRB1
IgG anti GBM against type IV collagen
crescenteric GN
pulm haemorrhages

> plasma exchange, pred, cyclophosphamide

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17
Q

causes of increased uric acid production or reduced excretion

A

increased production:
purine rich diet (beer, meat)
myelo/lymphoproliferative disorders
acidosis
cytolytic therapy
tumour lysis

reduced excretion:
renal failure
lead intoxication
diuretics, aspirin, cyclosporin

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18
Q

presentations of gout

A

acute crystal arthritis
gouty nephropathy
chronic tophaceous gout

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19
Q

indications for urate lowering therapy

A

more than one episode
or
1 attack and :
- tophi
- renal impairment
- uric acid stones
- not possible to stop diuretics
- v young

aim to reduce serum urate < 360 or 300 if tophaceous

use colchicine when starting ULT

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20
Q

granulomatosis with polyangiitis treatment

A

stage 1:
high dose steroids
cyclophosphamide
plasma exchange in severe cases

stage 2 manintenance:
replace cyclophosphamide with MTX or aza
continue steroids

stage 3 recurrence:
continue steroids or restart cyclo or start rituximab or plasma exchange

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21
Q

HSP tetrad

A

palpable rash
joint pain
renal and gastro invovlement

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22
Q

HSP antibodies

A

IgA

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23
Q

OA diagnosis

A

> 45y with activity related joint pain and less than 30 mins morning stiffness
or
XR

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24
Q

common causative organism of OM in IVDU

A

pseudomonas

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25
osteomyelitis abx
fluclox + fusidic acid or vanc + cefotaxime IV 2 weeks then 4-6 weeks PO
26
Brodie's abscess
subacute abscess in long bone metaphysis painful cultures may be negative
27
DEXA T scores
osteoporosis: T < - 2.5 normal: T > 1.0 osteopenia: T -1 to -2.5 arrange DEXA if FRAX > 10% give bisphosphonate if T < -2.5
28
causes of secondary osteoporosis
multiple myeloma, carcinomatosis, leukaemia heparin CTx corticosteroids, anticonvulsants alcohol hyperPTH, thyroid disorders, hypogonadism, pituitary tumours, addisons, T1DM vit C and D def RA, AS, TB, CKD thalassaemia, sickle cell
29
when to perform DEXA
- women > 65y and men > 75y with suspected OP - > 50y with fragility fracture or steroids or falls of BMI < 18.5 or smoker or alcohol > 14 units - < 50y with steroids, fragility fracture or untreated premature menopause
30
when to start OP treatment
minimal trauma hip/vertebral fracture minimal trauma fracture and T < -1.5 T < -2.5
31
bisphosphonates contraindications
hypocalcaemia uveitis delayed oesophageal emptying
32
bisphosphonate alternatives
strontium- risk of VTE, SJS calcitonin teriparatide- synthetic PTH denosumab- risk of osteonecrosis of jaw
33
stages of paget's disease
1. osteolytic 2. reparative 3. inactive
34
paget's
presentation in 40s coarse trabeculae, weak hypervascularised bone prone to pathological fracture > bisphosphonates (zolendronate first line) > calcitonin if bisphosphonates not tolerated teriparatide contraindicated (risk of osteosarcoma)
35
polyarteritis nodosa
medium sized arteries vasculitis assoc w/ hep B, (also C, HIV) subcut nodules, livedo reticularis, necrotic ulcers, HTN, ischaemic abdo pain, haematuria, mononeuritis multiplex ANCA neg rosary sign- microaneurysms tx: steroids and cyclophosphamide/aza
36
managing PMR
1. low dose pred + calcium, vit D, bisphosphonate 2. MTX + folic acid 3. tocilizumab
37
diagnosing polymyositis
ANA positive, muscle enzymes raised (also in dermato) anti-Jo seen more in pt with pulm fibrosis, arthritis, raynauds ESR, RF dx: EMG (short polyphasic potentials, spontaneous fibrillation) and muscle biopsy (necrosis and regeneration) creatinine phosphokinase and aldolase raised, can be used to monitor need to rule out malignancy (CTTAP) MSA and MAA to differentiate underlying malignancy
38
PMR aetiology/associations
myaesthenia gravid raynauds, systemic sclerosis hashimotos malignancy
39
polymyositis treatment
high dose steroids, taper add aza or ciclosporin if needed wean steroids and add maintenance DMARD lung involvement: steroids and ciclosporin or tacrolimus and cyclophosphamide
40
pseudogout associations
hyperparathyroidism hypothyroidism haemochromatosis dialysis, trauma, reduced magnesium
41
psoriatic arthritis
HLA B27 in 20% tx: DMARD (leflunomide, sulfasalazine, MTX, ciclosporin) or anti TNFa progressive course, prognosis worse for those with arthritis mutilans
42
environmental causes of Raynauds
smoking trauma, vibration, frostbite heavy metals, vinyl chloride beta blockers malignancy, infection, haem/endocrine disorders
43
raynauds treatment options
nifedipine sildenafil prostaglandins for incipient gangrene bosentan for extreme cases
44
seronegative spondyloarthropathies
psoriatic reactive ank spond
45
reactive arthritis complications
(rare) heart block aortic incompetence pericarditis
46
extra-articular features of reactive arthritis
conjunctivitis, uveitis urethritis keratoderma blennorrhgaicum, circinate balantis aphthous ulcers, erythema nodosum IBD symptoms
47
RA XR changes
early: may be no change juxta articular osteoporosis, osteopenia intermediate: joint space narrowing late: bone and joint destruction subluxation
48
diagnosing RA
RhF positive in 70% anti CCP more specific ESR and CRP may reflect disease activity
49
factors associated with poor prognosis in RA
RhF, anti CCP, HLA DR4 smoking extra articular features female early erosions severe disability at presentation
50
sarcoid histopathology
granulomas composed of macrophages, lymphocytes, epithelioid histiocytes > fuse to form multinucleate giant cells
51
sarcoid presentation
lung and skin most commonly involved -erythema nodosum, skin plaques, subcut nodules, lupus pernio - uveitis -painless rubbery lymphadenopathy - splenomegaly, deranged LFTs - CN palsies, meningitis, hydrocephalus, SOLs - arrhythmias, BBB, CHB - hypercalcaemia - bone cysts
52
Heerfordt-Waldenstrom syndrome
sarcoidosis with: - parotid enlargement - uveitis - fever - CN palsies
53
Lofgren syndrome
sarcoid: BHL + erythema nodosum + fever + arthralgia
54
managing sarcoid
steroids if hypercalcaemia and hypercalciuria, ophthal or CNS involvement pred, weaning after 4 weeks to maintenance dose MTX or azathioprine next line
55
Still's disease
polyarthritis, rash, intermittent fever systemic JIA IL-1, IL-6 involvement ANA positive is correlated to uveitis 10% develop macrophage activation syndrome MAS
56
macrophage activation syndrome MAS
fever organomegaly cytopaenias, coagulopathy raised ferritin, TGs reduced fibrinogen
57
drug induced lupus
M > F resolves on stopping drug CNS and renal disease rare ANA pos, dsDNA neg procainamide, isoniazid, hydralazine
58
SLE
type III hypersensitivity antibodies react with antigen > complexes accumulate in small blood vessels > attacked by neutrophils and complement > damage to endothelium > reduced supply to the organ
59
SLE blood tests
ANA in 95% antidsDNA, low complement, anti Smith anti-Ro/La, antiRNP (non specific) antiphospholipid should be tested CRP rises in joint disease and serositis low C3, C4 may suggest lupus nephritis
60
SLE treatment
steroids DMARDS for arthritis steroids, MTX, azathioprine for vital organ involvement plasma exchange and biologics for refractory disease
61
primary Raynauds vs Raynauds in systemic sclerosis
digital ulcers and calcinosis unusual in primary
62
scleroderma renal crisis
malignant HTN rapid renal impairment onion skin vasculature
63
limited vs diffuse sclerosis
limited: face, neck , distal limbs Calcinosis, Raynauds, oEsopheageal dysmotility, Sclerodactyly, Telangiectasia anti centromere pulm HTN more likely than renal crisis diffuse: includes proximal limbs anti Scl renal crisis more likely than pulm HTN scleroderma without organ disease plaques, linear
64
SS antibodies
RhF in 30% ANA in 90% anti centromere (limited), anti Scl70 (diffuse)
65
SS management, screening
-annual echo and PFTs (pHTN and fibrosis)( -BP and creatinine -avoid steroids due to risk of renal crisis -steroids are needed for pulm fibrosis, myositis -PPI for reflux -abx for SIBO - iloprost for digital ischaemia -ACEi for renal crisis
66
takayasu pathophysiology
CD4 and CD8 mediated transmural fibrosis > alternating areas of dilatations (pseudoaneurysms) AKA pulseless disease
67
thromboangiitis obliterans/Buerger disease
affects limbs mostly in young male smokers HLA B5
68
ANCA antibody associations
cANCA- anti PR3 pANCA- anti MPO
69
treating kawasaki
steroids are contraindicated due to risk of coronary aneurysms

MRCP 2 (12 decks)

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