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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
Q

osteomyelitis abx

A

fluclox + fusidic acid
or vanc + cefotaxime

IV 2 weeks then 4-6 weeks PO

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26
Q

Brodie’s abscess

A

subacute abscess in long bone metaphysis
painful
cultures may be negative

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27
Q

DEXA T scores

A

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

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28
Q

causes of secondary osteoporosis

A

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
Q

when to perform DEXA

A
  • 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
Q

when to start OP treatment

A

minimal trauma hip/vertebral fracture
minimal trauma fracture and T < -1.5
T < -2.5

31
Q

bisphosphonates contraindications

A

hypocalcaemia
uveitis
delayed oesophageal emptying

32
Q

bisphosphonate alternatives

A

strontium- risk of VTE, SJS
calcitonin
teriparatide- synthetic PTH
denosumab- risk of osteonecrosis of jaw

33
Q

stages of paget’s disease

A
  1. osteolytic
  2. reparative
  3. inactive
34
Q

paget’s

A

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
Q

polyarteritis nodosa

A

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
Q

managing PMR

A
  1. low dose pred + calcium, vit D, bisphosphonate
  2. MTX + folic acid
  3. tocilizumab
37
Q

diagnosing polymyositis

A

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
Q

PMR aetiology/associations

A

myaesthenia gravid
raynauds, systemic sclerosis
hashimotos
malignancy

39
Q

polymyositis treatment

A

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
Q

pseudogout associations

A

hyperparathyroidism
hypothyroidism
haemochromatosis
dialysis, trauma, reduced magnesium

41
Q

psoriatic arthritis

A

HLA B27 in 20%
tx: DMARD (leflunomide, sulfasalazine, MTX, ciclosporin) or anti TNFa
progressive course, prognosis worse for those with arthritis mutilans

42
Q

environmental causes of Raynauds

A

smoking
trauma, vibration, frostbite
heavy metals, vinyl chloride
beta blockers
malignancy, infection, haem/endocrine disorders

43
Q

raynauds treatment options

A

nifedipine
sildenafil
prostaglandins for incipient gangrene
bosentan for extreme cases

44
Q

seronegative spondyloarthropathies

A

psoriatic
reactive
ank spond

45
Q

reactive arthritis complications

A

(rare)
heart block
aortic incompetence
pericarditis

46
Q

extra-articular features of reactive arthritis

A

conjunctivitis, uveitis
urethritis
keratoderma blennorrhgaicum, circinate balantis
aphthous ulcers, erythema nodosum
IBD symptoms

47
Q

RA XR changes

A

early:
may be no change
juxta articular osteoporosis, osteopenia

intermediate:
joint space narrowing

late:
bone and joint destruction
subluxation

48
Q

diagnosing RA

A

RhF positive in 70%
anti CCP more specific
ESR and CRP may reflect disease activity

49
Q

factors associated with poor prognosis in RA

A

RhF, anti CCP, HLA DR4
smoking
extra articular features
female
early erosions
severe disability at presentation

50
Q

sarcoid histopathology

A

granulomas composed of macrophages, lymphocytes, epithelioid histiocytes
> fuse to form multinucleate giant cells

51
Q

sarcoid presentation

A

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
Q

Heerfordt-Waldenstrom syndrome

A

sarcoidosis with:
- parotid enlargement
- uveitis
- fever
- CN palsies

53
Q

Lofgren syndrome

A

sarcoid:
BHL + erythema nodosum + fever + arthralgia

54
Q

managing sarcoid

A

steroids if hypercalcaemia and hypercalciuria, ophthal or CNS involvement

pred, weaning after 4 weeks to maintenance dose
MTX or azathioprine next line

55
Q

Still’s disease

A

polyarthritis, rash, intermittent fever
systemic JIA
IL-1, IL-6 involvement
ANA positive is correlated to uveitis
10% develop macrophage activation syndrome MAS

56
Q

macrophage activation syndrome MAS

A

fever
organomegaly
cytopaenias, coagulopathy
raised ferritin, TGs
reduced fibrinogen

57
Q

drug induced lupus

A

M > F
resolves on stopping drug
CNS and renal disease rare
ANA pos, dsDNA neg
procainamide, isoniazid, hydralazine

58
Q

SLE

A

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
Q

SLE blood tests

A

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
Q

SLE treatment

A

steroids
DMARDS for arthritis
steroids, MTX, azathioprine for vital organ involvement
plasma exchange and biologics for refractory disease

61
Q

primary Raynauds vs Raynauds in systemic sclerosis

A

digital ulcers and calcinosis unusual in primary

62
Q

scleroderma renal crisis

A

malignant HTN
rapid renal impairment
onion skin vasculature

63
Q

limited vs diffuse sclerosis

A

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
Q

SS antibodies

A

RhF in 30%
ANA in 90%
anti centromere (limited), anti Scl70 (diffuse)

65
Q

SS management, screening

A

-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
Q

takayasu pathophysiology

A

CD4 and CD8 mediated
transmural fibrosis
> alternating areas of dilatations (pseudoaneurysms)
AKA pulseless disease

67
Q

thromboangiitis obliterans/Buerger disease

A

affects limbs
mostly in young male smokers
HLA B5

68
Q

ANCA antibody associations

A

cANCA- anti PR3
pANCA- anti MPO

69
Q

treating kawasaki

A

steroids are contraindicated due to risk of coronary aneurysms

MRCP 2 (12 decks)

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