Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

MRCP - Passmed > Rheumatology > Flashcards

Rheumatology Flashcards

1
Q

What is classically impaired in adhesive capsulitis (frozen shoulder)? Which patient population is more likely to get this?

A

Pain upon external rotation both on active and passive movement

Diabetes is major RF - 20% of diabetics develop this

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Drug causes of gout?

A

diuretics: thiazides, furosemide
ciclosporin
alcohol
cytotoxic agents
pyrazinamide
aspirin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

RFs for avascular necrosis of hip?

A

long-term steroid use
chemotherapy
alcohol excess
trauma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Differences between limited cutaneous systemic sclerosis and diffuse cutaneous systemic sclerosis?

A

Limited:
- Mainly affected proximal limbs + face
- Anti-centromere antibodies

Diffuse:
- Mainly affects trunk + proximal limbs
- Anti Scl-70 antibodies (higher risk of severe interstitial lung disease)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Features of systemic sclerosis? (scleroderma, limited cutaneous systemic sclerosis and diffuse cutaneous systemic sclerosis)

A

Condition of unknown aetiology characterised by hardened, sclerotic skin and other connective tissues.

It is four times more common in females

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Main cause of death in diffuse cutaneous systemic sclerosis?

A

Respiratory involvement seen in 80% - ILD and PAH

other complications include renal disease (start on ACEi) and HTN

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Examples of TNF-inhibitors?

A

Etanercept

Infliximab

Adalimumab

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Inhertiance of Familial Mediterranean Fever?

A

Autosomal recessive

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Features of familial mediterranean fever? mx?

A

Reoccurring episodes of abdo pain, fever, arthralgia and chest pain

Colchicine can help

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

DMARD safe in pregnancy and breastfeeding?

A

Sulfasalazine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Adverse effects of Sulfasalazine?

A

Oligospermia
SJS
Pneumonitis / lung fibrosis
Myelosuppression
May colour tears / contact lenses

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Reactive arthritis features?

A

classic triad of urethritis, conjunctivitis and arthritis

(can’t see, pee or climb a tree)

Defined as arthritis develops following infection where organism can’t be recovered from joint

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Features of osteomalacia?

A

Bone pain, tenderness and proximal myopathy (-> ?waddling gait)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Which individuals are susceptible to azathiopurine? Safe in pregnancy?

A

TPMT deficient people

Safe in pregnancy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Behcets triad?

A

oral ulcers, genital ulcers and anterior uveitis (HLA B51)

Also get thrombophelbitis and DVTs +
arthritis
neurological involvement (e.g. aseptic meningitis)
GI: abdo pain, diarrhoea, colitis
erythema nodosum

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Behcets epidemiology?

A

Eastern mediterraneans
Men&raquo_space; with more severe disease
Young adults 20-40y
30% have FHx

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What is deposited in pseudogout?

A

calcium pyrophosphate dihydrate (CPPD) crystals

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

RFs for pseudogout?

A

Increasing age (main)

If younger:
Haemochromatosis
Wilsons
Hyperparathyroidism
low Mg, low PO4
acromegaly

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Inflammatory arthritis involving DIP swelling + dactylitis (finger/toe swelling looks like sausages)-> ????

A

Psoriatic arthritis

Can also cause spinal stiffness and reduced cervical spine mobility

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Type of collagen in osteogenesis imperfecta?

A

Type 1 collagen

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What are Heberden’s nodes and Bouchard’s nodes? Which disease are they found in?

A

Heberdens node (painless bony swelling at DIP)

Bouchards node (painless bony swelling at PIP)

Found in OA due to osteophyte formation

Think about which letter is proximal / distal in alphabet

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

When to be careful giving sulfasalazine to patients?

A

If they have G6PD deficiency (Tito)

Allergy to aspirin / sulphonamides due to cross reactivity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What are the issues for SLE and pregnancy?

A

Risk of maternal autoantibodies crossing placenta -> neonatal lupus erythematosus

Complications inc. congenital heart block (associated strongly with anti-Ro ab) - Ro block!

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Anti-ribonuclear protein (anti-RNP) is found in which disease? How do they present?

A

Mixed connective tissue disease

Present with:
- Raynauds before most sx (90%)
- Polyarthralgia / arthritis
- Myalgia + Dactylitis

M:F - 1:3
30-40y avg age

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Which complements are low in active SLE disease?

A

C3, C4 due to formation of immune complexes and consumption

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Mx of ank spond?

A

1st line - Exercise + NSAIDs

2nd - DMARDs only if peripheral joint involvement

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

Main target for pANCA and cANCA?

A

cANCA - serine proteinase 3 (PR3)

pANCA - myeloperoxidase (MPO)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

Muscular inflammation + skin manifestations (red, scaly bumps over knuckles) - what disease? what is clinical sign? what is the main autoantibodies?

A

Dermatomyositis

Grotton’s papules - red scaly bumps over knuckles

Anti-Mi-2 - HIGH SPECIFIC (seen in 25%)
ANA (60%)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

positive birefringent rhomboid-shaped crystals are seen in which disease?

A

Pseudogout

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

What is polyarteritis nodosa? Associated with which infection?

A

PAN - vasculitis affecting medium-sized arteries with necrotizing inflammation leading to aneurysm formation

Associated with Hep B infection

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

Fever, malaise, arthralgia

Mononeuritis multiplex, sensorimotor polyneuropathy

Livedo reticularis

Renal impairment +- haematuria

Which condition is this?

A

Polyarteritis Nodosa

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

Arterial/venous thrombosis, miscarriage, livedo reticularis → which disease and antibodies?

A

Antiphospholipid syndrome

Anticardiolipin + Anti-Beta2 glycoprotein I ab

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

gradual onset leg and back pain, weakness and numbness which is brought on by walking (with a normal clinical examination)

Diagnosis? Differentiate from claudication? Ix/ mx?

A

Spinal stenosis

Differentiation:
- Positional element - sitting > standing + easier to walk uphill v downhill

Ix: MRI
Mx: Laminectomy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

CXR finding in ank spond?

A

Apical fibrosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

Organism for osteomyelitis? When is a different organism more likely?

A

Staph aureus

Salmonella more common in sickle cell

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

Fever/back pain with pain on extension of the hip

Diagnosis?

A

Iliopsoas abscess

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

What feature suggests psoriatic arthritis v RA?

A

Assymetrical oligoarthritis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

XR features in ank spond? what if no changes but still suspecting

A

XR sacroiliac joint:
- Sacroilitis - subcondral sclerosis + sclerosis
- Squaring of lumbar vertebrae
- Syndesmophytes - ossification of outer fibres of annulus fibrosis
- Bamboo spine - LATE AND UNCOMMON

Early disease may not show XR changes so should get MRI - can show inflammation of sacroiliac joints (BM oedema)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

Purple/red rash on upper eyelids - what is this called? seen in which disease? which ab?

A

Heliotrope rash - seen in dermatomyositis

Anti-Jo1 ab

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

Marfans gene? protein affected?

A

FBN1 gene chromosome 15

Protein fibrillin 1

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

Eye features in marfans?

A

Upward lens dislocation (superotemporal ectopia lentis)

Blue sclera

Myopia (near sightedness)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

Low serum calcium,
low serum phosphate,
raised ALP and raised PTH

which disease?

A

Osteomalacia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

Bisphosphonate MoA?

A

Inhibits osteoclasts

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

Which feature helps distinguish pseudogout from gout?

A

x-ray: chondrocalcinosis - knee this can be seen as linear calcifications of the meniscus and articular cartilage

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
44
Q

worse on resisted wrist extension/suppination whilst elbow extended is suggestive of which disease?

A

Lateral epicondylitis (tennis elbow - also seen in house painting)

TENNIS IS LATERAL AS YOURE HITTING IT AWAY FROM THE OPONENT

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
45
Q

GPA - which antibody?

Eosinophilic granulomatosis w/ polyangitis + other - which antibody?

A

cANCA = granulomatosis with polyangiitis

pANCA = eosinophilic granulomatosis with polyangiitis + others

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
46
Q

Advice on how to take bisphosphonate?

A

Take at least 30 minutes before breakfast with plenty of water + sit-upright for 30 minutes following

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
47
Q

Pain on the radial side of the wrist/tenderness over the radial styloid process + worse upon ulnar deviation?

A

De Quervain’s tenosynovitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
48
Q

Cause of bulls eye retinopathy? what does this lead to?

A

Can lead to severe and permenant visual loss

Seen in Hydroxychloroquine use (see how many OOOOOO there is like a bullseye)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
49
Q

Denosumab MoA?

A

RANKL inhibitor (nuclear factor kappa-I)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
50
Q

Apremilast MoA? When is it used?

A

phosphodiesterase type-4 (PDE4) inhibitor - used in active psoriatic arthritis - if patients have inadequate response / intolerant to prev DMARD therapy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
51
Q

HLA in reactive arthritis?

A

HLA B27

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
52
Q

patients older than 65 years who have taken, or who are likely to remain on oral corticosteroids for more than 3 months

Need what tx and why?

A

Oral bisphosphonates - osteoporosis protection

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
53
Q

Drug that can cause exposed bone in oral cavity? Sign name?

A

Osteonecrosis of jaw secondary to bisphosphonate use

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
54
Q

Pain is usually elicited by resisted wrist flexion with pronation while keeping the elbow flexed 90 degrees or resisted forearm pronation with the elbow extended

Suggestive of which condition?

A

Medial epicondylitis (Golfer’s elbow)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
55
Q

No trauma

Painful swelling on posterior elbow

Middle aged man

Diagnosis?

A

Olecranon bursitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
56
Q

Poor prognostic features of RA?

A

rheumatoid factor positive
anti-CCP antibodies
poor functional status at presentation
X-ray: early erosions (e.g. after < 2 years)
extra articular features e.g. nodules
HLA DR4
insidious onset

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
57
Q

What is an early XR finding in RA?

A

Juxta-articular osteoporosis/osteopenia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
58
Q

Which patients should be offered prophylaxis against gout?

A

All patients after their 1st attack (2-4 weeks post acute)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
59
Q

How is risk of osteonecrosis of jaw increased in those with bisphosphonates?

A

IV therapy v oral

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
60
Q

What happens to prophylactic allopurinol dose during acute gout attack?

A

Continue allopurinol in current dose

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
61
Q

What are syndesmophytes and when are they seen?

A

This is the ossification of the outer fibres of annulus fibrosus seen in Ank Spond

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
62
Q

Gram staining in septic arthritis is …..

A

Gram staining is negative in around 30-50% of cases

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
63
Q

Anti-Jo1 ab seen in?

A

Anti-Jo-1 (Polymyositis/Dermatomyositis):

‘Jo can’t flex her muscles’ (muscle weakness in polymyositis/dermatomyositis).

(anti-mi2 is more secific for dermatomyositis)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
64
Q

Anti-dsDNA seen in?

A

Anti-dsDNA (Systemic Lupus Erythematosus - SLE):

‘Double Stranded DNA gets SLE-iously messed up’ (dsDNA links to lupus).

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
65
Q

Anti-Smith ab seen in?

A

Anti-Smith (Anti-Sm) (SLE):

‘Smith is sleek for SLE’ (Smith exclusively ‘slinks’ to lupus).

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
66
Q

Anti-Ro / La seen in?

A

Anti-Ro/Anti-La (Sjögren’s Syndrome and SLE):

‘Ro and La make you dry like the Sahara’ (dryness in Sjögren’s).

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
67
Q

Anti-centromere is seen in?

A

(Limited Systemic Sclerosis - CREST):

‘Centering on limited CREST’ (centromere links to limited CREST).

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
68
Q

Anti-Scl-70 is seen in?

A

Anti-Scl-70 (Diffuse Systemic Sclerosis):

‘Scl-erosis spreads like 70 mph across the body’ (diffuse systemic sclerosis).

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
69
Q

Anti-Mitochondrial (AMA) is seen in?

A

Anti-Mitochondrial (AMA) (Primary Biliary Cholangitis):

‘Your bile ducts scream ‘AMA-zing, we’re out of order!’’ (Primary Biliary Cholangitis).

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
70
Q

apremilast MoA?

A

phosphodiesterase type-4 (PDE4) inhibitor → suppression of pro-inflammatory mediator synthesis and promotion of anti-inflammatory mediators

71
Q

Sjogrens patients are at increased risk of which ca?

A

Lymphoid ca

72
Q

Mx of discoid lupus in order?

A

topical steroid cream

oral antimalarials may be used second-line e.g. hydroxychloroquine

avoid sun exposure

73
Q

What are the features of Felty syndrome?

A

(RA + splenomegaly + low white cell count)

74
Q

Extra articular manifestations of RA?

A

respiratory: pulmonary fibrosis, pleural effusion, pulmonary nodules, bronchiolitis obliterans, methotrexate pneumonitis, pleurisy

ocular: keratoconjunctivitis sicca (most common), episcleritis, scleritis, corneal ulceration, keratitis, steroid-induced cataracts, chloroquine retinopathy
osteoporosis

ischaemic heart disease: RA carries a similar risk to type 2 diabetes mellitus

increased risk of infections

depression

75
Q

An X-ray of the skull is performed, which shows large, well-defined lytic lesions and a thickened vault.

Can be seen in which disorder - raised ALP? What other markers of bone turn over are also raised?

A

Pagets disease of bone:

procollagen type I N-terminal propeptide (PINP)
serum C-telopeptide (CTx)
urinary N-telopeptide (NTx)
urinary hydroxyproline

76
Q

Who does Raynauds disease (primary) typically present in and how?

A

Young women with bilateral sx

77
Q

What is the majority (90%) of cases of gout due to?

A

decreased renal excretion of uric acid

78
Q

What are the main features of SLE mx?

A

Basics: Use NSAIDs + sun-block

Hydroxycholoroquine - tx of choice

If internal organ involvement eg renal, neuro, eye - consider pred and cyclophosphamide

79
Q

What are the antibodies associated with anti-phospholipid syndrome?

A

Anti-cardiolipin antibodies and anti-beta2 glycoprotein I antibodies

80
Q

Which antibodies for CREST syndrome

A

CREST = Limited (central) systemic sclerosis = anti-centromere antibodies

81
Q

Which ab are most specific and sensitive for SLE?

A

ANA is 99% sensitive

anti-Sm & anti-dsDNA are 99% specific

82
Q

Mx of Familial Mediterranean Fever?

A

colchicine may help

83
Q

Clotting in antiphospholipid syndrome?

A

Prolonged APTT + Thrombocytopaenia

84
Q

Mx of Raynauds if CCB doesnt work / CI?

A

IV prostacyclin (eg epoprostenol) infusion - effects can last weeks - months

85
Q

What examination findings can be seen with carpal tunnel?

A

weakness of thumb abduction (abductor pollicis brevis)

wasting of thenar eminence (NOT hypothenar)

Tinel’s sign: tapping causes paraesthesia

Phalen’s sign: flexion of wrist causes symptoms

86
Q

patients aged 75 and over with a history of fragility fractures

Mx of osteoporosis?

A

Start bisphosphonates w/out DEXA

87
Q

What DEXA score quantifies osteoporosis?

A

the BMD threshold for defining osteoporosis is a T-score of - 2.5 SD or below

88
Q

tingling in the little and ring finger and worsening of symptoms when the elbow is bent for prolonged periods

Suggestive of which dx?

A

Cubital tunnel syndrome

89
Q

features of polyarteritis nodosa?

A

fever, malaise, arthralgia

weight loss

hypertension

mononeuritis multiplex, sensorimotor polyneuropathy

testicular pain

livedo reticularis

haematuria, renal failure

perinuclear-antineutrophil cytoplasmic antibodies (ANCA) are found in around 20% of patients with ‘classic’ PAN

hepatitis B serology positive in 30% of patients

90
Q

PAN - what antibody is likely to be positive?

A

No antibodies - rarely pANCA (20%)

91
Q

Reflexes and nerve roots pneumonic?

A

S1, S2: Ankle jerk, or “buckle my shoe”

L3, L4: Knee jerk, or “kick the door”

C5, C6: Biceps and brachioradialis reflexes, or “pick up sticks”

C7, C8: Triceps reflex, or “lay them straight”

92
Q

Sensory loss dorsum of foot
Weakness in foot and big toe dorsiflexion

What nerve root is affected?

A

L5 compression

93
Q

Which nerve roots when compressed show +ve femoral stretch and sciatic nerve stretch?

A

+ve sciatic nerve stretch test: L5, S1

+ve femoral stretch test: L3, L4

94
Q

Similarities and differences between L3 /4 compression

A

Both:
+ve femoral stretch test
reduced knee reflex
weak hip adduction
Weak knee extension

L3:
Sensory loss over anterior thigh
Weak hip flexion

L4:
Sensory loss anterior aspect of knee and medial malleolus

95
Q

Features of lateral epicondylitis?

A

worse on resisted wrist extension/supination whilst elbow extended

96
Q

Which connective tissue disorder is most associated with raynauds?

A

Scleroderma (systemic sclerosis)

Also - RA + SLE

97
Q

What are the skin features of reactive arthritis?

A

circinate balanitis (painless vesicles on the coronal margin of the prepuce)

keratoderma blenorrhagica (waxy yellow/brown papules on palms and soles)

98
Q

Mycophenolate mofetil MoA?

A

Inhibits of inosine-5’-monophosphate dehydrogenase which is needed for purine synthesis

99
Q

What indicates poor prognosis in Polymyositis?

A

ILD - eg fibrosing alveolitis or organising pneumonia

Seen in 20%

100
Q

What is the defect in osteogenesis imperfecta?

A

Type I collagen (mutations in the COL1A1 or COL1A2 genes)

101
Q

What can relieve carpal tunnel pain in some patients?

A

Shaking their hands

102
Q

What antibody is associated with systemic sclerosis?

A

anti-centromere (CREST - limited cutaenous)

anti-scl-70 (diffuse cutaneous)

103
Q

Which systemic sclerosis is more likely to involve ILD and PAH?

A

Diffuse cutaneous systemic sclerosis

104
Q

Main difference between limited cutaneous and diffuse cutaneous systemic sclerosis?

A

Diffuse cutaneous systemic sclerosis = trunk + proximal limbs mainly

Limited cutaneous systemic sclerosis = face and distal limbs predominately

105
Q

What are the causes of drug induced lupus?

A

Most common causes
> procainamide
> hydralazine

Less common causes
> isoniazid
> minocycline
> phenytoin

106
Q

What are the features of Ank spond?

A

6As:

Apical fibrosis
Anterior uveitis
Aortic regurgitation
Achilles tendonitis
AV node block
Amyloidosis

107
Q

L5 lesion features?

A

loss of foot dorsiflexion + sensory loss dorsum of the foot

108
Q

Which condition is likely to display DIP swelling and dactylitis?

A

psoriatic arthritis

109
Q

Mx of GCA?

A

Uncomplicated GCA (no visual involvement and/or jaw/tongue claudication) - oral pred

Complicated GCA (with visual involvement and/or jaw/tongue claudication) - IV methylpred 3 days before oral pred

Same day ophthal rv
Bone protection w bisphosphonates if long course of steroids

110
Q

What is a possible complication of Temporal arteritis / GCA which presents with swollen pale disc and blurred margins on fundoscopy?

A

anterior ischemic optic neuropathy

111
Q

What can happen to the eyes in Marfans syndrome?

A

upwards lens dislocation (superotemporal ectopia lentis)

blue sclera

myopia

112
Q

Mx of Sjogrens?

A

Artificial salvia + tears

Pilocarpine can help stimulate saliva production

113
Q

Approximately what percentage of patients with psoriasis develop an associated arthropathy?

A

10-20%

114
Q

Marfans inheritance?

A

AD

115
Q

Mx of secondary thromboprophylaxis in antiphospholipid syndrome?

A

Initial VTE - lifelong warfarin 2-3 INR

Recurrent whilst on Warfarin - life long increase INR to 3-4 and consider low dose aspirin

Arterial thrombosis - life long aspirin 2-3

116
Q

Ab associated with congenital heart block in SLE?

A

Anti-RO = ROad Block = Congenital heart block in SLE.

117
Q

How can you distinguish pseudogout from gout on XR?

A

Chondrocalcinosis helps to distinguish pseudogout from gout

118
Q

Anti-U1 RNP is +ve in which disorder?
What other ab may be positive?

A

Mixed connective tissue disease

ANA is usually +ve

119
Q

Dermatomyositis antibodies

Most common v most specific?

A

Most common = ANA (60%)

Most specific = Anti Mi 2

120
Q

patients usually experience exacerbated pain upon wrist extension against resistance when their elbow is extended

seen in which disorder?

A

Lateral epicondylitis

121
Q

Mx of Pagets?

A

bisphosphonates - oral risendronate / IV zoledronate

122
Q

How does radial tunnel syndrome present?

A

similarly to lateral epicondylitis however pain is typically distal to the epicondyle and worse on elbow extension/forearm pronation

numbness or tingling sensations in the dorsum of the hand or fingers may occur due to compression of the radial nerve, further supporting a diagnosis of radial tunnel syndrome.

123
Q

McArdles disease - deficiency?

A

Myophosphorylase deficiency

124
Q

Azathioprine - Moa?

A

Metabolised to active compound which inhibits purine synthesis

125
Q

RF type of ab?

A

IgM against Fc portion of IgG

126
Q

Birbeck granules on electron microscopy (tennis racket shaped granules) dx?

A

Langerhans cell histiocytosis

127
Q

Which condition most commonly has anti-jo1?

A

Polymyositis > dermatomyositis

128
Q

Complications of pagets?

A

deafness (cranial nerve entrapment)
bone sarcoma (1% if affected for > 10 years)
fractures
skull thickening
high-output cardiac failure

129
Q

Ankle - Ottawa rules?

A

An ankle x-ray is required only if there is any pain in the malleolar zone and any one of the following findings:
> bony tenderness at the lateral malleolar zone (from the tip of the lateral malleolus to include the lower 6 cm of posterior border of the fibular)
> bony tenderness at the medial malleolar zone (from the tip of the medial malleolus to the lower 6 cm of the posterior border of the tibia)
> inability to walk four weight-bearing steps immediately after the injury and in the emergency department

130
Q

Presentation of mixed connective tissue disorder?

A

Raynaud’s phenomenon often precedes other symptoms and occurs in 90% of cases

Polyarthralgia/arthritis

Myalgia

‘Sausage fingers’(dactylitis)

131
Q

What can present with tingling/numbness of the 4th and 5th finger? cause?

A

Cubital tunnel syndrome caused by compression of ulnar nerve

132
Q

When should oral NSAIDs be used in mx of OA in 1st line?

A

Hip OA- topical is mainly for hand / knee OA

133
Q

hydroxyproline what disease is this implicated in?

A

increased serum and urine levels of hydroxyproline in Pageets

134
Q

Pseudoxanthoma elasticum cardiac features?

A

mitral valve prolapse, increased risk of ischaemic heart disease

135
Q

How does azathioprine toxicity in those with TPMT deficiency present?

A

Presents as BM suppression -> pancytopaenia

136
Q

Azathioprine adverse effects

A

bone marrow depression
consider a full blood count if infection/bleeding occurs

nausea/vomiting

pancreatitis

increased risk of non-melanoma skin cancer

137
Q

What is characterised by follicular keratin plugs?

A

Discoid lupus erythematosus

138
Q

Golimumab Moa?

A

TNF-a inhibitor used in refractory ank spond

139
Q

Leflunomide Adverse effects?

A

DMARD used in RA can cause:

gastrointestinal, especially diarrhoea
hypertension
weight loss/anorexia
peripheral neuropathy
myelosuppression
pneumonitis

140
Q

Features of Stills disease?

A

> arthralgia
elevated serum ferritin
rash: salmon-pink, maculopapular
pyrexia - typically rises in the late afternoon/early evening in a daily pattern and accompanies a worsening of joint symptoms and rash
lymphadenopathy

rheumatoid factor (RF) and anti-nuclear antibody (ANA) negative

141
Q

Which one of the following cells secretes the majority of tumour necrosis factor in humans?

A

Macrophages

142
Q

Which foods to avoid in gout?

A

Those that are high in purines e.g. Liver, kidneys, seafood, oily fish (mackerel, sardines) and yeast products

143
Q

Pathophysiology of de quervains tenosynovitis?

A

inflammation of the sheath containing the extensor pollicis brevis and abductor pollicis longus tendons

144
Q

Painful arc on shoulder exam is suggestive of what injury?

A

shoulder impingement, most commonly secondary to supraspinatus tendonitis

145
Q

What are the different rotator cuff muscles and their function?

A

Supraspinatus aBDucts arm before deltoid
Most commonly injured

Infraspinatus Rotates arm laterally

teres minor aDDucts & rotates arm laterally

Subscapularis aDDuct & rotates arm medially

SItS

146
Q

What disease can present as widening of the wrist joints due to an excess of non-mineralized osteoid at the growth plate?

A

Rickets

147
Q

Will TNF inhibitors help with radiological progression of ank spond?

A

No

148
Q

EDS defect?

A

Type III defect

149
Q

Looser’s zones x-ray (areas of incomplete fracture that appear as lucent bands perpendicular to the surface of the bone, usually bilateral and symmetric)

Suggestive of what dx?

A

Osteomalacia

150
Q

What is important to check for in osteoporosis in a man?

A

Testosterone, SHBG, FSH, LH levels

151
Q

DEXA score interpretations?

A

T score is based on bone mass of young refrence population

Z score is adjusted for age, gender and ethnicity

152
Q

Ix findings in PMR?

A

raised inflammatory markers e.g. ESR > 40 mm/hr

note creatine kinase and EMG normal

153
Q

What is the minimum steroid intake a patient should be taking before they are offered osteoporosis prophylaxis?

A

Equivalent of prednisolone 7.5 mg or more each day for 3 months

154
Q

Which features are common / not common for drug induced lupus?

A

Common:
Arthralgia, myalgia and skin + pulmonary involvement

Glomerulonephritis is unusual in drug-induced lupus

155
Q

When should Z score be used in osteoporosis?

A

A Z-score is helpful in diagnosing secondary osteoporosis and should always be used for children, young adults, pre-menopausal women and men under the age of 50

156
Q

AVN of hip v trochanteric bursitis?

A

AVN: GROIN pain, pain on internal rotation

Trochanteric bursitis: lateral hip, pain on internal and external rotation

157
Q

how does trochanteric bursitis present?D

A

isolated lateral hip/thigh pain with tenderness over the greater trochanter

158
Q

lower back pain associated with neurological problems such as bladder and bowel dysfunction

In a marfans pt - dx?

A

Dural ectasia

159
Q

What is the greatest predictor of future thrombosis in patients with anti-phospholipid syndrome?

A

Lupus anticoagulant

160
Q

Cardiac features in antiphospholipid syndrome?

A

Normal

161
Q

proximal myopathy in combination with mechanic hands

What dx? what sx is important to ask ab?

A

Anti-synthetase syndrome - important to check re ILD (lung involvement)

162
Q

T score interpretation?

A

Normal: T-score ≥ -1.0
Osteopaenia: T-score between -1.0 and -2.5
Osteoporosis: T-score ≤ -2.5

163
Q

How can relapsing polychondritis present?

A

As well as ear problems, relapsing polychondritis may present with nasal chondritis, respiratory tract involvement and arthralgia

164
Q

What is magic syndrome?

A

Mouth and genital ulcers with inflamed cartilage (MAGIC) syndrome refer to a condition in which features of Behcet’s disease and relapsing polychondritis occur in the same individual

165
Q

What is recommended 2nd line in osteoporosis of PM women who cant tolerate oral alendronate?

A

PO risendronate

166
Q

Double contour sign on knee US - dx?

A

Gout

167
Q

Ank spond pain at night?

A

It is worse and improves when they get up

168
Q

Which joints are involved in hand OA?

A

Carpometacarpal

DIPs

169
Q

Bloods in osteopetrosis?

A

normal calcium, phosphate, ALP and PTH levels

bone hardening due to the malfunction of osteoclasts -> increased risk of fractures

170
Q

Reactive arthritis mx?

A

symptomatic: analgesia, NSAIDS, intra-articular steroids

sulfasalazine and methotrexate are sometimes used for persistent disease

symptoms rarely last more than 12 months

171
Q

Joint involvement in RA? moa of 1st line mx?

A

symmetrical involvement of the metacarpophalangeal (MCP) and proximal interphalangeal (PIP) joints

1st line = Methotrexate = Reversible dihydrofolate reductase inhibitor

172
Q

reoccurring episodes of abdominal pain, fever, arthralgia, and chest pain

dx? and inheritance?

A

FMF - autosomally recessive

173
Q

Criteria for antiphospholipid dx?

A

Clinical criteria
1. Vascular thrombosis: ≥1 clinical episode of arterial, venous, or small-vessel thrombosis in any tissue or organ, validated by imaging studies or histopathology
2. Pregnancy morbidity: e.g. unexplained, consecutive, and spontaneous abortions

Laboratory criteria
1. Positive for LA on ≥2 occasions at least 12 weeks apart
2. Positive aCL on ≥2 occasions at least 12 weeks apart
3. Positive anti-β2GP1 antibodies on ≥2 occasions at least 12 weeks apart

174
Q

What is the most common cardiac defect seen in Marfan’s syndrome?

A

dilation of the aortic sinuses which may predispose to aortic dissection

MRCP - Passmed (17 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions