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UKMLA > Rheumatology > Flashcards

Rheumatology Flashcards

1
Q

What type of arthritis is associate with skin and nail changes?

A

Psoriatic arthritis

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2
Q

What type of nail changes are seen in psoriatic arthritis?

A

Pitting and ocholyosis?

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3
Q

What is ocholyosis?

A

When nail separates from skin

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4
Q

Which joints are usually affected in rheumatoid ?

A

Metacarpophalangeal joints

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5
Q

Which joints are affected in psoriatic arthritis?

A

Distal interphalangeal joints

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6
Q

What is 1st line management for ankylosing spondylitis?

A

NSAID’s

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7
Q

What is treatment for ankylosing spondylitis after NSAIDs? Specifically for peripheral joint disease NOT spinal inflammation?

A

DMARDS - methotrexate and sulfasalazine

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8
Q

What is management for ankylosing spondylitis in cases of spinal inflammation?

A

Anti tnf biologics - Adalimumab

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9
Q

What is the definition of ankylosing spondylitis?

A

Seronegative inflammatory arthritis primarily involving the axial skeleton

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10
Q

What’s the common presentation of ankylosing spondylitis?

A

Younger man with early morning lower back stiffness - gets better with activity
Sacroiliac joint tenderness
Enthesis’s - Achilles tendonitis and plantar fasciitis
Anterior uveitis

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11
Q

What bedside test can be done in ankylosing spondylitis?

A

Modified schober’s test - if distance on forward flexion is less than 5cm it indicates restricted forward flexion

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12
Q

What investigations are needed in ankylosing spondylitis?

A

Pelvic x-ray
Lumbar xray
MRI is mot sensitive

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13
Q

What may be seen on lumbar x-ray in ankylosing spondylitis?

A

Bamboo spine - fusion of vertebral column - the vertebral bodies may become square looking

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14
Q

If pt has severe heart failure should nsaids be given?

A

No - they’re contraindicated

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15
Q

Should warfarin be used in pregnancy?

A

No - use LMWH and low dose aspirin

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16
Q

What is given in miscarriage prevention?

A

Low dose aspirin and LMWH

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17
Q

What ‘s the dose of aspirin that should be taken in anti-phospholipid syndrome pregnancy?

A

75-150mg daily from 12 weeks gestation till delivery

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18
Q

What cells are low in SLE?

A

Lymphopenia - low lymphocyte count

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19
Q

Which HLA is associated with a poor prognosis of rheumatoid?

A

HLA-DR4

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20
Q

Which antibodies are found in churg strauss syndrome (eosinophilic granulomacytosis)?

A

P-ANCA

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21
Q

How does churg strauss syndrome present?

A

Polyneuropathy
Adult onset asthma
Small vessel vasculitis in lower extremeties
Eosinophilia

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22
Q

Which antibodies are positive in diffuse systemic scelorosis?

A

Anti-topoisomerase antibodies

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23
Q

How does diffuse systemic scleorosis present?

A

Raynaud’s
Vascular complications like ischaemic digital ulcers
Hypertensive crisis
Pulmonary arterial hypertension
Fibrosing complications involving lung and heart and GI tract

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24
Q

What antibodies are found in dermatomyosisits?

A

Anti-Mi-2 antibodies

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25
Q

Which antibodies are seen in CREST syndrome - limited systemic sclerosis?

A

Anti-centromere antibodies

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26
Q

How does limited systemic sclerosis present?

A

Raynauds
Calcinosis
Telengiectesia
Intestinal hypomotility
Dysphagia - swallowing of solids an issue and then liquids
Sclerodactyly

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27
Q

Which antibodies are present in rheumatoid?

A

Anti-CCP

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28
Q

Which marker is most specific for SLE?

A

Anti-dsDNA and anti-Sm

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29
Q

What is granulomatosis with polyangiitis? (Wegener granulomatosis)

A

Rapidly progressing glomerunephritis and pulmonary haemorrhage
Patient will be systemically unwell and there is a background of recurrent sinusitis or chronic cough
Nasal septum deformity
Rash
Joint symptoms
Haemoproteinuria
C-ANCA positive

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30
Q

How is granulomatosis with polyangiitis confirmed?

A

Renal biopsy

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31
Q

What is first line treatment for SLE?

A

hydroxychloroquine

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32
Q

What is the presentation of behcets disease?

A

Anterior uveitis@ painful red eye, photophobia, blurred vision and hypoyon
Genital and oral ulcers
Erythema nodosum
Pulmonary artery aneurysm

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33
Q

Which HLA is Behcet’s assocaited with?

A

HLA-B51

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34
Q

Which antibodies are present in APS?

A

Anticardiolipin and lupus anticoagulant and anti-beta glycoprotein 1 - APL can cause miscarriages

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35
Q

What is presentation of polymyalgia rheumatica?

A

Bilateral shoulder, hip and girdle pain with morning stiffness

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36
Q

What is first line treatment for polymyalgia rheumatica?

A

Low dose oral prednisolone

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37
Q

What is takayasu’s arteritis?

A

Granulomatous vasculitis mainly in young women

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38
Q

How does takayasu’s arteritis present?

A

New onset headaches
Visual changes
Arm claudication
BP difference between each arm

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39
Q

What would be the presentation difference between takayasu’s arteritis and fibromuscular dysplasia?

A

Fibromuscular dysplaisa affects renal and carotid arteries

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40
Q

What is pathergy?

A

Formation of a papule at the site of trauma (for example cannula insertion_ - specific feature of behcet’s disease

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41
Q

What antibodies are positive in granulomatosis with polyangitis (wegener’s)

A

c-anca

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42
Q

Which HLA are found in ankylosing spondylitis?

A

HLA-B27

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43
Q

What pathogen causes septic arthritis in IV drug users?

A

Pseudomonas

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44
Q

What is the polymyositis and dermatomyosisits?

A

Bilateral and proximal muscle weakness and in case of dermatomyositis - skin rashes

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45
Q

How does polymyositis present?

A

Bilateral and proximal hip and shoulder and girdle muscle weakness
As disease progresses:
Pharyngeal or oesophageal muscles weaken leading to dysphonia and dysphagia
Resp muscles can lead to type 2 resp failure

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46
Q

How can dermatomyositis present?

A

Muscular features present in polymyositis but also heliotrope rash (lilac discolouration of eyelid skin + periorbital oedema)
Gottron’s papules: scaly and erythematous papules over knuckles, and extensor surfaces
V-sign rash - rash affecting anterior chest and neck
Shawl sign - when rash affects upper arms and shoulders

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47
Q

What is amyotrophic dermatomyositis?

A

Characteristic skin changes but not muscle involvement

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48
Q

Which markers are raised in both dermatomyositis and polymyositis?

A

They turn your muscles into clay (CLAAA)
C - creatine kinase
L lactate dehydrogenase
A - Aldolase
ALT
AST

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49
Q

What is treatment for dermatomyositis and polymyositis?

A

Corticosteroids - moitor CK to know tapering dose
Additional immunosuppressants - methotrexate or mycophenolate if needed

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50
Q

How is a diagnosis of APL made?

A

Positive antibody result on 2 seperate occasions with at least 12 week interval between them

51
Q

Which antibodies are positive in psoriatic artheritis?

A

None - it’s a seronegative arthropathy so negative rheumatoid antibody screen

52
Q

What is achilles tendon enthesopathy a feature of?

A

Psoriatic arthritis

53
Q

Which gene mutation is present in Marfaan’s?

A

Fibrillin 1 gene

54
Q

What is gold standard investigation for ankylosing spondylitis?

A

MRI

55
Q

How can osteoarthritis present?

A

Pain in join during or after use
Stiffness esp in mornings or after a period of inactivity
Loss of flexible and range of motion
Grating sensation or feeling of bone rubbing on bone
Heberden’s nodes
Bouchard’s nodes

56
Q

Where are heberden’s nodes vs bouchard’s nodes?

A

Heberden’s: swelling of distal interphalangeal joint
Bouchard node: swelling of proximal interphalangeal joint

57
Q
A
58
Q

What’s the acronym to diagnose osteoarthritis?

A

LOSS
L- loss of joint space - cartilage thinning
O - osteophytes - bone spurs - new bone around joint margins
S - subchondral sclerosis - Increased bone density - so areas look whiter on x-ray
S - subchondral cysts

59
Q

What is a common side effect of ciclosporin?

A

Diarrhoea

60
Q

What is mechanism of action of ciclosporin?

A

Lowers activity of T lymphocytes by inhibiting calcineurin

61
Q

What is first line treatment of trochanteric bursitis?

A

Rest and ice

62
Q

How does trochanteric bursitis present?

A

Inflammation over bursa as lateral hip pain and swelling with positive Trendelenburg test.

63
Q

What are the signs of methotrexate toxicity? and which medications can exarcebate this?

A

Fatigue
Mouth sores
Shortness of breath
- trimethoprim

64
Q

How does livedo reticularis look like?

A

Mottled lace like appearance on legs

65
Q

What is IgG4 related disease?

A

Chronic inflammatory condition characterized by tissue infiltration with lymphocytes and IgG4-secreting plasma cells, various degrees of fibrosis - can present as recurrent worsening episodes of autoimmune pancreatitis - seen with new onset diabetes diagnosing and suasage pancreas sign ( diffuse thickening of pancreas)

66
Q

What is familial Mediterranean fever?

A

Familial Mediterranean fever (FMF) is a genetic autoinflammatory disorder that causes recurrent fevers and painful inflammation of your abdomen, chest and joints.

67
Q

What is first line treatment of raynauds?

A

CCB usually nifedipine - they are vasodilators

68
Q

What are the main side effects of alendronic acid (oral bisphosphonates)?

A

Oesophageal reactions like oesophagitis
Ulcers
Erosions
Strictures
Can presents as odynophagia
Dysphagia
New or worsening dyspepsia

69
Q

Which antibodies are present in sjogren’s?

A

Anti ro and anti-La

70
Q

Which medication can be used as an alternative to nsaid’s in GI bleed patients and why is this medication effective?

A

Celocoxib : selective COX-2 inhibitor - they have a lower risk of GI ulceration than regular NSAID’s because they inhibit COX-1 to a lesser extent and COX 1 is protective for gastric mucosa

71
Q

Which rash is associated with antiphospholipid syndrome?

A

Livedo reticularis - mottled lace like rash found on lower limbs

72
Q

What is a known side effect to be careful of with hydroxychlorquine?

A

Retinal toxicity - presenting with poor central vision, difficulty breating or accomodating objects and change in colour vision

72
Q

What type of toxicity is common in methotrexate?

A

Neutropenia
Folate deficiency anaemia
Liver

73
Q

What can cause false positive for APL ?

A

Syphilis that’s why it’s important to do a treponemal serology

74
Q

What is triad of felty syndrome?

A

Long standing rheumatoid arthritis
Idiopathic neutropenia
SplenomegaLy

75
Q

What is enteropathic arthritis a complication of?

A

IBD

76
Q

What is first line treatment for behcet’s?

A

Steroids or colchicine

77
Q

Other than eosinophilic granulomatosis with polyangiitis what can present with positive pANCA?

A

Microscopic polyangiitis - presents with respiratory, renal and generalised symptoms

78
Q

What is most common associated side effect of methotrexate and why?

A

Oral ulceration - due to methotrexate interfering with folate metabolism which leads to mucosal damage which can manifest as mouth sores

79
Q

What infection is polyarteritis nodusa strongly associated with?

A

Hep B infection

80
Q

Which organs does polyarteritis nodusa not affect?

A

Lungs

81
Q

Which antibodies are positive in limited cutaneous systemic sclerosis?

A

Anti-centromere

82
Q

In Diffuse cutaneous systemic sclerosis what antibodies are positive?

A

Anti - scl -70

83
Q

What is main management of sjogren’s?

A

Topical and targeted symptomatic relief - for example Hypromellose - used as artificial tears and applied as eye drops

84
Q

What can differentiate polymyositis from polymyalgia rheumatica?

A

In PR there is proximal bilateral muscle PAIN but weakness is not a prominent feature unlike in polymyositis where weakness is a prominent feature

85
Q

Which malignancy is highly associated with dermatomyositis?

A

Lung - which can cause progressive breathlessness - esp if this new onset of muscle weakness

86
Q

Why are NSAID’s nephrotoxic?

A

They cause vasoconstriction of afferent renal arterioles

87
Q

What gland becomes swollen in sjogrens?

A

Parotid gland

88
Q

If a young man presents with achilles tendonitis and back pain what should you start thinking?

A

Ankylosing spondylitis

89
Q

Which HLA is associated with Behcets?

A

HLA-B51

90
Q

What is dural ectasia?

A

As the membrane expands, it can press on the vertebrae in your lower back, which can cause: backache. headache. numbness or pain in your legs. - commonly associated with marfan’s

91
Q

Which type of lens dislocation is common in marfans?

A

Superior lens dislocation

92
Q

What bone related issue can anti-epileptics like phenytoin cause? and why?

A

Osteoporosis
Osteomalacia
Rickets
Due to their cytochrome P450 enzyme inducing effects - increases conversion of vitamin D to it’s inactive form
Phenytoin also stimulates osteoclasts inhibiting osteoblasts and reduces intestinal calcium absorption

93
Q

What’s the difference between buerger’s and raynauds?

A

Buerger’s Disease is a serious, tobacco-related condition characterized by vessel inflammation and clotting, while Raynaud’s Disease involves vasospasms often triggered by cold or stress, with the primary form being less severe and secondary form associated with systemic diseases.

94
Q

What’s the diagnostic first line for takayasu’s?

A

CT angiogram

95
Q

What type of anaemia is caused by folate deficiency?

A

Macrocytic anaemia

96
Q

What antibody is positive in dermatomyositis?

A

Anti-Jo1

97
Q

What creatinine clearance level would indicate alendronate can’t be used?

A

Under 35

98
Q

How often should methotrexate be taken?

A

Once weekly

99
Q

Which tests should be done before commencing methotrexate?

A

Baseline liver function
Renal function
FBC
Chest x-ray - as methotrexate can cause pneumonitis

100
Q

What’s the most common cause of acute septic arthritis?

A

Staph aureus

101
Q

What could mean gonorrhoea causes acute septic arthritis?

A

Young male
Presence of necrotic pustules

102
Q

What type of lymphoma is sjogren’s associated with?

A

MALT - mucosa associated lymphoid tissue low grade B cell non hodgkin lymphoma

103
Q

What happens with the pulses in takayasu’s arteritis?

A

Radial pulses may be absent
Bruits may be audible over the carotids

104
Q

What is first line investigation for polymyositits?

A

Creatinine kinase
2nd line is the EMG

105
Q

What is most definitive test for polymyositis?

A

Muscle biopsy

106
Q

What is good pasture’s syndrome?

A

Anti-glomerular basement membrane antibodies against type 4 collagen found within the glomerular and alveolar basement membranes

107
Q

What is juxta -articular erosions and what are they an early sign of?

A

Erosions near joint space
Rheumatoid

108
Q

What is an adverse effect of leflunomide (RA drug) to be monitored at each review?

A

Blood pressure as it can cause hypertension - if after hypertensive medication BP is still uncontrolled then stop the leflunomide

109
Q

What is still’s disease?

A

Idiopathic autoinflammatory condition characterised by:
1. Pyrexia
Arthralgia
Salmon pink rash
Elevatedferritin -exceeding 10,000
Increase liverenzymes

110
Q

What is treatment for still’s disease?

A

NSAIDS and aspirin first line
Low dose cortticosteroids next
with antiIL1 agents

111
Q

What eye issue is a side effect of corticosteroid use?

A

Glaucoma

112
Q

What are gottron’s papules?

A

Erythematous papule and patches with scaling over dorsal metacarpophalangeal and interphalangeal joints - one of the cutaneous signs for dermatomyositis

113
Q

What is the commonest form of rheumatoid factor antibody?

A

IgM against IgG

114
Q

What is the quantiferon test?

A

Diagnostic tool for TB - important to do before starting biologics as they can reactivate latent TB

115
Q

Which type of respiratory failure is polymyositis more likely to lead to?

A

Chronic type 2

116
Q

Under what circumstance can a patient have their steroids stopped abruptly?

A

2 week course of 20mgoral pred a day - basically if the oral course is less than 3 weeks. BUT if the course was more than 40mg pred then it needs slow withdrawal

117
Q

What is a common extra-muscular manifestation associated with polymyositis?

A

Interstitial lung disease

118
Q

How does staph aureus present on histology?

A

Gram positive cocci in grape like clusters

119
Q

What effect can sulfasalazine have on male fertility?

A

Reversible azoospermia

120
Q

What is most definitive test for sjogren’s?

A

Salivary labial gland biopsy

121
Q

Which clotting test is prolonged in APL?

A

Activated partial thromboplastin time - aPTT

122
Q
A

UKMLA (12 decks)

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