Rheumatology Flashcards
seronegative spondyloarthropathies associated with HLA-B27. Triad of ‘cant see, cant wee and cant climb a tree’
Reactive arthritis
What is the most common pathogen which results in the post-dysenteric form of reactive arthritis?
Shigella Flexneri
What is the most common sti responsible for reactive arthritis?
Chlamydia trachomatis
What antibody may be detected upto 10 years before the development of rheumatoid arthritis and can be used to screen patients eligible for anti-TNF therapy?
Anti-cyclic citrullinated peptide antibody
Mutation in what protein causes Marfans syndrome? (Autosomal dominant, tall stature, dilatation of aortic sinuses, mitral valve prolapse, upwards lens discolouration)
Fibrillin-1
Mutation in what protein is the cause for Beals syndrome? ( Multiple joint contractures (especially elbow, knee and finger joints), and crumpled ears in the absence of significant aortic root dilatation )
Fibrillin-2
What collagen mutation is involved in Cardiac-Valvular Ehlers-Danlos syndrome? (skin hyperextensibility, easy bruising, atrophic scar formation, joint hypermobility and severe, progressive cardiac valvular defects comprising of mitral and/or aortic valve insufficiency)
Polypeptides in type I collagen
recurrent DVTs, and learning disability, defect in Cystathionine β-synthase
homocystinuria
If the DIP joints are affected is it more likely to be rheumatoid arthritis or psoriatic arthritis?
Psoriatic
Female, below the age of 65 is going to be on prednisolone for some time. as a result DEXA scan is performed and T score is between 0 to -1.5. what is the best course of action?
Repeat bone density scan in 1-3 years
Drug class of Apremilast which is used in conjunction with other medications for management of psoriatic arthritis?
Phosphodiesterase type-4 inhibitor
Mechanism of action of Methotrexate?
dihydrofolate reductase inhibitor
X-ray findings characteristic of Ankylosing spondylitis?
Sacro-ilitis on pelvic x-ray, squaring of lumbar vertebrae, bamboo spine, syndesmophytes:, apical fibrosis on cxr
Multiple fractures in a child when they begin to walk, blue tinge in the sclera, abnormality in type 1 collagen, autosomal dominant inheritance
Osteogenesis Imperfecta
Triad of Behcets syndrome? (HLA B51)
Oral Ulcers + genital ulcers + Anterior Uveitis
What part of the coagulation cascade is raised in Antiphospholipid syndrome?
Paradoxical rise in APTT (Ex-vivo reaction of lupus anticoagulant)
Primary thromboprophylaxis in Antiphospholipid syndrome?
Low dose Aspirin
Secondary thromboprophylaxis in Antiphospholipid syndrome?
Life long warfarin
Lesion site: Sensory loss of posterolateral aspect of leg and lateral aspect of foot, weakness in plantar flexion of foot, reduced ankle reflex, positive sciatic nerve stretch test
S1
Lesion site: sensory loss over the anterior of the thigh, weakness of knee extension and a reduced patella reflex,
L3
Lesion site: ensory loss over the knee, weakness of ankle dorsiflexion and a reduced patella reflex,
L4
Lesion site: sensory loss in the dorsum of the foot alongside weakness of big toe extension, not plantar flexion.
L5
Lesion site: sensory loss in the posteromedial aspect of the leg, buttocks and genitals and weakness in knee flexion.
S2
What is the autoantibody for Mixed connective tissue disorder?
Anti-ribonuclear protein
medium vessel vasculitis, is clinched by the presence of mononeuritis multiplex i.e. peripheral neuropathy affecting two or more non-contiguous nerve trunks, as well as hepatitis B infection
Polyarteritis Nodosa
large vessel vasculitis which comes with an increased risk of hypertension, aneurysms and hypertension. A textbook examination finding would be absent peripheral pulses
Takayasu Vasculitis
Disorder of osteoclasts, older male, isolated rise in ALP, urinary hydroxyproline
Pagets disease
Two most specific autoantibodies for SLE?
Anti-SM + Anti-dsDNA
Bone pain, tenderness and proximal myopathy, waddling gait?
Osteomalacia
Condition + Treatment: characterised by follicular keratin plugs and is thought to be autoimmune in aetiology. Some of the key features, as described in this scenario, are a raised, erythematous rash, most commonly seen on the face and scalp in young women. It may be photosensitive, as alluded to here, with worsening of the lesions without a sunhat. Lesions healing often cause scarring and pigmentation, sometimes causing non-reversible scarring alopecia, as in this case.
Discoid Lupus
Topical Steroids (1st line)
Oral Hydroxychloroquine (2nd Line)
Common target of pANCA?
Myeloperioxidase
Common target of cANCA?
Serine Protinase 3
What disease is most strongly related to HLA antigen DR4?
Rheumatoid Arthritis + T1DM
What two autoimmune conditions are associated with pANCA?
-Microscopic polyangiitis
-Churg-Strauss syndrome
Pamidronate
-Indication?
-MOA?
-Hypercalcaemia of Malignancy / Pagets Disease
-Bisphosphonate. Inhibits osteoclast mediated bone reabsorption.
Gout
-Cause
-Crystal shape
-Birefringence
-Affected joints
-Inflammatory cascade?
-Acute gout management?
-Urate lowering therapy for prevention?
-Monosodium urate crystals
-Needle
-Strongly negative under polarised light
-First MTP, ankles, knees
-NLRP3 inflammsone resulting in IL-1B release
-NSAIDS (Naproxen) / Colchicine
-Allopurinol (Xanthine oxidase inhibitor)
Pseudogout
-Cause
-Crystal shape
-Crystal birefringence
-Commonly affected joints
-Tx
-Calcium pyrophosphate
-Rhomboid
-Weakly positive
-Knees, wrists, shoulders and ankles
-NSAIDS / Colchicine
