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Rheumatology Flashcards

1
Q

bones affected in pagets

A

Paget’s disease of the bone generally affects the skull, spine/pelvis, and long bones of the lower extremities

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2
Q

bloods in pagets

A

raised alkaline phosphatase (ALP)
calcium and phosphate are typically normal. Hypercalcaemia may occasionally occur with prolonged immobilisation

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3
Q

management pagets

A

BISPHSPHONATES

if bone pain, skill or long bone deformity, fracture, periarticular pagets

bowing + bossing –> bisphosphonates

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4
Q

complications pagets

A

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

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5
Q

flare of RA

A

corticosteroids - IM or PO

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6
Q

increased PTH

A

increases calcium

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7
Q

CKD and hyperparathroidism

A

Secondary HYPERparathyroidism
- HYPOcalcaemia
- HIGH phopshate
- HIGH ALP

Kidneys can’t activate vit D –> vit D can’t excrete phopshate
PTH rasies to try to increase Ca, and stimulates osteoclast activity

–> raise in ALP

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8
Q

osteoporosis bone profile

A

all normal

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9
Q

osteomalacia bone profile

A

low Ca, phophate
high ALT, PTH

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10
Q

who can certify someone as blind

A

Only consultant ophthalmologists (rather than GPs) are allowed by law to certify patients as legally blind or partially sighted in the UK

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11
Q

salter-harris

A

In paediatric practice, fractures may also involve the growth plate and these injuries are classified according to the Salter-Harris system (given below):

SALTeR is the one I was taught:
1- Straight *xray normal)
2- Above
3- Lower
4- Through everything
5- Rammed

As a general rule, it is safer to assume that growth plate tenderness is indicative of an underlying fracture even if the x-ray appears normal. Injuries of Types III, IV and V will usually require surgery. Type V injuries are often associated with disruption to growth.

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12
Q

patient with dementia without capcity should always be on..

A

a DOLS

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13
Q

bisphosohonates and CKD

A

contraindicated

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14
Q

Gout: irate lowering therapy

A

the British Society of Rheumatology Guidelines now advocate offering urate-lowering therapy to all patients after their first attack of gout
ULT is particularly recommended if:
>= 2 attacks in 12 months
tophi
renal disease
uric acid renal stones
prophylaxis if on cytotoxics or diuretics
(ALLOPURINOL)

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15
Q

tennis elbow - when is pain

A

TENnis elbow = pain on resisted exTENsion with elbow exTENded

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16
Q

methotrexate most common lung manifestation

A

pneumonitis

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17
Q

two interactions of metotrexate

A

avoid prescribing trimethoprim or co-trimoxazole concurrently - increases risk of marrow aplasia
high-dose aspirin increases the risk of methotrexate toxicity secondary to reduced excretion

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18
Q

what to always give with methotrexate

A

folic acid

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19
Q

Schirmer’s test

A

used to determine whether the eye produces enough tears to keep it moist

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20
Q

Rheumatology markers:
RA

A

Anti-CCP

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21
Q

ANCA

A

Vasculitides

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22
Q

Anti-Jo1

A

Polymyo/Dermatomyositis

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23
Q

Anti-dsDNA -

A

SLE

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24
Q

Anti-Ro/ anti-La=

A

Sjogrens

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25
how long chronic fatigue to be diagnosed (how Long Sx present for)
3 months
26
keratoderma blennorrhagicum on the soles of his feet - a waxy yellow rash pathognomonic for
reactive arthritis
27
Common in pregnancy Ligament laxity increases in response to hormonal changes of pregnancy Pain over the pubic symphysis with radiation to the groins and the medial aspects of the thighs. A waddling gait may be seen
Pubic symphysis dysfunction
28
An uncommon condition sometimes seen in the third trimester of pregnancy Groin pain associated with a limited range of movement in the hip Patients may be unable to weight bear ESR may be elevated
Transient idiopathic osteoporosis
29
osteoporosis and pain
pain is not worse when you press it!!
30
most common side effect on colchicine
diarrhoea
31
Rheumatoid arthritis: drug side effects
Leflunomide LEF= Liver impairment LUN= Lung interstitial disease Hydroxychloroquine HYE=Eye (retinopathy, corneal deposits) Penicillamine P for proteinuria also causes Exacerbation of myasthenia gravis the "-imabs" cause reactivation of TB
31
what to do with allurinol in gout acute
Patients already prescribed allopurinol should continue to take it at the same dose during acute episodes. This is of course in contrast to the advice that patients should not be started on allopurinol until an acute attack has settled.
32
aspirin and which anti rheumatic drug have overlapping allergic reaction? (1)
sulfasalazine
33
MHA and MCA - which takes precedent?
MHA always overrides MCA
34
when can a patient get a bisphosphate holiday in RA?
After a five year period for oral bisphosphonates (three years for IV zoledronate), treatment should be re-assessed for ongoing treatment, with an updated FRAX score and DEXA scan. This guidance separates patients into high and low risk groups. To fall into the high risk group, one of the following must be true: Age >75 Glucocorticoid therapy Previous hip/vertebral fractures Further fractures on treatment High risk on FRAX scoring T score <-2.5 after treatment If any of the high risk criteria apply, treatment should be continued indefinitely, or until the criteria no longer apply. If they are in the low risk group however, treatment may be discontinued and re-assessed after two years, or if a further fracture occurs.
35
antiphospholipid bloods
raised APTT and normal PT and can result in thrombocytopenia.
36
roughened red papules over the extensor surfaces and are seen in dermatomyositis
grottrons papules
37
trigeminal neuralgia vs temporal arteritis
jaw caludication = temporal artertitis
38
polymalgia rheumatic and no response to steroids after 3 weeks..
typically respond dramatically to steroids, failure to do so should prompt consideration of an alternative diagnosis
39
Azathioprine monitoring needed
FBC, LF T FBC, LFT before treatment FBC weekly for the first 4 weeks FBC, LFT every 3 months
40
methotrexate monitoring (3)
FBC, LFT, U&E
41
ACEi monitoring
U&E prior to treatment U&E after increasing dose U&E at least annually
42
amiodarone monitoring (4) Ongoing monitoring (2)
TFT, LFT, U&E, CXR prior to treatment TFT, LFT every 6 months
43
Statin monitoring (3)
LFTs at baseline, 3 months and 12 months
44
which endocrine drug needs blood monitoring (1)
glitazones - LFT
45
lithium monitoring (3) Ongoing monitoring (3)
Lithium level, TFT, U&E TFT, U&E prior to treatment Lithium levels weekly until stabilised then every 3 months TFT, U&E every 6 months
46
sodium valproate monitoring (2)
LFT, FBC before treatment LFT 'periodically' during first 6 months
47
methotrexate side effeccts
Myelosuppression Liver cirrhosis Pneumonitis
48
sulfalazine SE
Rashes Oligospermia Heinz body anaemia Interstitial lung disease
49
T score and bone protection
> 0 = Reassure Between 0 and -1.5 = Repeat bone density scan in 1-3 years Less than -1.5 = Offer bone protection The first-line treatment is alendronate. Patients should also be calcium and vitamin D replete.
50
entanercept SE
Demyelination Reactivation of tuberculosis
51
x Hydroxychloroquine what to warn people about
EYEs
52
CREST Sx
CREST syndrome is a subtype of limited systemic sclerosis and includes: calcinosis, Raynaud's phenomenon, oesophageal dysmotility, sclerodactyly, telangiectasia
53
HLA-B27
AS
54
Psoriatic arthritis: symmetric or asymmetric? (1) other features
Patterns symmetric polyarthritis very similar to rheumatoid arthritis 30-40% of cases, most common type asymmetrical oligoarthritis: typically affects hands and feet (20-30%) until recently it was thought asymmetrical oligoarthritis was the most common type, based on data from the original 1973 Moll and Wright paper. Please see the link for a comparison of more recent studies sacroiliitis DIP joint disease (10%) arthritis mutilans (severe deformity fingers/hand, 'telescoping fingers') Other signs - psoriatic skin lesions - periarticular disease - tenosynovitis and soft tissue inflammation resulting in: enthesitis: inflammation at the site of tendon and ligament insertion e.g. Achilles tendonitis, plantar fascitis tenosynovitis: typically of the flexor tendons of the hands dactylitis: diffuse swelling of a finger or toe nail changes pitting onycholysis
55
polymayalgia rheumatica how quick to follow up after givine steroids? (1)
after 1 week of steroids to check response if no response --> alternative diagnosis
56
Heberdens vs Bouchards
Heberden's nodes - swelling of the distal interphalangeal joints. Bouchard's nodes - swelling of proximal interphalangeal joints
57
Antihistone antibodies are associated with
drug induced lupus (also ANA)
58
what is drug induced lupus (1) common causes (2) less common causes (3)
Luke SLE but resolves with stopping the drug (arthralgia, myalgia, skin (molar rash) and pulmonary involvement (pleurisy) Most common causes 1- procainamide 2- hydralazine Less common causes 3- isoniazid 4- minocycline 5- phenytoin
59
Antiphospholipid syndrome skin presentation
Livedo reticularis, which is a reticular, mottled, purplish discolouration of the skin that occurs due to impaired blood flow in the cutaneous vessels. In antiphospholipid syndrome (APS), the presence of antiphospholipid antibodies leads to a hypercoagulable state, causing thrombosis in small blood vessels. This vascular compromise manifests as livedo reticularis, particularly on the legs, arms, and trunk. The pattern is often described as resembling a fishnet or lace-like appearance and may become more prominent with cold exposure. Livedo reticularis is considered one of the characteristic cutaneous manifestations of APS and can be an early clinical sign of the syndrome.lo
60
long term steroids: what to do RE bone protection?
start ASAP regardless of FRAX/ DEXA (oral alendronate+ ensure calcium+vitD replete)
61
radial tunnel syndrome vs lateral epicondylitis
Radial tunnel syndrome presents similarly to lateral epicondylitis however pain is typically distal to the epicondyle and worse on elbow extension/forearm pronation
62
foods to avoid in gout
Foods to avoid include those high in purines e.g. Liver, kidneys, seafood, oily fish (mackerel, sardines) and yeast products
63
radial tunnel syndrome vs cubital tunnel
Radial tunnel syndrome presents similarly to lateral epicondylitis however pain is typically distal to the epicondyle and worse on elbow extension/forearm pronation
64
axial loading mechanism fall - what specific injury to look for
calcaneal fracture
65
1st line treatment ankylosing spondylitis vs poly myalgia rheumatica
AS= PHYSIO PM= steroids
66
Bechets
multisystem vasculitis --> arthritis iritis recurrent ora and genital ulcers neurological disease --> steroids
67
shoulder dislocation- ant or posterior
95% anterior
68
type of anaemia in RA
normocytic normochromic anamia
69
Colles fracture
FOOSH wrist fracture
70
most common cause sciatica
herniated disk L4/5, L5/S1
71
spondyloisthesis
slipped disc

MSRA (22 decks)

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