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MSRA > Rheumatology > Flashcards

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

Hypocalcaemia is a relatively common complication of chronic kidney disease. It is caused by the kidneys being unable to activate vitamin D and excrete phosphate, meaning calcium is ‘used up’ in calcium phosphate. This low level of calcium causes secondary hyperparathyroidism, where there is an increase in parathyroid hormone (PTH) in order to try and raise calcium levels. It does this by stimulating osteoclast activity to release more calcium, and this activity causes a rise in ALP found in bone. Therefore, the overall blood results expected are raised phosphate (due to an inability to excrete it), raised PTH (due to a reaction to hypocalcaemia) and raised ALP (due to the action of PTH).

Low serum calcium, raised serum phosphate, raised ALP and raised PTH - chronic kidney disease leading to secondary hyperparathyroidism

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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

24
Q

Anti-Ro/ anti-La=

A

Sjogrens

25
Q

how long chronic fatigue to be diagnosed (how Long Sx present for)

A

3 months

26
Q

keratoderma blennorrhagicum on the soles of his feet - a waxy yellow rash pathognomonic for

A

reactive arthritis

27
Q

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

A

Pubic symphysis dysfunction

28
Q

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

A

Transient idiopathic osteoporosis

29
Q

osteoporosis and pain

A

pain is not worse when you press it!!

30
Q

most common side effect on colchicine

A

diarrhoea

31
Q

Rheumatoid arthritis: drug side effects

A

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
Q

what to do with allurinol in gout acute

A

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
Q

aspirin and which anti rheumatic drug

A

Patients who are allergic to aspirin may also react to sulfasalazine

33
Q

MHA and MCA - which takes precedent?

A

MHA always overrides MCA

34
Q

when can a patient get a bisphosphate holiday in RA?

A

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
Q

antiphospholipid bloods

A

raised APTT and normal PT and can result in thrombocytopenia.

36
Q

roughened red papules over the extensor surfaces and are seen in dermatomyositis

A

grottrons papules

37
Q

trigeminal neuralgia vs temporal arteritis

A

jaw caludication = temporal artertitis

38
Q

polymalgia rheumatic and no response to steroids after 3 weeks..

A

typically respond dramatically to steroids, failure to do so should prompt consideration of an alternative diagnosis

39
Q

Azathioprine monitoring needed

A

FBC, LF T

FBC, LFT before treatment
FBC weekly for the first 4 weeks
FBC, LFT every 3 months

40
Q

methotrexate monitoring

A

FBC, LFT, U&E

41
Q

ACEi monitoring

A

U&E prior to treatment
U&E after increasing dose
U&E at least annually

42
Q

amiodarone monitoring

A

TFT, LFT, U&E, CXR prior to treatment
TFT, LFT every 6 months

43
Q

Statin montiroign

A

LFTs at baseline, 3 months and 12 months

44
Q

which endocrine drug needs montiroign

A

glitazones - LFT

45
Q

lithium monitoring

A

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
Q

sodium valproate monitoring

A

LFT, FBC before treatment
LFT ‘periodically’ during first 6 months

47
Q

methotrexate side effeccts

A

Myelosuppression
Liver cirrhosis
Pneumonitis

48
Q

sulfalazine SE

A

Rashes
Oligospermia
Heinz body anaemia
Interstitial lung disease

49
Q

T score and bone protection

A

T score Management
Greater than 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
Q

entanercept SE

A

Demyelination
Reactivation of tuberculosis

51
Q

x Hydroxychloroquine what to warn people about

A

EYEs

52
Q

CREST Sx

A

CREST syndrome is a subtype of limited systemic sclerosis and includes: calcinosis, Raynaud’s phenomenon, oesophageal dysmotility, sclerodactyly, telangiectasia

53
Q

HLA-B27

A

AS

54
Q

Psoriatic arthritis

A

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
Q

polymayalgia rheumatic how quick to follow up

A

after 1 week of steroids to check response

56
Q

Heberdens vs Bouchards

A

Heberden’s nodes - swelling of the distal interphalangeal joints.
Bouchard’s nodes - swelling of proximal interphalangeal joints

MSRA (17 decks)

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