Brainscape's Knowledge GenomeTM

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


See full index

1 - MSRA > Rheumatology > Flashcards

Rheumatology Flashcards

1
Q

Common features of ANCA associated vasculitis

A
  • Renal impairment
  • Resp symptoms - dyspnoea, haemoptysis
  • Systemic symptoms - fatigue, weight loss, fever
  • Vasculitic rash
  • Sinusitis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

cANCA associated with

A

Granulomatosis with polyangiitis

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

pANCA associated with

A

Churg-Strauss
UC
Primary sclerosing cholangitis
Anti-GBM disease
Crohn’s

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

Role of ANCA monitoring

A

Some correlation between cANCA levels and disease activity, not for pANCA

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

Gene associated with ankylosing spondylitis

A

HLA B27

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

Symptoms ankylosing spondylitis

A

Insidious onset low back pain and stiffness
Stiffness worse in morning, improves with exercise

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

Examination features ankylosing spondylitis

A

Reduced lateral flexion
Reduced forward flexion
Reduced chest expansion

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

What is Schober’s test

A

Line drawn 10cm above and 5cm below back dimples. Distance between the two lines should increase by more than 5cm when patient bends as far forward as possible

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

Conditions associated with ankylosing spondylitis

A
  • Apical fibrosis
  • Anterior uveitis
  • Aortic regurgitation
  • Achilles tendonitis
  • AV node block
  • Amyloidosis
  • Cauda equina syndrome
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

XR findings ankylosing spondylitis

A
  • Sacroilitis - subchondral erosions, sclerosis
  • Squaring of lumbar vertebrae
  • Bamboo spine
  • Syndesmophytes

Apical fibrosis on CXR

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

Spirometry ankylosing spondylitis

A

Restrictive defect (pulmonary fibrosis, kyphosis, ankylosis of costovertebral joints)

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

Management ankylosing spondylitis

A

NSAIDs first line
DMARD

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

Causes of antiphospholipid syndrome

A

Primary disorder
SLE
Lymphoproliferative disorders
Phenothiazines

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

Features antiphospholipid syndrome

A
  • Venous/arterial thrombosis
  • Recurrent miscarriage
  • Livedo reticularis
  • Pre-eclampsia
  • Pulmonary hypertension
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Investigation findings antiphospholipid syndrome

A

Positive antibodies
Thrombocytopenia
Prolonged APTT

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

What antibodies in antiphospholipid syndrome

A

Anticardiolipin antibodies
Anti-beta2GPI antidbodies
Lupus anticoagulant

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

Why prolonged APTT in antiphospholipid syndrome

A

Due to ex-vivo reaction of lupus anticoagulant autoantibodies with phospholipids in the coagulation cascade

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

Management antiphospholipid syndrome

A

Primary thromboprophylaxis - low dose aspirin
Secondary thromboprophylaxis - for first A/VTE, warfarin with target 2-3. If recurrent, consider + low dose aspirin, target 3-4

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

Adverse effects azathioprine

A

Bone marrow depression
Nausea/vomiting
Pancreatitis
Increased risk non-melanoma skin cncer

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

Gene association Behcet’s

A

HLA B51

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

Classic features Behcet’s syndrome

A

Oral ulcers
Genital ulcers
Anterior uveitis

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

Other features Behcet’s syndrome

A

Thrombophlebitis
DVT
Arthritis
Neurological involvement e.g. aseptic meningitis
Abdominal pain, diarrhoea, colitis
Erythema nodosum

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

What is positive pathergy test Behcets

A

Puncture site following needle prick becomes inflamed with small pustule

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

Uses of bisphosphonates

A

Prevention and treatment of osteporosis
Hypercalcaemia
Paget’s disease
Pain from bone mets

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

Adverse effects bisphosphonates

A

Oesophageal reactions - oesophagitis, oesophageal ulcers
Osteonecrosis of the jaw
Increased risk of atypical stress fractures of the proximal femoral shaft
Acute phase response (fever, myalgia, arthralgia) following administration
Hypocalcaemia

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

How to take bisphosphonates

A

Swallow whole with water while sitting or standing, empty stomach 30 mins before breakfast (or other oral meds), sit or stand upright for at least 30 mins after taking

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

Lab findings osteoporosis

A

Normal calcium, phosphate, ALP and PTH

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

Lab findings osteomalacia

A

Low calcium and phosphate
High ALP and PTH

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

Lab findings primary hyperparathyroidism

A

High calcium
Low phosphate
High ALP
High PTH

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

Lab findings chronic kidney disease (→ chronic hyperparathyroidism)

A

Low calcium
Increased phosphate
Increased ALP
Increased PTH

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

Lab findings Paget’s disease

A

Normal calcium and phosphate
Increased ALP
Normal PTH

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

Lab findings osteopetrosis

A

Normal

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

X-ray findings osteosarcoma

A

Codman triangle from periosteal elevation
Sunburst pattern

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

Risk factors osteosarcoma

A

Mutation of Rb gene
Paget’s disease of bone
Radiotherapy

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

X-ray findings Ewing’s sarcoma

A

‘Onion skin’ appearance

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

Most common site osteoma

A

Skull

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

Most common site giant cell tumour

A

Epiphyses long bones

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

Most common site osteosarcoma

A

Metaphyseal region long bones (prior to epiphyseal closure) - femur, tibia, humerus

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

Most common site Ewing’s sarcoma

A

Pelvis and long bones

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

Most common side chondrosarcoma

A

Axial skeleton

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

Causes dactylitis

A

Spondyloarthritis, e.g. psoriatic and reactive arthritis
Sickle cell disease
TB
Sarcoidosis
Syphilis

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

What is dermatomyositis

A

Inflammatory disorder causing symmetrical, proximal muscle weakness and skin lesions

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

Cause dermatomyositis

A

Idiopathic
Connective tissue disorders
Malignancy - ovarian, breast, lung - 20-25% of cases

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

What is polymyositis

A

Variant of dermatomyositis where skin manifestations are not prominent

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

Skin features dermatomyositis

A

Photosensitivity
Macular rash over back and shoulder
Heliotrope rash in periorbital region
Gottron’s papules
Mechanics hands
Nail fold capillary dilatation

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

What are Gottron’s papules

A

Roughened red papules over extensor surfaces of fingers

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

What is mechanics hands

A

Extremely dry and scaly hands with linear cracks on palmar and lateral aspects of fingers

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

Non-skin features of dermatomyositis

A

Proximal muscle weakness +/- tenderness
Raynaud’s
Respiratory muscle weakness
Interstitial lung disease, e.g. fibrosing alveolitis or organising pneumonia
Dysphagia, dysphonia

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

Investigation findings dermatomyositis

A

80% ANA positive
30% anti-synthetase antibodies, inc anti-Jo1, anti-STP, anti-Mi-2

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

Drug induced lupus vs SLE

A

In drug induced, renal and nervous system involvement unusual
Usually resolves on stopping drug

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

Features drug induced lupus

A

Arthralgia
Myalgia
Malar rash
Pleurisy

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

Antibodies drug induced lupus

A

ANA positive in 100%, dsDNA negative
Anti-histone in 80-90%
Anti-Ro/anti-Smith in 5%

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

Most common causes drug induced lupus

A

Procainamide
Hydralazine

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

Less common cause drug induced lupus

A

Isoniazid
Minocycline
Phenytoin

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

Inheritence Ehler-Danlos syndrome

A

AD

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

Features Ehler-Danlos syndrome

A

Elastic, fragile skin
Joint hypermobility, recurrent joint dislocation
Easy bruising
Cardiac lesions
Subarachnoid haemorrhage
Angioid retinal streaks

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

Cardiac lesions Ehler-Danlos syndrome

A

Aortic regurgitation
Mitral valve prolapse
Aortic dissection

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

Drugs causing 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
59
Q

Most common site gout

A

1st metatarsophalangeal joint

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

Uric acid suggestive of gout

A

≥360umol/L

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

Synovial fluid analysis in gout

A

Needle shaped negatively bifringent monosodium urate crystals under polarised light

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

Radiological features gout

A

Joint effusion
Well defined punched out erosions with sclerotic margins in juxta-articular distribution, often with overhanging edges
Relative preservation of joint space until late disease
Eccentric erosions
Soft tissue tophi

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

Acute management gout

A

NSAIDs and colchicine first line
Oral steroids if contraindicated

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

Limitations colchicine

A
  • Slower onset of action
  • Causes diarrhoea
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
65
Q

Colchicine in renal impairment

A

Can be used with caution
Reduce dose if 10-50, avoid if <10

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

Urate lowering therapy in gout

A

Allopurinol first line
Febuxostat second line

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

Dose of allopurinol

A

Initial dose 100mg OD, titrated to aim for serum uric acid <360

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

When to aim for uric acid <300 in gout

A

Patients with tophi, chronic gouty arthritis, ongoing frequent flares despite uric acid <360umol/L

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

Best antihypertensive in gout

A

Losartan (uricosuric action)

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

Referred lumbar spine pain cause and location

A

Femoral nerve compression cause referred pain in hip

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
71
Q

Referred lumbar spine pain features

A

Femoral nerve stretch test positive (lie patient prone, extend hip joint with straight leg then bend knee)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
72
Q

Cause of greater trochanteric pain syndrome

A

Due to repeated movement of fibroelastic iliotibila band

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
73
Q

Features of greater trochaneteric pain syndrome

A

Pain and tenderness over lateral side of thigh

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
74
Q

Cause meralgia paresthetica

A

Compression of lateral cutaneous nerve of thigh

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
75
Q

Features meralgia paresthetica

A

Burning sensation over antero-lateral aspect of thigh

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
76
Q

Risk factors avascular necrosis

A

High dose steroid therapy
Previous hip fracture or dislocation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
77
Q

Cause pubic symphysis dysfunction

A

Ligament laxity increases in response to hormonal changes of pregnancy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
78
Q

Features pubic symphysis dysfunction

A

Pain over the pubic symphysis with radiation to groin and medial aspect of thigh
Waddling gait

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
79
Q

Transient idiopathic osteoporosis features

A

Uncommon condition seen in third trimester of pregnancy

  • Groin pain associated with limited range of movement in the hip
  • May be unable to weight bear
  • ESR may be elevated
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
80
Q

Conditions associated with HLA-A3

A

Haemochromatosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
81
Q

Conditions associated with HLA-B51

A

Behcet’s disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
82
Q

Conditions associated with HLA-B27

A

Ankylosing spondylitis
Reactive arthritis
Acute anterior uveitis
Psoriatic arthritis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
83
Q

Conditions associated with HLA-DQ2/8

A

Coeliac

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
84
Q

Conditions associated with HLA-DR2

A

Narcolepsy
Goodpastures

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
85
Q

Conditions associated with HLA-DR3

A

Dermatitis herpetiformis
Sjorgens syndrome
Primary biliary cirrhosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
86
Q

Conditions associated with HLA-DR4

A

T1DM
RA

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
87
Q

Adverse effects hydroxychloroquine

A

Bull’s eye retinopathy - severe and permanent visual loss

88
Q

Hydroxychloroquine pregnancy

A

Can be used

89
Q

Mechanism type I hypersensitivity reaction

A

Antigen reacts with IgE bound to mast cells

90
Q

What reactions are type I allergic reactions

A
  • Anaphylaxis
  • Atopy (asthma, eczema, hayfever)
91
Q

Mechanism type II hypersensitivity reaction

A

IgG or IgM binds to antigen on cell surface

92
Q

What conditions involve type II hypersensitivity reactions

A
  • Autoimmune haemolytic anaemia
  • ITP
  • Goodpasture’s syndrome
  • Pernicious anaemia
  • Acute haemolytic transfusion reactions
  • Rheumatic fever
  • Pemphigus vularis/bullous pemphigoid
93
Q

Mechanism type III hypersensitivity reactions

A

Free antigen and antibody (IgG, IgA) combine

94
Q

What conditions involve type III hypersensitivity reactions

A
  • Serum sicknes
  • SLE
  • Post streptococcal glomerulonephritis
  • Extrinsic allergic alveolitis
95
Q

Mechanism type IV hypersensitivity reactions

A

T-cell mediated

96
Q

What conditions involve type IV hypersensitivity reactions

A
  • Tuberculosis (and tuberculin skin reaction)
  • Graft versus host disease
  • Allergic contact dermatitis
  • Scabies
  • Extrinsic allergic alveolitis
  • MS
  • GBS
97
Q

Mechanism type V hypersensitivity reactions

A

Antibodies that recognise and bind to cell surface receptor, either stimulating them or blocking ligand binding

98
Q

What conditions involve type V hypersensitivity reaction

A

Graves disease
Myasthenia gravis

99
Q

Features lateral epicondylitis

A
  • Pain and tenderness localised to lateral epicondyle
  • Pain worse on wrist extension against resistance with elbow extended, or supination of forearm with elbow extended
100
Q

Inheritance pattern Marfans

101
Q

Features Marfans syndrome

A
  • Tall stature
  • High arched palate
  • Arachnodactyly
  • Pectus excavatum
  • Pes planus
  • Scoliosis of >20 degrees
  • Heart lesions
  • Repeated pneumothoraces
  • Eye lesions
  • Dural ectasia
102
Q

Marfans syndrome heart lesions

A
  • Dilation of aortic sinuses (90%) → aortic aneurysm, aortic dissection, aortic regurgitation
  • Mitral valve prolapse (75%)
103
Q

Marfans syndrome eye lesions

A
  • Upwards lens dislocation
  • Blue sclera
  • Myopia
104
Q

Adverse effects methotrexate

A
  • Mucositis
  • Myelosuppression
  • Pneumonitis
  • Pulmonary fibrosis
  • Liver fibrosis
105
Q

Features methotrexate induce pneumonitis

A

Typically within year of starting treatment, acute or subacute
- Non productive cough
- Dyspnoea
- Malaise
- Fever

106
Q

Pregnancy methotrexate

A

Avoid pregnancy for 6 months after treatment (including men)

107
Q

Co-prescribe with methotrexate?

A

Folic acid 5mg weekly, taken more than 24hours after methotrexate

108
Q

Interactions methotrexate

A

Trimethoprim/co-trim (increased risk of marrow aplasia)
High dose aspirin (increased risk of methotrexate toxicity)

109
Q

Treatment methotrexate toxicity

A

Folinic acid

110
Q

Features of myopathies

A
  • Symmetrical muscle weakness, proximal > distal
  • Common problems rising from chair, getting out of bath
  • Sensation normal, reflexes normal, no fasciculation
111
Q

Causes myopathies

A

Inflammatory - polymyositis
Inherited - Duchennes/Beckers muscular dystrophy, myotonic dystrophy
Endocrine - Cushing’s, thyrotoxicosis
Alcohol

112
Q

When osteoarthritis can be diagnosed clinically w/ no investigations

A

Patient >45 years
Exercise related pain
No morning stiffness, or morning stiffness lasting <30 mins

113
Q

First line treatment osteoarthritis

A

Topical NSAIDs

114
Q

Second line treatment osteoarthritis

A

Oral NSAIDs

115
Q

Role of paracetamol or weak opioids osteoarthritis

A

Do not offer unless infrequently for short term pain relief, or other options contraindicated/not tolerated/ineffective

116
Q

Options of NSAIDs ineffective osteoarthritis

A

Intra-articular steroid infection
Joint replacement

117
Q

X-ray changes osteoarthritis

A

Loss of joint space
Osteophytes forming at joint margins
Subchondral sclerosis
Subchondral cysts

118
Q

Inheritance osteogenesis imperfecta

A

Autosomal dominant

119
Q

Features osteogenesis imperfecta

A

Presents in childhood
Fractures after minor trauma
Blue sclera
Deafness secondary to otosclerosis
Dental imperfections

120
Q

What is osteomalacia

A

Softening of bones secondary to low vitamin D levels leading to decreased bone mineral content

121
Q

Osteomalacia vs rickets

A

Osteomalacia in adults, rickets in children

122
Q

Causes osteomalacia

A
  • Vitamin D deficiency - malabsorption, lack of sunlight, diet
  • CKD
  • Drug induced
  • Inherited
  • Liver disease, e.g. cirrhosis
  • Coeliac disease
123
Q

Drugs causing osteomalacia

A

Anticonvulsants

124
Q

Features osteomalacia

A

Bone pain
Bone/muscle tenderness
Fractures, esp femoral neck
Proximal myopathy

125
Q

Blood findings osteomalacia

A

Low vit D
Low calcium and phosphate
Raised ALP

126
Q

X-ray findings osteomalacia

A

Translucent bands

127
Q

Main risk factors osteoporosis

A
  • History of glucocorticoid use
  • Rheumatoid arthritis
  • Alcohol excess
  • History of parental hip fracture
  • Low BMI
  • current smoking
128
Q

Medications worsening osteoporosis

A
  • Glucocorticoids
  • SSRIs
  • Antiepileptics
  • PPIs
  • Glitazones
  • Long term heparin therapy
  • Aromatase inhibitors, e.g. anastrozolee
129
Q

First line osteoporosis treatment

A

Bisphosphonates - alendronate, risedronate

130
Q

Second line osteoporosis treatment

131
Q

Other treatment options osteoporosis

A

Strontium ranelate
Raloxifene
Teriparatide
Tomosozumab

132
Q

What is Paget’s disease of bone

A

Disease of increased but uncontrolled bone turnover

133
Q

Paget’s disease features

A

Only 5% symptomatic

  • Bone pain - pelvis, lumbar spine femur
  • Bowing of tibia
  • Bossing of skull
134
Q

X-rays Paget’s disease

A

Osteolysis in early disease → mixed lytic/sclerotic lesions later
Skull - thickened vault, osteoporosis circumscripta

135
Q

Bloods Paget’s disease of bone

A

Isolated rise ALP

136
Q

Bone scintigraphy Paget’s disease of bone

A

Increased uptake focally at sites of active bone lesions

137
Q

Complications Paget’s disease of bone

A
  • Deafness (CN entrapment)
  • Bone sarcoma
  • Fractures
  • Skull thickening
  • High output cardiac failure
138
Q

What is polyarteritis nodosa

A

Vasculitis affecting medium-sized arteries with necrotising inflammation leading to aneurysm formation

139
Q

Infection associated with polyarteritis nodosa

140
Q

Features polyarteritis nodosa

A
  • Fever, malaise, arthralgia
  • Weight loss
  • Hypertension
  • Mononeuritis multiplex, sensorimotor polyneuropathy
  • Testicular pain
  • Livedo reticularis
  • Haematuria, renal failure
141
Q

Antibody associated with polyarteritis nodosa

A

pANCA (20%)

142
Q

Features polymyalgia rheumatica

A

Typically >60 years
Usually rapid onset (<1 month)
Aching, morning stiffness in proximal limb muscles
Mild polyarthralgia
Lethargy
Depression
Low grade fever
Anorexia
Night sweats

Not weakness

143
Q

Treatment PMR

144
Q

What is pseudogout

A

Form of microcrystal synovitis caused by the deposition of calcium pyrophosphate dihydrate crystals in the synovium

145
Q

Risk factors pseudogout

A
  • Increasing age
  • Haemochromatosis
  • Hyperparathyroidism, low phosphate
  • Acromegaly, Wilson’s disease
146
Q

Most common sites pseudogout

A

Knee, wrist, and shoulders

147
Q

Joint aspiration pseudogout

A

Weakly positively birefringent rhomboid-shaped crystals

148
Q

What is Raynaud’s phenomenon

A

Exaggerated vasoconstrictive response of the digital arteries and cutaneous arteriole to the cold or emotional stress

149
Q

Raynaud’s phenomenon vs Raynaud’s disease

A

Raynaud’s disease is primary, Raynaud’s phenomenon is secondary

150
Q

Secondary causes of Raynaud’s phenomenon

A
  • Connective tissue disorders, e.g. scleroderma, RA, SLE
  • Leukaemia
  • Type I cryoglobulinaemia, cold agglutinins
  • Use of vibrating tools
  • Drugs
  • Cervical rib
151
Q

Drugs causing Raynaud’s

152
Q

Factors suggesting underlying connective tissue disease in Raynaud’s

A
  • Onset after 40 years
  • Unilateral symptoms
  • Rashes
  • Presence of autoantibodies
  • Digital ulcers or calcinosis
153
Q

Management Raynaud’s

A

All patients should be referred to secondary care

First line - CCBs, nifedipine
Second line - IV prostacyclin infusions

154
Q

Genetic association reactive arthritis

155
Q

Features reactive arthritis

A
  • Urethritis
  • Conjunctivitis, anterior uveitis
  • Arthritis
  • Dactylitis
156
Q

Categories of reactive arthritis

A

Post-dysenteric form
Post-STI form

157
Q

Organisms causing post-dysenteric reactive arthritis

A

Shigella flexneri
Salmonella typhi and enteritidis
Yersina enterocolitica
Campylobacter

158
Q

Organisms causing post-STI reactive arthritis

A

Chlamydia trachomatis

159
Q

Management reactive arthritis

A

Analgesia
NSAIDs
Intra-articular steroids
Sulfasalazine and methotrexate sometimes used for persistent disease

160
Q

Pattern of arthritis in reactive arthritis

A

Typically asymmetrical oligoarthritis of lower limb

161
Q

Skin manifestations reactive arthritis

A

Circinate balanitis
Keratoderma blenorrhagica

162
Q

What is circinate balanitis

A

Painless vesicles on coronal margin of prepuce

163
Q

What is keratoderma blenorrhagica

A

Waxy yellow/brown papules on palms and soles

164
Q

Methotrexate side effects

A

Myelosuppression
Liver cirrhosis
Pneumonitis

165
Q

Sulfasalazine side effects

A

Rashes
Oligospermia
Heinz body anaemia
Interstitial lung diseas

166
Q

Side effects leflunamide

A

Liver impairment
Interstitial lung disease
Hypertension

167
Q

Side effects leflunomide

A

Liver impairment
Interstitial lung disease
Hypertension

168
Q

Side effects hydroxycholoroquine

A

Retinopathy
Corneal deposits

169
Q

Side effects prednisolone

A

Cushingoid features
Osteoporosis
Impaired glucose tolerance
Hypertension
Cataracts

170
Q

Side effects gold

A

Proteinuria

171
Q

Side effects penicillamine

A

Proteinuria
Exacerbation of myasthenia gravis

172
Q

Side effects etanercept

A

Demyelination
Reactivation of TB

173
Q

Side effects of infliximab

A

Reactivation of TB

174
Q

Side effects adalimumab

A

Reactivation of TB

175
Q

Side effects rituximab

A

Infusion reaction common

176
Q

Antibodies associated with rheumatoid arthritis

A

Rheumatoid arthritis
Anti-CCP

177
Q

What other conditions are associated with positive RF

A

Felty’s syndrome
Sjorgens syndrome
Infective endocarditis
SLE
Systemic sclerosis
General population (5%)

178
Q

Role of CCP in RA diagnosis

A

May be detected 10 years before development, allows for early detection of patients suitable for aggressive anti-TNF therapy

Recommended in suspected RA with neg RF

179
Q

First line treatment RA

A

DMARD monotherapy +/- short course of bridging prednisolone

180
Q

Choices for initial DMARD RA

A

Methotrexate (most widely used)
Sulfasalazine
Leflunomide
Hydroxychloroquine (only if mild or palindromic)

181
Q

Disease monitoring RA

A

Combination of CRP and disease activity

182
Q

Management of flares of RA

A

Corticosteroids - oral and IM

183
Q

Indication for TNF-inhibitor in RA

A

Inadequate response to at least 2 DMARDs including methotrexate

184
Q

Poor prognostic features RA

A

RF positive
Anti-CCP antibodies
Poor functional status at presentation
Early erosions on x-ray (<2 years)
Extra articular features, e.g. nodules
HLA DR4
Insidious onset

185
Q

X-ray findings RA

A

Loss of joint space
Juxta-articular osteoporosis
Soft tissue swelling
Periarticular erosions
Subluxation

186
Q

Most common organism septic arthritis

A

Staphylococcus aureus

187
Q

Most common organism septic arthritis in young people

A

Neisseria gonorrhoeae

188
Q

Most common location septic arthritis adults

189
Q

Synovial fluid findings septic arthritis

A

Leucocytosis with neutrophil predominance
Gram stain neg in 30-50% cases

190
Q

Treatment septic arthritis

A

IV fluclox (clinda if allergic)
4-6 week treatment, typically switched to oral at 2 weeks

Needle aspiration to decompress joint
Arthroscopic lavage may be required

191
Q

Features Sjorgen’s syndrome

A

Dry eyes
Dry mouth
Vaginal dryness
Arthralgia
Raynaud’s, myalgia
Sensory polyneuropathy
Recurrent parotidis
Renal tubular acidosis

192
Q

Antibodies in Sjorgen’s syndrome

A

RF - 50%
ANA - 70%
Anti-Ro - 70%
Anti-La - 30%

193
Q

Management Sjorgens syndrome

A

Artificial saliva and tears
Pilocarpine (stimualte saliva production)

194
Q

Cautions sulfasalazine

A

G6PD deficiency
Allergy to aspirin or sulphonamides (cross sensitivity)

195
Q

Adverse effects sulfasalazine

A
  • Oligospermia
  • Stevens-Johnson syndrome
  • Pneumonitis/lung fibrosis
  • Myelosuppression, Heinz body anaemia, megaloblastic anaemia
  • May colour tears
195
Q

SLE skin features

A

Malar rash - spare nasolabial folds
Discoid rash - scaly, erythematous, well demarcated rash in sun exposed areas, may progress to become pigmented and hyperkeratotic before becoming atrophic
Photosensitivity
Raynaud’s phenomenon
Livedo reticularis
Non-scarring alopecia

196
Q

Sulfasalazine in pregnancy/breastfeeding

A

Safe to use

197
Q

SLE MSK features

A

Arthralgia
Non-erosive arthritis

198
Q

Cardiovascular features SLE

A

Pericarditis, myocarditis

199
Q

Respiratory features SLE

A

Pleurisy
Fibrosing alveolitis

200
Q

Renal features SLE

A

Proteinuria
Glomerulonephritis

201
Q

Neuropsychiatric features SLE

A

Anxiety and depression
Psychosis
Seizures

202
Q

SLE antibodies

A

ANA - 99%
RF - 20%
Anti-dsDNA and anti-Smith - high specificity, low sensitivity

203
Q

Patterns of disease systemic sclerosis

A

Limited cutaneous systemic sclerosis
Diffuse cutaneous systemic sclerosis
Scleroderma (without organ involvement)

204
Q

Features limited cutaneous systemic sclerosis

A

Raynaud’s (may be first sign)
Scleroderma affecting face and distal limbs

205
Q

Antibodies associated with limited cutaneous systemic sclerosis

A

Anti-centromere

206
Q

Subtype limited cutaneous systemic sclerosis

A

CREST syndrome

207
Q

Features CREST syndrome

A

Calcinosis
Raynaud’s phenomenon
Oesophageal dysmotility
Sclerodactlyl
Telangiectasia

208
Q

Features diffuse cutaneous systemic sclerosis

A

Scleroderma affects trunk and proximal limbs
Respiratory involvement - interstitial lung disease, pulmonary arterial hypertension
Renal disease and hypertension

209
Q

Antibodies associated with diffuse cutaneous systemic sclerosis

A

Anti scl-70

210
Q

Treatment renal disease diffuse cutaneous systemic sclerosis

A

ACE inhibitor - captopril typically used

211
Q

Features scleroderma

A

Tightening and fibrosis of skin
Plaques or linear

212
Q

Antibodies associated with systemic sclerosis

A

ANA positive 90%
RF positive 30%

213
Q

Visual features temporal arteritis

A

Anterior ischaemic optic neuropathy (most common)
Diplopia

214
Q

Treatment temporal arteritis

A
  • Urgent high dose glucocorticoids as soon as diagnosis suspected
  • Urgent opthal review
215
Q

Steroid choice temporal arteritis

A

If no visual loss, high dose pred used
If evolving visual loss, IV methylpred

216
Q

Who needs vit D supplementation

A

All pregnant and breastfeeding women
All children aged 6 months - 5 years unless formula fed >500ml/day
Adults >65y
Housebound patients

1 - MSRA (23 decks)

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