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MK > Rheumatology > Flashcards

Rheumatology Flashcards

1
Q

Which Ab has been shown to be a marker for malignancy associated myositis?

A

Anti-p155/140

More severe cutaneous involvement and increased risk of malignancy in DM

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2
Q

Osteomalacia: Aetiology, Presentation, Ix?

A

Impaired bone mineralization of bone

Aetiology:
Vitamin D def
Abnormal metabolism of Vit D e.g. liver disease, Kidney disease - RTA
Poor absorption
Low phosphate levels
Presence of bone mineralization inhibitors e.g. aluminium

Presentation:
Pain
Deformity
Proximal myopathy

Ix:
Ca low
Ph low
ALP high

Tx:
Calcium and Vit D if def
Phopshate wasting conditions - give phosphate
Removal of tumour

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3
Q

where does discoid lupus typically affect?

A

Face and causes scarring

Seldom associated with arthritis

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4
Q

What is subcutaneous lupus erythematosis? Where does it occur? Ab associated with it? Tx?

A

A variant form of SLE

Photosensitive distribution
systemically unwell and arthritis common

Ix:
Ro (SSA) positive
ANA strongly positive
dsDNA -ve

Tx:
Anti-malarials
Does not respond to steroids

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5
Q

What is the most common neuro presentation of Eosinophilic granulomatosis with polyangiitis?

A

Foot drop or wrsit drop

Associated with symptoms pf asthma which precedes the rash.

Dx by skin biopsy showing leucocytoclastic vacultitis
ANA is negative
50% +ve for ANCA

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6
Q 
Polyarteritis nodosa (PAN):
What
Presentation
Histopath
Known associations
A

Necrotising vasculitis affecting small to medium sized arteries.

Presentation:
Myalgia
Livedo reticularis
HT
Abdominal pain- post prandial
Lower limb claudications
Renal failure
MI

Histopath:
polymorphonuclear infiltrate and a homogenous eosinophilic (so called fibrinoid necrosis) appearance to the necrosed vessel walls.

Associated with Hepatitis B. A known pathological link to PAN.

Granulomatous inflammation does not occur.
LUNGS are spared.

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7
Q

List the HLA - B27 associated diseases?

Enthesitis associated areas?

A

Ankylosing spondylitis
Reactive arthritis
Psoriatic arthritis
IBD associated

Enthesitis:
Uveitis
Sacroiliitis
Achilles tendonitis
Aortic regurgitation
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8
Q

What is the leading cause of mortality in scleroderma?

A

Respiratory disease - ILD and PHT

Followed by Cardiac disease

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9
Q

Common complications of RA?

A

Carpel tunnel syndrome - median nerve (sensory loss over palmar aspect of thumb, index, middle and radial surface of ring finger + weakness of wrist flexion)

Tendon rupture

Cervical myelopathy

Vasculitis

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10
Q

C6 radiculopathy. Presentation?

A

Weakness in wrist extension, elbow flexion.

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11
Q

Indications for Tx for OP in post menopausal women.

Recommended Ca intake to prevent fractures?

A

Low trauma fracture
Age > 75 or T score lower than -2.5
Tx with bisphophonate or Denosumab.

Ca 1200 mg/day.
CaCo3 otherwise
Ca citrate if on PPI

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12
Q

Sjogren’s syndrome. Most common presentation?

A

Peripheral neuropathy, sensory most common. Painful peripheral dysaesthesia and Raynaud’s.

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13
Q

MCTD ab associated?

A

Anti-RNP

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14
Q

Polymyositis. Ab associated?

A

Anti-Jo

Anti-jo +ve is the strongest predictor of ILD
- pulmonary disease is the most frequent cause of death

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15
Q

Viral myopathy. Weakness proximal or distal?

A

Proximal

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16
Q

Markers of SLE activity?

A

dsDNA
Low C4, somteimes C3
ESR

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17
Q

OA. Aspirate shows WCC>1000?

A

No, not OA if there is >1000 WC

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18
Q

Paget’s causes inflammatory arthritis?

A

No

19
Q

Psoriasis signs on XR?

A

thickened bony cortex
fluffy periostitis
Pencil in cup deformity

20
Q

Fibromylagia:
Age group
Presentation

A 
Middle aged women
Classic hx:
Widespread pain
Dramatic descriptions
Fatigues +++
Poor sleep
Non refreshing sleep
Emotional distress
Multiple tender points - 18

Normal inflammatory markers

21
Q 
Polymylagia rheumatica:
Age group
Presentation
Ix
Tx
A

Elderly

Presentation:
Marked inflammatory hx, proximal girdle
- early morning stiffness++
- improves after a few hours 
Pain/limited active shoulder movement
Normal passive movement

Ix:
ESR elevated
CRP and CK normal

Tx:
Very responsive to steroids!

22
Q 
Adhesive capsulitis aka Frozen shoulder:
Age group
Presentation
RF
Ix
Tx
A

50-60y

Globally limited active and passive movement

RF:
DM
post traumatic
Protease Inhib

Ix:
XR and US to exclude OA and rotator cuff injury

Tx:
Resolves completely after 18-24 months
corticosteroid injections have limited effectiveness

23
Q

Pain on internal rotation in abduction. Dx?

A

Bursitis

24
Q

Normal passive range of motion but reduced active movements in certain directions (usually pain). Dx?

A

Rotator cuff injury

25
Q

Synovial fluid WCC. Following ranges correspond to:

WCC 50 000

A

WCC 50 000 = septic

26
Q

Excluding vaculitis, what other condition is associated with a +ve ANCA?

A

Glomerulonephritis

27
Q

Causes of Avascular necrosis?

A 
Steroids
Heavy EtOH
SLE, HIV (watch interaction steroid and ritonavor)
Antiphospholipid syndrome
Trauma
Bisphosphonates
28
Q

Temporal arteritis. What age group does it never occur in?

A
29
Q

What is the commonest cause of a Baker’s cyst?

A

OA

Mass in politeal fossa
Bursa behind medial head of gastrocnemius
Directly communicates with knee joint

30
Q

MCD:
Presentation
Ix

A 
Overlap synrome with features of SLE, Scleroderma and RA
Raynaud's common
Oedema
Puffy hands
Arthalgia
Arthritis
Myositis
Fibrosing alveolitis
Pul HT
50% have Sjogren's syndrome
Ix:
ANA+ speckled
U1 RNP +ve
SSA/ro +ve
Leucopenia
thrombocytopenia
ESR elevated
RF +ve 70%
31
Q

If RNP +ve and dsDNA +ve. Dx?

A

SLE

Not MCTD

32
Q

Pt presents with polyartharlgia and fatigue. A negative ANA is most useful in excluding?

A

SLE
Sensitive 99.9%
5% of normal population with have +ve ANA
Increases with age, 10% of pts 70-80y

33
Q

leucocytoclastic vasculitis in post capillary venules with IgA deposition. Dx?

A

HSP

Presents with fever, arthralgia, abdo pain and rash

34
Q

The most common cause of primary hyperuricaemia is?

A

Decreased renal excretion of uric acid, 85-90%
10-15% due to other causes
- inherited defect in ourine synthesis
- ATP metabolism defect
- Increased cell turnover
- overproducers
2/3 of hyperuricaemic patients remain asymptomatic

35
Q

Tx of acute GOUT. If renal impairment, which drug do you avoid?

A

Colchicine and NSAIDs

High dose colchicine no better than low dose colchicine!

36
Q

XR changes in Gout vs. Psoriatic arthritis

A

Gout:
punched out erosions and overhanging edges
Soft tissue swelling an deposition tophi
Joint space narrowing preserved (unless very advanced)

Psoriatic:
Pencil in cup deformity
Ankylosis of joint
Loss of joint space

37
Q

In a pt with GOUT and HT which antihypertensive is most likely going to help control the Gout?

A

Losartan

38
Q

What is febuxostat?

A

Xanthine oxidase inhibitor

39
Q

Which diuretics raise plasma urate?

Which CTx drugs raise plasma urate?

A

Diuretics:
Thiazide
Loop

CTx:
Cylosporin
Tacrolimus

40
Q

Uricosuric drugs that can be used to as hypouricaemic drug therapy.

A

Probenecid, benzbromarone, lesinurad

Losartan, fenofibrate

41
Q

What is the most specific sign of temporal arteritis?

A

Jaw claudication

42
Q 
Pt with all of the following antibodies +ve. Dx?
ANA
dsDNA
RF
Anticardiolipin and lupus anticoagulant
Anti-RNP
SSA and SSB
A

SLE

dsDNA specific

43
Q

What is the best feature for distinguishing ankylosing spondylitis from mechanical back pain?

A

Early morning stiffness

44
Q

+ve antihistone associated with?

A

Drug induced SLE.

Five main drugs are hydralazine, isoniazide, procainamide, penicillinamine and anti-TNFalpha.

MK (28 decks)

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