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FRACP Clinical > Rheumatology > Flashcards

Rheumatology Flashcards

1
Q

What are side effects of methotrexate?

A
  • hepatic toxicity
  • pulmonary fibrosis
  • haematological: low WCC, thrombocytopenia
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2
Q

Side effects of cyclosporin?

A
  • renal impairment

- HTN

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3
Q

What are side effects and precautions when using Biologics?

A
  • infection
  • TB reactivation
  • Allergic reaction
  • no live vaccines
  • CI in active HepB and C
  • increase skin cancer
  • not good in pregnancy
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4
Q

What is the differential for deforming symmetrical arthropathy?

A
  • RA
  • psoriatic arthritis
  • SLE (jaccoud arthropathy)
  • tophaceous gout
  • other seronegative arthropathy
  • very severe OA
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5
Q

What are the XR changes of RA?

A
  • soft tissue swelling
  • symmetrical joint space narrowing
  • marginal joint erosions
  • juxta-articular joint osteoporosis
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6
Q

Investigations for RA?

A
  • RF, anti-CCP
  • ESR/CRP
  • Hb re: anaemia chronic disease
  • XR
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7
Q

Management of RA?

A 
Non pharm: Physio, splints, OT
Pharm:
- NSAID
- DMARD: MTX, leflunomide, hydroxychloroquine, cyclo, azathio
- Biologics: TNF, non TNF
Surgical: joint replacement
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8
Q

What is on the SLE criteria list?

A 
MD SOAP BRAIN
Malar rash
Discoid rash
Serositis
Oral ulcers
Arthritis
Photosensitive rash
Blood abnormal: haemolytic anaem, leukopenia
Renal disorder: proteinuria, GN
ANA
Immunologic disorder: dsDNA, anti-Sm, antiphospholipid 
Neuro disorder: psychosis or seizure

4 or more = dx of SLE

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9
Q

Causes of drug induced lupus?

A
  • hydralazine
  • procainamide
  • isoniazid
  • phenytoin
  • methyldopa

Drug induced SLE: anti histone Ab

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10
Q

What are the investigations for SLE?

A
  • ANA, dsDNA, anti-Sm, anti-ro (congenital CHBlock)
  • anti U1RNP if MCTD suspected rather than pure SLE
  • ESR, C3/C4, CH50
  • FBC: hb, low WCC, low play
  • UA: proteinuria, blood
  • renal biopsy
  • APS: anti cardiolipin, B2 glycoprotein, lupus anticoagulant
  • MRI and LP if CNS lupus
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11
Q

Treatment of SLE?

A
  • NSAID
  • hydroxychloroquine: monitor eyes
  • Ca blockers for raynaud
  • pred for active disease
  • anti coagulation if thrombosis/APS
  • OP prevention (pred)
  • AZA, cyclophosphamide, or MTX
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12
Q

What are features of Wegeners and Ix?

A
  • lung and kidney involvement
  • SOB, cough/haemoptysis, nasal congestion
  • crackles throughout lungs
  • c-ANCA
  • urine: casts, dysmorphic red cells
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13
Q

What are features and Ix for Churg-Strauss?

A

Churg “Struassthma-panca”

  • asthma, allergic rhinitis, eczema, peripheral neuropathy
  • p-ANCA
  • biopsy
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14
Q

What investigations for scleroderma?

A
  • ESR
  • folate, B12 - malabsorption
  • anti centromere (CREST)
  • anti scl70 (diffuse scleroderma)
  • gastroscopy, esophageal manometry
  • ILD: PFT, hrCT, 6min walk test
  • TTE: pulm HTN
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15
Q

What is the treatment for scleroderma?

A
  • avoid smoking
  • PPI
  • Ca blocker for Raynaud
  • Abx for gut bacterial overgrowth
  • PAH Rx: endothelin receptor antagonists, PDE inhibitors
  • pred for pericarditis or early ILD
  • cyclophosphamide for ILD
  • ACEi for renal protection
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16
Q

Clinical features of Dermatomyositis?

A
  • Grottron papules
  • shawl sign
  • heliotrope rash
  • arthritis
  • proximal weakness
17
Q

What is MTCD?

A

Overlap features of SLE, scleroderma, polymyositis

18
Q

Extra articular manifestations of ank spond?

A 
6 A's:
Atlanto-axial subluxation
Anterior uveitis
Apical lung fibrosis
Aortic regurgitation
Amyloidosis (kidneys)
Autoimmune bowel disease (UC)
(Arthritis)
19
Q

What antibodies for Dermatomyositis/polymyositis?

A

Anti jo1
Anti mi2
Anti U1RNP
Anti synthetase

20
Q

1) Pattern of weakness in Dermatomyositis and polymyositis?

2) Pattern in inclusion body myosotis?

A

1) proximal

2) proximal and distal

21
Q

What are the hand XR features of gout?

A
  • tophi
  • punched out erosions
  • intraosseous lytic lesions
22
Q

What are XR hand features of psoriatic arthritis?

A
  • pencil in cup deformity

- distal erosive change with bone proliferation

23
Q

What are extra articular features of RA?

A
  • Raynaud
  • dry eyes, scleritis
  • neck pain: C1-2 subluxation
  • pulmonary fibrosis
  • pericarditis, IHD
  • peripheral neuropathy
  • anaemia
  • Vasculitis: ulcers, mononeuritis multiplex
24
Q

What is Felty Syndrome?

A

RA + neutropenia + splenomegaly

25
Q

What are the main causes of death in SLE?

A
  • infection
  • renal failure
  • lymphoma
  • MI
26
Q

What to test for for anti phospholipid syndrome?

A
  • anti cardiolipin
  • lupus anticoagulant
  • b2 glycoprotein
27
Q

How to diagnose anti phospholipid syndrome?

A

Clinical: > 1 VTE or recurrent miscarriage or low platelets
Lab: antiphospholipid antibodies

FRACP Clinical (11 decks)

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