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Year 4 Overview/Random tests > Rheumatology > Flashcards

Rheumatology Flashcards

1
Q

What are the four main connective tissue diseases?

A

Scleroderma
SLE
Polymyositis/dermatomyositis
Polymyalgia rheumatics

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2
Q

Risk factors for RA? (Order of importance)

A 
Female gender - premenopause (after: same)
20-40 yrs?
Family history
HLA-DR4/HLA-DR1
Smoking, infection, diet and hormonal
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3
Q

Clinical features of RA?

A 
Stiff in morning (>1 hour)
Symmetrical joint pain
Swollen joints
Small joints of hand, feet and wirst
Speed of onset: quick
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4
Q

Specific hand signs in RA?

A 
Earlier: 
Swollen MCPs/PIPS/MTPs
Later:
Boutonniere deformity
Swan neck deformity
Ulnar deformity
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5
Q

Extra-articular features of RA?

A 
Scleritis
Dry eyes
Lymphadenopathy
Anaemia
Rheum nodules
Osteoporosis
Vasculitic skin rash
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6
Q

Extra-articular pulmonary features of RA?

A

Rheumatoid nodules, fibrosis, bronchiectasis

?

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7
Q

MoA of methotraxate?

A

x

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8
Q

MoA of hydroxychloroquine?

A

x

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9
Q

MoA of sulfasalazine?

A

x

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10
Q

Anitbody for RA?

A

Anti-CCP

RF/CRP etc

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11
Q

TNF-alpha inhibitors examples?

A

infliximab, adalimumab and etanercept

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12
Q

B-cell blocker example?

A

rituximab

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13
Q

IL-1 receptor antagonist example?

A

Anakinra

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14
Q

Anti-IL-6 receptors monoclonal antibody?

A

Tocilizumab

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15
Q

Cut offs in DAS28 for high/moderate/low

A

> 5.1 : high
3.2-5.1: moderate
<3.2: low
<2.6: remission

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16
Q

Most common route for septic arthritis?

A

Haematogenous (from UTI/resp infection)

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17
Q

Most common causative organism for SA in prosthetic joints?

A

Staph epidermidis

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18
Q

Most common causative organism for SA?

A

Staph aureus

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19
Q

Common features of spondyloarthropathies?

A 
RF -ve/seronegative
HLA-B27 association
axial arthritis
enthesitis (tendon/ligament insertion)
dactylitis
extra-articular manifestations
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20
Q

Skin psoriasis before/concurrent/after %?

A

70%
5%
25%
(chronological)

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21
Q

Other risk factors for psoriatic arthritis?

A

Joint/tendon trauma, HIV, caucasians.

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22
Q

History features that point towards psoriatic arthritis?

A

Like RA but no nodules and seronegative

Asymmetrical oligoarthritis

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23
Q

What is mutilans arthritis?

A

Most severe and rare psoriatic arthritis.

Osteolysis -> small joint destruction and shortening

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24
Q

Particularly effective combination of drugs for psoriatic arthritis?

A

Methotrexate and ciclosporin

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25
Q

Ank spond - early stage disease?

A

SI joint inflammation
IV discs/costovertebral/zygapophyseal/costotransverse joints and intravertebral ligaments
Subchondral granulation -> fibrocartilage -> osification

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26
Q

Ank spond - later disease?

A

Anular fibrosis - outermost layer calcifies - creates syndesmophytes (bony bridge between vertebral bodies)
Ankylosis - if fuse with body above

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27
Q

Extra-articular features of ank spond?

A 
Atlanto-axial subluxation
Anterior uveitis
Apical lung fibrosis
Aortic incompetence
AV node block
Achilles tendinitis
Amyloidosis (rare/late)
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28
Q

Other than pain etc, other clinical features of ank spond?

A

Reduced chest expansion
Loss of lumbar lordosis
Question mark posture
Peripheral synovitis

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29
Q

Ratio of male to female for chlamydia-induced reactive arthritis and post-dysentry?

A

9: 1
1: 1

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30
Q

Reiter’s syndrome?

A

Reactive arthritis, conjunctivitis and urethritis

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31
Q

Drug risk factors for gout?

A

Diuretics, aspirinm ciclosporin and laxatives

32
Q

Management of acute gout?

A

NSAIDs (strong - indomethacin/naproxen, ?maybe add PPI) and Colcichine 0.5mg/6 hours

Can use corticosteroids

33
Q

Managment of chronic gout?

A

Lifestyle, allopurinol 1-2 weeks after inflammation settled, with co-prescription of cover from NSAID/colchicine

34
Q

Second line to allopurinol in gout?

A

Febuxostat

35
Q

Differentiating features of pseudogout?

A

Bigger joints, equal gender ratio, no role for allopurinol

36
Q

Risk factors for CPPD?

A

Age >40, trauma, OA, hyperparathyroidism, hypomagnesaemia, diuretics, wilson’s disease, haemachromatosis, hypothyroidism and acromegaly

37
Q

Large vessel vasculitis?

A

Giant cell arteritis/Takayasu’s arteritis

38
Q

Medium vessel vasculitis?

A

Polyarteritis nodosa

Kawasaki disease

39
Q

Small vessel vasculitis?

A

Immune Complex SVV: IgA (Henoch-Schonlein)/ cryobylinaemic
anti-GBM disease

ANCA-associated SVV: granulomatosis w/ polyangitis (wegeners) and microscopic polyangitis (Churg-Strauss)

40
Q

Asthma and/or nasal allergies is associated with which vasculitis?

A

Churg-Strauss Syndrome

41
Q

Isolated p-ANCA positive vascultitis?

A

Churg-Strauss Syndrome - eosinophil-rich and necrotizing granulomatous inflammation associated with asthma and inflammation.

42
Q

c-ANCA positive vasculitis? May also be p-ANCA positive

A

Granulomatosis with polyangitis - Wegener’s

Resp/renal/epistaxis etc

43
Q

Causes of secondary vasculitis?

A

RA/SLE
Syphillis, TB, Hep B/C
Drugs
Infection

44
Q

Large vessel vasculitis - sex distribution?

A

More common in women generally

Polyarteritis nodosa affects more men

45
Q

Small artery vasulitis which is ANCA negative?

A

Either microscopic polyangiitis (glomerulonephritis)

or anti-glomerular basement membrane disease or HSP/anticryo etc

46
Q

What is the pathophysiology behind Henoch-Schonlein purpura?

A

IgA deposition - affecting skin, GI tract, arthritis

47
Q

In which country of origin is Behcet’s disease most common?

A

Turkish

48
Q

Which vasculitis presents with claudication of the arms?

A

Takayasu’s arteritis

49
Q

Which syndrome is aGBM associated with?

A

Goodpastures

50
Q

Features of Behcet’s disease?

A

Oral and genital ulceration
Ocular involvement
Cutaneous involvement - erythema nodosum or papulopustular rash
Arthritis
GI features - diarrhea/anorexia
Neuro features - encephalitis, confusion or CN palsy

51
Q

Features of Kawasaki disease?

A

Strawberry tongue, lip cracking and congestion of oropharyngeal mucosa

52
Q

Temporal arteritis - history clues?

A 
50% of patients with GCA have PMR
Age over 50
Females (3x)
Caucasians
Abrupt onset headache
Tender/swelling
Jaw claudication
53
Q

What visual features of GCA should be asked about?

A

Amaurosis fugax - transient visual loss in one eye
Blurring/diplopia
Partial/complete vision loss

54
Q

‘halo sign’ on US?

A

GCA

55
Q

Clinical features of PMR?

A 
Bilateral shoulder/thigh muscle pain for more than 1 month
Morning stiffness, over 1 hour
Systemic features
Response to corticosteroids
Normal (initial) muscle strength
56
Q

Important tests when diagnosing PMR?

A

Exclude thyroid disease
Exclude multiple myeloma with serum plasma electrophoresis
Raised ESR is diagnostic (other inflam markers/U/Es and radiography)

57
Q

Starting dose of pred for PMR?

A

15-20mg

58
Q

Typical demographic for SLE?

A

Afro-Carribean/asian women of child-bearing age
Sun exposure
Smoking
Drug triggers

59
Q

SOAP BRAIN MD?

A 
Serositis
Oral Ulcers
Arthritis
Photosensitivity
Blood disorders
Renal disorder
ANA positive
Immunological disorder
Neurological disorder
Malar rash
Discoid rash
60
Q

Disease associated with SLE?

A

Antiphospholipid syndrome

61
Q

Clinical features of antiphospholipid syndrome?

A

Coagulation defects
Livedo reticularis
Obstetric - recurrent miscarriage
Thrombocytopenia

62
Q

Mx of SLE?

A

Patient education - smoking, sun, conception advice, infection surveillance, monitoring
Pharmacological - analgesic/as system affected
eg hydroxychloroquine for skin/joint probs and high dose steroids for renal/cardiac/neuro involvement

63
Q

Polymyositis/dermatomyositis hallmarks

A

PM: symmetrical proximal muscle weakness, muscle pain/tenderness, systemic features, pulmonary fibrosis/aspiration pneumonia and resp failure
DM: PM plus: gottron’s papules, heliotrope rash, photosensitivity, nail-fold erythema

64
Q

Starting pred dose for PM?

A

60-80mg

65
Q

Sjogren’s syndrome?

A

Lymphocytic infiltration and inflammation of salivary, lacrimal and exocrine glands
F:M, 9:1
Assoc - RA/SLE/scleroderma

66
Q

Features of Sjogren’s syndrome

A

Dry eyes, xerostomia, parotid swelling, vaginal dryness, dry cough, dysphagia and systemic features

67
Q

Diagnosis of Sjogren’s?

A

Schirmer’s test, and Anti-Ro/anti-La etc etc

68
Q

4 types of scleroderma?

A

Systemic - CREST/Limited and Diffuse

Localised - Morphoea and Linear

69
Q

Antibody for scleroderma?

A

ANA

70
Q

CREST?

A 
Calcinosis
Raynaud's
Oesophageal dysmotility
Sclerodactyly
Telangiectasia
71
Q

How do type 1 and type 2 primary osteoporosis vary?

A

Type 1: post-menopausal - increased osteoclast activity, distal radius and vertebral bones commonly affected
Type 2: senile - reduced osteoblast activity. NOF comon

72
Q

Osteoporosis treatment?

A

1 - Bisphosphonates eg alendronate (inhibit osteoclasts)
2 - Denosumab (monoclonal antibody)
3 - Strontium ranelate
Many others

73
Q

Features of Paget’s disease?

A

Increased ALP
Complications: bone pain, bone deformity and enlargement, increased temp over bone, pathological fractures, 2 OA, Tinnitus/hearing loss (sensorineural - nerve compression)

74
Q

Most common cause of vitamin D deficiency?

A

Chronic kidney disease - conversion problem

UV light exposure inadequate

75
Q

Complications of ankylosing spondilitis?

A 
Anterior uveitis
Aortitis
Atlanto-axial subluxation/dislocation
Aortic regurgitation
AV node block (Type 1 heart failure)
Apical lung fibrosis
Amyloidosis - kidneys etc, also IgA nephropathy
76
Q

Methotrexate - what do you not co-prescribe?

A

Trimethoprim, clotrimazole, dihydrocodeine

77
Q

What does methotrexate do? How does this help with toxicity treatment?

A

Inhibits folic acid synthesis

Give folin acid

Year 4 Overview/Random tests (11 decks)

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