Rheumatology Flashcards
1
Q
What are the four main connective tissue diseases?
A
Scleroderma
SLE
Polymyositis/dermatomyositis
Polymyalgia rheumatics
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
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
4
Q
Specific hand signs in RA?
A
Earlier: Swollen MCPs/PIPS/MTPs Later: Boutonniere deformity Swan neck deformity Ulnar deformity
5
Q
Extra-articular features of RA?
A
Scleritis Dry eyes Lymphadenopathy Anaemia Rheum nodules Osteoporosis Vasculitic skin rash
6
Q
Extra-articular pulmonary features of RA?
A
Rheumatoid nodules, fibrosis, bronchiectasis
?
7
Q
MoA of methotraxate?
A
x
8
Q
MoA of hydroxychloroquine?
A
x
9
Q
MoA of sulfasalazine?
A
x
10
Q
Anitbody for RA?
A
Anti-CCP
RF/CRP etc
11
Q
TNF-alpha inhibitors examples?
A
infliximab, adalimumab and etanercept
12
Q
B-cell blocker example?
A
rituximab
13
Q
IL-1 receptor antagonist example?
A
Anakinra
14
Q
Anti-IL-6 receptors monoclonal antibody?
A
Tocilizumab
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
16
Q
Most common route for septic arthritis?
A
Haematogenous (from UTI/resp infection)
17
Q
Most common causative organism for SA in prosthetic joints?
A
Staph epidermidis
18
Q
Most common causative organism for SA?
A
Staph aureus
19
Q
Common features of spondyloarthropathies?
A
RF -ve/seronegative HLA-B27 association axial arthritis enthesitis (tendon/ligament insertion) dactylitis extra-articular manifestations
20
Q
Skin psoriasis before/concurrent/after %?
A
70%
5%
25%
(chronological)
21
Q
Other risk factors for psoriatic arthritis?
A
Joint/tendon trauma, HIV, caucasians.
22
Q
History features that point towards psoriatic arthritis?
A
Like RA but no nodules and seronegative
Asymmetrical oligoarthritis
23
Q
What is mutilans arthritis?
A
Most severe and rare psoriatic arthritis.
Osteolysis -> small joint destruction and shortening
24
Q
Particularly effective combination of drugs for psoriatic arthritis?
A
Methotrexate and ciclosporin
25
Ank spond - early stage disease?
SI joint inflammation
IV discs/costovertebral/zygapophyseal/costotransverse joints and intravertebral ligaments
Subchondral granulation -> fibrocartilage -> osification
26
Ank spond - later disease?
Anular fibrosis - outermost layer calcifies - creates syndesmophytes (bony bridge between vertebral bodies)
Ankylosis - if fuse with body above
27
Extra-articular features of ank spond?
```
Atlanto-axial subluxation
Anterior uveitis
Apical lung fibrosis
Aortic incompetence
AV node block
Achilles tendinitis
Amyloidosis (rare/late)
```
28
Other than pain etc, other clinical features of ank spond?
Reduced chest expansion
Loss of lumbar lordosis
Question mark posture
Peripheral synovitis
29
Ratio of male to female for chlamydia-induced reactive arthritis and post-dysentry?
9: 1
1: 1
30
Reiter's syndrome?
Reactive arthritis, conjunctivitis and urethritis
31
Drug risk factors for gout?
Diuretics, aspirinm ciclosporin and laxatives
32
Management of acute gout?
NSAIDs (strong - indomethacin/naproxen, ?maybe add PPI) and Colcichine 0.5mg/6 hours
Can use corticosteroids
33
Managment of chronic gout?
Lifestyle, allopurinol 1-2 weeks after inflammation settled, with co-prescription of cover from NSAID/colchicine
34
Second line to allopurinol in gout?
Febuxostat
35
Differentiating features of pseudogout?
Bigger joints, equal gender ratio, no role for allopurinol
36
Risk factors for CPPD?
Age >40, trauma, OA, hyperparathyroidism, hypomagnesaemia, diuretics, wilson's disease, haemachromatosis, hypothyroidism and acromegaly
37
Large vessel vasculitis?
Giant cell arteritis/Takayasu's arteritis
38
Medium vessel vasculitis?
Polyarteritis nodosa
| Kawasaki disease
39
Small vessel vasculitis?
Immune Complex SVV: IgA (Henoch-Schonlein)/ cryobylinaemic
anti-GBM disease
ANCA-associated SVV: granulomatosis w/ polyangitis (wegeners) and microscopic polyangitis (Churg-Strauss)
40
Asthma and/or nasal allergies is associated with which vasculitis?
Churg-Strauss Syndrome
41
Isolated p-ANCA positive vascultitis?
Churg-Strauss Syndrome - eosinophil-rich and necrotizing granulomatous inflammation associated with asthma and inflammation.
42
c-ANCA positive vasculitis? May also be p-ANCA positive
Granulomatosis with polyangitis - Wegener's
| Resp/renal/epistaxis etc
43
Causes of secondary vasculitis?
RA/SLE
Syphillis, TB, Hep B/C
Drugs
Infection
44
Large vessel vasculitis - sex distribution?
More common in women generally
| Polyarteritis nodosa affects more men
45
Small artery vasulitis which is ANCA negative?
Either microscopic polyangiitis (glomerulonephritis)
| or anti-glomerular basement membrane disease or HSP/anticryo etc
46
What is the pathophysiology behind Henoch-Schonlein purpura?
IgA deposition - affecting skin, GI tract, arthritis
47
In which country of origin is Behcet's disease most common?
Turkish
48
Which vasculitis presents with claudication of the arms?
Takayasu's arteritis
49
Which syndrome is aGBM associated with?
Goodpastures
50
Features of Behcet's disease?
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
Features of Kawasaki disease?
Strawberry tongue, lip cracking and congestion of oropharyngeal mucosa
52
Temporal arteritis - history clues?
```
50% of patients with GCA have PMR
Age over 50
Females (3x)
Caucasians
Abrupt onset headache
Tender/swelling
Jaw claudication
```
53
What visual features of GCA should be asked about?
Amaurosis fugax - transient visual loss in one eye
Blurring/diplopia
Partial/complete vision loss
54
'halo sign' on US?
GCA
55
Clinical features of PMR?
```
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
Important tests when diagnosing PMR?
Exclude thyroid disease
Exclude multiple myeloma with serum plasma electrophoresis
Raised ESR is diagnostic (other inflam markers/U/Es and radiography)
57
Starting dose of pred for PMR?
15-20mg
58
Typical demographic for SLE?
Afro-Carribean/asian women of child-bearing age
Sun exposure
Smoking
Drug triggers
59
SOAP BRAIN MD?
```
Serositis
Oral Ulcers
Arthritis
Photosensitivity
Blood disorders
Renal disorder
ANA positive
Immunological disorder
Neurological disorder
Malar rash
Discoid rash
```
60
Disease associated with SLE?
Antiphospholipid syndrome
61
Clinical features of antiphospholipid syndrome?
Coagulation defects
Livedo reticularis
Obstetric - recurrent miscarriage
Thrombocytopenia
62
Mx of SLE?
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
Polymyositis/dermatomyositis hallmarks
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
Starting pred dose for PM?
60-80mg
65
Sjogren's syndrome?
Lymphocytic infiltration and inflammation of salivary, lacrimal and exocrine glands
F:M, 9:1
Assoc - RA/SLE/scleroderma
66
Features of Sjogren's syndrome
Dry eyes, xerostomia, parotid swelling, vaginal dryness, dry cough, dysphagia and systemic features
67
Diagnosis of Sjogren's?
Schirmer's test, and Anti-Ro/anti-La etc etc
68
4 types of scleroderma?
Systemic - CREST/Limited and Diffuse
| Localised - Morphoea and Linear
69
Antibody for scleroderma?
ANA
70
CREST?
```
Calcinosis
Raynaud's
Oesophageal dysmotility
Sclerodactyly
Telangiectasia
```
71
How do type 1 and type 2 primary osteoporosis vary?
Type 1: post-menopausal - increased osteoclast activity, distal radius and vertebral bones commonly affected
Type 2: senile - reduced osteoblast activity. NOF comon
72
Osteoporosis treatment?
1 - Bisphosphonates eg alendronate (inhibit osteoclasts)
2 - Denosumab (monoclonal antibody)
3 - Strontium ranelate
Many others
73
Features of Paget's disease?
Increased ALP
Complications: bone pain, bone deformity and enlargement, increased temp over bone, pathological fractures, 2 OA, Tinnitus/hearing loss (sensorineural - nerve compression)
74
Most common cause of vitamin D deficiency?
Chronic kidney disease - conversion problem
| UV light exposure inadequate
75
Complications of ankylosing spondilitis?
```
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
Methotrexate - what do you not co-prescribe?
Trimethoprim, clotrimazole, dihydrocodeine
77
What does methotrexate do? How does this help with toxicity treatment?
Inhibits folic acid synthesis
| Give folin acid
