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Rheumatology Flashcards

1
Q

If a patient presents with numbness and burning pain over the anterolateral skin of the thigh, which condition may you suspect first?

A

Meralgia paraesthetica

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2
Q

Which X-ray changes are associated with RA?

A
  1. Loss of joint space
  2. Juxta-articular osteoporosis
  3. Soft tissue swelling
  4. Periarticular erosions
  5. Subluxation
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3
Q

What is De Quervain’s syndrome?

A

Inflammation of the sheaths of the extensor pollicis brevis and adductor pollicis longus tendons

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4
Q

Which criteria cause a patient to be labelled high risk for osteoporotic fracture?

A
  1. >75
  2. Glucocorticoid treatment
  3. Previous hip/vertebral fracture
  4. Further fractures during treatment
  5. High risk on FRAX scoring
  6. T score < -2.5 after treatment
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5
Q

If a patient has raised APTT, normal PT and thrombocytopenia, which condition is suspected?

A

Anti-phospholipid syndrome

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6
Q

On a full blood count, which readings will be characteristically high and also low for a patient with osteomalacia?

A

High - ALP

Low - Calcium, phosphates, vitamin D

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7
Q

What must NSAIDs be co-prescribed with?

A

PPIs

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8
Q

CREST syndrome is associated with which other rheumoatological condition?

A

Limitied cutaneous systemic sclerosis

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9
Q

The pencil in cup deformity is associated with which condition?

A

Psoriatic arthritis

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10
Q

Which conditions encompass CREST syndrome?

A
  1. Calcinosis
  2. Raynaud’s syndrome
  3. Oesophageal dysmotility
  4. Sclerodactyly
  5. Telangiestasia
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11
Q

After which length of time will patients be reviewed when taking bisphosphonates?

A

5 years

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12
Q

Which social factor increases the risk of AVN?

A

Alcohol excess

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13
Q

What is one of the earliest clinical signs for ankylosing spondylitis?

A

Reduced lateral flexion

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14
Q

Trochanteric bursitis is known by which other name?

A

Greater trochanteric pain syndrome

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15
Q

What is a severe side effect of hydroxychloroquine?

A

Severe and permanent retinopathy

(HEYEdroxychloroquine)

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16
Q

Which treatment works great for polymyalgia rheumatica?

A

15mg prednisolone

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17
Q

Isoniazid can cause which two major conditions?

A
  1. Lupus (drug induced)
  2. Peripheral neuropathy
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18
Q

What causes meralgia paraesthetica?

A

Compression of lateral cutaneous nerve

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19
Q

Bisphosphonates can cause ___________ problems

A

Bisphosphonates can cause oesophageal problems

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20
Q

Which class of drugs increases the risk of AVN?

A

Long term steroids

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21
Q

What will be done in a review after 5 years for a patient on bisphosphonates?

A

Update FRAX and DEXA scores

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22
Q

Which drug may cause drug-induced lupus?

A

Isoniazid

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23
Q

Which pulses are affected in Buerger’s disease?

A

Pedal pulses

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24
Q

What is the class of drugs which are first line for ankylosing spondylitis?

A

NSAIDs

(DMARDs too if peripheral joint involvement)

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25
Q

Pseudogout causes changes in the joint space similar to which other condition?

A

OA

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26
Q

What is the classical sign associated with Buerger’s disease on angiogram?

A

Tortuous corkscrew shaped collateral vessels

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27
Q

If a patient is deemed to be low risk for osteoporotic fracture during their 5 year review for bisphosphonates, how will their treatment be altered?

A
  1. Discontinue bisphosphonate use
  2. Reassess after 2 years or subsequent fracture
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28
Q

Behcet’s syndrome involves a triad of which symptoms?

A
  1. Oral ulcers
  2. Genital ulcers
  3. Anterior uveitis
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29
Q

Which test can be done for De Quervain’s tenosynovitis?

A

Finkelstein’s test

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30
Q

What are the normal ranges for ESR in

a) Men
b) Women

A

a) 0-22mm/hr
b) 0-29mm/hr

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31
Q

Dactylitis is associated with which group of rheumatological conditions?

A

Seronegative arthropathies

32
Q

Which type of people are commonyl affected by trochanteric bursitis?

A
  1. Women 50-70
  2. Runners
33
Q

Keratoderma blenorrhagica is commonly seen in which rheumatological condition?

A

Reactive arthritis

34
Q

ESR will be _______ in temporal arteritis

A

ESR will be raised in temporal arteritis

35
Q
A
36
Q

What is given to patients to counteract the development of drug induced peripheral neuropathy from taking isoniazid?

A

Pyridoxine

(a vitamin B6)

37
Q

Polymyalgia rheumatica is assocuated with which type of onset?

A

Fast (< 1 month)

38
Q

What causes trochanteric bursitis?

A

Repeated movement of fibroelastic iliotibial tract (IT band)

39
Q

How should a patient’s medication for gout be altered during a flare up?

A

Remains the same

(do not stop allopurinol for those already on it)

40
Q

How can lateral epicondylitis be defined?

A

Pain at the lateral epicondyle worse on restricted wrist extension/supination whilst the elbow is extended

41
Q

The femoral nerve stretch test will be positive when there is what?

A

Referred lumbar spine pain

42
Q

What is the first line treatment for OA?

A

Paracetamol and topical NSAIDs (if knee/hand involvement)

43
Q

Which type of inheritance is Ehler-Danlos syndrome associated with?

A

Autosomal dominant

44
Q

In which population is Buerger’s disease most common?

A

Young male smokers

45
Q

If anti-phospholipid syndrome occurs as a secondary disease, which condition is it most likely to be assocuated with?

A

SLE

46
Q

At which point will it be decided that a patient requires allopurinol for gout?

A

>/= 2 attacks in 12 months

47
Q

If a patient has an allergic reaction to aspirin, they have a high liklihood of also being allergic to which other drug?

A

Sulfasalazine

48
Q

What percentage of patients with psoriasis suffer from a related athropathy?

A

10-20%

49
Q

In terms of X-raying the ankle, what are the Ottaw rules in order to make a decision?

A

Pain in the malleolar zone plus one of:

  1. Bony tenderness at lateral malleolar zone
  2. Bony tenderness at medial malleolar zone
  3. Inability to walk 4 weight bearing steps after injury and on presentation
50
Q

Which DMARD is associated with hypertension?

A

Leflunomide

51
Q

Reactive arthritis encompasses which syndrome?

A

Reiter’s syndrome

(a triad of uveitis, urethritis, arthritis)

52
Q

Where is pain experienced in trochanteric bursitis?

A

Lateral side of thigh

53
Q

Which sex and age bracket at most commonly affected by De Quervain’s tenosynovitis?

A

Females

30-50

54
Q

Drug induced lupus is associated with which antibodies?

A

Anti-histone antibodies

55
Q

Which type of internal malignancy is associated with dermatomyositis?

A
  1. Lung
  2. Ovarian
  3. Breast
56
Q

Which antibiotics should be avoided with methotrexate?

A

Anti-folate antibiotics

(Trimethoprin and co-trimoxazole)

57
Q

Why should anti-folate antibiotics be avoided with methotrexate?

A

Both have a risk of bone marrow aplasia

(additive folate depletion)

58
Q

Which X-ray sign is pathognomonic of pseudogout?

A

Chondrocalcinosis

(visible calcification of cartilage)

59
Q

Which antibody is associated with diffuse systemic sclerosis?

A

Anti-SCL 70

60
Q

Which antibody is associated with limited systemic sclerosis?

A

Anti-centromere

61
Q

In a patient with De Quervain’s, where will pain be felt?

A

Radial side of wrist

Tenderness over radial styloid process

62
Q

Which drug can interfere with uric acid excretion?

A

High dose (600mg+) aspirin

63
Q

What is osteopetrosis?

A

Marble bone disease

Dense, thick bones prone to fracture

64
Q

Which mode of inheritance is associated with Ehler-Danlos sydrome?

A

AD

65
Q

Which test can be used for De Quervain’s and what does it involve?

A

Finklestein’s test

Pain over radial styloid on forced flexion/abduction of thumb

66
Q

Which DMARD is associated with causing hypertension?

A

Leflunomide

67
Q

What does De Quervain’s involve?

A

Inflammation of sheaths of extensor pollicis brevis and abductor pollicis longus tendons

68
Q

Which type of problems do bisphosphonates commonly ellicit?

A

Oesophageal problems

69
Q

Behcet’s syndrome encompassess which triad?

A
  1. Oral ulcers
  2. Genital ulcers
  3. Anterior uveitis
70
Q

Which drug can cause an increase in atypical stress fractures in the proximal femoral shaft?

A

Alendronate

71
Q

At which T-score should patients under 65 be offered bone protection if they are at risk of corticosteroid induced osteoporosis?

A

T < 1.5

72
Q

If a patient is taking warfarin or other anticoagulant, which type of ant-inflammatory medication should be avoided?

A

NSAIDs

(risk of gastric bleed)

73
Q

The clinical manifestations of dermatomyositis are due to the effects of which antibody?

A

ANA

74
Q

What is the normal range for platelets?

A

150-450 platelets/nL

75
Q

If a patient with rheumatoid arthritis is going to have surgery, which X-rays should they have prior and why?

A

Anteroposterior and lateral cervical spine radiographs

Atlanto-axial subluxation is associated with RA

Precautions may be to be taken in surgery

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