Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Specialities > Rheumatology > Flashcards

Rheumatology Flashcards

1
Q

What 2 drugs would you avoid prescribing to a patient on methotrexate?

A

Trimethoprim or cotrimoxazole

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What is the monitoring of methotrexate?

A

FBC, U+E and LFT before starting, repeated weekly until therapy stabilised, then every 2-3 months.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What is the triad of Felty’s syndrome?

A
  • RA
  • Neutropenia
  • Splenomegaly
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What is the acute mx of gout?

A
  • NSAIDs (avoid in warfarin- GI bleed)
  • Colchicine (SE: diarrhoea)
  • Intra-articular steroid injection
  • Oral steroids (pred) if others CI
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What are the indications for allopurinol prophylaxis?

A
  • Recurrence
  • Tophi
  • Renal disease
  • Uric acid renal stones
  • If on cytotoxic or diuretics
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

At what time should allopurinol be prescribed if indicated? Co-prescribe? Dose?

A

2 weeks after an acute attack has settled (may prescip further attack)

Initially 100mg OD, titrate to uric acid <300

NSAID or colchicine cover when starting

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What are the red flags for sinister causes of back pain?

A
  • <20yrs or >55
  • Acute onset in elderly people
  • Constant or progressive pain
  • Nocturnal apin
  • Pain worse on being supine
  • Fever, night sweats, weight loss
  • Hx of malignancy
  • Abdo mass
  • Thoracic back pain
  • Morning stiffness
  • Bilateral or alternating leg pain
  • Neurological disturbance (inc sciatica)
  • Sphincter disturbance
  • Immunosuppression
  • Lew claudication or exercise-related leg weakness/numbness (spinal stenosis)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What nerves are tested in the straight leg raise?

A

L4, L5, S1

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What nerves are tested on the femoral stretch test?

A

L4 and above

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What are the features of acute cauda equina compression?

A

= Neurosurgical emergency

  • Alternating or bilateral root pain in legs, saddle anaesthesia, low of anal tone on PR, bladder +/- bowel incontinence
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What are the features of acute cord compression?

A
  • Bilateral pain
  • LMN signs at level of compression
  • UMN and sensory loss below
  • Sphincter disturbance
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What pain and weakness would an L2 lesion cause?

A

Pain: across upper thigh.
Weakness: hip flexion and adduction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What pain and weakness would an L3 lesion cause?

A

Pain across lower thigh
Weakness: Hip adduction, knee extension
Dec knee jerk

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What pain and weakness would an L4 lesion cause?

A

Pain: across knee to medial malleolus
Weakness: Knee extension, foot inversion and dorsiflexion
Dec knee jerk

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What pain and weakness would an L5 lesion cause?

A

Pain: lateral shin to dorsum of foot and great toe
Weakness: hip extension and abduction. Knee flexion. Foot and great toe dorsiflexion.
Dec great toe jerk

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What pain and weakness would an S1 lesion cause?

A

Pain: posterior calf to lateral foot and little toe
Weakness: knee flexion. Foot and toes plantar flexion. Foot eversion.
Dec ankle jerk.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What are the signs and symptoms of localised osteoarthritis?

A
  • Localised disease is typically knee or hip
  • Pain on movement and crepitus
  • Worse at end of day
  • Background pain at rest
  • Joint gelling- stiffness after rest up to 30 mins.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What are the signs and symptoms of primary/general osteoarthritis?

A 
- Heberden's nodes (DIPs)
 (+ Bouchard's nodes (PIPs))
- Commonly affected: DIPs, thumb CMJ, knees
- Joint tenderness
- Bony swelling
- Dec ROM
- Mild synovitis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What are the typical findings on plain x-ray in OA?

A

Loss of joint space
Osteophytes
Subarticular sclerosis
Subchondral cysts

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What is the most common joint affected by septic arthritis?

A

Knees >50%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What are the RF for septic arthritis?

A
  • Pre-existing joint disease, especially RA
  • DM
  • Immunosuppression
  • CKD
  • Recent joint surgery
  • Prosthetic joints
  • IVDU
  • > 80
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What is the most important Ix in suspected septic arthritis?

A

Urgent joint aspiration for micro and culture

23
Q

What empirical abx would you use for septic arthritis?

A
  • Fluclox
  • Clindamycin if allergy
  • Vancy IV if MRSA or hx of
  • Cefotaxime if gonococcal or gram -ve suspected
24
Q

What is the typical presentation in RA?

Other presentations?

A
  • Symmetrical swollen, painful and stiff small joins of hands and feet, worse in the morning
  • Less commonly: sudden onset, widespread arthritis
  • Palindromic RA = recurring arthritis of various joints
  • Systemic illness with fever, weight loss, pericarditis and pleurisy, with few joint symptoms initially.
25
Q

What antibodies are most specific for RA?

A

Anti-CCP

26
Q

What scale is used to measure disease activity in RA? What is the target score?

A

DAS28

<3

27
Q

What is the first-line treatment in RA?

A

DMARDs - should be started within 3 months of persistent symptoms. Can take 6-12 weeks for symptomatic benefit.

28
Q

What is typically the best combination of DMARDs in RA?

A

Methotrexate, sulphasalazine and hydroxychloroquine

29
Q

What are the potential SE of methotrexate?

A

Immunosuppression -> pancytopenia, neutropenic sepsis (monitor FBCs)

  • Pneumonitis
  • Oral ulcers
  • Hepatotoxicity
30
Q

What are the potential SE of sulfasalazine?

A
  • Rash
  • Dec sperm count
  • Oral ulcers
31
Q

What are the potential SE of leflunamide?

A
  • Teratogenic (M and F)
  • Oral ulcers
  • HTN
  • Hepatoxicity
32
Q

What is the potential SE of hydroxychloroquine?

A

Irreversible retinopathy (annual opthal review)

33
Q

What is the first-line agent for active RA after failure to respond to 2 DMARDs and with a DAS28 >5.1?

A

TNF-alpha inhibitors (Infliximab, etanercept etc)

Can also be used as mono therapy if methotrexate CI - used adalimumab or etanercept.

34
Q

What is the agent of choice in severe, active RA where DMARDs and a TNF-alpha have failed/ CI?
What would you use if this is ineffective or CI?

A

B cell depletion - Rituximab

then

IL-1 and IL-6 inhib: Tocilizumab in combo with methotrexate.

35
Q

What are the SE of biologics?

A
  • Serious infection, inc reactivation of TB and hep B
  • Worsening heart failure
  • Hypersensitivity
  • Injection site-reactions
  • Blood disorders
  • ANA and reversible SLI-type illness
36
Q

What antibody is associated with diffuse cutaneous systemic sclerosis?

A

Scl-70

37
Q

What antibody is associated with limited cutaneous systemic sclerosis?

A

Anti-centromere

38
Q

What are the skin features of dermatomyositis?

A
  • Photosensitive
  • Macular rash over back and shoulder
  • Heliotrope rash in periorbital region
  • Gottron’s papules - roughened red papules over extensor surfaces of fingers
  • Nail fold capillary dilatation
39
Q

What are the common antibodies in dermatomyositis?

A

Majority are ANA positive

25% anti-Mi-2 positive

40
Q

What is the triad of Reiter’s syndrome?

A
  • Urethritis
  • Conjunctivitis
  • Arthritis
    (Reactive arthritis)
41
Q

What is HLA-B27 associated with?

A

Reactive arthritis

Ankylosing spondylitis

42
Q

What antibody is commonly associated with antiphospholipid syndrome?

A

Anti-Cardiolipin antibody

43
Q

What is anti-DsDNA highly specific for?

A

SLE

44
Q

What is anti-mitochondrial antibody associated with?

A

Primary biliary cirrhosis

45
Q

What is chondrocalcinosis?

What does this suggest?

A

Loss of joint space, with linear calcification of the articular cartilage
Pseudogout.

46
Q

What would you see on joint aspiration in pseudo gout?

A

Weakly-positively birefringent rhomboid shaped crystals

47
Q

When would you start bone protection in a patient with PMR?

A

Straight away, as it is likely that they will be on a significant dose of pred for >3 months.

Give Vit D, calcium supplements and oral bisphosphonates (alendronate)

48
Q

In general what would you do as a result of the following T-scores?

  • > 0
  • Between 0 and -1.5
  • Less than -1.5
A
  • > 0: Reassure
  • Between 0 and -1.5: Repeat scan in 1-3 years
  • Less than -1.5: Offer bone protection
49
Q

What is the first-line drug treatment for Raynauds?

A

Nifedipine

50
Q

What antibody is fairly specific to polymyositis?

A

Anti-Jo1

51
Q

What is Takyasu’s arteritis?

Symptoms?

A

An inflammatory, obliterative arteritis affecting the aorta and branches

  • Upper limb claudication
  • Diminshed/absent pulses
  • Raised ESR
  • F>M
52
Q

What is Buergers disease?

Signs and symptoms?

A

Segmental, thrombotic occlusions of the small and medium sized lower limb vessels. Commonest in young, male smokers.

  • Proximal pulses present, loss of pedal pulses.
  • Tortuous, corkscrew shaped collateral vessels may be seen on angiography.
53
Q

In what condition and what two allergies might you be cautious of prescribing sulfasalazines?

A

GP6D deficiency

Allergy: aspirin or sulphonamides

54
Q

Give 2 common and 3 less common causes of drug-induced lupus?

A
  • Procainamide
  • Hydralazine

Less common:

  • Isoniazid
  • Minocycline
  • Phenytoin

Specialities (12 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions