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Medicine - med school > Rheumatology > Flashcards

Rheumatology Flashcards

1
Q

cANCA and pANCA - name the diseases associated with each anti-neutrophil cytoplasmic antibody

A

cANCA - granulomatosis with polyangiitis (Wegener’s granulomatosis)

pANCA - Chrug-Strauss syndrome + others (microscopic polyangiitis, primary sclerosing polyangiitis, etc.)

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2
Q

Complications in RA - what composes Felty’s syndrome?

A

RA + splenomegaly + low WCC

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3
Q

Secondary prevention of osteoporotic fractures in post-menopausal women

A
  1. Rx is indicated following osteoporotic fragility fractures in post-menopausal women who are confirmed to have osteoporosis (T score of -2.5 SD or below)
  2. In women 75 y/o or older - DEXA scan may not be needed before Rx
  3. Vitamin D and calcium supplementation should be offered to ALL women
  4. Alendronate first line
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4
Q

Antibodies associated with:

  1. Limited cutaneous systemic sclerosis (CREST)
  2. Diffuse cutaneous systemic sclerosis
A
  1. Anti-centromere antibodies
  2. scl-70 (topoisomerase) antibodies

In both cases, ANA positive in 90%; RF positive in 30%

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5
Q

‘Plantar spur’ and ‘pencil and cup’ deformity are features in what condition?

A

Psoriatic arthritis

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6
Q
  1. What is Paget’s disease of the bone?
  2. Clinical features (incl. blood results)
  3. Management
A
  1. Increased but uncontrolled bone turnover (primarily thought to be disorder of osteoclasts)
  2. Features:
    - Older male with bone pain and ISOLATED raised ALP
    - Bone pain distribution: usually in pelvis (asymmetrical), lumbars spine, femur
    - Skull XR: thickening of calvarium, osteoporosis circumscripta
  3. Mx - indications for Rx include bone pain, skull or long bone deformity, fracture, periarticular Paget’s = give bisphosphonates or calcitonin (less commonly used)
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7
Q

Drug-induced lupus (e.g. in isoniazid, phenytoin, procainamide, hydralazine) - which antibody is associated with this?

A

Anti-histone antibodies

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8
Q

Disease associated with the following antibodies:

  1. RF
  2. Anti Jo-1
  3. Anti scl70
  4. Anticentromere
A
  1. RA
  2. Polymyositis
  3. Diffuse systemic sclerosis
  4. Limited cutaneous SS
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9
Q

Blood test values in osteoarthritis (calcium, phosphate, ALP and PTH)

A

NORMAL!

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10
Q

Asymptomatic patient with raised uric acid - what is your next management?

A

Do commence any treatment for asymptomatic hyperuricaemia to prevent gout!

Lifestyle changes (less red meat, alcohol and sugar) can reduce uric acid levels without drug treatment and so can be advised

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11
Q

Three features of reactive arthritis

A

Urethritis + arthritis and conjunctivitis (Reiter’s syndrome)

‘Can’t see, pee or climb a tree’

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12
Q

Osteoarthritis - management

A
  1. 1st line - paracetamol and topical NSAIDs
  2. 2nd line - NSAIDs (oral - co-prescribe PPI), intra-articular corticosteroid injections, COX-2 inhibitors, opiates
  3. Non-pharmacological - braces, supports, insoles, etc
  4. Joint replacement (ortho referral) if all other measures fail
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13
Q

Rheumatoid arthritis - extra-articular features

A
  • Anaemia of chronic disease (normocytic, normochromic)
  • Constitutional: fever, weight loss, fatigue
  • Raynaud’s
  • Abdo: splenomegaly (Felty’s = arthritis, splenomegaly, neutropenia (plus anaemia and lymphadenopathy)
  • Resp: pulmonary fibrosis, pleural effusions (exudate)
    Cardiac: pericardial effusions
  • Ocular: keratoconjunctivitis sicca (most common), scleritis/episcleritis, corneal ulceration, keratitis
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14
Q

What is Felty’s syndrome?

A

RA + splenomegaly + low WCC (neutropenia)

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15
Q

New management guidlines (NICE 2018) for rheumatoid arthritis

A

See flashcards

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16
Q

Joint aspirate on reactive arthritis

A

Cloudy yellow in colour, culture negative, WCC raised

17
Q

Pattern of pyrexia in Still’s disease

A

Typically rises in the late afternoon/early evening in a daily pattern and accompanies a worsening of joint symptoms and rash

18
Q

Ankylosing spondylitis - NSAIDs have been ineffective, which drug would you recommend next?

A

TNF-alpha blockers such as infliximab and etanercept.

NB DMARDs like methotrexate have not shown any benefit to Ank Spond

19
Q

Spot diagnosis - isolated rise in ALP

Which bones are usually affected by this disease?

A

Paget’s disease of the bone

Skull, spine/pelvis, and long bones of the lower extremities

20
Q

Chemotherapy is a known risk factor for the development of which rheumatological condition?

A

Gout (increased breakdown of cells lead to hyperuricaemia)

21
Q

Pharmacological treatment for reynaud’s

A

Nifedipine

22
Q

Anti-phospholipid syndrome

  1. APTT and PT levels
  2. Platelet levels
A

Raised APTT and normal PT

Thrombocytopenia

23
Q

Advice to patients who would like to conceive and are currently taking methotrexate

A

Patients using methotrexate require effective contraception during and for at least 3 months after treatment in men or women

Medicine - med school (10 decks)

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