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Rheumatology Flashcards

1
Q

Which joint is the most commonly affected by gout?

A

1st metatarsophalangeal joint (Big toe)

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2
Q

Give 2 causes of increased urate production.

A
  1. Diet- red meat, alcohol, seafood
  2. Drugs- Cytotoxics, Warfarin
  3. Psoriasis
  4. Genetics
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3
Q

Give 2 causes of decreased urate excretion.

A
  1. Drugs- aspirin, anti HTN drugs, diuretics
  2. CKD
  3. Male gender
  4. Elderly
  5. Metabolic syndrome
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4
Q

Which treatments can be used for acute gout?

A
  1. RICE- rest ice compress elevate
  2. NSAIDs high dose
  3. Colchicine
  4. Steroids- oral, IM or intra articular
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5
Q

Which treatments can be used to prevent gout/ as prophylaxis?

A
  1. Avoid triggers
  2. Allopurinol- start >3weeks after acute gout
    (Febuoxstat if intolerant of Allopurinol)
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6
Q

Which joint is most commonly affected by septic arthritis?

A

Knee

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7
Q

Give 3 differential diagnoses for monoarthritis.

A
  1. Septic arthritis
  2. Osteoarthritis
  3. Crystal arthropathy: Gout/ pseudogout
  4. Trauma-haemarthrosis
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8
Q

Is Colchicine typically used to prevent gout acutely or for prevention?

A

Acute

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9
Q

Is Allopurinol typically used to prevent gout acutely or for prevention?

A

Prevention

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10
Q

____________ involves widespread pain above and below the diaphragm, with 11 or more of 18 tender points.

A

Fibromyalgia

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11
Q

Which hand joints are usually spared in rheumatoid arthritis?

A

DIPs

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12
Q

Are pleural effusions in rheumatoid arthritis patients usually transudates or exudates?

A

Transudate

Low glucose

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13
Q

What type of finger deformity has:

  • DIP flexion
  • PIP hyperextension
A

Swan neck

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14
Q

What type of finger deformity has:

  • PIP flexion
  • DIP hyperextension
A

Boutonniere’s

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15
Q

Rituximab is a biological therapy which works by targeting __ cells.

A

B cells

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16
Q

Give 1 example of an Anti TNF alpha drugused for RA treatment.

A
  1. Infliximab
  2. Etanercept
  3. Golimumab
  4. Adalimumab
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17
Q

Tocilizumab works as an antagonist for which receptors?

A

Il-6

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18
Q

Give 3 or more examples of extra-articular features of RA.

A
  1. Rheumatoid nodules
  2. Pulmonary thickening, pulmonary effusion, nodules and fibrosis
  3. Anaemia of chronic disease
  4. Leg ulcers
  5. Eyes- scleritis, dry eyes
  6. Dry mouth
  7. Cervical spine inflammation leading to cord compression
  8. Vasculitis
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19
Q

What is the name given to the group of conditions characterised by:

  1. HLA-B27 positive and RF negative
  2. Spinal inflammation
  3. Sacro-iliac joint involvement
  4. Enthesitis
A

Seronegative spondyloarthropathies

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20
Q

Keratoderma Blennorrhagica is usually found in which seronegative spondyloarthropathy?

A

Reactive arthritis

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21
Q

Adalimumab, Golimumab and Etanercept are all Anti _____ drugs.

A

Anti TNF alpha

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22
Q

“Pencil in cup” deformity is seen radiologically in which type of arthritis?

A

Psoriatic arthritis

in particular arthritis multilans

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23
Q

“Bamboo spine” is seen radiologically in which condition?

A

Ankylosing spondylitis

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24
Q

Give 1 example of an organism causing a GI infection that can lead to reactive arthritis.

A
  1. Campylobacter
  2. Salmonella
  3. Shigella
  4. Neisseria
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25
Q

Reactive arthritis is considered to be chronic if it lasts for more than ____ months.

A

6 months

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26
Q

Reiter’s Syndrome is a triad of symptoms (Arthritis + Urethritis + ___________) which can be found in reactive arthritis.

A

Conjunctivitis

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27
Q

Does the arthritis in reactive arthritis usually affect the upper or lower limbs?

A

Lower limbs

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28
Q

Anti centromere antibodies are found in which condition?

A

CREST- Limited systemic sclerosisfscl

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29
Q

Anti JO1 antibodies are found in which 2 conditions?

A

Polymyositis

Dermatomyositis

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30
Q

Anti dsDNA antibodies are found in which condition?

A

SLE

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31
Q

Anti phospholipid antibodies are found in which conditions?

A

SLE

Anti phospholipid syndrome

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32
Q

Anti CCP antibodies are found in which condition?

A

RA

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33
Q

Anti Scl70 antibodies are found in which condition?

A

Diffuse Systemic sclerosis

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34
Q

Name 2 or more autoantibodies that may be found in SLE patients.

A
  1. ANA
  2. Anti dsDNA
  3. Anti phospholipid
  4. Anti Smith
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35
Q

What happens to C3 and C4 (complement) levels in SLE patients?

A

C3 and C4 DECREASE

Due to consumption of complement

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36
Q

What happens to CRP and ESR levels in SLE?

A

ESR is raised

CRP usully normal

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37
Q

First line treatment for ankylosing spondylitis is __________ and ________.

A

NSAIDs and exercise

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38
Q

Name as many of the 4 DMARDs used for RA as possible.

A
  1. Methotrexate
  2. Hydroxychloroquine
  3. Sulfasalasinze
  4. Leflunomide
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39
Q

Give 1 example of a side effect of Methotrexate.

A
  1. Hepatotoxic/ cirrhosis
  2. Bone marrow suppression
  3. Hair loss
  4. Sore mouth/ mouth ulcers
  5. Nausea and diarrhoea
  6. Pneumonitis/ pulmonary fibrosis
  7. Teratogenic
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40
Q

Which DMARD is usually given first to patients with rheumatoid arthritis?

A

Methotrexate

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41
Q

Before starting Methotrexate, patients usually need to have bloods and a _________.

A

Chest X ray

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42
Q

Which DMARD has side effects including retinopathy and seiures?

A

Hydroxychloroquine

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43
Q

Name 3 or more risk factors for septic arthritis.

A
  1. Diabetes
  2. Joint disease (RA)
  3. Immunosuppression
  4. CKD
  5. IVDU
  6. Recent joint surgery/ prosthesis
44
Q

Name 3 or more causes of secondary osteoporosis.

A
  1. Hyperparathyroidism
  2. Hyperthyroid
  3. Coeliac disease
  4. CKD
  5. Liver disease
  6. Cushing’s disease
  7. Drugs- Steroids, aromatase inhibitors
  8. Autoimmune- RA
  9. Malignancy eg. Myeloma, leukaemia, bone mets
45
Q

Denosumab is a Rank-ligand inhibitor used to treat which condition?

A

Osteoporosis

46
Q

Zoledronate, Risodronate and Alendronate are all ___________ drugs used for the treatment of osteoporosis.

A

Bisphosphonates

47
Q

Out of the following immunosuppressants, which are NOT SAFE in pregnancy?

  1. Hydroxychloroquine
  2. Methotrexate
  3. Sulfasalazine
  4. Azathioprine
  5. Cyclophosphamide
  6. Leflunomide
  7. Mycophenolate
A

Methotrexate
Mycophenolate
Cyclophosphamide
Leflunomide

48
Q

Which category of drugs aim to slow damage to joints, reduce relapses, induce remission and allow tapering of glucocorticoids?

A

DMARDs

49
Q

ANA, Anti centromere and Anti Scl-70 (Topoisomerase) autoantibodies are found in which connective tissue disorder?

A

Systemic sclerosis

50
Q

Which anti hypertensives are used to prevent renal crises in Systemic Sclerosis?

A

ACEIs/ ARBs

51
Q

Anti Ro and Anti La antibodies are found in which connective tissue disorder?

A

Sjorgens

52
Q

Dry eyes, xerostomia and parotid swelling are features of which connective tissue disorder?

A

Sjorgens

53
Q

Lymphocytic infiltration of exocrine tissue occurs in which connective tissue disorder?

A

Sjorgens

54
Q

Myositis and dermatomyositis are rare conditions involving chronic inflammation of ________ muscle.

A

Striated

55
Q

Giant cell arteritis affects which size blood vessel?

A

Large

56
Q

Takayasu’s arteritis affects which size blood vessel?

A

Large

57
Q

Polyarteritis nodosa affects which size blood vessel?

A

Medium

58
Q

Kawasaki disease (vasculitis) affects which size blood vessel?

A

Medium

59
Q

Microscopic polyangitis affects which size blood vessel?

A

Small

60
Q

Granulomatosis polyangitis (Wegener’s) affects which size blood vessel?

A

Small

61
Q

cANCA antibodies are found in which type of vasculitis?

A

Granulomatosis polyangitits (Wegener’s)

62
Q

pANCA antibodies are found in which type of vasculitis?

A

Microscopic polyangitis

63
Q

Vasculitis is usually initially treated with steroids and which immunosuppressant?

A

Cyclophosphamide

64
Q

Proximal muscle weakness, dysphagia, arthralgia, lung fibrosis and skin features are characteristic of which connective tissue disorder?

A

Dermatomyositis

65
Q

What does ANCA stand for?

A

Anti-neutrophil cytoplasmic antibodies

66
Q

Polyarteritis nodosa is often associated with which infection?

A

Hepatitis B

67
Q

Oral and genital ulcers, uveitis, skin lesions and arthritis are features of which type of vasculitis?

A

Behcet’s syndrome

68
Q

Name 1 or more differential diagnoses for vasculitis.

A
  1. Connective tissue diseases eg. SLE
  2. Sarcoidosis
  3. Chronic infection eg. TB, HIV, Hepatitis, Syphilis, Subacute bacterial endocarditis
  4. Malignancy
  5. Drug induced
69
Q

Which age and gender of patients are most commonly affected by pseudogout?

A

Elderly

Females

70
Q

Give 1 or more risk factors for pseudogout.

A
  1. Old age (females)
  2. Hyperparathyroidism
  3. Haemochromatosis
  4. Hypophosphataemia
71
Q

Balanitis, keratoderma blenorrhagica, uveitis, mouth ulcers and enthesitis are characteristic features of which type of arthritis?

A

Reactive arthritis.

72
Q

The DAS28 is a measure of disease activity in which disease?

A

Rheumatoid arthritis

73
Q

What 4 things are scored in the American College of Rheumatology (2010) Diagnostic criteria?

A
  1. Joint involvement (more points for smaller joints and more joints)
  2. Serology (RF or CCP)
  3. Acute phase reactants (CRP or ESR)
  4. Duration over 6 weeks
74
Q

In osteoporosis, blood calcium. phosphate and ALP levels are usually ________.

A

Normal

75
Q

Give 2 or more examples of drugs used in the management of osteoporosis.

A
  1. Bisphosphonates eg. Zoledronate, Alendronic acid
  2. Rank ligand inhibition eg. Denosumab
  3. Calcium and Vit D
  4. HRT
  5. Recombinant PTH (Teraparatide)
  6. Strontium
76
Q

Oesophagitis, photosensitivity, jaw osteonecrosis and atypical fractures are potential side effects of ___________ which are used for osteoporosis.

A

Bisphosphonates

77
Q

Which immunosuppressant can make patient’s urine and tears yellow-orange, as well as causing photosensitivity, oligospermia and skin rashes?

A

Sulfasalazine

78
Q

Which 2 drugs are typically used for INDUCTION treatment in hospital for SLE?

A
  1. High dose steroid - IV methylprednisolone

2. IV Cyclophosphamide

79
Q

Which 3 DMARDs may be used along with Hydroxychloroquine for MAINTENANCE treatment in SLE?

A
  1. Methotrexate
  2. Mycophenolate
  3. Azathiaprine
80
Q

Which ANCA vasculitis has mainly renal symptoms?

A

Microscopic polyangitis

81
Q

Which type of vasculitis can present with respiratory symptoms (including nasal crusting, epistaxis, SOB, chest pain, pulmonary haemorrhages), glomerulonephritis or skin rashes?

A

Granulomatosis with polyangitis (Wegener’s)

82
Q

Gottron’s papules, a heliotrope rash around the eyes and a “shawl sign” macular rash are features of which connective tissue disorder?

A

Dermatomyositis

83
Q

Which types of cancer are linked with cancer associated dermatomyositis?

A 
Lung
Pancreatic
Ovarian
Colorectal
NHL
84
Q

For reactive arthritis, patients can be treated with joint splinting and NSAIDs. If the disease is chronic >6 months then the DMARDs __________ or __________ can be used.

A

Methotrexate

Sulfasalazine

85
Q

Polymyalgia rheumatica may be found in patients with which vasculitic condition?

A

Temporal arteritis (Giant Cell Arteritis)

86
Q

In Polymyalgia Rheumatica, patients usually have _____ ESR results and ________ CK results.

A

Raised ESR

Normal CK

87
Q

Bisphosphonates are contraindicated in patients with an ____ of <35,

A

eGFR

88
Q

First line treatment of osteoporosis is usually which bisphosphonate?

A

Alendronic acid

89
Q

If a patient with osteoporosis can’t tolerate Alendronic acid due to oesophagitis, which other drugs should they be offered?

A

Other bisphosphonate: Risedronate/ Etidronate

90
Q

_____ disease involves increased but uncontrolled bone turnover due to osteoclast defect, and on Xray presents as a thickening of the skull calvarium.

A

Paget’s

91
Q

Azathioprine reacts with which gout medication to result in bone marrow suppression?

A

Allopurinol

92
Q

In osteomalacia (adult ricket’s) serum phosphate and calciuim levels are ____ and ALP levels are high.

A

LOW calcium and phosphate

93
Q

Which condition is characterised by arterial/ venous thrombosis, miscarriage and livedo reticularis?

A

Anti phospholipid syndrome

94
Q

Which condition may involve a tall patient with a high arched palate, pectus excavatum, pes planus, and hypermobility?

A

Marfan’s syndrome

95
Q

It is recommended that pregnant women take folic acid and which Vitamin during pregnancy?

A

Vitamin D

96
Q

Marfan’s syndrome is inherited in an autosomal _______ manner.

A

Dominant

97
Q

Hyperparathyroidism is a risk factor for which type of arthritis?

A

Pseudogout

98
Q

How long after stopping Methotrexate should women wait before trying to conceive?

A

6 months

99
Q

Reduced lateral ______ of the lumbar spine is one of the earliest signs of Anyklosing Spondylitis.

A

Lateral flexion

100
Q

Osteomalacia is normal bone amount but ___ mineral content.

A

Low

101
Q

Give 2 or more causes of osteomalacia.

A
  1. Liver failure
  2. Renal failure
  3. Vit D deficiency (low sunlight, absorption, poor diet)
  4. Vit D resistance (inherited)
  5. Drug induced (AEDs)
  6. Tumour induced osteomalacia
102
Q

What will the serum Calcium, phosphate and ALP be in a patient with osteomalacia?

A

Calcium and phosphate LOW

ALP RAISED

103
Q

Looser’s zones/ pseudofractures on X-ray are suggestive of which condition?

A

Osteomalacia

104
Q

Which condition involves increased but uncontrolled bone turnover, which is symptomatic in only 5% of patients?

A

Paget’s disease of bone

105
Q

What will the serum Calcium, phosphate and ALP be in a patient with Paget’s disease of bone?

A

Calcium and phosphate NORMAL

ALP RAISED

Surg (6 decks)

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